Comparison of Remote Versus In-Person Behavioral Consultation for Treatment of Canine Separation...

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This article was downloaded by: [Tufts University] On: 27 January 2012, At: 06:57 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Journal of Applied Animal Welfare Science Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/haaw20 Comparison of Remote Versus In-Person Behavioral Consultation for Treatment of Canine Separation Anxiety Nicole Cottam a , Nicholas H. Dodman a , Alice A. Moon-Fanelli a & Gary J. Patronek b a Department of Clinical Science, Tufts Cummings School of Veterinary Medicine b Animal Rescue League of Boston, Boston, Massachusetts Available online: 25 Jan 2008 To cite this article: Nicole Cottam, Nicholas H. Dodman, Alice A. Moon-Fanelli & Gary J. Patronek (2008): Comparison of Remote Versus In-Person Behavioral Consultation for Treatment of Canine Separation Anxiety, Journal of Applied Animal Welfare Science, 11:1, 28-41 To link to this article: http://dx.doi.org/10.1080/10888700701729148 PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.tandfonline.com/page/terms- and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden.

Transcript of Comparison of Remote Versus In-Person Behavioral Consultation for Treatment of Canine Separation...

This article was downloaded by: [Tufts University]On: 27 January 2012, At: 06:57Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

Journal of Applied AnimalWelfare SciencePublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/haaw20

Comparison of RemoteVersus In-Person BehavioralConsultation for Treatment ofCanine Separation AnxietyNicole Cottam a , Nicholas H. Dodman a , Alice A.Moon-Fanelli a & Gary J. Patronek ba Department of Clinical Science, Tufts CummingsSchool of Veterinary Medicineb Animal Rescue League of Boston, Boston,Massachusetts

Available online: 25 Jan 2008

To cite this article: Nicole Cottam, Nicholas H. Dodman, Alice A. Moon-Fanelli & GaryJ. Patronek (2008): Comparison of Remote Versus In-Person Behavioral Consultationfor Treatment of Canine Separation Anxiety, Journal of Applied Animal WelfareScience, 11:1, 28-41

To link to this article: http://dx.doi.org/10.1080/10888700701729148

PLEASE SCROLL DOWN FOR ARTICLE

Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone isexpressly forbidden.

The publisher does not give any warranty express or implied or make anyrepresentation that the contents will be complete or accurate or up todate. The accuracy of any instructions, formulae, and drug doses should beindependently verified with primary sources. The publisher shall not be liablefor any loss, actions, claims, proceedings, demand, or costs or damageswhatsoever or howsoever caused arising directly or indirectly in connectionwith or arising out of the use of this material.

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Comparison of Remote Versus In-PersonBehavioral Consultation for Treatment

of Canine Separation Anxiety

Nicole Cottam, Nicholas H. Dodman,and Alice A. Moon-FanelliDepartment of Clinical Science

Tufts Cummings School of Veterinary Medicine

Gary J. PatronekAnimal Rescue League of Boston

Boston, Massachusetts

To investigate the validity of remote consultation for treatment of canine separationanxiety, this study compared the efficacy of 2 types of behavioral services offered byTufts Cummings School of Veterinary Medicine (TCSVM): (a) “PetFax,” a remoteconsultation service in which dog caregivers (owners) and a certified applied animalbehaviorist correspond via fax or email and (b) in-person clinic consultation, whichrequires that owners bring their dogs to the Animal Behavior Clinic at TCSVM toconsult with a board-certified veterinary behaviorist, a veterinary behavior resident,or a certified applied animal behaviorist. The study tested 4 variables for significantdifferences between PetFax users and clinic visitors: (a) pre- and posttreatment anxi-ety scores; (b) owner-reported improvement; (c) percentage of rehomed dogs, dogsrelinquished or euthanized because of separation anxiety; and (d) clarity of communi-cation with owners. The study found no significant differences between the groups.Difference scores and owner reports demonstrated substantial reduction in separationanxiety in both groups. Results indicate remote consultation is a valid way for behav-ioral professionals to share behavior modification advice with owners regarding ca-nine separation anxiety.

