Rick A. Yount, Director, Paws for Purple Hearts
Madam Chairwoman and Members of the Subcommittee, as the Founder and Director of the Paws for Purple Hearts program, I would like to thank you for the opportunity to submit a statement for the record in support of H.R. 198, the Veterans Dog Training Therapy Act and H.R. 1154, the Veterans Equal Treatment for Service Dogs Act. I am pleased that the Subcommittee is recognizing the important roles that dogs are playing in helping to heal the physical and psychological wounds of our Nation’s Veterans.
Attached to this statement is an overview of the Paws for Purple Hearts (PPH) program that inspired the introduction of H.R. 198, the Veterans Dog Training Therapy Act. The program’s pilot was originally implemented at the Palo Alto VA Trauma Recovery Program at Menlo Park commencing in July 2008. It has since expanded to DOD medical facilities, including Walter Reed Army Medical Center and the National Intrepid Center of Excellence for Psychological Health and Traumatic Brain Injury. The provisions of H.R. 198 are based on the PPH program developed at VA Menlo Park.
I created the PPH program based on my experience as a licensed social worker and certified service dog instructor. The program was designed to provide meaningful therapeutic activities based on the continued mission of caring for the needs of a fellow Veteran. The training was developed to address all three symptom clusters associated with Post Traumatic Stress Disorder (PTSD). Since beginning this therapeutic intervention model three years ago at VA Menlo Park, I have witnessed amazing responses to this program from both active duty Service Members involved in the current conflicts, as well as Vietnam Veterans who have participated in the training of service dogs for their fellow Veterans. Many accredited assistance dog organizations involve prisoners and at-risk teens in the training of dogs to serve people with disabilities. When it comes to training dogs for Veterans, no one takes that task more seriously than those who served by their sides in conflict. Veterans who have experienced psychological wounds never stray from the core value of caring for their fellow Veterans. This warrior ethos serves as a powerful motivational tool to inspire Veterans with psychological injuries, including PTSD, to voluntarily participate in the training of service dogs for their comrades. After teaching hundreds of college students and at-risk teens to train service dogs, I have found no one more dedicated to the cause than the Warriors and Veterans I have worked with in the PPH program.
Training a service dog for a fellow Veteran provides a valuable opportunity for the Veteran trainer to reintegrate into civilian life. As part of the training, the Veterans have the responsibility to teach the dogs that the world is a safe place. Through that process, they must convince themselves of the same. The Veteran trainers are taught to praise and treat the dogs when they hear a car backfire or other startling events. Rather than turning inward to ruminate on their past trauma, they must get outside of their own heads to focus on the dogs and their mission to help another Veteran. Additionally, the dogs act as social lubricants and offer opportunities to Veterans, who often isolate themselves from society, to experience positive interactions with members of the community. The training requires the emotionally numb Veterans to use demonstrative positive emotion in order to successfully teach their dogs. Veterans participating in the program have reported that using positive emotions to praise the dogs has significantly improved their family dynamics as their children respond to this positive parenting strategy.
PPH offers a symbiotic opportunity to address the needs of two cohorts of Veterans in one program. It is safe, available, cost-effective, and has earned the respect of VA and DOD health care providers. In addition to the recognized mental health benefits of the training, the quality of the service dogs that result from that training was documented recently by the History Channel’s “Modern Marvels” program dedicated to dogs. Venuto, the PPH dog that was featured in the program, enhanced the mental health of 20+ Veterans with PTSD as they participated in his training. Venuto was then successfully partnered with a Veteran who is paraplegic as a result of a Spinal Cord Injury (SCI).
To substantially benefit over 20 Veterans with one dog allows the VA to provide outreach to a greater number of Veterans without the logistical challenges of providing a dog to each Veteran. Also, the Veteran trainers gain valuable dog handling and care skills should they receive a service dog in the future. As described in the attachment, the presence of the service dogs in training at VA and DOD medical facilities also benefits other patients and health care providers.
The positive clinical observations of the VA Menlo Park service dog training program were formally presented during workshops at the VA National Mental Health Conference and the International Society for Traumatic Stress Studies Conference in 2009. I was joined by a Menlo Park VA Staff Psychologist and a Recreational Therapist in making those presentations. The workshops inspired significant interest from other VA Medical Centers in replicating the program at their sites.
