Review Reports - Dogs as Therapeutic Partners, Not Therapeutic Tools: Ethical Considerations for AAT in the Correctional Setting

Round 1

Reviewer 1 Report

Overall, this is an interesting manscript/study that contributes to a gap area in the literature. That said, there a number of areas that require further attention that would enhance clarity and strength of the paper. The methods section requires more detail to fully understand the research design used and how the author(s) arrived at the findings (details on the data analysis i.e., who analyzed the raw data, was inter-rater reliability used, were member checks used? The findings section could be reorganized and shortened. Perhaps creating a table that include the numerical/percentage responses to specific interview questions would help with this. At times, the findings were presented as if they were drawn from a survey rather than qualitative interviews. A stronger linkage to the literature would strength your discussion section. See additional comments below:

Line 35 rather than "fields" consider "accrediting bodies" as used in line 81 to keep consistency.

Line 38 - does the use of the word "juvenile" imply that these are young people who are incarcerated or just young people generally speaking? I am asking as the next sections go on to discuss AAT and individuals who are incarcerated. Clarify the sentence where "juvenile" is used.

Line 69 and Line 73 - clarify use of the word "safety". Psychological? Physical? Emotional?

Line 87 "...other types of therapy visits". Do you mean other types of therapy dog visits?

Line 91 - "may incorporate dogs into their work settings". Do you mean therapy dogs or companion dogs generally? If therapy dogs, which I think is the intent, please include the word "therapy".

Line 93 - I am suggesting a short opening paragraph that gives the reader a sense of what will be included in the literature review i.e. the areas of focus in the literature that will be included.

Line 140- "the dogs does not get harmed purposely or inadvertently" Does this refer to physical harm, accidents, or something else?

Line 158 - "recertification" and "initial certification" of the dog is mentioned. This is the first mention of an evaluative process for a therapy dog team (handler and dog) that leads to "certification". I am suggesting that mention be made of this important step earlier in the manuscript.

Line 169 - Try to avoid using the editorial "we".

Line 172 - The sentence "They have there own needs...." It seems that a follow-up sentence is needed to complete your thought/idea here.

Line 179 - try to avoid the use of "etc.".

Line 181 - I am suggesting to use more tentative language i.e., "may" create conflict of interest.

Line 199- Is this in the state of New York or the city of New York?

Line 211 - where is the MCC located?

Line 216 - "the dogs are often resting". Provide a bit more detail about what this means for the dogs.

Line 217 - What are some of the "difficult concepts"?

Line 222- What was the minimum criteria to be a participant in the study? You mention the 12th team was not included because they had done only 3 visits.

Lines 224-225 - you need to write out in full the acronyms for the educational credentials of participants.

Line 239 - Define "rescue". Did the dog come from an animal rescue organization or something else?

Line 247 - interviewing participants does not necessarily mean that a study is qualitative. Why was a qualitative approach to this study used? A bit more detail is needed in this section. What specific qualitative approach was used? Also, in keeping with a qualitative study, I am recommending changing some of the language you have used. For example, the heading "measures" I used but you could/should refer to this section as data collection and analysis.

Line 241 - I am suggesting that you remove the quote by the handler.

I think that the participants backgrounds could be placed into a table. the information on the dogs could also be placed into a table. Creating tables would allow for ease of reading. Wondering what a Labradoodle mix is? Labradoodle are mixed breeds.

Line 260 - The interviews were not audio recorded but notes were taken? And the notes were verbatim comments by participants? Were there two researchers conducting the interviews? Provide information on who collected the data and how accuracy of participant words was achieved using note taking. You need to clarify what you did in your analysis using open coding “open-ended approach”.

Line 266- Need to describe how you are using the language of “themes” and “categories” because it is not clear to me how the author(s) arrived at their findings.

Line 268 – Provide a summary of the themes that emerged from the data (how many?).

Overall, the findings are interesting but as presented read more like survey research. Description of the meaning of each of “categories” is needed. Otherwise the findings read as response rates to questions. The findings section could be re-organized and shortened for clarity. Consider putting numerical responses for each question into a table.

Line 644 – it is mentioned that this is an exploratory study. This should be stated early in the manuscript and in the methods section.

Line 648 – what are the “mental health disciplines”?

Line 649 – Remove the word “very”. In fact, I am suggesting rewriting the first sentence.