JOURNAL OF APPLIED ANIMAL WELFARE SCIENCE, 11:28–41, 2008Copyright © Taylor & Francis Group, LLCISSN: 1088-8705 print/1532-7604 onlineDOI: 10.1080/10888700701729148

Correspondence should be sent to Nicole Cottam, Tufts Cummings School of Veterinary Medicine,200 Westboro Road, North Grafton, MA 01536. Email: [email protected]

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The number of healthy companion animals relinquished and euthanized in U.S.shelters is believed to be in the millions (Kass, New, Scarlett, & Salman, 2001)and could account for a third of all canine deaths (Patronek, Glickman, Beck,McCabe, & Ecker, 1996). The Regional Shelter Relinquishment Study foundthat behavioral problems were the most frequently given reasons for canine re-linquishment (Salman et al., 1998). Salman et al. (2000) found that at least onebehavioral reason was given for the relinquishment of 40% of the dogs in thisstudy. Some caregivers (owners) of companion animals (pets) with behaviorproblems ask their veterinarians to euthanize their animals. Patronek andDodman (1999) estimate U.S. veterinarians euthanize 224,000 pets each year forbehavioral reasons. Thus, an extraordinary number of companion animals dieeach year as a result of behavior problems.

Successful treatment of companion animal behavior problems might help de-crease the number of pets who are relinquished and euthanized. However, veteri-narians report they feel unsure about their ability to diagnose and treat suchproblems (Patronek & Dodman, 1999). This is not surprising because few U.S.veterinary schools offered courses in animal behavior before the 1990s. Stricklin(1983) surveyed deans of 29 North American veterinary schools and found thatonly 6 of 15 respondents had a mandatory, nonhuman animal behavior course aspart of their curriculum. In 1993, the American Veterinary Medical Associationdemonstrated the importance of the veterinarian’s role in addressing companionanimal behavior problems by granting veterinary behavioral medicine specialtyprivilege. In 1991, the Animal Behavior Society began offering certification forveterinary and nonveterinary professionals interested in applying learning theoryand ethological principles to resolve companion animal behavior problems.Among other rigorous academic and experiential requirements, recipients musthave a doctorate or master’s degree in the field of animal behavior to receive thiscertification.

The issue of who is qualified to address animal behavior problems is controver-sial. Some feel that only those with medical degrees are qualified to diagnose be-havior problems and suggest treatment options (Overall, 2006), makingveterinarians the only professionals qualified to address companion animal behav-ior problems. Proponents of this view report that the proper role of nonveterinarybehaviorists is to assist owners in implementing learning theory-associated treat-ment suggestions—such as desensitization—prescribed by the veterinarian. Op-ponents of this view point out that many veterinarians—because of the lack ofeducation about companion animal behavior problems as part of their veterinaryeducation—are not prepared to diagnose animal behavior problems and proposetreatments.

However, many will agree that a limited number of academically qualified ex-perts are currently in the emerging field of applied companion animal behaviortherapy. As a consequence, owners of pets with behavioral problems often do not

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have direct access to professional behavior-specialty services. Telecommunica-tions across the miles to address training and behavioral issues could help resolvethe lack-of-access problem—especially for those people living in rural, confined,underserved, or isolated populations.

Although telecommunication is coming of age in human psychological researchand practice (Leigh et al., 2000), the literature examining the validity of remote con-sultation in pet behavioral modification therapy is sparse. Hsu and Serpell (2003)looked at the value of in-depth history questionnaires in formulating behavioral di-agnoses and found that diagnoses made from such questionnaires were accurate forseven different diagnostic categories. Accuracy was based on validation of the diag-nosis by a behaviorist at a follow-up visit in a clinical setting. To our knowledge,onlyoneprior study (Dodman,Smith,&Holmes,2005)directlymeasured thevalid-ity of remote consultation. This study found that fax-based consulting betweenowner and behaviorist was as effective as an in-clinic behavioral consultation for di-agnosingand treatingcanineowner-directedaggression.Thepresent studywascon-ducted to evaluate whether remote consultation is valid for assessing and treatingcanine separation anxiety and exploring further the validity of remote behavioralconsulting. Separation anxiety was chosen for the following reasons:

1. It is a prevalent problem that accounts for 5% to 40% of cases presented tobehaviorists (Horwitz., 2000; Voith & Borchelt, 1996);

2. Veterinary literature has described it well as a discrete entity;3. It is a serious ongoing welfare concern for affected dogs; and4. It may lead to the breakdown of the human–animal bond, relinquishment,

abandonment, or euthanasia of the pet.

