Original Manuscript

Child Maltreatment
1-8
A Randomized Controlled Trial of ª The Author(s) 2018
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Animal-Assisted Therapy as an Adjunct DOI: 10.1177/1077559518817678
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to Intensive Family Preservation Services

Erin Flynn1 , Julia Roguski2, Julie Wolf 3, Kate Trujillo4,

Philip Tedeschi1, and Kevin N. Morris1

Abstract
This study examined the effects of animal-assisted therapy delivered as an adjunct to standard-of-care intensive family
preservation services, compared with usual care alone. Method: Families referred by Child Protective Services (Mchild age ¼ 6
years + 4; Mparent age ¼ 32 years + 8.26) were individually randomized to experimental (n ¼ 14) or control (n ¼ 14) intervention.
Family functioning outcomes were measured using the North Carolina Family Assessment Scale for Reunification. Results: All
four targeted family functioning outcomes were significantly increased for participants who received animal-assisted therapy as an
adjunct to intensive family preservation services (n ¼ 14) with medium to large effect sizes. These improvements were sustained
in two of the subscales through discharge. No significant differences were measured for the distal clinical outcome of disposition
of children at discharge. Conclusions: Findings suggest that adding animal-assisted therapy as an adjunct can improve evidence-
based clinical interventions aimed at enhancing the caregiving contexts of children.

Keywords
family preservation, child and adolescent development, parent–child relationships, randomized clinical trial, Child Protective
Services