Line 650 – What is meant by “symbiotic” relationships. More explanation is needed here.

Line 660 – Word missing in the sentence. What were the organizations that handlers were affiliated with? What type of training did they receive as part of their certification process?

Line 664- What is meant by a lack of “ethical training”?

Line 665- Which two AAT organizations are being referred to here. Rewrite for clarity.

Line 667 – Do mean include ethics in their “standards”?

Line 670 – Remove the quote from this section.

Line 675 – Unclear who is being referred to when using “therapy dog organizations”.

Line 680 – remove the word etc.

Line 681 – Who is the director? Is this a person who was the direct contact for the AAT program?

Lines 681-683 – rewrite for clarity.

Line 687 – I understand the intent of this sentence but it seems incomplete. How does respect for the canine and human unfold in this AAT setting?

Line 690 – how can concerns be alleviated? What was done by the AAT setting to alleviate concerns?

Line 692 – What change in protocol is being referred to here? Need to contextualize this statement.

Line 692 – Line 702 needs to be removed or rewritten. Too much information is given about a specific incident that is not necessarily needed to make the point that is being made.

Line 719 – Remove the participant quote.

Line 738 – What were the protocols of the PPPs? This should likely be discussed in the manuscript.

Line 745 – You have used the acronym AAT throughout. Use in this sentence to be consistent.

Line 748 – The intent of qualitative research is not to generalize findings to other populations. I do not see this as a limitation.

Line 753 – what is meant by “longer”?

Line 755 – What are the requirements of certifying AAT organizations regarding first visits?

Line 763 – What is meant by “residents”?

Author Response

6 September 2021

re: manuscript ID socsci-1284576

Social Sciences Editor:

Thank you for your consideration of our article entitled, Your dog as a therapeutic partner, not a therapeutic tool: Ethical considerations for AAT in the correctional setting. We have outlined details of the revisions to the paper and our responses to the reviewers.

Response to reviewer #1’s line by line comments (line number reference the reviewer’s comments:

line 35: changed “fields” to “accrediting body” as suggested
line 38: we disagree that clarification is necessary here; the overall context of the paper clearly indicates that the study examined the use of AAT in correctional settings.
line 69 & 73: the phrase “sense of safety” is meant to convey a general, overall sense of safety rather than a specific aspect of safety; it is not uncommon for offenders to express feeling “unsafe” while in prison without being able to articulate a specific type of safety
line 87: Other types of visits means non-jail visits or traditional therapy visits
line 91: added “therapy” as suggested
line 93: We appreciate the suggestion; however, we believe that the paper’s introduction serves this purpose sufficiently (if not explicitly) and the paper flows well as it is.
line 140: changed the wording of the sentence for efficiency; re: reviewer’s comment… the context of the sentence is clear that the handlers must be watchful to prevent harm to the dogs stemming from the client or the physical environment; line 130 clearly indicates that the paragraph discusses the handler’s responsibility to ensure both mental and physical safety of the dogs
line 158: this paragraph is a good place to introduce the concept of certification for the dogs and we’ve added a couple statements to the beginning of the paragraph to better introduce the concept.
line 169: replaced the phrase, “how do we ensure…safely” with “no method exists to ensure the proper and safe inclusion of therapy dogs”
line 172: combined the sentences in lines 172-173 for great efficiency; re: reviewer’s comment…the sentence following the one mentioned by the reviewer is the follow-up that completes the thought as indicated by the adverb “Hence”; we could change ‘hence’ to ‘therefore’ if doing so would improve clarity
line 179: sentence revised to omit ‘etc.’; also added “such as” in line 178 for clarity
line 181: replaced ‘a conflict of interest’ with ‘role conflict’ a term more accurately describing a situation where differing role expectations can cause conflicting or incompatible priorities or job pressures
Line 199: the exact locations of the facilities used in the study are identified in the following paragraph
Line 211: added clarification indicating that MCC is in Lower Manhattan in New York City
Line 216: The sentence was revised for better word flow and structure; we believe that the word ‘resting’ is self-explanatory but added “laying down” in parentheses.
Line 217: They are used as examples when we discuss more complex topics like problem solving. The women learn specific steps that can be used to help solve any problem. We typically would not begin with a very complex problem, such as what will happen to their children if they are sentenced to several years. That could be very overwhelming. We will start will a small, benign problem involving one of the dogs. Once they understand the steps conceptually, we can build to more difficult concepts like care for one’s children.
Line 222: Everyone who worked as a team for PPP was included with the exception of the 12^th They only had three visits because they were terminated from the program (as explained later in the article). Her dog was very anxious for the first two visits. After we spoke to her about it, she gave her a dog a sedative for the 3^rd visit, which is not allowed and clearly unethical.
Line 224-225: degree acronyms replaced with full titles
Line 239: Rescue is a common term used to describe a dog who is obtained from a shelter, and animal rescue or is found abandoned. This was included in parentheses.
Line 247: “Measures” changed to “Data Collection and Analysis”; added text explaining the reasoning we took a qualitative approach to this study; revised text to clarify that interviews utilized a semi-structured interview schedule common to qualitative research; the second paragraph of the section provides details of how responses were coded and analyzed.
Line 241: quote removed; “Labrador-mix” means that the dog was the result of a breeding between a Labrador retriever and a dog of unknown breed; making this distinction is not terribly relevant to the paper. A table was created and added to the end of the manuscript.
Line 260: Correct, the interviews were not audio recorded. We find participants are often more relaxed when a recorder is not in use, particularly when speaking to those in corrections work. One can write very quickly and transcribe the same day. If someone is talking too quickly, the researcher can ask them to slow down or if the researcher misses something, they can ask them to repeat what was said. Only one researcher conducted all of the interviews for consistency and the notes were verbatim comments by participants. Open-ended approach was removed; it meant using the framework analysis. The sentence was revised to reflect this.
Line 266 & 268: added
- “description of the meaning of each categories is needed” – The categories are identified in the subheadings of the results section are generally self-explanatory and explained in each subsection.
- “otherwise the findings read as response rates to questions; consider putting numerical responses for each question” – the study utilized an interview schedule, not a survey; while we can see the reviewer’s perspective on presentation, individual themes in each in each category are identified in the findings section. We revised this to include the 4 themes found within the categories which included the special bonds which exist between canines and humans; confidence in the recognition and handling of stressful situations; differences in qualifying or requalifying as a therapy team; and the feasibility for the well-being and enjoyment of the canine partner in a correctional setting.
- “finds section could be re-organized and shortened for clarity” – we feel that the article is well organized as it is with each subsection representing a common category of responses from interviews. The section could be shortened, as the reviewer suggests, however doing to would necessitate the loss of quality. We would note to this reviewer that qualitative research often results in longer articles than quantitative studies.
Line 644: added “exploratory” to line 83 and mentioned the exploratory scope of the study to line 249
Line 648: replaced “particular from the mental health disciplines” with “among mental health professional organizations”
Line 649: replaced 1^st sentence with, “Responses indicated that all handlers possess a strong commitment to PPP and the program’s participants.”
Line 650: replace the phrase ‘special symbiotic relationships’ with ‘mutually beneficial relationships’

Line 660: replaced “had” with “how”; dog handler training is discussed in detail in the results section under the subheading “Training, Recertification, & Ethics” The organizations are mentioned on page 13 line 273. They are not distinguished throughout to protect the confidentiality of the handlers, who are part of a very small sample.

Line 664: the phrase “lack of ethical standards” does not appear on this line; the line reads, “with a lack of national standards creating inconsistencies in ethical training…”

Line 665: They are mentioned on page 13 line 273. They are not distinguished throughout to protect the confidentiality of the handlers.

Line 667: replaced “practices” with “standards”
line 670: quote removed
line 675: sentence omitted
Line 680: replaced “etc.” with “among others”
Line 681: added “PPP” to indicate that concerns were addressed to the PPP program director
Line 681-683: added “Study participants reported that…” as an example of PPP handlers following the best practice mentioned in the preceding sentence.
Line 687: sentence deleted
Line 690: replaced “they” with “handlers and their dogs” for clarity; as indicated in the paragraph’s opening sentence, the concerns were alleviated by allowing the handler’s and their dogs to visit the facility prior to program start.
Line 692: sentence revised to more clearly indicate the change in program protocol
Line 692-702: paragraph revised to reduce detail on the specific incident and focus on the lessons learned from the incident.
Line 719: quote removed, and accompanying sentence revised to accommodate the deletion.
Line 738: PPP is not in charge of the therapy dogs – the affiliated therapy dog organization is in charge of the dogs and their handlers and sets the safety protocols that handlers follow. Other safety measures were implemented by the program to increase safety (i.e., walking in hallways not frequented by residents, keeping the dogs on a short leash, etc). These are discussed in the findings and are discussed throughout the last section of the findings under the subheading/category – The Jail Specifics of AAT.
Line 745: suggested change made
Line 748: we disagree; whether a limitation of qualitative research in general or this study we still perceive this as a limitation.
Line 753: replaced “longer” with “in programs greater in length than the one studied”
Line 755: there are no national standards in this regard. Each therapy organization sets its own standards as mentioned in the article. Some require a training class, others allow for just a test. Some agencies shadow a new team on their first few visits.
Line 763: “residents” in this context is used in place of “inmates”