METHODS

Eligible participants consisted of clients with dogs who displayed signs of sepa-ration anxiety and utilized one of two behavioral services offered by TuftsCummings School of Veterinary Medicine (TCSVM) between January 1998 andJuly 2005:

1. “PetFax,” a hospital-approved, remote, fax-based consultation service inwhich clients use an eight-page, in-depth questionnaire to describe theirpets’ behavior problem to a certified applied animal behaviorist (seehttp://www.tufts.edu/vet/vet_common/pdf/petfax/request1.pdf) and

2. In-clinic consultation at the Animal Behavior Clinic (ABC) at TCSVM byan applied animal behaviorist, veterinary behaviorist, or a veterinary be-havior resident (all Tufts-approved clinicians).

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Before their in-clinic appointment, owners filled in the same eight-pagequestionnaire that PetFax clients used to describe their dog’s behavior and eitherbrought it with them to the ABC or faxed/mailed/emailed it in ahead of time.

PetFax

Separation anxiety was confirmed from owners’ responses to specific question-naire inquiries regarding their dog’s behavior in four general situations:

1. While the owner was home with the dog,2. When the owner was leaving the home,3. When the owner was away (evidence of vocalization, destructive behavior,

inappropriate elimination, inappetence), and4. When the owner returned home.

Within a few days, PetFax clients were sent a personalized, written report con-firming the likelihood that separation anxiety accounted for their dog’s behaviorand, with suitable medical caveats and provisos, advising them how to modifyand manage their dog’s anxious behavior by the following:

1. Avoidance of the cycle of anxiety that occurs during the owner’s departureand arrival,

2. Independence training at times when the owner is home,3. Short-term planned departures,4. “Employment” in the form of environmental enrichment while the owner is

away, and5. An increase in daily aerobic exercise.

Handouts on separation anxiety—its presentation and current treat-ments—were also faxed to owners. Clients were made aware of adjunctivepharmacological treatments used by Tufts veterinary behavior staff to treatseparation anxiety and advised to contact their local veterinarian to discuss thepharmacological and behavioral suggestions provided in the written PetFaxconsultation response. Follow-up phone calls between the client’s local veteri-narian and Tufts veterinary behaviorist—to discuss medical concerns andpharmacological strategies—are included as part of the PetFax service. Alsoincluded are follow-up phone calls between the owner and the certified appliedanimal behaviorist to discuss implementation of behavior modification tech-niques. The frequency of follow-up calls involving participants in this studywas not tallied.

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In-Clinic Consultation

Clients who attended clinic consultations brought their dogs to the ABC atTCSVM for a 1.5- to 2-hr meeting with a Tufts-approved behavioral consultantwho was a board certified veterinary behaviorist, a veterinary behavior resident,or a certified applied animal behaviorist. Clinic clients received personalizedmanagement and behavior modification recommendations to help address theirdog’s separation anxiety. As with the PetFax service, these recommendations in-cluded (a) avoidance of the cycle of anxiety that occurs during the owner’s de-parture and arrival, (b) independence training at times when the owner is home,(c) short-term planned departures, (d) “employment” in the form of environmen-tal enrichment while the owner is away, and (e) an increase in daily aerobic ex-ercise. The veterinary behaviorist or veterinary behavior resident was availableto address any medical or pharmacological needs for cases seen by the certifiedapplied animal behaviorist. For instance, if a dog had any known or suspectedmedical problem that might be contributing to the anxiety, medical examinationand relevant laboratory tests were performed by the veterinary behaviorist orveterinary behavior resident. If medication was deemed necessary or was re-quested by an owner, it was prescribed by the veterinary behaviorist or veteri-nary behavior resident.