There is a great opportunity for collaboration between the VA and the DOD with regard to the training, provision, and research associated with service dogs. The Army Surgeon General held an Animal-Assisted Intervention Symposium in December of 2009. The Army Family Act Plan of 2010 identified “providing service dogs to Wounded Warriors” as the #2 priority out of 82 issues. The leadership at the National Intrepid Center of Excellence (NICoE) for Psychological Health and Traumatic Brain Injury under the Defense Centers of Excellence has embraced service dog training as an intervention worthy of research. The VA could simplify the task of collecting specified outcomes by partnering with the NICoE to avoid duplication of effort and waste of resources.
The VA has questioned whether there is a substantial need for service dogs by Veterans. This issue was addressed in a 2007 study published in the Psychosocial Process Journal that indicated 42 percent of randomly selected Veterans with SCI desired information concerning service dogs. The study determined that “Among veterans with SCI there is a substantial interest in service dogs. Health care providers have a responsibility for educating individuals with SCI about the potential benefits and drawbacks of service dogs and for facilitating the process of obtaining information from service dog training organizations.” The study concluded that, “The VA could help support these organizations financially or establish training centers of its own to increase the availability of trained dogs in order to accomplish what Public Law 107-135 intended.”
The Department of Veterans Affairs is not currently providing any funding for the service dog training therapy pilot program at VA Menlo Park, even though VA officials have recognized the therapeutic value of the program. Private donors provided the seed funding to demonstrate the efficacy of this intervention for the symptoms of PTSD. Although the Secretary currently has the authority to establish a VA funded Veterans service dog training pilot program, the Department has resisted taking any financial responsibility for this promising intervention. Consequently, enactment of H.R. 198 is necessary to sustain the VA Menlo Park pilot program and to expand this model to other VA treatment facilities.
I support the provisions of H.R. 1154, the Veterans Equal Treatment for Service Dogs Act, because Veterans should be afforded the same rights at VA facilities as other Americans are provided under the Americans with Disabilities Act. Language needs to be included in the bill to ensure that service dogs in training under the guidance of certified instructors associated with Veterans Dog Training Therapy programs receive the same status as fully trained service dogs for purposes of access to VA facilities.
Paws for Purple Hearts (PPH)
|Palo Alto VA Health Care System
Trauma Recovery Program
Menlo Park, CA 94025
|Walter Reed Army Medical Center
Warrior Transition Brigade
Washington, DC 20307
National Intrepid Center of Excellence
National Naval Medical Center
Bethesda, MD 20889
Paws for Purple Hearts (PPH) is a dual-purpose program created to meet the needs of Service Members and Veterans with physical and/or psychological injuries. The approach uses the process of service-dog training to remediate Post-Traumatic Stress symptoms in Service Members and Veterans. The trained dogs are then placed with fellow Veterans who have mobility-limiting injuries.
Founded on the time-honored tradition of Veterans-helping-Veterans, PPH enables Service Members and Veterans to actively provide support for their fellow injured Service Members and regain a tangible sense of purpose. PPH is currently being implemented at Department of Defense (DoD) and Veterans Administration (VA) sites. Two hundred active duty and Veterans with PTSD have participated in the program since it was first offered in 2008. Five service-dogs trained by PPH instructors have been placed with Veterans. Two Service Members have become accredited service dog-trainers and are pursuing careers in this field.
The curriculum of the service-dog training program is specifically designed to remediate the core-symptoms of Post Traumatic Stress, such as re-experiencing, avoidance, and hyperarousal. Clinical experience to date has been encouraging with respect to traumatic stress symptom and harm reduction, a decrease in the need for pain and sleep medicine and improved communication skills and sense of well-being.