Thank you for your very thougthful comments on this manuscript.

Reviewer 2 Report

I am very concerned that the authors are presenting this as animal assisted therapy (guided by a licensed/degreed healthcare or human service provider, goal driven, clear hypothesis, measures for specific client goals via an intervention plan, and documented- none of these conditions are present), when it may actually be animal assisted activities (volunteer visiting teams)- these are not the same thing. It is being presented for mental health professionals but all of the content refers to volunteer visiting. The literature review and supporting citations are lacking. Authors state that several documents do not exist when in fact, they do and are published.

Comments for author File: Comments.pdf

Author Response

6 September 2021

re: manuscript ID socsci-1284576

Social Sciences Editor:

Response to reviewer #2 – 1^st set of comments:

We are unclear as to the “missing documents” referred to by this reviewer.
The reviewer is unclear about AAT. We have a letter of support from the lead person from IAHAIO (International Association of Human Animal Interactions Organization) -from Dr. Brinda Jegatheesan - who is a leading expert in the field of AAT (animal assisted therapy) and the VP of IAHAIO. We asked her to please review our work in 2018 and comment upon whether she felt our research protocol met the definition for AAT, rather than AAA (animal assisted activity). She said our work is AAT and not AAA. The White paper is the leading document on definitions for AAT, AAA, etc. She is the lead author of that paper. We can provide a copy of the letter if needed.
The reviewer comments that the article is “being presented to mental health professionals, but…refers to volunteer visiting.” We note that first, due to decreasing budgets nationwide many prisons and jails rely upon volunteers to deliver rehabilitative content. Secondly, the article is not targeted specifically at mental health professionals but rather any professional utilizing animal assisted therapy or with a concern for the ethical treatment of working animals.
we disagree with the reviewer’s statement that the literature review and citations are “lacking”, particularly without any guidance from the reviewer in the manner in which the review is lacking.

Response to reviewer #2 – Follow-Up Comments

The reviewer comments – “I am not seeing definitions for animal assisted therapy that differentiate it from AAA. Since AAT is goal driven with treatment plans – I would recommend that you include this content. There are no program goals- they should be measurable and progress would be documented”. –

Response: This article is not about the program itself but about the ethical use of canines in a jail-based program. The article would be too lengthy to include full information about the program and its outcome measures, which are in relation to the incarcerated mothers. We have included as much information as space will allow without going too far off topic, this includes our primary outcome measures – please see page 11. We also added results from a previous study that examined outcome measures when comparing women who engaged in this parenting course with AAT vs those who engaged in the same course without AAT. Those who want to learn more about the program itself and its effects on incarcerated women can also refer to that article.

The reviewer comments – “States no national standards. There are several professional level organizations with standards for AAT: AAII, IAHAI, SCAS, Pet Partners now has a professional level .”

Response: These are all great resources but are not national standards; they are standards put forth by individual agencies, which we believe is a problem and an issue that we point the reader to consider. Each has standards but as explained, the standards are not consistent and vary from agency to agency. The standards one follows depends on the agency they certify and/or register with. As in the case with private practitioners, they may not have registered with any agency and even if they did, they typically do not volunteer with that agency and have no need to return to requalify.

