Animal-Assisted Therapy with Children in Out of Home Care.

Animal-Assisted Therapy will be implemented with children who are undergoing trauma-focused cognitive behavioural therapy (TF-CBT) while in out-of-home care and have active cases with the National Child Protection Service (CPS). The primary objective of this intervention is to measure resting heart rate, blood pressure, and subjective units of distress (SUDs) during the last five minutes of therapy sessions, both with and without the presence of a dog, to determine whether the dog's presence influences physiological and subjective measures of calmness. Heart rate will be tracked using a Polar H10 chest strap, while blood pressure will be assessed with an Omron device. The children's visual ratings of SUDs will be collected by a registered psychologist with six years of experience working with children. TF-CBT therapy sessions will be conducted individually and face-to-face, once a week for 45 minutes; only the first ten sessions are part of the study. The therapy dog will be present during five of these sessions. Sessions will be personalized for each participant following the phases of TF-CBT to address trauma. TF-CBT is a phase-based, components-based model that follows a sequential, manualized programme to ensure fidelity and is time-limited, usually delivered within a maximum treatment length of six months (Cohen et al., 2017). The phases are delivered in the following order 1) Stabilization Skills, 2) Trauma Narrative and Processing, 3) Integration/Consolidation with the components described in the acronym PRACTISE: Psychoeducation and Parenting Skills, Relaxation Skills, Affective Modulation Skills, Cognitive Coping Skills, Trauma Narration and Processing, In Vivo Mastery, Conjoint Child-Parent Sessions, and Enhancing Safety and Developmental Trajectory. The child works through these phases at their own pace, e.g., during psychoeducation general information about their specific trauma is shared, during relaxation skills coping stratigies such as breathing are learnt. Adherence to TF-CBT is measured by implementing the four core principles, duration and proportionailty relates to session duration and topic - Complex trauma may take 16-25 sessions to address, with a longer duration on the stabilisation phase. The second principle relates to the correct sequence of phases and components, they must be delivered sequentially as they build on from each other. The third principle is gradual exposure which aims to support the child and caregiver in successfully working through issues of avoidance of the trauma and finally including caregivers whenever possible. These four principles can be recorded on the fidelity checklist avaliable from the TF-CBT therapist certification website. Each participant will have a copy of this checklist in their file. Therapy dog activities will be written into each participants therapy plan. For example during the relaxation skills component, coaching the dog through breathing skills may help the child learn them and use them. Teaching the dog a new skill/trick may help the child learn how to break skills down and understand that learning new skills takes time, including learning how to process their own trauma. The therapy dog has recieved training with a Dogs NZ trainer and achieved the Canine Good Citizen Gold Award. It is intended that sessions will occur in three CPS sites in Northland, New Zealand, all are urban based sites that serve large rural communities.