Putting the Ducks in a Row: Development of a Duck-assisted Green Care Intervention for Persons with Traumatic Brain Injury

Green Care therapies are defined as the engagement of a patient with the nature, exposing patients to a nature based therapeutic setting that may facilitate their recovery. Such therapies became popular at the end of the twentieth century. This therapeutic approach may include therapeutic horticulture, nature therapies, care farming, facilitated exercise, and animal-assisted therapies with farm animals (AATF). This paper describes the processes of planning and creating an AATF-based clinical intervention wherein persons with TBI interacted with ducks (in twice weekly, 1-hour groups) for 12 wk at a TBI rehabilitation facility. The discussion includes site identification, stakeholder engagement, intervention design and human and animal safety procedures. The research methods, theoretical framework, ethical consideration, and risk reduction strategies for human participants and ducks are discussed. Also, description of challenges and blueprints of possible solutions for other researchers interested in developing similar initiatives. This program will serve as a study site for examining effects of AATF-based interventions on self-efficacy, depression, and anxiety in persons with TBI. If the study suggests that AATF interventions with ducks may lead to positive changes, the proposed study will be followed with studies that include larger samples at multiple sites. Findings in this paper may contribute to the implementation science body of knowledge. Because of that, the information in this paper may benefit the researchers outside of the healthcare arena. From that perspective methods described in this paper may help to develop studies that focus on policy development, program expansion, or individual project implementation.

Animal-Assisted Green Care Farming for Patients With Mental and Physical Disorders: A Narrative Review

Green care is an umbrella term that includes numerous therapeutic interventions that immerse the patient into nature and natural environments. Animal-assisted therapy (AAT) with farm animals is a component of green care that may benefit patients with mental health disorders. While the majority of research exploring farm AATs originated in Europe, interest in this therapeutic intervention is emerging in the United States. While there are green care farms utilizing animal therapies in the United States, these therapeutic interventions have not been reported in the scientific literature. Further exploration of this topic in the United States may benefit various patient populations and contribute to overall better health care. A literature review found that farm AATs may be beneficial for patients with mental health disorders, but did not identify any studies addressing AAT with farm animals in the context of physical health disorders. This may be a desirable direction for future research.

Personalized Strategy for Animal-Assisted Therapy for Individuals Based on the Emotions Induced by the Images of Different Animal Species and Breeds

Simple Summary

In this study, we hypothesized that the personalized strategies for the animal-assisted therapy (AAT) could be improved by selecting animal species and breeds for individuals (persons) according to the emotions induced in the persons by different animal species and breeds. To our knowledge, this study is the first in the area in which the FaceReader technique has been applied to improve the methodology of AAT, which could be the first step to avoiding and/or minimizing stressful situations during a person’s contact with an animal. To implement the aim, the images of different animal species (dogs, cats, pigs, sheep, and horses) and various breeds of those species were used. This study showed that the animal species is a significant factor in the intensity of the ‘neutral’ and ‘happy’ emotions as well as valence. In addition, animal breed is a significant factor in the intensity of the emotion ‘happy’ and valence. Finally, in this study, we obtained results that could be used as a personalized strategy for improvement of the AAT and to help the individuals select a pet.

Abstract

The aim of this study was to apply the FaceReader technique to select the animal species and breed for a personalized AAT based on the emotions (‘neutral’, ‘happy’, ‘sad’, ‘angry’, ‘surprised’, ‘scared’, ‘disgusted’, and ‘contempt’) induced in the persons (18–64 years old) by the images of different animal species and breeds. To implement the aim, the images of different animal species (Canis familiaris, Felis silvestriscatus, Sus scrofa domesticus, Ovis aries, and Equus caballus) and their breeds (dogs: Australian shepherd, pug, Labrador retriever, Doberman, miniature schnauzer, beagle, three mixed-breed types, Yorkshire terrier, Cane Corso, Samoyed, and Chihuahua; cats: British shorthair, Himalayan cat, three mixed breed types, Siamese cat, Sphynx, and Bengal cat; horses: Norwegian Fjord, Exmoor pony, Andalusian, and Friesian; pigs: Vietnamese pot-bellied and Kunekune; sheep: Herdwick sheep and Suffolk sheep) were used. This study showed that the animal species is a significant factor in the intensity of the emotions ‘neutral’ and ‘happy’ as well as valence, and the animal breed is a significant factor for the emotion ‘happy’ intensity and valence. The obtained results could be used as a personalized strategy for improving AAT and helping the individuals to select a pet.