The reviewer - “states that mental health professionals do not have guidelines, yet there are ACA guidelines that have been in place for a few years. The ACA offers: APA ACA Ethical Standards and Competencies in AAIs, Position Statement on Animal Welfare, the works from Dr. Leslie Stewart on competencies. “ -

Response: We appreciate the sharing of these sources and do not refute that others in the field may have written about these competencies. The issue is whether it has been incorporated in the code of ethics and although the APA addresses research with animals in its code of ethics, none address working with animals in a therapeutic manner, which was our concern. The resource you provided states - With regard to specialty areas, the ACA Code of Ethics (American Counseling Association [ACA], 2014) clearly states, “Counselors practice in specialty areas new to them only after appropriate education, training, and supervised experience. While developing skills in new specialty areas, counselors take steps to ensure the competence of their work and to protect others from possible harm”. Yet, this does not specifically address animals. In the other article, they specifically state – “Although there is currently no ACA ethical code section specifically addressing therapy animal advocacy, protecting the welfare of the therapy animal is an additional ethical consideration relevant to AAT-C”. This specifically addresses our point in the article and we added these authors as a source.

The reviewer states – “Page 5- line 108 You state: Therapy dog visits have not been found to lead to overfatigue or lack of motivation (Barstard, 2014). 108 While visiting post-surgical children, therapy dog heart rates were not significantly changed (Palestrini et 109 , 2017). Stress levels appear to remain consistent with therapy dogs, demonstrating similar levels at the 110 beginning and end of a visit (Silas et al., 2019). Minor stress may be noticed but with proper instructions for 111 clientele and a well-trained handler, it is considerably lessened (Barstard, 2014; Ng, 2014). The concern is that these studies refer to volunteer visiting which is not the same as animal assisted therapy. Dogs work in a very different capacity, frequency and duration, and sometimes for more than one handler. Not convinced you should use AAA references in proving points about AAT unless you have sufficient evidence to support it.” -

Response: With limited research in this area, we wanted to provide this information. As mentioned in the article, during “regular” visits, such as to hospitals, nursing homes, etc, which can be considered volunteer visits and are often classified as AAA…dogs are consistently engaged for an entire 45 minutes to one hour. In PPP, although the visits are longer, the dogs have significant rest periods. We are trying to demonstrate that if consistent visiting for 45 minutes to an hour is unlikely to lead to detrimental effect for the canine, then a two hour session, with ample rest, is unlikely to do so as well.

The reviewer states - On page 7, line 151 , there is a similar situation. It describes that dogs should be in good health, enjoy people, be able to remain calm in unfamiliar places with unfamiliar people, and feel comfortable with potential clients touching them, kissing them, hugging them, or as in the case with children, possibly touching them inappropriately (i.e., grabbing their tail) 153 Glenk, 2017). However, most therapists practice AAT in a consistent setting, and many therapists do not allow clients to hug and kiss their dogs as they are knowledgeable about the study or proxemic preferences.” -

Response: This is one type of visit of a therapy animal may engage in but there are others. Therapists may or may not allow clients to engage with a therapy dog in a certain way. Without consistency in the guidelines or inclusion within the mental health disciplines’ code of ethics, it is not required that they do or do not do this. This article is also not focused on therapists but looks at how therapy dogs may be utilized in a variety of settings and why it could be problematic.

The reviewer states – “On page 8, line 155, you wrote Therapy dogs must 155 possess certain personality characteristics (i.e., no sensitivity to touch, well-disciplined, calm, etc.), other- 156 wise they could pose a danger to the client; it is important to remember that as dogs age, their tolerance 157 changes (Winkle et al., 2020), which is why the issue of recertification is just as important as initial certification. The authors of the Winkle article specifically discussed that the term CERTIFICATION is problematic. But you chose to use a sentence from that article to justify that certification and recertification is important. That is not what the authors stated.” -

Response: Yes this is correct. We added further clarification for Winkle’s point. Agencies do use this term, which is confusing.

The reviewer states – “There are several areas in which you state that a lack of national standards…. please review AAII Standards and Competencies: https://aai-int.org/aai/standards-of-practice/I do wonder if you define NATIONAL STANDARDS (why you mean by lack of, this would clear up a lot of things). Are you speaking of a governing body that can offer certification rather than the international organizations that offer standards and competencies. There are plenty of standards out there for professionals, but the greatest problem may be that professionals continue to go to volunteer visiting organizations – which is not conducive and in some cases incompatible with what we would expect in a therapy setting.” -

Response: Yes, this is what we are referring to. We have clarified this point on page 9.

The reviewer states “Line 187-188 could use a citation.”

Response: Allen & Colbert, 2016 was added.

The reviewer states “Line 215- define a duration for ‘typical therapy dog visit” or just define how long the range of times are for the program.” –

Response: The sentence before and after this sentence state that the visit is 2 hours but we added it to this sentence as well for further clarification.