Caregiving contexts involving maltreatment negatively impact
the developmental health and well-being of children. Experi-
ences of early adversity in childhood, such as abuse and
neglect, place children at risk for emotion dysregulation, poor
affective processing skills (Cicchetti, 2016), and formation of
insecure disorganized patterns of attachment (Cyr, Euser,
Bakermans-Kranenburg, & van IJzendoorn, 2010). Maltreated
children are at greater risk for developing dissociative symp-
toms that can hinder healthy development of the self-system
and lead to poorer psychosocial functioning (Carlson, Yates, &
Sroufe, 2009). Growing evidence suggests that child maltreat-
ment also affects the development and functioning of the brain
(Hart & Rubia, 2012).
Interventions that stabilize families and improve family
functioning enhance children’s health and development by
reducing the risk of recurrence of maltreatment (Berliner
et al., 2015). Intensive family preservation services (IFPS) are
recognized as a promising practice for use with families
referred by Child Protective Services (CPS). A meta-analysis
of IFPS programs found them to have a medium and positive
effect on family functioning (d ¼ .486; Al et al., 2012). IFPS
are characterized by case management, small caseloads, 24-hr
availability, in-home services, and intensive (6–15 hr per week)
and time-limited (1–4 months) services (McWey, Humphreys,
& Pazdera, 2011). Parenting skills training is typically a key
component of IFPS and is associated with improvements in
parenting, child behavior, and general family functioning (Lun-
dahl, Risser, & Lovejoy, 2006).
The Homebuilders® model of IFPS is a comprehensive in-
home program that utilizes cognitive behavioral, social learn-
ing, and crisis intervention theory to provide parenting skills
training. Studies of this model have measured improvements in
parenting and reductions in maltreatment, at least in the short
term, when the program is implemented with fidelity (e.g.,
Schweitzer, Pecora, Nelson, Walters, & Blythe, 2015). Home-
builders received a rating of 2, “supported by research
evidence,” according to the California Evidence-Based Clear-
inghouse for Child Welfare (CEBC, 2016a), and there is no
1
Graduate School of Social Work, University of Denver, Denver, CO, USA
2
Savio, Denver, CO, USA
3
Wolf Biostat, LLC, Nederland, CO, USA
4
Department of Social Work, Metropolitan State University of Denver,
Denver, CO, USA
Corresponding Author:
Kevin N. Morris, Graduate School of Social Work, Institute for Human-Animal
Connection, University of Denver, Denver, CO 80208, USA.
Email: kevin.morris@du.edu
2 Child Maltreatment XX(X)
evidence of additional risk associated with children remaining
in the home during the intervention (Schweitzer et al., 2015).
Family engagement in social services is positively associ-
ated with improved psychosocial outcomes and is a precondi-
tion for family preservation services to affect family
functioning (Holdsworth, Bowen, Brown, & Howat, 2014).
Formation of a positive working alliance, or rapport, between
the therapist and client can create greater client engagement in
therapy (Kemp, Marcenko, Hoagwood, & Vesneski, 2009). Yet
cultivation of such an alliance with families involved in the
Child Welfare System can be especially challenging due to the
inherently coercive nature of nonvoluntary services (Sykes,
2011). Engagement of families in services is often undermined
by the stigma associated with child welfare involvement and
the marginalization experienced by many of these families
(Damashek, Doughty, Ware, & Silovsky, 2011). Thus, innova-
tive approaches are needed to increase engagement and rap-
port, particularly for therapy with CPS-referred families.
Including therapy-certified animals in clinical treatment envir-
onments might be one such approach (Signal, Taylor, Prentice,
McDade, & Burke, 2016).
There is growing evidence that interventions involving ani-
mals can positively affect the psychological health of humans
(e.g., Bert et al., 2016). Studies have found that such interven-
tions can effectively reduce depression, post-traumatic stress
symptoms, anxiety, and fear (Dietz, Davis, & Pennings, 2012;
O’Haire & Rodriguez, 2018) and improve cognitive function,
emotional well-being, empathy, and motivation (Gee, Church,
& Altobelli, 2010; Seivert, Cano, Casey, Johnson, & May,
2016; Wohlfarth, Mutschler, Beetz, Kreuser, & Korsten-
Reck, 2013). A systematic review of the benefits and risks
associated with including animals in clinical environments
found that the benefits far outweighed the risks (Bert et al.,
2016).
Evidence suggests that structured, goal-directed inclusion of
animals by health or human service professionals, defined as
animal-assisted therapy (AAT; Jegatheesan et al., 2015), is an
effective adjunct to evidence-based practices (Signal et al.,
2016). More specifically, multiple lines of research suggest that
incorporation of animals into therapy settings may enhance
client engagement in services. Numerous studies report that
direct social interaction among humans is increased in the
presence of animals (Beetz, 2017). Within clinical environ-
ments, animals can reduce barriers to client engagement
(Balluerka, Muela, Amiano, & Caldentey, 2014), bolster
clients’ feelings of safety (Eaton Hoagwood, Acri, Morrissey,
& Peth-Pierce, 2016), increase motivation to attend therapy,
and elevate clients’ appraisals of the situation (Schneider &
Harley, 2006). These factors are particularly relevant to thera-
pists working with clients who have experienced maltreatment
or marginalization by persons of authority when early cultiva-
tion of trust is critical (Berliner et al., 2015).
Incorporation of dogs, specifically, in AAT has been shown
to reduce physiological indicators of stress (Bert et al., 2016)
and enhance calmness during situations that are inherently
stressful, fear-inducing, or associated with social stigma (Lang,
Jansen, Wertenauer, Gallinat, & Rapp, 2010), such as those
often experienced by CPS-referred families during traditional
therapy sessions. However, no empirical studies have measured
the efficacy of AAT as an adjunct to IFPS to improve family
functioning and, thereby, enhance children’s health and
development.
Current Aim and Hypothesis
The present study measured the efficacy of an AAT protocol as
an adjunct to the Homebuilders model of IFPS. The AAT inter-
vention was a 12-module program delivered in community
settings during therapeutic, supervised family visitation ses-
sions aimed at enhancing positive family interactions and par-
enting skills among CPS-referred families. The AAT
intervention incorporates four activities that target the most
common family functioning issues encountered in the agency,
including supervision of children, expectations of the children,
bonding with the children, and disciplinary practices. Each of
the four activities had three versions, based on a commonly
employed cognitive learning and behavior modification model
(Meichenbaum, 1977), resulting in a total of 12 modules. It was
hypothesized that families in a defined, 12-week AAT protocol
delivered as an adjunct to the standard-of-care IFPS (IFPS þ
AAT; experimental intervention) would have improved family
functioning, compared to families that received the standard-
of-care IFPS without the AAT protocol (IFPS). Whether any
proximal improvements were sustained in the families who
received IFPS þ AAT was also assessed. Further, whether any
improvements translated into distal outcomes, specifically
whether more children remained in the home with their family
at the time of discharge compared to families without the AAT
protocol, was evaluated.
Method
Participants
Families of 1- to 17-year-old children and adolescents (M ¼ 6,
SD ¼ 4) were recruited, with 14 in each of the IFPS and IFPS þ
AAT groups (Table 1). Families were recruited from an agency
working with CPS to provide services for youth and families in
two large western cities in the United States. All families were
enrolled in the IFPS program because of identified needs or
concerns that their children were at risk of experiencing abuse
or neglect and to divert children from foster care. Parental
substance use, domestic violence, and child abuse and neglect
were the conditions noted most often by social service profes-
sionals working with these families. However, referral reason
data were limited to reports of conditions by the referring
agency. Four of the families identified as Black (14.3%), 9 as
White/Hispanic (32.1%), and 15 as White/non-Hispanic
(53.6%). Most families had one to two children (67.9%). Par-
ents ranged in age from 18 to 48 years (M ¼ 32, SD ¼ 8.26). In
13 families, caregivers were single parents (46.4%), 13 families
had caregivers who were partnered (46.4%), and in 2 families
the primary caregiver was a relative of the children (7%). Most
Flynn et al. 3