PROGRAM OVERVIEW AND HISTORY
Paws for Purple Hearts (PPH) is an innovative therapeutic service-dog-training program that teaches Veterans and active duty military personnel with Post Traumatic Stress Disorder (PTSD) the skill of training service-dogs for Veterans with war-related injuries. The use of psychiatric service-dogs with patients who have psychiatric disorders is well described (Barker & Dawson, 1998; Mason & Hagan, 1999). Studies have shown that under stressful conditions, the presence of a dog is effective at reducing stress responses in healthy adults, adults with hypertension, and in children with attachment disorders (Allen, 1991 and 1999; Kortschal, 2010). PPH is a voluntary program and is used as an adjunct to a wide range of PTSD treatments including Cognitive Behavioral Therapy (CBT), Prolonged Exposure (PE), Cognitive Processing Therapy (CPT) and/or medications.
PPH was created by social worker and professional dog trainer Rick Yount, in 2006. It was inspired by the success of a therapeutic service-dog training program he started in Morgantown, West Virginia to help at-risk teens develop social skills while providing them with a rewarding career path. Yount’s Golden Rule Assistance Dog Program (GRAD) was offered to public school drop-outs through Morgantown’s Alternative Learning Center. Several GRAD-trained assistance dogs were placed with disabled veterans. In July 2008, Yount’s Paws for Purple Hearts program was implemented at the Palo Alto VA’s Men’s Trauma Recovery Program in Menlo Park, California. One hundred and thirty Service Members have participated in that program. Based on the program’s success, Yount was asked to establish PPH at Walter Reed’s Army Warrior Transition Brigade (WTB). Forty-five Soldiers have participated in the formal Internship Program or the Patient Service-dog Training Program since February, 2009. In October of 2010, PPH was invited to be part of the PTSD and Traumatic Brain Injury research and treatment mission at the new National Intrepid Center of Excellence (NICoE), in Bethesda, MD.
MILITARY NEED FOR SERVICE DOGS AND COST EFFECTIVENESS
A 2009 study published in The American Journal of Public Health found that close to 40 percent of Iraq and Afghanistan Veterans treated at American health centers during the previous six years were diagnosed with PTSD, depression, or other mental health issues. The study also found that a lack of social support—being separated, divorced, widowed, etc., may pose a serious risk for new post-deployment mental health problems and underscores the need for social support services for returning Veterans who are unmarried and/or without social support. (Seal, et al., 2009). Sixty percent of PTSD patients still meet the criteria for PTSD after being treated with empirically supported interventions (Monson, 2006; Schnurr, 2007). Therefore, it is imperative to explore adjunctive treatments for PTSD that may improve outcomes.
There is also substantial interest in service-dogs among Veterans with Spinal Cord Injury. A survey in 2007 showed that thirty percent of Veterans with Spinal Cord Injury reported at least some interest in obtaining a service-dog and 42 percent desired information concerning service-dogs (Brashear, 2007). This urgent need of Veterans for well-trained service-dogs has been recognized by Congress with passage of several laws authorizing the Department of Veterans Affairs to provide service-dogs to disabled Veterans.
The 2010 Army Family Action Plan named “provide service-dogs for Wounded Warriors” as the #2 priority out of 82 issues. Involving Veterans and Service Members in the training of service-dogs for fellow Veterans creates a symbiotic opportunity to serve two needs with one program.
The PPH Program supplies high-quality purpose-bred service dogs. Certified PPH dog-trainers or selected “puppy-parents” take responsibility for the welfare and behavior of the dogs at all times when the dogs are on military or VA property. This allows active-duty Service Members and Veterans with PTSD who cannot or do not own dogs, to have the opportunity to experience the high quality connection with a dog that provides the powerful relief of PTSD symptoms. It also circumvents the logistical difficulties of owning and keeping dogs on base and in medical centers. The program is also highly cost-effective, providing dog-assisted therapeutic relief to a large number of PTSD patients with a limited number of service dogs. For instance, in the course of the 30-60 day PPH program offered at the Palo Alto VA Hospital, as many as 20 patients with PTSD may participate in the training of single service dog. All participants come away from the program with the valuable knowledge and skills that will allow them to connect with dogs they may own in the future in the most rewarding and therapeutic way.