The reviewer states “Line 224 – spell out MA or MS and other degrees before using abbreviations. “ –

Response: This was changed.

The reviewer states - There is some confusion that you could clear up- by definition- AAT is provided by a licensed/degreed healthcare provider , goal oriented, etc. But the article reads (page 12, middle paragraph) that the handlers were interview2ed- and they were not identified as actual therapists. Do they meet the definition of AAT or is this really AAA? “ -

Response: AAT does not have to be provided by a licensed therapist. The IAHAIO (International Association of Human Animal Interactions Organization) has the leading paper/definition for AAT which is referenced on page 3 – they have to be delivered by health, education and human service professionals. The instructor/director is a health, education and human service professional. As stated above from the first set of comments, the protocol was sent to IAHAIO and was approved as AAT.

The reviewer states “The article also describes that they were all CERTIFIED- you may wan tot expand on that as a CERTIFICATION is difficult to come by versus a registration, which is more common. “ -

Response: Thank you. This is an important point. The issue of certification v registration is expanded upon and no longer used to describe the teams in the sample section. Qualify and requalify were used as alternatives.

Reviewer states “Curious about the subjective questions “Do you like working in the PPP program” which can sway the content.” -

Response: It was a simple question to see whether teams enjoyed working in the program. Not everyone enjoys working in a confined atmosphere with numerous rules and procedures to follow. If there was a canine who presented with stress, the unhappiness or dissatisfaction of the handler could be a possible explanation.

Reviewer states “Most of the comments are not specific to animal assisted THERAPY treatment/goals. This continues to feel like AAA. There is no mention of goal oriented treatment plans at all. IT does not meet the criteria for AAT.” -

Response: This is addressed in response to other comments above. Information regarding outcome measures for the program were added but is not the focus of this article. The program was also distinguished as AAT by IAHAIO.

The reviewer states “I do not see an appendix or a chart with the actual questions for the “handlers”/therapists – will this be provided for review? “ -

Response: The questions are presented in the findings. Unfortunately, space limitations make this difficult to add as a full appendix.

The reviewer states “Line 306- For the educated reader of this article, one of the quotes is not accurate from a handler’ it says that They are trained for temperament. They exclude a majority of dogs right away. Temperament has been defined as an animal's personality, makeup, disposition, or nature. ... Temperament is not the physical characteristics of a dog, and it is not learned behaviors such as sit, down and stay. Temperament is not something trained.” -

Response: This was a direct quote from one of the teams – we were reporting their words. If it pleases the reviewer, it was removed.

The reviewer states “I am concerned that the handlers do not have education in dog traits and how they are specific to AAT. I do not see any credential that would make these handlers experts. Some of the things they mention are incompatible with what we would see in therapy. There is no such thing as a one size fits all. Dogs working with elderly in a skilled nursing facility are very different than working with adolescents in a behavioral treatment center or in a veteran individual session. Line 320 ‘appearing relaxed” is not a description – what does that look like,. Difficult to identify their level of knowledge with this choice of words.” -

Response: These teams have gone through training and are connected to a therapy dog organization that qualifies them and requalifies them. Those in charge of this process are experts in dog education. This may be an issue with inconsistences in the field about who is appropriate for this work or what type of background may be needed. This is why we argue that there should be a national standard. We can only imagine that some organizations require very little to register or qualify their teams.

The reviewer states – “In lines 321-328, some of these (wagging tail, showing belly) may not be signs of enjoyment- they may be signs of appeasement, or stress. It would help if they had given more detail.” -

Response: This can be true but again this is their perception based on their experience. This is one of the issues mentioned in the literature review about evaluation of one’s own dog being subjective. In the first few years of PPP, the director of training was present with the teams to assess for problematic behaviors. This is now addressed in the discussion.

The reviewer states “Wondering if a dog behavior specialist was on this team who should have knowledge about behavior – they could help code things more accurately?” -

Response: The Director of Training for the community-based therapy dog organization is not a researcher but has been consulted throughout this project. She has assisted with clarification but she is not a social scientist.

The reviewer states “Line 348-352 is great- this is what we would expect to see from someone with solid interpretations of dog body language” and “Line 358-366 is also great information…all of page 173 is so useful! This is what people need to hear. These are all very clear examples of advocacy.’ -

Response: It seems clear that some people are more knowledgeable than others. This was added to the discussion section in addition to addressing the fact that PPP had the Director of Training for the therapy dog organization onsite for its few years to safeguard against any potential issues.