Table 1. Participant Demographics.

IFPS þ AAT (n ¼ 14) IFPS (n ¼ 14)

Variable n % n %

Primary caregiver ethnicity

Black 2 14.3 2 14.3
White, Hispanic 3 21.4 6 42.9
White, non-Hispanic 9 64.3 6 42.9
Primary caregiver education
Less than high school 2 14.3 3 21.4
High school 3 21.4 6 42.9
College or trade school 3 21.4 0 0
Not available 6 42.9 5 35.7
Primary caregiver gender
Female 13 92.9 10 71.4
Male 1 7.1 4 28.6
Primary caregiver employment
Employed 2 14.3 5 35.7
Unemployed 10 71.4 4 28.6
Not available 2 14.3 5 35.7
Annual household income
US$16,000 or less 11 78.6 6 42.9
More than US$16,000 0 0 6 42.9
Not available 3 21.4 2 14.3
Parental involvement in justice system
Prior involvement 7 50 3 21.4
No prior involvement 5 35.7 9 64.3
Not available 2 14.3 2 14.3
Referral reason
Parental substance abuse 3 21.4 4 28.6
Abuse, neglect, and/or domestic violence 4 28.6 3 21.4
Mental health services needed 1 7.1 0 0
Multiple reasons (two or more) 6 42.9 7 50
Number of children
1–2 children 10 71.4 9 64.3
3 or more children 4 28.6 5 35.7
Caregiver type
Single parent 9 64.3 4 28.6
Partnered parent 4 28.6 9 64.3
Relative 1 7.1 1 7.1

M (SD) Minimum–Maximum M (SD) Minimum–Maximum

Primary caregiver age (in years) 33.1 (7.5) 22–45 32.5 (9.3) 18–48
Children age (in years) 5.9 (3.9) 1–16 6.6 (4.3) 1–17
Note. IFPS ¼ intensive family preservation services; AAT ¼ animal-assisted therapy.