WORKING DOGS/WORKING TRAINERS
Paws for Purple Hearts engages Service Members in the active duty of creating valuable service dogs for other disabled Service Members. PPH’s training philosophy is based on a strong bond and positive methods of shaping behaviors. Mastering the skills and patience required to train a service dog helps the PPH trainers to regain control of their emotions, focus their attention, and improve their social competence and overall sense of wellbeing. Two participants in the Palo Alto VA program have gone on to pursue accreditation as professional dog trainers and we anticipate that many more will be inspired to become professionally involved in creating the thousands of service dogs that will be needed by our wounded warriors.
DOGS HEALING THE WORKPLACE
The impact of the PPH Program on Veterans and Service Members has been observed to reach well beyond its participants. Nearly 500 Service Members have benefited indirectly from the presence of the PPH program in PTSD residential treatment. These are Vets who share rooms with the dogs and their trainers, those who interact with the dogs as “uncles,” and those who encounter dogs that are present in their various treatment groups. A conservative estimate of 650 WTs have also been indirectly impacted by the presence of this program on the campus of Walter Reed. The presence of the program on VA and military installations brings these PPH participants and their dogs into friendly contact with dozens of other Service Members every day and provides not only a stress reducing interaction, but also the opportunity for the PPH participants to share their positive experiences with fellow Veterans and Service Members.
DOGS HEALING THE HOME
The methodology used in training service dogs to assist individuals with mobility impairments has striking similarities to the best practices of effective parenting. The goal of creating a respectful and responsible service dog requires the employment of sound behavioral shaping techniques based on positive and humane methods. Using the service dog training to draw attention to these parallels provides a means to teach critical parenting tools in a non-threatening manner.
HOW THE PROGRAM WORKS
PTSD symptoms fall into three broad categories: Re-experiencing, avoidance/numbing and increased arousal. The interventions in the PPH program are targeted to remediate each category of these symptoms as follows:
- Re-experiencing: Procedures used in training PPH service-dogs require the trainer to focus on the dog’s “here and now” point of view to recognize the “teachable moments” when instruction will be most effectively processed and retained. The presence of the dog during a stressful situation or encounter changes the context of the arousal event and anchors the trainer in the present, reminding the Service Members or Veterans that they are no longer in dangerous circumstances. If the patient/trainee does experience a trigger for symptoms, the presence of the dog can lower anxiety levels.
- Avoidance and Numbing: Training a service-dog requires that it be carefully exposed to a wide range of experiences in the community. This creates a need for service members with PTSD to challenge their impulses to isolate and avoid those same environments that the dogs must learn to tolerate. Dogs are natural social lubricants and so it is nearly impossible for the trainer to isolate from other people during this part of the training. Interactions with others in the company of the dogs, has been reported to be less threatening since the focus of the interaction is on the dog and the training.
In order to shape the behavior of a service-dog, the trainer must also connect successfully with the dog. PTSD patient-trainers must overcome their emotional and affective numbness in order to heighten their tone of voice, bodily movements, and capacity for patience in order deliver their commands with positive, assertive clarity of intention and confidence. In doing this, trainers soon discover they can earn their dog’s attention and best guide them to the correct response. The dog’s success must then be rewarded with emotionally-based praise. The PPH training technique allows the trainers to experience rewarding positive emotional stimulation and social feedback. The basic daily needs of a service-dog involve structured activities that also bring the trainer and dog into the kind of close nurturing contact that further creates a behavioral and psychological antidote to social avoidance.
- Arousal: PPH service-dogs are bred to be responsive to human emotions and needs. Their sensitivity to and reflection of their trainer’s emotional state provides immediate and accurate measures of the trainer’s projected emotion. This also challenges the trainer to overcome his or her tendency for startle reactions in order to relay a sense of security and positive feedback when their young dogs are faced with environmental challenges such a loud sirens and approach by strangers.
PPH service-dogs are also bred to be affectionate and have a low-arousal temperament that puts their trainers “at ease.” With these dogs at their sides, PPH trainers perceive greater safety and social competence and are able to shift out of their hyper-vigilant, defensive mode into a relaxed state that makes them ready and able to connect with others.