The reviewer states (but the entire sentence was not completed) “Line 407—I am unaware of any organizations that offer certification for AAT—there are organizations for volunteer visiting… perhaps you could describe the AAT organization that “ -

Response: One of the therapy dog organizations uses certification as the term for teams. The other uses certification and registration. In examining the terminology used by Pet Partners, different terminology has been incorporated to avoid this confusion. Requalification and qualification are more fitting terms. The use of the word certification did not fit the definition provided by Pet Partners.

The reviewer states “Line 421 states in addition to their AAT training- what specifically were they trained for specific to AAT??? In a previous section they “ -

Response: This sentence was not completed so it is difficult to know if this response addresses the reviewer’s issue specifically. Each organization has its own training. In the interview, the teams touch upon topics they learned about. The wording was changed to – In addition to the training to become a therapy team...

The reviewer states – “I am becoming more confident that this article is referring to AAA and not AAT. I recommend that the authors either include the criteria from AAT definitions, or that they avoid using the term therapy at all. This is clearly not a therapy program. It is AAA which is volunteer visiting. Again, no mention of licensed-degreed services that are treatment plan based or measured outcomes for those specific goals.” –

Response: This issue has been addressed above. We added the following in the description for PIO (the curriculum used in PPP), that PIO was reviewed by the Substance Abuse and Mental Health Services Administration and is included on the national registry of evidence-based programs and practices.

The reviewer states – “Line 645 states therapeutic interventions—no evidence of this in the entire article.” -

Response: The program is a cognitive-behavioral parent management program. This was also added to PIO’s description.

The reviewer states – “Two therapy dog or AAT organizations are mentioned throughout yet they are not named while the PPP is named. This creates a barrier for readers to understand the context of this article- readers could easily look up the organization curriculum (which ideally would be laid out in this text).” -

Response: They are mentioned on page 13 line 273. They are not distinguished throughout to protect the confidentiality of the handlers, especially since this is a small sample size.

The reviewer states “The article makes many leaps to mental health providers but that is not the context of what was written. There is no discipline specific content, treatment theories or frames of reference, goals, measures, documentation, etc.”

Response: The intention was to make readers aware that this is a gap in the field and without an oversight agency or even affiliation with a dog therapy organization, there are concerns for the welfare of dogs used in private therapy.

The reviewer states – “Line 781—these ethical standards already exist- look them up.” -

Response: This was addressed previously. There are standards that exist but they are not consistent and are non-existent in the code of ethics for the mental health disciplines. There are no national guidelines which all are required to follow.

We thank you for your very thoughtful comments regarding this manuscript.

Round 2

Reviewer 1 Report

A couple of spelling issues e.g., line 235 the word "verses" when is should be "versus" and minor formatting issues e.g., line 709 indent paragraph. Should master of social work on line 253 be capitalized?

I appreciated reading this paper as the area of ethics (human and animal) in AAT is understudied. I appreciate that the paper was specific to AAT in a prison setting.

Author Response

The errors have been fixed. Thank you for your careful reading and for your help in making this a stronger manuscript.

Reviewer 2 Report

I will continue to recommend that if this was AAT, that they simply include the qualifications of the healthcare or human service professional so it is distinguishable to AAT vs AAA. While I realize that 3 years ago, it was agreed by BJ at IAHAIO that it was AAT, it needs to be make clear in the paper. Also note that IAHAIO is in the midst of clarifying their terminology to reflect the licensed degreed or equivalent nature of the person directing AAT. Evidenced by their past two meetings on the topic of terminology, it would no longer fit what was said three years ago-- IAHAIO is growing and working with several other organizations on this topic. Please recall that your readers are from more than one organization and several other organizations make it clear in their definitions that there is a difference between AAT and AAA via the qualifications of the person directing the program.

If this can be professionally clarified, I would have no problem with this being published as the authors have made appropriate edits. Btu making sure that it is directly related to AAT would require that they list that the director was indeed a healthcare or human service provider.

Author Response

On page 11 - 2nd paragraph, it is stated that the Director is a human services provider and that in each class one of the therapy teams is a LCSW. Thank you for your critique and helping to make this a stronger manuscript.