of the families who participated were low economic status
(US$16,000 annual income; 60.7%). One or both parents in
10 families had prior involvement in the justice system other
than the referral case (35.7%). Of the primary caregivers, 23
were female (82.1%) and 5 were male (17.9%). Most parents
had not completed education beyond high school (82.3%), and
half were unemployed (50%).
Procedure
Enrollment began in August 2010 with eligible families
recruited to the study by their primary therapists using an
institutional review board–approved oral presentation upon
entering the IFPS program. Exclusion criteria included family
history of animal abuse, allergy to dogs, or having children
younger than 1 year old. If parents agreed to participate, an
in-person meeting was set up to complete the consent process
for the family. In addition to the consent form signed by the
parent(s), all family members over the age of 11 years received,
were briefed on, and were asked to sign informed assent forms.
Of the 110 families who met eligibility criteria, 43 consented
and were randomized to the experimental (n ¼ 27) or the con-
trol (n ¼ 16) intervention (see Figure 1). Data collection was
completed for 14 families in each group indicating that the
4 Child Maltreatment XX(X)

within five general domains (Environment, Parental Capabil-

Assessed for eligibility (n=1,909) ities, Family Interactions, Family Safety, and Child
Well-Being). Each AAT session had a similar structure: (1)
Excluded (n=1,866) preparing the room (putting water out for the therapy dog,
Enrollment x Not meeting inclusion
criteria (n=1,799)
checking for a safe environment), (2) greeting and discussing
x Declined to the dog’s week with the handler, (3) conducting the primary
participate (n=67)
x Other reasons (n=0)
AAT component targeted at the identified session goal, (4)
Randomized (n=43)
engaging in an additional activity involving the dog (e.g., pet-
ting the dog), and (5) leaving (cleaning up).
Four primary AAT components were aimed at the four sub-
Allocation
Allocated to intervention Allocated to intervention scales of the NCFAS-R that are among the most commonly
(n=27) (n=16) deficient family skills. The first primary AAT component,
x Received intervention x Received intervention
(n=27) (n=16) which consisted of teaching the family the dog’s cues (e.g., sit
x Did not receive x Did not receive and down), was intended to engage the family in discussing
intervention (n=0) intervention (n=0)
child supervision skills. It was aimed at affecting the Super-
Follow-Up vision of Child(ren) subscale within the Parental Capabilities
Lost to follow-up (unable to Lost to follow-up (unable to domain. The second primary AAT component, which involved
contact) (n=5) contact) (n=5)
Discontinued intervention Discontinued intervention teaching the dog to demonstrate self-discipline through the
(change of services) (n=3) (change of services) (n=1) ability to leave something it desires, was intended to facilitate
the parents’ understanding of appropriate disciplinary practices
and the use of rewards and consequences to keep their child
Analysis
safe. It was aimed at affecting the Disciplinary Practices sub-
Analysed (n=14) Analysed (n=14)
x Excluded from analysis x Excluded from analysis
scale within the Parental Capabilities domain. The third pri-
(withdrew from study) (withdrew from study) mary AAT component, which entailed grooming the dog, was
(n=13) (n=2)
intended to provide an opportunity to discuss the benchmarks
of establishing a safe, trusting relationship. It was aimed at
Figure 1. Flow of participants through each stage of experiment. affecting the Bonding with the Child(ren) subscale within the
Family Interactions domain. The fourth primary AAT compo-
experimental group had a higher attrition rate. The assessment nent, which consisted of teaching the dog a new trick, was
(see Measures section) was completed by the primary therapist intended to facilitate the parents’ understanding of develop-
at intake and again when families completed the intervention. mentally appropriate expectations of the child. It was aimed
The follow-up assessment was completed by the primary thera- at affecting the Expectations of the Child(ren) subscale within
pist within 1-week of discharge from the program. Families the Family Interactions domain. The clinicians were given a set
were individually randomly assigned to the IFPS or IFPS þ of example questions for each session to facilitate discussion of
AAT interventions. The AAT intervention was manualized and the activity and to help tie it into the desired family skill.
delivered in the community by a trained clinician working with Each primary AAT component had three versions based on
a consistent volunteer handler-dog team for each assigned fam- Meichenbaum’s theory of Cognitive Behavior Modification
ily. The intervention involved 12 sessions each with a maxi- (1977). In the first version, Speech of Others, the clinician and
mum duration of 30 min within one of the regularly scheduled dog handler demonstrate the activity while discussing it out
IFPS sessions. All families in the study received the Home- loud. In the second version, Overt Speech, the clinician and
builders model of IFPS. Families in the IFPS þ AAT group parent demonstrate the activity while discussing it out loud. In
received the additional AAT protocol during their usual visita- the third version, Covert Speech, the parent tries, as much as
tion sessions. possible, to demonstrate the activity while discussing it out
loud (with the handler monitoring the dog). Therefore, the
protocol consists of three versions of the four primary AAT
AAT intervention protocol. The AAT protocol was designed to be components for a total of 12 sessions. The comparison group
incorporated into the existing IFPS offered by the organization. families received the standard-of-care IFPS, but no equivalent
Four parenting skills perceived as most frequently lacking by intervention targeting the same four family functioning skills
families served by the agency where the study was conducted without a dog.
(supervision of children, expectations of the children, bonding
with the children, and disciplinary practices) were targeted
with commonly employed AAT activities (referred to as the
Measures
primary AAT components). These parenting skill areas are Family functioning. The proximal effects of the AAT protocol on
among those assessed by the North Carolina Family Assess- family functioning were measured pre- and postintervention
ment Scale for Reunification (NCFAS-R; Reed-Ashcraft, Kirk, and at follow-up using the NCFAS-R, with family functioning
& Fraser, 2001), which scores 31 areas of interest (subscales) measured in both groups at intake, approximately 12 weeks
Flynn et al. 5