CLINICAL OBSERVATIONS AND PARTICIPANT TESTIMONIALS
Over the last three years, anecdotal reports from the PPH program director and PTSD treatment team members indicate that PPH participants exhibit the following improvements
- Increase in patience, impulse control, emotional regulation
- Improved ability to display affect, decrease in emotional numbness
- Improved sleep
- Decreased depression, increase in positive sense of purpose
- Decrease in startle responses
- Decrease in pain medications
- Increased sense of belongingness/acceptance
- Increase in assertiveness skills
- Improved parenting skills and family dynamics
- Less war stories and more in the moment thinking
- Lowered stress levels, increased sense of calm
The following are observations made by Rick Yount after operating PPH for two years at the Palo Alto VA and at Walter Reed (Case 1), testimonies from Service Members who participated in the program (Case 2-5), and testimony from a disabled Veteran who has received a PPH trained mobility-assistance dog (Case 6). All persons involved in these accounts gave consent for their story to be included here.
Case 1: A Marine hit by multiple separate IED explosions during his multiple tours in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), the war in Afghanistan, had been in the PTSD treatment program for several weeks but was not participating in treatment despite a myriad of behavioral and pharmacological interventions. He sat in the corner with his sunglasses on, occasionally twitching his head from side to side in a tic-like manner. His peers were hesitant to interact with him due to his body language and lack of motivation to respond to their attempts to connect with him. His interest in the dogs prompted him to participate in the PPH program. Within two days of working in the PPH program, he began to smile and bond with the dog. His involvement led to his first positive interactions with staff and fellow Veterans. Instead of leaving the PTSD program without successfully completing it, he was able to finish the entire program and process his trauma through the support of his dog, peers and treatment team.
Case 2: This testimony was given by a PPH participant with PTSD who served in Iraq as a National Guard Reservist was struggling with family issues:
My family has noticed a difference in the way I interact with them as a result of working with my service-dog in training. I am patient with my children when they are around, I haven’t yelled at them in several months and they aren’t afraid of me when I’m around. I think that is a direct result of working with my dog. I have also benefited from the association with my service-dog in training as we spend time on bonding every day. I feel loved by him and I feel comforted when he is around. It’s been nearly 4 years since I have felt comforted. When the dog is with me people that I pass come up and talk to me and I have social interaction that I wouldn’t have had without the dog. I’m grateful the VA started this program and I got to be part of it. I wish more veterans got the opportunity I’ve been given to work with these amazing animals. Please consider this program on a larger scale so more veterans can benefit from training or receiving a service-dog.
Case 3: A young soldier, recently returned from Iraq, arrived in the PTSD program. He had recently attempted to take his own life. His struggle with hopelessness continued to inhibit his affect and stifle his ability to engage in treatment. One of the dogs interacted with him while he was waiting for the next group to begin. He smiled as he pat the dog on his head. He began training the next day, taking the training tasks very seriously. His psychiatrist told the Director of the Service-dog Program that the dog had accomplished what the doctor had been unable to do in six months. After his discharge from the program, the soldier was partnered with a service-dog to continue helping with his PTSD symptoms.
Case 4: A Marine who had served as a “Devil Dog” (term used to refer to a Marine) for nineteen years was treated for PTSD in 2005. He returned for treatment in 2006 when he was unable to control his anger. He asked to join the newly instituted PPH program. He voluntarily provided this account of his experience with PPH:
I would have never imagined by working with these dogs my life would change forever. After over a year with severe sleep, depression and anger issues I found myself able to sleep for longer periods of time during the night and found myself calm during times where I would have exploded in anger. After analyzing this major change in my behavior the doctors quickly discovered that the common denominator was a service-dog trainee named Verde.
Please understand that my story is not a rare one. I have seen remarkable changes in not only myself but in the other residents that have participated in the training of these animals. For years doctors have thrown medication at my issues with minimal results but Verde has caused my life that would have been surely shortened by my issues to be full again. I know that I will always suffer with PTSD issues but having my new friend by my side like a fellow Marine will ensure that my quality of life will improve.