Animal Assisted Interventions in the Green Care Framework: A Literature Review

Green Care (GC) and Animal Assisted Interventions (AAI) are recognised practices useful to enhance the wellbeing of people through interaction with nature and animals. This study aims at understanding the interconnections between GC and AAI by analysing deeply which interaction with animals is conducted. Therefore, we carried out a literature search through Web of Science and Google Scholar that allowed retrieval of 993 records; after the PRISMA selection process, 42 were included. Relevant information was extracted: year of publication, geographical location, objectives, settings in agricultural environment, animal species, characteristics of users involved, type of human–animal interaction, coexistence of other activities without animals, animal health and welfare issues. From the review emerged that research on GC with animals is common in high-income countries and that the line between AAI and occupational therapy is often vague. Moreover, the most common setting for these interventions appears to be the farm, and frequently animals involved are not selected according to their ethological characteristics. Users in this context are extremely various and not only involved in activities with animals. Within the included studies, we noted a lack in the consideration of animal welfare that indicates the need for increased awareness among practitioners and a more ethical approach when animals are involved.

The impact of care farms on quality of life, depression and anxiety among different population groups: A systematic review

Care farming (also called social farming) is the therapeutic use of agricultural and farming practices. Service users and communities supported through care farming include people with learning disabilities, mental and physical health problems, substance misuse, adult offenders, disaffected youth, socially isolated older people and the long term unemployed. Care farming is growing in popularity, especially around Europe. This review aimed to understand the impact of care farming on quality of life, depression and anxiety, on a range of service user groups. It also aimed to explore and explain the way in which care farming might work for different groups. By reviewing interview studies we found that people valued, among other things, being in contact with each other, and feeling a sense of achievement, fulfilment and belonging. Some groups seemed to appreciate different things indicating that different groups may benefit in different ways but, it is unclear if this is due to a difference in the types of activities or the way in which people take different things from the same activity. We found no evidence that care farms improved people's quality of life and some evidence that they might improve depression and anxiety. Larger studies involving single service user groups and fully validated outcome measures are needed to prove more conclusive evidence about the benefits of care farming.

Nature-based interventions in institutional and organisational settings: a scoping review

The objective of this review was to scope the literature on nature-based interventions that could be conducted in institutional settings where people reside full-time for care or rehabilitation purposes. Systematic searches were conducted across CINAHL, Medline, Criminal Justice Abstracts, PsycINFO, Scopus, Social Care Online and Cochrane CENTRAL. A total of 85 studies (reported in 86 articles) were included. Four intervention modalities were identified: Gardening/therapeutic horticulture; animal-assisted therapies; care farming and virtual reality-based simulations of natural environments. The interventions were conducted across a range of settings, including inpatient wards, care homes, prisons and women's shelters. Generally, favourable impacts were seen across intervention types, although the reported effects varied widely. There is a growing body of literature on nature-based interventions that could be applied to a variety of institutional settings. Within most intervention types, there is sufficient research data available to perform full systematic reviews. Recommendations for future systematic reviews are offered.

Impact and cost-effectiveness of care farms on health and well-being of offenders on probation: a pilot study

Background

Care farms (CFs), in which all or part of the farm is used for therapeutic purposes, show potential for improving well-being for disadvantaged groups. We assessed the feasibility of determining the cost-effectiveness of CFs in improving quality of life compared with comparator sites among probationers undertaking community orders (COs).

Objectives

(1) To conduct a systematic review of CF impacts and mechanisms in improving health and logic model development; (2) to inform future studies by estimating differences in quality of life and other outcomes, identifying factors driving CO allocation and ways to maximise recruitment and follow-up; and (3) to assess feasibility of cost-effectiveness analysis.

Review methods

A mixed-methods synthesis following Campbell Collaboration guidelines. Pilot study: three probation service regions in England, each with a CF and a comparator CO site. Participants were adult offenders (aged ≥ 18 years) serving COs. The primary outcome was quality of life [as measured via the Clinical Outcome in Routine Evaluation–Outcome Measure (CORE-OM)]. Other outcomes were health behaviours, mental well-being, connectedness to nature and reconvictions.

Data sources

In November 2014, we searched 22 health, education, environmental, criminal justice and social science electronic databases, databases of grey literature and care farming websites across Europe. There were no language restrictions. A full list of databases searched is given in Appendix 1; some examples include Web of Science, Cumulative Index to Nursing and Allied Health Literature (via EBSCOhost), The Campbell Library, Criminal Justice Abstracts (via EBSCOhost), MEDLINE (via Ovid) and Scopus (Elsevier B.V., Amsterdam, the Netherlands).