Table 2. NCFAS-R Targeted Subscale Score Changes in the IFPS þ AAT (Experimental Intervention) Group and IFPS (Control Intervention)
Group.

Pre- to Postintervention Pre-Intervention to Follow-Up

M D (SD) M D (SD)

NCFAS-R Subscale p IFPS þ AAT IFPS r p IFPS þ AAT IFPS r

Supervision of children .008 1.2 (1.25) .0 (.67) .53 .340 0.8 (1.09) 0.2 (1.20) .20
Disciplinary practices .035 1.0 (1.17) .1 (.66) .42 .063 1.6 (0.88) 0.6 (1.01) .37
Bonding with children .016 1.0 (1.41) .2 (.8) .47 .008 1.2 (0.97) 0.3 (1) .51
Expectations of children .007 1.2 (1.12) .1 (.73) .53 .050 1.8 (1.09) 0.5 (1.13) .39

Note. IFPS ¼ intensive family preservation services; AAT ¼ animal-assisted therapy.

Table 3. NCFAS-R Targeted Subscale Score Changes Within IFPS (Control Intervention) Group.

Pre- to Postintervention Postintervention to Follow-Up

NCFAS-R Subscale P Negative Ranks Positive Ranks r p Negative Ranks Positive Ranks r

Supervision of children 1 3 3 0 .257 1 3 .27

Disciplinary practices .257 2 5 .21 .157 1 4 .33
Bonding with children .655 3 2 .08 .257 3 1 .27
Expectations of children 1 4 4 0 .102 1 5 .38
Note. IFPS ¼ intensive family preservation services; NCFAS-R ¼ North Carolina Family Assessment Scale for Reunification.

