Emotional Support Animal Position Statement

 

Emotional Support Animal Position Statement

American Psychological Association (APA),

Section 13 Human-Animal Interaction,

Division 17 (Society of Counseling Psychology)

 

Author

Betz King, Psy.D., L.P.

 

Major Contributors

Amy Ames, DNP, APRN, PMHNP-BC

Jennifer Coleman, MA, MS, PhD.

Eva Cross, MS

Kate Dresher, Psy.D.

Adam Duberstein, MA, TLLP

Amy Johnson MA, MAT, LPC, CPDT-KA, UW-AAB

Lori Kogan, PhD

Cara A. Miller, PhD

Patricia Nitkin, PhD., CCC

Ariann Robino, PhD, LPC, NCC

Natalie Runge MA, LPCC

Leigh Tucker Ph.D.

Katrina Winsor MS, MS, CBCC-KA, CPDT-KA

 

POSITION

Personal and professional interest in Emotional Support Animals (ESAs) has increased significantly within the last several years, creating new opportunities and challenges for clients, psychologists, and the public. To help provide guidance to psychologists on this topic, the Human-Animal Interaction Section (Section 13 of Division 17) of the American Psychological Association (hereafter referred to as “HAI section”) has created a formal position statement regarding ESAs.

It is the recommendation of the HAI section that psychologists generally refrain from writing disability determination letters for ESAs because of the need for specialized training and experience necessary for such determinations; potential risks to clients, the public, psychologists and the animal; and dual role challenges. Further elaboration follows.

NOTE: This document is meant to enhance and not supplant the need for psychologists to have a thorough knowledge of their local, state, and federal laws and policies surrounding ESAs, as well as the Ethical Principles of Psychologists and Code of Conduct.

DEFINITION

Clinicians need to be familiar with the appropriate lexicon of the field which requires knowing the differences between a service animal, therapy animal and emotional support animal. The HAI section follows the definitions and Summary of Legal Rights for Access for Assistance Animals as published by the American Veterinary Medical Association (2017):

An emotional support animal (ESA) may be an animal of any species, the use of which is supported by a qualified physician, psychiatrist or other mental health professional based upon a disability-related need. An ESA does not have to be trained to perform any particular task. ESAs do not qualify as service animals under the Americans with Disabilities Act (ADA), but they may be permitted as reasonable accommodations for persons with disabilities under the Fair Housing Act. The Air Carrier Access Act provides specific allowances for ESAs traveling on airlines, though documentation may need to be provided. American Veterinary Medical Association. (2020, June 7). Service, emotional support and therapy animals. https://www.avma.org/resources/animal-health-welfare/service-emotional-support-and-therapy-animals

THE ESA DISABILITY DETERMINATION PROCESS

Currently, the only way for an animal to be legally designated as an ESA for purposes of airline travel or housing accommodations is through a valid letter provided by a qualified, licensed healthcare or human service provider stating that the animal is medically necessary for an individual’s treatment. In contrast to service animals, ESAs are not intended, nor given special permission, to be brought into public spaces including public covered entities; as such, no additional training or suitability screening is required, although it may be optionally undertaken by an owner/handler. While this lack of preparation and evaluation may be reasonable and appropriate for ESAs in a single family dwelling, it can be problematic when ESAs are brought into stressful and unpredictable environments such as through airports and on planes, into apartment buildings, college dormitories, and hotels, and even into other shared, semi-public, or public covered entities. At the time of this publication, the ESA disability determination process is under review through the U.S Department of Transportation’s Notice of Proposed Rulemaking. (Feb 5, 2020)  https://www.regulations.gov/docket?D=DOT-OST-2018-0068