Results

Our systematic review identified 1659 articles: 14 qualitative, 12 quantitative and one mixed-methods study. Small sample sizes and poor design meant that all were rated as being at a high risk of bias. Components of CFs that potentially improve health are being in a group, the role of the farmer and meaningful work, and interaction with animals. There was a lack of quantitative evidence indicating that CFs improve quality of life and there was weak evidence of improved mental health, self-efficacy, self-esteem, affect and mood. In the pilot study we recruited 134 respondents, and only 21 declined; 37% were allocated to three CFs and the remainder to comparators. This was below our recruitment target of 300. Recruitment proved challenging as a result of the changes in probation (probation trusts were disbanded in 2014) and closure of one CF. We found significant differences between CFs and comparator users: those at CFs were more likely to be male, smokers, substance users, at higher risk of reoffending (a confounder) and have more missing CORE-OM questions. Despite these differences, the use of propensity analysis facilitated comparison. Participants consented to our team accessing, and we were able to link, probation and police reconviction data for 90% of respondents. We gained follow-up questionnaire data from 52% of respondents, including health and social care use cost data. We transformed CORE-OM into CORE-6D, allowing derivation of quality-adjusted life-years. As a pilot, our study was not powered to identify significant differences in outcomes. Qualitatively, we observed that within COs, CFs can be formally recognised as rehabilitative but in practice can be seen as punitive.

Limitations

Changes in probation presented many challenges that limited recruitment and collection of cost data.

Conclusions

Recruitment is likely to be feasible in a more stable probation environment. Retention among probationers is challenging but assessing reconvictions from existing data is feasible. We found worse health and risk of reoffending among offenders at CFs, reflecting the use of CFs by probation to manage challenging offenders.

Future work

A sufficiently powered natural experiment is feasible and of value. Using reconvictions (from police data) as a primary outcome is one solution to challenges with retention. Propensity analysis provides a viable method for comparison despite differences in participants at CFs and comparator sites. However, future work is dependent on stability and support for CFs within probation services.

Study registration

This study is registered as PROSPERO CRD42014013892 and SW2013–04 (the Campbell Collaboration).

Funding details

The National Institute for Health Research Public Health Research programme.

Exploring the Role of Farm Animals in Providing Care at Care Farms

We explore the role of farm animals in providing care to different types of participants at care farms (e.g., youngsters with behavioural problems, people with severe mental problems and people with dementia). Care farms provide alternative and promising settings where people can interact with animals compared to a therapeutic healthcare setting. We performed a literature review, conducted focus group meetings and carried out secondary data-analysis of qualitative studies involving care farmers and different types of participants. We found that farm animals are important to many participants and have a large number of potential benefits. They can (i) provide meaningful day occupation; (ii) generate valued relationships; (iii) help people master tasks; (iv) provide opportunities for reciprocity; (v) can distract people from them problems; (vi) provide relaxation; (vii) facilitate customized care; (viii) facilitate relationships with other people; (ix) stimulate healthy behavior; (x) contribute to a welcoming environment; (xi) make it possible to experience basic elements of life; and (xii) provide opportunities for reflection and feedback. This shows the multi-facetted importance of interacting with animals on care farms. In this study the types of activities with animals and their value to different types of participants varied. Farm animals are an important element of the care farm environment that can address the care needs of different types of participants.

Engagement in elderly persons with dementia attending animal-assisted group activity

The need for meaningful activities that enhance engagement is very important among persons with dementia (PWDs), both for PWDs still living at home, as well as for PWDs admitted to a nursing home (NH). In this study, we systematically registered behaviours related to engagement in a group animal-assisted activity (AAA) intervention for 21 PWDs in NHs and among 28 home-dwelling PWDs attending a day care centre. The participants interacted with a dog and its handler for 30 minutes, twice a week for 12 weeks. Video-recordings were carried out early (week 2) and late (week 10) during the intervention period and behaviours were categorized by the use of an ethogram. AAA seems to create engagement in PWDs, and might be a suitable and health promoting intervention for both NH residents and participants of a day care centre. Degree of dementia should be considered when planning individual or group based AAA.

Understanding how prevocational training on care farms can lead to functioning, motivation and well-being

PURPOSE

Prevocational training aims to improve basic vocational and social skills, supporting return to work for people who have been out of work for a long time. Care farms provide prevocational training; the aim of the study was to use the self-determination theory to gain an understanding of how these programmes can lead to healthy functioning and motivation for clients.

METHOD

A total of 194 participants in prevocational training on care farms answered questions about demographic information, their perception of being a colleague, the social community on the farm, experiencing nature and animals and need satisfaction. A cross-sectional design resulting in a structural equation model was used to understand how elements of the care farm context influence satisfaction of three psychological needs.

RESULTS

The results showed that a feeling of being a useful colleague led to competence, experiencing a sense of group belonging led to relatedness and autonomy, while receiving social support from the farmer led to satisfaction of all three needs for the participants.