after initiation of therapy, and at follow-up (within 1 week of
discharge from treatment). This instrument is a widely used and
validated measure of family strengths and stressors that are
predictive of child maltreatment and was given a rating of “A”
(psychometrics well demonstrated) by the CEBC (2016b). The
NCFAS-R was routinely used by clinicians at the agency to
assess changes in family functioning associated with therapy.
Therefore, clinicians administering the NCFAS-R during the
study had extensive training and experience with the instru-
ment prior to the study. Consistent with standard use of the
instrument, the entire family was considered the clinical unit,
thereby accounting for family size and age spectrum variation
in the sample.
Clinical outcome. The distal effects of IFPS þ AAT on family
functioning were measured using clinical data routinely col-
lected by the agency where the study was conducted. Specifi-
cally, this was the number of children who remained in the
home with their family at the time of discharge from treatment
rather than being placed in out-of-home care settings such as
foster care.
Results
Intervention Effects on Family Functioning
One-sided Wilcoxon Rank Sum tests identified significantly
greater changes (p  .05) in each of the four NCFAS-R sub-
scales targeted by the IFPS þ AAT intervention, as measured
by changes in pre- and postintervention NCFAS-R scores in the
IFPS þ AAT and IFPS intervention groups with medium to
large effect sizes (r ¼ .42–.53; Table 2). One-sided Wilcoxon
Rank Sum tests were used to examine group differences in
changes in each of the four targeted NCFAS-R subscales from
pre-intervention to follow-up. Significantly greater changes
(p  .05) were identified in two of the four NCFAS-R sub-
scales, bonding with children and expectations of children with
medium to large effect sizes (r ¼ .51 and .39, respectively).
Borderline significance (.05 < p  .10) was found in the dis-
ciplinary practices subscale in families who received IFPS þ
AAT with a small effect size (r ¼ .37; Table 2). Time from
postintervention to follow-up assessment ranged from 10 to
246 days (M ¼ 82, SD ¼ 58).
A one-sided signed-rank test was used to characterize
changes in NCFAS-R scores for the four targeted subscales
throughout treatment of the IFPS and IFPS þ AAT intervention
groups. Within the IFPS intervention group, changes in
NCFAS-R subscale scores from pre- to postintervention (n ¼
14) and postintervention to follow-up (n ¼ 9) were not statis-
tically significant (Table 3). Within the IFPS þ AAT interven-
tion group, statistically significant increases in all four targeted
subscales of the NCFAS-R were found following participation
in the IFPS þ AAT intervention (n ¼ 14) compared to pre-
intervention scores (n ¼ 14), p  .05, with medium to large
effect sizes (r ¼ .44–.51), and no significant differences were
found at follow-up (n ¼ 9) when compared to postintervention
scores (Table 4).
Intervention Effects on Clinical Outcome
Group differences in number of children that remained in the
home at the time the family was discharged from treatment
6 Child Maltreatment XX(X)
Table 4. NCFAS-R Targeted Subscale Score Changes Within the IFPS þ AAT (Experimental Intervention) Group.
Pre- to Postintervention
NCFAS-R Subscale p Negative Ranks Positive Ranks
Supervision of children .007 0 9
Disciplinary practices .018 2 9
Bonding with children .017 2 10
Expectations of children .011 1 9
Note. IFPS ¼ intensive family preservation services; AAT ¼ animal-assisted therapy; NCFAS-R ¼ North Carolina Family Assessment Scale for Reunification.
were examined using a 2 (group: IFPS þ AAT, IFPS)  2
(disposition at discharge: in-home, out-of-home) Fisher’s exact
test. At the time of discharge from the treatment program, a
greater percentage of children in the treatment group remained
in the home (52.4%) compared with children in the control
group (47.6%), though this difference was not found to be
statistically significant (p ¼ .50).
Discussion
The present study provides the first randomized controlled
clinical trial to examine the effects of AAT on family function-
ing with CPS-referred families and the effects of AAT as an
adjunct to evidence-based IFPS therapies. A statistically sig-
nificant improvement was measured in family functioning for
families who received AAT delivered as an adjunct to an
evidence-based, standard-of-care IFPS intervention (IFPS þ
AAT) relative to families who received only standard-of-care
IFPS. These findings align with those of previous studies in
which AAT was found to be an effective adjunct to established
therapies (Calvo et al., 2016; Kern-Godal, Arnevik, Walder-
haug, & Ravndal, 2015; O’Haire & Rodriguez, 2018; Signal
et al., 2016). The improvements in family functioning were
sustained in two of the four subscales, and possibly a third
subscale, at least until discharge from the program. This is
consistent with a small but growing number of studies that
have identified a sustained clinical effect of AAT (Berget,
Ekeberg, Pedersen, & Braastad, 2011; Bert et al., 2016; Hoag-
wood, Acri, Morrissey, & Peth-Pierce, 2016; Lundqvist,
Carlsson, Sjödahl, Theodorsson, & Levin, 2017). These mea-
sured improvements in family functioning were not reflected