COMPETENCE

The Ethical Principles of Psychologists and Code of Conduct Competence 2.01 (hereafter referred to as the Ethics Code; American Psychological Association, 2017) states that psychologists provide services only within the boundaries of their competence, based on education, training, and supervised experience. When providing services new to them, psychologists undertake relevant education, training, supervised experience, consultation or study. Without possession of comprehensive knowledge, skills, and attitudes regarding therapeutic human-animal interactions, animal-related behavior, as well as a thorough knowledge of the policies surrounding ESAs at the local, state, and federal levels, psychologists risk practicing outside their scope of competence. While psychologists’ scope of practice allows for psychological assessment and DSM 5 diagnosis, it does not include the assessment of human-animal interaction/bond or animal behavior. The field of psychology maintains an emphasis on evidence-based practices, yet therapeutic treatments involving ESAs are not yet broadly codified into such evidence-based practices. That is, while an ESA may, in specific situations, help to mitigate symptoms associated with a DSM-5 diagnosis, the current literature does not support empirical evidence and the potential risks are great enough that the HAI section recommends that psychologists refrain from writing letters for clients requesting an assessment or letter for the sole purpose of obtaining an ESA.

CONSULTATION

APA Ethics Code 2.01b (American Psychological Association, 2017) states that “psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals…(c) Psychologists planning to provide services, teach, or conduct research involving populations, areas, techniques, or technologies new to them undertake relevant education, training, supervised experience, consultation, or study.” With regard to ESAs, consultation may involve collaborating with animal trainers, behaviorists, veterinarians, or clinical providers with HAI specializations as would be outlined in the Summary of Considerations for APA Ethical Standards Competencies in Animal-Assisted Interventions, thus ensuring that psychologists work within their scope of competencies. Given the absence of overarching licensing or accrediting bodies for this matter, as well as the absence of federal or state mandates, the onus is on the clinician to ensure ethical practices.

DUAL ROLES

Emotional Support Animal disability determination letters are formal determinations of a physical or mental health disability. In this capacity, “disability” is a legal concept, based on federal law, and psychologists who write letters of recommendation for existing clients may be entering into forensic roles. Per the Ethics Code 2.01(f) (American Psychological Association, 2017), psychologists functioning in a forensic role must be or become reasonably familiar with judicial or administrative rules governing their roles. In addition, psychologists who write letters for existing clients may be functioning in dual roles – clinical and forensic. Ethics Code 3.05

(American Psychological Association, 2017) states that psychologists refrain from entering multiple relationships where there is a reasonable expectation of harm to the client. Consequently, it is the recommendation of the HAI section that psychologists refrain from writing ESA disability determination letters for clients with whom they have an existing clinical relationship.

RISKS

Psychologists who consider writing a disability determination letter recommending an ESA should be aware of the inherent risks to the clinician, client, animal, public and the credibility of the field of psychology. Current state, local, and federal laws and policies regarding vaccinations, licensing and registrations for Service, Assistance, Emotional Support, and Therapy animals must be followed. The animal’s owner/handler is responsible for liability and other expenses and considerations associated with such adherence, regardless of financial or other access barriers. Specific potential risks to animals, clients, the public and psychologists are identified below.

Potential Risks to Client

  • Client misconception that an ESA can replace or is an evidence-based, indicated substitute for professional mental health care
  • Over-reliance on the ESA contributing to worsening status/increased symptoms of a mental health disorder
  • Animal allergies
  • Potential for fraud/legal concerns if ESA is misrepresented by the client/handler and/or misconstrued by the public as a service animal
  • Personal injury or property damage from an inadequately trained or insufficiently socialized animal
    • Injury to other persons and animals or destruction/disruption to a setting or facility
  • Zoonotic infection or disease
  • Financial and emotional burdens due to potential behavior problems associated with inadequately trained, insufficiently socialized or dispositionally ill-fitting companion animals
  • Possible rupture to the clinical or therapeutic relationship, as an ESA and its owner/handler could be found liable for any of the aforementioned. This may occur despite the fact that the clinician has endorsed the client’s need and presumed capacity to partner with and benefit from an ESA, as well as the animal’s suitability as an ESA, through a thorough informed consent process.