Data Collection Method: “Before” and “After” Scores

Before scores—used to quantify separation anxiety—were obtained by generat-ing a score from a checklist used to indicate the presence and severity of behav-iors associated with separation anxiety at the time of the initial PetFax orin-clinic consultation (Table 1). Owners rated the severity of their dog’s anxietyas mild, moderate, or severe in 13 situations. Many owners indicated that theirdog’s anxiety was mild to moderate or moderate to severe by placing a check onthe column dividers. Thus the degree of a dog’s anxious reaction in each of the13 different situations was given a value as follows: No = 0, Mild = 1, Mild toModerate = 1.5, Moderate = 2, Moderate to Severe = 2.5, and Severe = 3. Thehighest score possible for a dog is 39, which would be the result if the dog’s be-havior was described as “severe” in all 13 situations. If an owner failed to an-swer a question, that question was ignored when generating both the before andthe after score. An after score was generated from the information received in apostal follow-up survey. Clients were given the opportunity to re-rate the sever-ity of their dog’s behavior in the same 13 situations. A difference score was gen-erated by subtracting each dog’s after score from the before score.

In addition to re-rating the severity of their dog’s separation anxiety via Table 1,owners were asked to report on their perception of the consultation process. Seven

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multiple-choice questions with response options in the form of a 4- or 5- pointLikert scale were posed:

1. Feelings toward the clarity of the questions asked by the behaviorist;2. Owner-reported comprehension of the etiology of the behavior problem;3. Clarity of the treatment options supplied;4. Satisfaction with the amount of written information provided relevant to

their dog’s behavior problem;5. Ability to remember advice;6. Whether, and to what degree, the treatment options were implemented; and7. The ease of implementing the behaviorist’s suggestions.

Owners were asked one limited-choice question regarding their perception ofany change in their dog’s anxious behavior (“> 75% improvement,” “up to75% improvement,” “up to 50% improvement,” “up to 25% improvement,”“no improvement,” or “worse”). Owners were also asked if their dog hadbeen euthanized, rehomed, or relinquished because of the dog’s separation

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TABLE 1Diagnostic Checklist Used for Separation Anxiety

Behavior No Mild Moderate Severe

Does your dog follow you around the house?Does your dog become anxious at the sound of car

keys?Does your dog become anxious when you put on

your coat or shoes?Does your dog become aggressive when you leave?Does your dog exhibit other problem behaviors as

you prepare to leave?Does your dog bark or whine excessively within 30

minutes of your departure?After you leave does your dog’s activity decrease?After you leave does your dog appear depressed?After you leave does your dog have a loss of

appetite?Only in your absence does your dog destroy

property?Only in your absence does your dog urinate or

defecate in your home?Does your dog regularly have diarrhea, vomit, or

lick excessively in your absence?Does your dog exhibit an excessive greeting on your

return (jumping, hyperactivity, barking, morethan 2–3 minutes)?

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anxiety and whether medication was used as part of their dog’s treatmentplan.

A total of 201 owners were mailed a follow-up survey, a letter explaining thepurpose of the study, and a self-addressed stamped envelope. The follow-up sur-vey was pretested for clarity with one nonparticipant client who came to the ABCfor an appointment. Appointment time constraints prevented the survey from be-ing tested with more nonparticipant clients.

Data Analysis

The data were analyzed with SPSS 13.0 statistical software package. Frequencydistributions were generated for the before and difference anxiety scores. Thesedata were nonnormally distributed. The null hypothesis, that no differences ex-isted between the two consultations groups in either the average difference scoreor before score, was tested using the nonparametric Mann–Whitney t test for in-dependent samples. The Mann–Whitney t-test was also used to detect a differ-ence in the difference scores of medication users and nonusers. Fisher’s Exacttest (2-sided) was used to test for a relationship between consultation type andthe following:

1. Owner-reported percentage change in anxious behavior;2. Rate of rehoming, relinquishment, or euthanasia due to separation anxiety;3. Clients’ attitudes toward their consultation; and4. Use of medication. Fisher’s Exact test (2-sided) was also used to check for a

relationship between use of medication and owner-reported percentagechange in anxious behavior.

