Treatment Plan or Plan of Care (Animal-Assisted Therapy)

Treatment Plan / Plan of Care: Animal-Assisted Therapy (AAT)

Patient: [Name] • DOB: [DOB] • MRN: [MRN]
Date: [Plan creation date] • Author: [Name, credentials, role]
Referring/Attending Provider: [Name, credentials / N/A] • Setting: [outpatient / inpatient / school-based / home / other]
Episode Start Date: [Start date] • Certification Interval: [From–To / N/A]

(This is a forward-looking plan of care. Reference the full evaluation rather than duplicating it.)

Referral and Indication for Animal-Assisted Therapy

Referral Source and Date: [Referring provider and date / initiated by evaluation]
Diagnoses from Referral: [Diagnoses if provided / N/A]

Clinical Rationale for AAT: [Patient-specific rationale describing barriers the animal component addresses and expected mechanism of benefit such as engagement, co-regulation, graded exposure, task persistence, or social facilitation]
AAT Role in Plan: [core / adjunct / time-limited trial] (If time-limited trial, specify continuation criteria.)

Diagnoses and Problem List

Primary Diagnosis: [Primary diagnosis driving care]
Secondary Diagnoses: [Relevant conditions affecting treatment, prognosis, or precautions]

• P1: [Functional problem statement including any AAT-relevant safety issues] [provisional / confirmed]
• P2: [Functional problem statement] [provisional / confirmed]
• P3: [Functional problem statement] [provisional / confirmed]

(Present problems in descending priority. Add or remove as appropriate.)

Baseline Status Summary

[Baseline functional performance relevant to goals: assistance levels, distances, frequency/duration/accuracy of target behaviors. Include standardized measure scores with instrument name and date. Note AAT-specific observations such as tolerance of animal proximity, approach/avoidance behaviors, attention span. Document precautions including medical devices, cognitive/communication factors affecting consent and safety. Reference full evaluation location.]

Skilled Rationale and Medical Necessity

Skilled Care Justification: [Why skilled professional care is required: clinical judgment for task grading, monitoring physiologic/behavioral responses, safeguarding devices, behavior shaping, caregiver training, differential assessment]

AAT Indication: [Patient-specific mechanism of benefit; how progress and AAT efficacy will be measured; why non-animal approaches are insufficient for this patient]

Risk Acknowledgment: [Key risks identified such as allergy, infection, falls, bites/scratches, emotional distress; reference mitigation measures in Safety Screening section. If risks are elevated, justify proceeding or note contraindication.]

Safety Screening and Consent

Consent: [patient oral consent / patient written consent / guardian consent] • Relationship: [Relationship if guardian / N/A] • Date: [Date]
Patient Assent: [obtained / not applicable]

• Allergies: [Species/breed, reaction type/severity, mitigation plan / none known / unknown—screen prior to first animal contact]
• Phobia/Fear/Cultural or Religious Concerns: [Description / none reported]
• History of Aggression Toward Animals or Unsafe Handling: [Description / none reported]
• Immunocompromised or Infection Control Precautions: [Status and isolation requirements / none / unknown—screen prior to first animal contact]
• Open Wounds/Non-Intact Skin/Invasive Devices: [Sites and required contact restrictions / none]
• Dietary Restrictions Relevant to Treat-Feeding: [Restrictions / treat-feeding prohibited / none]

Contraindications/Precautions: [contraindications present / precautions only / none] (If present, specify: AAT deferred/modified/prohibited, alternatives, or operational precautions such as distance maintained, no licking, no bed placement, barriers required.)
Clearance Status: [Cleared for AAT / Not cleared / Conditional—specify conditions]

Animal and Handler Parameters

Animal: [Species/type] • Role: [visiting therapy animal team / facility animal] • Program Affiliation: [Program/ID / N/A] • Health Clearance: [Status and date / N/A] • Behavioral Suitability: [Brief note]

Handler: [Name / TBD] • Role: [volunteer handler / clinician-handler / AAT staff]
Responsibilities: [Animal control, positioning relative to devices/wounds, hygiene/cleaning protocols, stress signal monitoring, session termination authority, incident reporting]

Animal Welfare Safeguards: [Session time limits, rest break requirements, stress signal monitoring plan, stop rules]
Infection Prevention: [Hand hygiene requirements, barrier requirements, prohibited behaviors, prohibited locations]

(If animal/handler not yet assigned, specify required qualifications and coordination steps.)

Goals

(Goals must be measurable with baseline, target criterion, timeframe, assistance level, and context. Indicate AAT use and measurement method for each.)

P1: [Problem title]

• LTG: [Functional outcome from baseline to target within timeframe with assistance level in context] • Measurement: [Method/tool] • AAT: [Yes / No] • Discharge Criteria: [Criteria]
• STG: [Stepping-stone objective from baseline to target within timeframe] • Measurement: [Method] • AAT: [Yes / No]
• STG: [Additional objective] • Measurement: [Method] • AAT: [Yes / No]

P2: [Problem title]

• LTG: [Functional outcome with parameters as above]
• STG: [Stepping-stone objective with parameters as above]

P3: [Problem title]

• LTG: [Functional outcome with parameters as above]
• STG: [Stepping-stone objective with parameters as above]

(Add or remove problems and goals as appropriate.)

Planned Interventions

(Describe AAT elements operationally. Specify grading parameters and the animal's role. Include safety operationalization.)

P1 Interventions

• [Intervention description including AAT elements] • Grading: [Proximity, duration, complexity, environmental stimulation, cueing, physical demands] • Animal's Role: [motivational catalyst / task component / graded stimulus / co-regulation] • Safety: [Prohibited actions with substitutions, device protection, positioning]
• [Additional intervention as above]

P2 Interventions

• [Intervention with grading, animal role, and safety parameters]

P3 Interventions

• [Intervention with grading, animal role, and safety parameters]

Dosage

Service Type/Discipline: [OT / PT / SLP / Psychology / Social Work / Nursing / Interdisciplinary / other]
Frequency: [Sessions per week] • Duration: [Weeks or total visits; include tapering plan if intended]
Session Length: [Minutes range] • AAT Portion: [Approximate minutes per session] • Animal Present: [every session / selected sessions]

Care Coordination

• Notifications Required: [Parties to notify prior to AAT sessions]
• Scheduling Constraints: [Handler availability, room booking, environmental timing]
• Visit Logs/Contact Tracing: [Location per facility policy]
• Incident Reporting: [Process for bites, scratches, falls, animal accidents]
• Patient/Caregiver Education: [Hand hygiene, safe interaction rules, recognizing animal stress signals, home carryover if applicable]

Reassessment and Plan Modification

Reassessment Interval: [Every X visits or weeks] • Measures to Review: [Specified outcome measures]

AAT Continuation Criteria: [Engagement improvement, measurable progress per specified metrics]
AAT Discontinuation Criteria: [Safety rule violations, patient distress, allergic reaction, infection control restrictions, animal stress/fatigue, no measurable benefit after defined trial period] (Specify objective thresholds and timeframes.)

(Document any significant plan modification with date, what changed, rationale, and authorizing clinician.)

Signatures

Establishing Clinician: ____________________ Credentials/ID: ____________________ Date: __________
Certifying Provider: ____________________ Date: __________ Recertification: [Interval / N/A]

• [ ] Facility AAT policy reviewed
• [ ] Consent obtained and documented
• [ ] Therapy animal team/facility animal approval verified

(If signatures pending, note routing: [Pending—routed to X on date].)