Potential Risks to Animal

Prior to endorsing the benefits of an Emotional Support Animal, the psychologist should make reasonable efforts to ensure that the client can provide adequate food, water, housing, and veterinary care, not impinged by their disability. Additional risks include:

  • Illness, undue stress, or injury from interactions with the public or ill-behaved animals handled by others in public
  • Undue stress from potential extended exposure to unfamiliar or stressful environments
  • Neglect or other abuse; poor mental health in owner/handler may limit, impair, or prevent adequate animal care
  • Undue stress from being handled by a person or persons without specialized training in animal welfare

Potential Risks to Public

  • Physical injury from inadequately trained and or dysregulated animal
  • Emotional distress and or trauma from an encounter with an ill-behaved animal
  • Unsocialized animals may be disruptive and interfere with normal activities
  • Unsocialized animals may have maladaptive interactions with other animals (especially toward service animals)
  • Fraudulent animals contribute to public skepticism, which hurts those with valid service animals and erodes public trust in the veracity of service animal training
  • When handlers with fraudulent animals have greater public access, public risk increases
  • The more unsuitable the animal, the greater the potential risk (i.e. exotic pet, undomesticated/wild animal).
  • Zoonotic infection or disease transmission from exposure to animals.
  • Animal allergies and phobias.

Potential Risks to Psychologist

  • Potential liability for injury/illness caused by animal to client or others
  • Potential to be called to testify if the disability determination, ESA assessment, or ESA designation is challenged or if an incident occurs
  • Potential need to defend the disability determination in court; psychologist may be called upon to explain their decision and the ways they reached this opinion despite the lack of evidence-based best practices
  • Ethical considerations for practicing outside the scope of competence secondary to the dearth of evidence from clinically-sound, rigorous, and relevant research (such as that based on systematic review, with reasonable effect sizes, and statistical significance; American Psychological Association, 2006) for the assignation of treatments incorporating the purposeful presence and utility of ESAs
  • The erosion of public and collegial trust in the psychologist’s competency to practice within their scope of expertise
  • Liability for adverse client outcomes due to the use of an unvalidated treatment such as an ESA
  • Potential dual-relationship conflicts (clinical and forensic) when assessing one’s own client

FRAUDULENT ESA DOCUMENTATION

The lack of standards and competencies required for ESA designation or status determination has resulted in much confusion regarding certifications, identification cards, vests, and tags. Additionally, such confusion has fostered a robust market for means of falsely “certifying” pets as assistance animals. The following are current rules and regulations pertaining to ESAs:

  • The ADA and DOJ do not currently recognize any form of certificate, identification card, vest, or tag as proof of an animal’s designation as a service animal OR an Emotional Support Animal. Such items may be considered fraudulent, regardless of the claims asserted on these items
  • A “registration” or “certification” does not constitute appropriate documentation of any type of helper animal
  • Service dogs are NOT required to wear vests, identification tags, and identification cards. Some handlers choose to use a vest to discourage others from approaching or distracting the service dog
  • The ONLY way to designate an ESA as such is through a letter provided by a healthcare or human service provider
  • Per the Air Carrier Access Act and the Fair Housing Act, ESAs are only allowed to travel by air, and to live in housing that might otherwise prohibit animals.  The ESA designation does not grant public access in any other contexts.

See Assistance Animal Fraud published and endorsed by the AVMA (American Veterinary Medical Association, 2017).

This document is not intended as an exhaustive list, rather it provides the minimum information and resources required to make an informed decision as to whether to write a letter endorsing the benefits of an emotional support animal.