RESULTS

Respondents

Eighteen of the 201 surveys sent were returned to TCSVM as “address un-known.” Of the 183 remaining surveys (66 PetFax and 117 clinic), 69 were re-turned. Twenty-eight surveys were returned from the PetFax group and 41 fromthe clinic group. The total response rate was 38% (42% PetFax and 35% clinic).The average number of months between the time of consultation and the date ofresponse to the survey was 21.6 months (SD +/– 11.3). Sixty-five percent ofclinic survey respondents were seen by a board certified veterinary behaviorist,20% by a veterinary behavior resident, and 15% by the certified applied animalbehaviorist.

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Change in Separation Anxiety Score

No significant difference was found between the two consultation groups in thebefore score. The average before separation anxiety score for PetFax dogs was17.3 (SD +/–4.6, n = 25) and 16.9 (SD +/–5.6, n = 37) for dogs brought to theclinic. No significant difference was found between the mean difference score ofdogs treated via PetFax and those brought to our clinic. The average differencescore for dogs treated via PetFax was 7.1 (SD +/–6.0, n = 25), whereas the aver-age difference score for dogs brought to the clinic was 6.6 (SD +/–6.4, n = 37)Note: a positive difference score value reflects improvement in behavior. Thesechanges represent a 41% improvement (7.1/17.3) for PetFax dogs and a 39 %improvement (6.6/16.9) for dogs brought to the clinic. Seven surveys were notused in the difference score analysis (3 PetFax, 4 in-clinic) because the ownerseither did not complete the posttreatment checklist (n = 5) or provided ambigu-ous responses to it (n = 2).

Owner-Reported Change in Separation Anxiety

The majority of clients in both consultation groups reported that their dog’s sep-aration anxiety improved. Figure 1 illustrates the number of owners in each con-sultation group who reported that their dog’s separation anxiety got worse, didnot improve, or got better by 25, 50, 75, or more than 75%. Twenty-one out of27 (78%) PetFax clients and 34 out of 37 (92%) in-clinic clients reported thattheir dog’s separation anxiety improved by 25, 50, 75, or more than 75%. Nosignificant difference between owner-perceived behavior change and consulta-tion method was detected. One PetFax owner did not respond to the surveyquestion regarding improvement (the dog was relinquished due to separationanxiety). Three in-clinic owners failed to answer the improvement survey in-quiry (dogs were rehomed or euthanized due to separation anxiety) and oneowner’s response was ambiguous and disregarded.

Percentage of Dogs Euthanized, Relinquished,or Rehomed

In addition, the relationship between method of consultation and decision abouta dog’s future—relinquished, rehomed, or euthanized—was examined. No sta-tistical difference was found between the two groups. One of 27 PetFax dogs(3.7%) was relinquished to a shelter, and 3 of 41 in-clinic dogs (7.3%) were re-turned to the breeder, rehomed, or euthanized because of separation anxiety.

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One other PetFax dog was euthanized, but the owner failed to indicate whetherthe dog was euthanized due to separation anxiety or for some other reason.

Communication With Client

The following results summarize the outcome of seven survey inquiries maderegarding the participants’ perception of the consultation process.

No significant difference was found between consultation type and clarity ofquestions asked by the behaviorist. All respondents in the PetFax group and mostin-clinic respondents (90%) indicated that the questions posed by the behavioristduring the consultation were either “mostly clear” or “entirely clear.”

Clients were also asked, “How well do you understand why your dog has a be-havior problem?” No difference between the two consultation groups was found.The majority of all clients (86%) responded that they “mostly understood” or“completely understood” why their dog had a behavior problem. Specifically,89% of PetFax clients and 83% of in-clinic visitors “mostly understood” or “com-pletely understood” why their dog had a behavior problem.

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FIGURE 1 Consultation type versus owner-reported change in separation anxiety.

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The two consultation groups did not differ in the percentage of respondentswho reported the instructions were “clear” or “mostly clear.” When asked, “Howclear was the behaviorist’s advice?”, the majority of owners (91%) in both groupsanswered “mostly clear” or “entirely clear.”