CONCLUSIONS

The results explain how prevocational training can stimulate participants' functionality, motivation and well-being. This understanding enables initiators and managers of prevocational training to understand and further strengthen the need-supportive elements of such programmes. Implications for Rehabilitation Prevocational training on care farms can facilitate motivation, functioning and well-being for clients. Making clients feel like useful colleagues that belong to a client group will strengthen the positive qualities of these programmes. Support, understanding and acknowledgement from the farmer are the most important elements for a positive development for the clients.

Mental health rehabilitation in a care farm context: A descriptive review of Norwegian intervention studies

BACKGROUND

C are farming is a service developed at farms for promoting mental and physical health and is increasingly used in mental health rehabilitation in Norway.

OBJECTIVE

This article aims to present a descriptive review of Norwegian intervention research on care farms that provide rehabilitation for people with mental health disorders.

METHODS

This literature review applied a non-systematic search strategy: all articles in the field known to the authors were selected for inclusion. The selected studies were intervention studies that were conducted on farms in Norway, that used adult participants with mental health problems/disorders, and that reported outcome measures related to mental health. The studies and articles presented quantitative and/or qualitative data.

RESULTS

The findings from the published articles report improvements to mental health problems, such as depression, anxiety, perceived stress, positive affect, rumination, and self-efficacy. Qualitative data describe a variety of positive experiences, such as improved coping ability, increased social support, and appreciation of the care farm activity.

CONCLUSION

Participating in interventions on care farms positively influences mental health. Care farming may therefore be used as a supplementary approach in mental health rehabilitation, as it offers meaningful and engaging occupations and social inclusion.

Farm-based interventions for people with mental disorders: a systematic review of literature

PURPOSE

Farms are increasingly used in mental healthcare. This study aimed to systematically review the evidence on the effectiveness of farm-based interventions for patients with mental disorders.

METHODS

Controlled and uncontrolled studies of farm-based interventions were included. Within- and between group effect sizes were calculated. Qualitative data were summarized using thematic synthesis. The review followed the PRISMA, Cochrane and COREQ standards.

RESULTS

The eleven articles included reported results of five studies, three of which were randomized control trials (RCTs). Overall, 223 patients with depressive disorders, schizophrenia or heterogeneous mental disorders attended three types of farms-based interventions. Favourable effects on clinical status variables were found in one study in patients with depressive disorders that did not respond to medication and/or psychotherapy, and in one RCT in patients with schizophrenia. Assessment of rehabilitative effects (functioning and quality of life) was limited and yielded conflicting results. Patients' experiences revealed that social and occupational components of interventions were perceived as beneficial, and provided insights into how farm-based interventions may facilitate recovery.

CONCLUSIONS

Our results suggest that the farm environment should be considered, especially for patients with mental disorders who do not achieve an adequate response with other treatment options. Further research is needed to clarify potential social and occupational benefits.

Farm animal-assisted intervention: relationship between work and contact with farm animals and change in depression, anxiety, and self-efficacy among persons with clinical depression

Fourteen adults with clinical depression participated twice a week in a 12-week farm animal-assisted intervention consisting of work and contact with dairy cattle. Each participant was video-recorded twice during the intervention, and the recordings were categorized with respect to various work tasks and animal and human contact. Levels of anxiety and depression decreased and self-efficacy increased during the intervention. Interaction with farm animals via work tasks showed a greater potential for improved mental health than via sole animal contact, but only when progress in working skills was achieved, indicating the role of coping experiences for a successful intervention.

Attitudes to animal-assisted therapy with farm animals among health staff and farmers

Green care is a concept that involves the use of farm animals, plants, gardens or the landscape in cooperation with health institutions for different target groups of clients. The present study aimed at examining psychiatric therapists' (n = 60) and farmers' (n = 15) knowledge, experience and attitudes to Green care and animal-assisted therapy (AAT) with farm animals for people with psychiatric disorders. Most respondents had some or large knowledge about Green care, but experience with Green care was generally low in both groups. Both farmers and therapists believed that AAT with farm animals could contribute positively to therapy to a large or very large extent, with farmers being significantly more positive. Most of the therapists thought that AAT with farm animals contributes to increased skills in interactions with other humans, with female therapists being more positive than males. Two-thirds of the therapists believed that AAT with farm animals to a large extent could contribute better to mental health than other types of occupational therapy. There were no differences in attitudes to AAT between psychiatrists/psychologists and psychiatric nurses. This study confirms the marked potential of offering AAT services with farm animals for psychiatric patients by documenting positive attitudes to it among psychiatric therapists.