Case 5: Army Veteran returned from Iraq showing many of the signs of PTSD. Over the next four years, his depression deepened, he lost his job and was divorced. He tried many different medications and finally was enrolled in the PTSD program. He volunteered this testimony about PPH:
While in the program I learned a lot about PTSD and gained many tools to help me cope with the disorder, but there was one part of the program that stood apart; Paws for Purple Hearts. Soon after signing up to train the dogs I found myself sleeping better and was in a surprisingly good mood, before I knew it I was not hiding in my room anymore. I started laughing again and I began to feel good. I felt good about myself and what I was doing; helping to train this dog for a fellow veteran. Going out and not isolating was a huge leap forward for me. When you are with one of these dogs everyone wants to stop you and talk to you. This is not the most comfortable thing for someone with PTSD. After a while I was having conversation with complete strangers. They come with such a positive attitude that it reinforces that not all people in the world are bad and it begins to rebuild trust, which is one of the many things that one with PTSD struggles with. Another struggle is self restraint and patience and working with a dog will test your patience. If at any time I feel uneasy or start to have a little anxiety all I have to do is reach down and pet my dog or maybe even bend down and give him a hug, and it seems that everything is going to be just fine.
As my time for being part of this program came near an end, I discovered I wanted and needed to continue being part of this program. So I enrolled in The Bergin University of Canine Studies, to further expand my education in the service-dog field. In May of 2010 I completed the AS program. The PPH program has not only helped me in learning to cope with PTSD, but it has also helped me find what it is that I want to do in life. I know without this I could easily slip back into a lot of the old patterns that I had. My hope is to share with other Veterans the wonder of working with these dogs and help them get the same help I got through this program.
Case 6: The following is a personal account of how a PPH bred and Veteran-trained service dog has affected the life of the Veteran with PTSD who also uses a wheelchair as a result of his spinal cord injury. He suffered a spinal cord injury while serving in the Army during the Vietnam era. He received his service-dog in December 2009. His dog helps by pulling his wheelchair, retrieving dropped objects, bracing for transfers and opening doors. The impact that his dog has had on his PTSD symptoms are expressed in his reflections.
Since being paired with my dog I have realized many benefits. Some nights I couldn’t turn my brain off. I would be on hyper vigilance unable to sleep at all. I was given Trazadone (PRN). I hated the way I would feel the next day from Trazadone. Since receiving my dog, my sleep has improved 100 percent and I no longer use it. Over the years I’ve been prescribed many meds for pain (300 mg. TDI) Gabapentin for burning pain nerve, Morphine, and Oxycontin. I now take no pain meds and have learned to live with my constant pain which flairs with activity or weather. I have also taken several prescription drugs to treat depression including Prozac and Welbutron. I feel no need to take depression medication anymore either.
The Veteran also reported significant improvement in his emotional control, positive social interaction and parenting skills and family dynamics.
THE NEED FOR EMPIRICAL STUDY OF THE PPH INTERVENTION
The PPH research team, in collaboration with senior research officials at the NICoE, has designed the first research protocol to examine, systematically, PTSD symptom reduction as well as the physiologic and behavioral changes that occur during interactions between Veterans suffering from PTSD and dogs in the PPH service-dog-training program that is ongoing at Walter Reed Army Medical Center’s Warrior Transition Brigade and at the Palo Alto Veterans Administration Healthcare System Men’s Trauma Recovery Program.
Based on the scientific literature and clinical observations of the program to date, we hypothesize that we will be able to scientifically verify that PTSD symptoms will be reduced, psychosocial functioning will increase and markers of stress as well as inflammation will be reduced by the human-dog interaction in the PPH training program. This is exactly the sort of “evidence-based research” into the mind/body therapeutic effects of human-animal interaction that has been lacking and causing a resistance to the placement of service-dogs with Service Members and Veterans despite Congressional approval of legislation supporting this effort and the growing demand from Wounded Warriors. We hope that the PPH study will advance not only our scientific understanding of the healing powers of animals in our lives, but provide the science that the DoD and VA need to approve animal-assisted therapy programs and the placement of service dogs with Service Members and Veterans with psychiatric and physical disabilities.
*** Footnote references are available upon request
Financial Disclosure Associated with the Statement for the Record of Rick A. Yount, Director, Paws for Purple Hearts
The Paws for Purple Hearts is a program of Bergin University of Canine Studies in Santa Rosa, CA. Bergin University was awarded a one year $245,000 contract by Walter Reed Army Medical Center in September 2010 to provide a Patient Service Dog Training Program from September 28, 2010, through September 27, 2011.