No significant difference between the two consultation groups was found withregard to satisfaction with the written materials provided. Seventy-one percent ofPetFax users and 60% of in-clinic visitors reported that that they received“enough” written material to help them understand and address their dog’s separa-tion anxiety.

No difference between the two groups was found regarding owner ability to re-member advice. Most of the clients in both groups (93%) remembered “most” or“all” of the suggestions offered by the behaviorist. Specifically, 93% PetFax cli-ents and 90% of in-clinic visitors reported remembering “most” or “all” of the sug-gestions.

Clients were asked whether they implemented the treatment suggestions and, ifso, how many of the suggestions they implemented. The groups did not differ inthe number of suggestions that they implemented. The majority (79%) of the cli-ents in both groups reported having implemented “most” or “all” of the sugges-tions. More specifically, 78% of PetFax clients and 80% of in-clinic clientsimplemented “most” or “all” of the suggestions. One owner in the PetFax groupand zero owners in the in-clinic group reported having implemented none of thetreatment suggestions.

Finally, clients were asked about the ease of implementing the suggestions ofthe behaviorists. No statistical difference between the two groups was found.Fifty-eight percent of PetFax users and 64% of clinic visitors reported that imple-menting the suggestions were “easy most of the time” or “very easy.” The remain-ing respondents (42% of PetFax users and 36% of clinic users) reported thatimplementing the advice was somewhat easy or not at all easy.

Use of Medication

Medications administered to dogs in this study included Prozac (fluoxetine),Clomicalm (clomipramine), Elavil (amitriptyline), Xanax (alprazolam), Inderal(propranolol), and melatonin. Sixty-two percent (16/26) of PetFax survey re-spondents used one or more of the aforementioned medications as part of theirdogs’ treatment for separation anxiety versus 93% (37/39) of in-clinic survey re-spondents (p = .002). Though this study was mainly concerned with searchingfor any therapeutic differences as a result of consultation method, differences inwhether use of medication affected improvement in these dogs’ separation anxi-ety was also evaluated, independent of consultation method. Medication wasused as part of the treatment plan for 53 dogs from both consultation methods.

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Owner-reported improvement information was available for 48 of the 53 medi-cation users. Eighty-three percent of owners (40/48) who used medication aspart of their dog’s treatment plan reported improvement in their dog’s separationanxiety, whereas 100% (12/12) of owners who did not use medication also re-ported improvement. In other words, owners who administered medication totheir dogs were no more likely to report improvement in their dog’s separationanxiety than owners who did not report using medication as part of their dogs’behavior modification plan. Furthermore, when the mean difference scores werecompared between medication users (6.6, SD +/–6.5, n = 47) and nonusers (8.8,SD +/–5.1, n = 12), no significant difference was found.

DISCUSSION

Although direct observation and standardized behavioral measurement of dogswith separation anxiety when alone, before and after treatment, would be thebest way to measure behavioral improvement, before and after treatment scoresbased on owner observations are also informative and useful for general identifi-cation of behavioral change. In this study, a decrease in separation anxiety scoreby approximately 40% was found in both consultation groups. Although thislevel of improvement seems only moderate, it should be regarded as clinicallysignificant if a high percentage of owners report improvement, which was truefor both groups of clients (78% PetFax, 92% in-clinic).

None of the owners of the four dogs who were relinquished to a shelter,rehomed, or euthanized responded to the question regarding owner-perceived per-centage improvement in separation anxiety, nor did they re-rate their dog’s anxietyvia the checklist. Such owner nonresponse could lead to a slight exaggeration ofthe owner-reported percentage improvement and mean difference scores if thesefour dogs demonstrated no behavioral improvement at all.

It is possible that the group of owners who completed this study did not repre-sent all owners of dogs with separation anxiety who used PetFax or had an in-clinicappointment. It could be that satisfied, motivated clients were more likely to re-spond, leading to an overestimation of improvement. Alternatively, an underesti-mation of improvement could have been made if dissatisfied clients were morelikely to respond. In addition, because the average number of months between thetime of consultation and the date of response to the survey was 21.6 months, varia-tion in owner perception of mild, moderate, and severe anxious behaviors overtime may have positively or negatively affected the difference scores.