POLICIES SPECIFIC TO ESAs (These are not static, they change on a regular basis) – 

Air Carrier Access Act https://www.transportation.gov/individuals/aviation-consumer-protection/service-animals-including-emotional-support-animals

Americans with Disabilities Act https://www.ada.gov/service_animals_2010.htm

Federal Fair Housing Act (FHAct, 42 U.S.C. 3601-3631.) https://www.justice.gov/crt/fair-housing-act-2  https://www.hud.gov/program_offices/fair_housing_equal_opp/disability_main

U.S. Department of Transportation – Notice of Proposed Rule Making (NPRM) – Traveling by air with Service Animals: https://www.transportation.gov/briefing-room/us-department-transportation-seek-comment-proposed-amendments-regulation-service (Feb 5, 2020)

RESOURCES

Animal Assisted Interventions International (2019).  Animal assisted intervention international standards of practice.  Retrieved from: https://aai-int.org/wp-content/uploads/2019/02/AAII-Standards-of-Practice.pdf

American Psychological Association. (2006). Evidence-based practice in psychology: APA presidential task force on evidence-based practice. American Psychologist, 61(4), 271-285.

Babione, J. M. (2010). Evidence-based practice in psychology: An ethical framework for graduate education, clinical training, and maintaining professional competence. Ethics & Behavior, 20, 443-453.

Certified Applied Animal Behaviorists (CAAB or ACAAB) from the Animal Behavior Society https://www.animalbehaviorsociety.org/web/applied-behavior-caab-directory.php

Certified Professional Dog Trainer listings: https://apps.apdt.com/eweb/DynamicPage.aspx?webcode=TrainerSearch

International Association of Human‐Animal Interaction Organizations. (2018). IAHAIO white paper: The IAHAIO definitions for animal assisted intervention and animal assisted activity and guidelines for wellness of animals involved.  Retrieved from http://iahaio.org/wp/wp-content/uploads/2019/01/iahaio_wp_updated-2018-19-final.pdf

Kogan, L.R., Schaefer, K., Erdman, P., Schoenfeld-Tacher, R. (2016). University Counseling Centers’ Perceptions and Experiences Pertaining to Emotional Support Animals. Journal of College Student Psychotherapy 30(4), 268-283.

Schoenfeld-Tacher, R.& Kogan LR,* (2017). Professional Veterinary Programs’ Perceptions and Experiences Pertaining to Emotional Support Animals and Service Animals. JVME, 44(1), 166-178.

Schoenfeld-Tacher, R, Hellyer, P., Cheung, L. & Kogan, L.* Public Perceptions of Service Dogs, Emotional Support Dogs and Therapy Dogs. Int. J. Environ. Res. Public Health (2017), 14(6), 642; doi:10.3390/ijerph14060642

Stewart, L. A., Chang, C. Y., Parker, L. K., & Grubbs, N. (2016). Animal-assisted therapy in counseling competencies. Alexandria, VA: American Counseling Association, Animal-Assisted Therapy in Mental Health Interest Network.

Younggren, J. N., Boisvert, J. A., & Bones, C. L.(2016). Examining Emotional Support Animals and role conflicts in professional psychology. Professional Psychology-Research and Practice, 47(4), 255-260. doi: 10.1037/pro0000083

Younggren, J. N., Boness, C. L., Bryant, L. M., & Koocher, G. P. (2019, August 1). Emotional Support Animal assessments: Toward a standard and comprehensive model for mental health professionals. Professional Psychology: Research and Practice.  Advance online publication.  http://dx.doi.org/10.1037/pro0000260

REFERENCES

American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. Retrieved September 9, 2019 from https://www.apa.org/ethics/code/

American Veterinary Medical Association (2017).  Assistance animals:  Rights of access and the problem of fraud.  Retrieved from https://www.avma.org/KB/Resources/Reports/Documents/Assistance-Animals-Rights-Access-Fraud-AVMA.pdf

Human Animal Interactions Ethics Workgroup (2020, May). Summary of Considerations for APA Ethical Standards Competencies in Animal-Assisted Interventions.

https://www.apa-hai.org/human-animal-interaction/wp-content/uploads/2020/05/Summary-of-Considerations-for-APA-Ethical-Standards-.pdf

Stewart, L. A., Chang, C. Y., Parker, L. K., & Grubbs, N. (2016). Animal-assisted therapy in counseling competencies. Alexandria, VA: American Counseling Association, Animal-Assisted Therapy in Mental Health Interest Network.