in the clinical outcome measured in this study (i.e., disposi-
tion of children at the time of discharge). However, many
factors affect clinical outcomes, so expanded studies are
needed to assess the distal outcomes of AAT within IFPS.
Several components of the AAT intervention were designed
to incorporate the findings of previous studies regarding poten-
tial mechanisms for increasing clinical engagement. The higher
attrition rate experienced in the treatment group is inconsistent
with these previous findings. Demographic differences
between the two groups (e.g., average family income) or the
need for additional active participation required of the families
in the treatment group could account for this difference. At a
basic level, the inclusion of dogs was intended to create an
environment where parents and children felt safe, calm, and
Postintervention to Follow-Up
r p Negative Ranks Positive Ranks r
.51 1 1 2 .00
.45 .084 1 5 .41
.45 .257 1 3 .30
.48 .059 0 4 .45
motivated to actively participate in treatment. The inclusion of
specific activities that centered on interactions with the dog
was intended to further enhance active engagement. Anecdotal
evidence from the therapists who delivered the IFPS þ AAT
interventions indicated that the sessions with the dog felt more
calm and warm than their typical IFPS practice and that clients
seemed to share personal experiences more quickly. Further,
the specific AAT activities utilized in the study were designed
to create opportunities to initiate discussion of sensitive topics.
The clinicians were trained to draw parallels between experi-
ences during activities with the dogs and specific parenting and
family skills. For example, challenges during teaching the dog
a “leave it” command provided opportunities to discuss age-
appropriate expectations and disciplinary practices used with
their children. Moreover, the AAT activities created unique
experiential opportunities for parents to apply new parenting
skills within an established cognitive behavior modification
model. Further research is needed to more specifically tie var-
ious components of the AAT protocol to engagement and clin-
ical outcomes.
The present study benefited from several methodological
strengths, including random assignment to treatment group and
the inclusion of a comparison group. The protocol was
designed to be relatively consistent to reduce intra- and inter-
client variability and to facilitate implementation by other child
welfare and AAT organizations. All clinicians and handlers
were trained in the AAT protocol using a standard curriculum.
They also received a variety of reference materials, including
brief overview cards to review immediately prior to each ses-
sion. Despite these strengths, certain limitations should be con-
sidered when interpreting the results of this study. First, the
sample size was relatively small, especially for testing distal
clinical effects of the intervention. While the study sample was
predominantly families that were White, low-income, and with
female single parents, family composition was not homoge-
nous (e.g., wide age range of the children). It remains to be
tested whether the findings would extend to families from more
advantaged or diverse backgrounds or where parents (espe-
cially men) were more involved in parenting. Second, only two
measures were used which may not address all potential con-
founding factors. Third, clinicians scoring the NCFAS-R were
not blinded to the participating families’ treatment condition,
allowing for potential bias in scoring. However, use of the
instrument is standardized across the family preservation
Flynn et al.
services at the organization, clinicians receive extensive train-
ing in use of the instrument, and fidelity checks are routine.
Fourth, although the randomized control design assumes that
groups did not differ on key variables prior to participating in
the intervention, average annual household income and
employment was higher among families in the IFPS interven-
tion than IFPS þ AAT intervention. These group differences
are notable given that poverty is associated with greater risk for
child maltreatment and involvement with the child welfare
system (Fong, 2017; Johnson-Reid, Drake, & Zhou, 2013; Ros-
tad, Rogers, & Chaffin, 2017). Finally, this pilot study was
designed to test the efficacy of the entire AAT intervention and
did not isolate the specific effects of the dog.
In conclusion, findings presented here demonstrate that
AAT as an adjunct to IFPS can improve family functioning
outcomes. Expanded studies of AAT in this context are needed
to isolate potential mediating variables, evaluate its impacts on
distal clinical outcomes, and measure the possible effects on
the developmental health of maltreated children.
Acknowledgments
We thank all participating families, Savio therapists and staff, the
Denver Pet Partners dog-handler volunteer teams, and Amy McCul-
lough for design input and implementation of the study. This study is
dedicated to the memory of David Bennett.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
ORCID iD
Erin Flynn https://orcid.org/0000-0002-3696-1335
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