Comparison of the level of improvement in separation anxiety with past find-ings is difficult because the quantitative anxiety-scoring method used in this studyis unique; however, comparison of the owner-rated percentage improvement canbe made. Our finding for percentages of overall improvement (78% PetFax, 92%

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in-clinic) are similar to the percentages of improvement reported elsewhere: 62%(Takeuchi, Houpt, & Scarlett, 2000), 67.9% (Takeuchi, Ogata, Houpt, & Scarlett,2001), 81% (Blackwell, Casey, & Bradshaw, 2006), and 85% (King et al., 2000).Our overall euthanasia and rehoming rates due to separation anxiety were low((PetFax euthanasia = 0%, rehoming rate = 3.7%; in-clinic euthanasia rate = 2.4%,rehoming rate = 4.9%) on the same order as Takeuchi et al., who reported a 12%euthanasia rate and 8% rehoming rate for dogs with separation anxiety. However,Takeuchi et al. (2000) did not specifically report whether the subjects wereeuthanized or rehomed as a result of separation anxiety.

Although PetFax clients used medication to treat their dogs’ separation anxietysignificantly less often than did clinic visitors, the two groups reported similar im-provement scores. Owners who used medication as part of their dogs’ treatmentplan were no more likely to report improvement than were owners who did not usemedication. This finding corroborates Podberscek, Hsu, and Serpell’s (1999) find-ing that typical signs of separation-related behavior problems were not signifi-cantly affected by treatment with clomipramine but were reduced with behavioraltherapy alone. Blackwell et al. (2006) recently found that 12 weeks of non-pharmacological treatment for separation-related disorders was effective for re-ducing separation symptoms. It is also worth noting that Dodman, Smith, andHolmes (2005) found no difference in aggression-improvement scores betweenmedication users and nonusers.

There was no significant difference noted between the two consultation meth-ods in clarity of questions, client comprehension of the dog’s behavior problem,client understanding of behaviorist’s instructions, satisfaction with written materi-als, owner ability to remember advice, number of implemented suggestions, orease of implementing suggestions. It bears noting that the three behaviorists usedthe same assessment, behavior modification, management methods, and handoutswhether the consultation was remote or in clinic. This might explain the lack ofsignificant differences between the two services.

CONCLUSION

Behaviorists often consult with owners in person and observe the patient directly(in a clinical setting or by making “house calls”); however, the patient’s problembehavior is not always displayed during the appointment. Although observingthe problem behavior directly is optimal (or via video surveillance), this cannotalways be arranged. Consultants typically rely on descriptive information pro-vided by owners when assessing the cause of the behavior problem and formu-lating a behavior modification plan. This study suggests that written/verbal com-munication without direct observation of the dog in the clinical setting is aseffective as direct communication with a client and observation of the dog in a

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clinical setting for assessing and managing canine separation anxiety. Direct ob-servation of the behavior problem and in-person interviews are more desirablethan remote consultation from the perspective of the owner and behaviorist;however, in-person consultations are not always feasible because of the lownumber, geographical location, and accessibility of qualified behaviorists. Ac-cording to the Animal Behavior Society’s Web site directory listing, there areonly 49 certified applied animal behaviorists nationwide (http://www.ani-malbehavior.org/ABSAppliedBehavior/caab-directory) and 39 board certifiedveterinary behaviorists in the United States (www.dacvb.org). Owners need amethod to access accurate information from qualified professionals; remote con-sulting is a valid option for clients to garner valuable information.

This study corroborates the results of Dodman et al. (2005) regarding remoteconsulting and lends credence to the observation that consulting via fax-based,written communication, with appropriate veterinary provisos, is a viable methodof treating canine separation anxiety. Future research is needed to determine if re-mote consulting is valuable in the treatment of other canine and feline behaviorproblems.

ACKNOWLEDGMENT

This study was approved and conducted under the auspices of The Center forAnimals and Public Policy, Cummings School of Veterinary Medicine at TuftsUniversity, 200 Westboro Road, North Grafton, MA 01536.

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