Shoot for the moon with your behavior treatment plan
Sarah J. Wooten, DVM
Dr. Sarah Wooten graduated from UC Davis School of Veterinary Medicine in 2002. A member of the American Society of Veterinary Journalists, Dr. Wooten divides her professional time between small animal practice in Greeley, Colorado, public speaking on associate issues, leadership, and client communication, and writing. She enjoys camping with her family, skiing, SCUBA, and participating in triathlons.
Help veterinary clients and their pets make life better by implementing an efficient behavior treatment plan.
The beagle ... err basenji ... has landed. Photo: Shutterstock.comAccording to a 2013 study, 65% of pet owners who decided not to keep their pets in the home reported some behavioral reason for relinquishment, and 49% of those who relinquished their pet indicated that at least one difficult behavior was a strong influence on their decision to hand their pet over.1
How many of our clients mention that their pet has a problematic behavior? How do you deal with dogs that are the opposite of canine good citizens? Barking too much? Jumping riotously? Biting? How many of us feel competent enough to help clients having behavioral pet problems beyond handing them a bottle of pills?
Clients who have pets with behavior problems are often at their wits' ends, in crisis, lost and hopeless without a clue of what to do next. This is a client who needs you.
The problem for veterinarians is that behavior is hard and time-consuming. Some veterinary students graduate without rotating through behavior and don't have the training. Signs of a behavior problem can be nebulous and disappear and reappear like quarks, and case histories seem more prone to subjective client opinions than, say, a tumor. Fortunately, Fetch dvm360 Conference speaker Beth L. Strickler, MS, DVM, DACVB, is on deck to share her top tips on getting started in behavioral consultation-for every veterinary practice.
Train your staff to triage behavior phone calls
Client phone calls about behavior can be sorted into two categories: urgent or important but not urgent. Dr. Strickler considers cases where the pet is at risk for removal from the home or cases where people or animals are at risk for bodily harm to be urgent cases that need to get in as soon as possible. The cat that has been peeing in the closet for the past five years-but the owner loves the cat-needs to be seen but doesn't necessarily need to get in on a Friday at 5 p.m.
What if you can't get them in today?
What do you tell the client when they call and you can't get them in today? Dr. Strickler recommends having “if then” scripts available for staff to use to help the client cope until they can get in to be seen. These scripts can be used to give the client a preliminary management plan.
For example, if the cat is peeing in the house:
> What kind of litter boxes do you have?
> Have you tried a new one?
> How often do you clean the box?
> Is it OK if I email you a handout that may help you until you can get in?
The latter, of course, requires developing a series of templates that can be easily customized and emailed to clients so they feel supported until they get in to see you. (We've got tons of behavior handouts here.)
Reserve enough time for a thorough consult
Anyone who has done behavioral consulting knows that you can't stuff an initial behavior appointment into a 20-minute appointment slot. Train your staff to book consultations with enough time to gather information, then charge appropriately for your time.
Dr. Strickler recommends setting realistic expectations during the first visit. Use words like “process,” “plan,” “work together” and “begin.” Having this conversation will help you determine which clients are committed to change over time and which ones just want a quick fix.
Prepare them for the appointment, what to expect and what to bring to the visit, and ask clients to fill out a behavior form before they arrive at the clinic. (Check out a downloadable behavior form here.) Dr. Strickler also recommends that safety information be addressed if any symptoms of aggression are present.
If you have the space, Dr. Strickler recommends creating an exam room that mimics a more comforting, less clinical room with ambient lighting and couches. The benefit of these spaces is that they allow the client to relax, which may encourage the pet to relax. Dr. Strickler also finds that pets act more natural in living room settings as opposed to a clinical exam room.
Some veterinarians find it less overwhelming for all parties involved to break the initial visit into multiple appointments. The first visit may be used to gather information, the second visit may be used to start medication, and the third may be used to start behavior modification.
Questions, questions and more questions
Dr. Strickler uses extensive information-gathering behavioral history forms. Asking clients to fill out history forms before they come to their appointment also helps her determine which clients may comply, and which may not. Here are some of the questions she asks:
> What is your perception of the problem? (While the client's perception of what is happening is sometimes inaccurate, it's still important to frame it in a way that they will listen to you.)
> What is your goal for your pet's behavior?
> What have you already tried? What has helped? What has not helped?
> Is your pet receiving any current medication, or did it in the past? If so, how much and for how long?
> Has your pet received any training? By whom? What worked? What didn't work?
> Is your pet in pain? Does your pet have orthopedic pain?
> Describe a typical 24 hours for your pet.
> Describe the very first incident and the most recent incident.
The four-pronged treatment plan
Dr. Strickler's behavior training plans consist of four equally important parts:
1. Behavior modification. This is by far the hardest for clients, Dr. Strickler finds, so she discusses behavior modification early in the discussion of the treatment plan. Utilizing a behavior technician or a certified trainer can help the clients through this process, she says.
2. Environmental modification. What needs to change in the environment to reduce stress, bar access or decrease triggers?
3. Enrichment. Getting a dog or cat's mind engaged to its fullest potential is critical, and enrichment through environment or cognitive toys is an essential part of treatment. (Want more on enrichment? We've dedicated a Leadership Challenge to the cause.)
4. Pharmaceutical intervention. Dr. Strickler discusses behavioral medication last to emphasize that the drug isn't the cure but just one part of a four-part plan.
Want more? Dr. Strickler recommends a couple of books: Decoding Your Dog and the soon-to-be-released Decoding Your Cat. She says both will be great resources for both clients and veterinarians. She also recommends dacvb.org as a go-to resource as well. Want even more? Dr. Strickler says another great continually updated resource is the behavior college's blog at Psychology Today's website.
Kwan JY, Bain MJ. Owner attachment and problem behaviors related to relinquishment and training techniques of dogs. J Appl Anim Welf Sci 2013;16:168-183.