Field Educator: A Scholarly Journal from the Simmons University School of Social Work

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Social workers have worked in veterinary settings in the United States since the early 1980’s. Beginning in 1982, Susan Cohen, DSW directed one of the earliest client support programs at Animal Medical Center in New York City training numerous social work interns. By the early 1990’s, only a handful of helping professionals were employed by schools of veterinary medicine around the country.  Today, the majority of schools of veterinary medicine employ social workers or counselors with other degrees, but their roles in the schools vary.  Some work with bereaved animal owners (clients) exclusively; some only offer counseling for veterinary students, and others teach communication skills to the students.  There are only thirty schools of veterinary medicine in the United States, and few of the schools, even when they employ degreed social workers, offer internship opportunities to students of social work. Some veterinary private practitioners throughout the country, especially those with large or specialty practices, have recognized the value of adding professional social work services to their practice. This unique area of social work demands some specialized training, and social work students hoping to concentrate in the area of veterinary medicine desire more internship opportunities.

Since 2013 in the Dallas-Fort Worth area, social work students have had the opportunity to complete a practicum in a Texas private veterinary hospital. One Masters student attending the University of Tennessee School of Social Work has completed the practicum and two Bachelors students from Texas Woman’s University Social Work Program have completed the block practicum thus far.  In addition, a licensed clinical social worker has completed the required hours for her veterinary social work certificate from the University of Tennessee School of Social Work at the hospital.  A Texas Woman’s University student, Brittany McPherson LBSW, has been hired as the first full-time veterinary social worker in Texas.  She plans to attend the University of Tennessee for her masters and her veterinary social work certificate in 2016 while continuing her employment at the hospital.  An advanced Masters student from the University of Texas at Arlington and a Bachelors student from Texas Woman’s University have been accepted to do their practicums in Spring 2016.

Sandra Brackenridge, LCSW, an Associate Professor and field instructor at TWU’s Social Work Program, developed the veterinary social work internship. Her scholarship reflects her interests in the human-animal bond, pet loss, and stress management for veterinary professionals. Her prior experience includes development of a program within a school of veterinary medicine encompassing: a pet loss counseling program for clients, a counseling service for students, instruction and consultation for students and staff regarding communication with and bereavement of clients, an animal-assisted therapy program, and a social work internship placement program.  She served as pet loss consultant for both Idaho and Texas Veterinary Medical Foundations.

Located in Lewisville, Texas, the field site, identified as the Center for Veterinary Specialty and Emergency Care, provides treatment of companion animals by veterinary specialists in neurology, surgery, internal medicine, critical care, palliative care, and dialysis for animals in need.  Following relocation to a new free-standing building in August of 2014, the hospital added 24-hour emergency services, alternative (holistic) veterinary services, dentistry, physical therapy, and advanced state-of-the-art medical equipment including a CT scan. The number of staff, as well as the number of animals and clients served, has increased three-fold since the relocation.  There are more than eighty staff members including administrators, client services, veterinarians, nurses, veterinary technicians, and one newly hired LBSW.

Clients who seek specialty care for their pets frequently have an intense attachment to their animals.  Many of the animals are critically or terminally ill. The vast majority of clients served by the hospital on any given day are emotionally vulnerable or distraught at the thought of losing what many animal owners consider to be members of their family (Cohen, 2002). There is much diversity reflected in the clients of the hospital in terms of gender, sexual orientation, race, ethnicity, religion and nationality. The families who bring their animals in for care may be elderly, single, or childless couples.

Veterinary professionals witness and participate in the death of their patients five times more than human medical professionals (Hart & Hart, 1987).  Because of this loss, the emotional cost to the staff in terms of compassion fatigue can be exceptional. The social work program at the veterinary hospital has responded with supportive services intended specifically for staff. The Center for Veterinary Specialty and Emergency Care, since expanding services, has experienced an average of three deaths per day. Notably some days, staff members have provided support for up to nine clients/client families experiencing impending pet loss.

Veterinary social work practicum students provide several different services at multiple intervention levels.  Some of the micro-level interventions provided are: supportive counseling, grief support and counseling, end-of-life decision-making, and advocacy and brokering of resources.  Resources needed by clients may include: financial resources for animal care, referral to other counseling services, and referral to animal hospice care services. Reading materials and educational packets are provided to clients.  Crisis intervention is provided regularly to clients who may experience a loss. Assessments for suicidality, hoarding, mental health issues, and domestic violence are necessary practices. Clients are referred by an in-house veterinary professional to the social work student, who will offer in-person support and follow-up services by phone or email.  Clients who have a chronically or terminally ill animal are regularly supported, as are bereaved clients with follow-up phone calls.  A pet-loss support group is offered once a month free of charge to the clients and community.  Social Work students are trained in co-facilitating the pet-loss support group before leading the support group.

Social work masters students also offer micro-level interventions with hospital staff; if staff is in need of longer-term counseling, in order to avoid dual-relationships, they are referred to outside providers along with other resources.  However, staff may utilize an MSW student with informal briefings whenever staff feels the need if they are experiencing workplace stressors, feelings of compassion fatigue, or emotionally overwhelming cases.  The MSW students are trained using role-play in order to implement debriefing. Students are instructed to read a provided statement about confidentiality as well as the following explanation:  “Debriefing is not psychotherapy or counseling, but debriefing is thought to help with compassion fatigue and prevention of burnout.  The social worker may offer suggestions on coping with compassion fatigue and stress management if needed” (Aycock & Boyle, 2009; Boyle, 2011; Keene, Hutton, Hall, & Rushton, 2010; Serwint, 2004).  The student will ask if the staff member has any questions before proceeding with a standardized series of questions exploring whether the staff member is feeling overwhelmed, or reviewing an intervention to ascertain whether it was positive or effective and what can be done differently in the future.
It should be noted that one of the most difficult stressors for veterinary professionals in a busy practice is the client need for support and attention.  The addition of a social work professional trained to interact and intervene with these clients is a huge relief for the staff, as they are then able to focus on the care of the patient with confidence that the clients are being supported.

Social work students in the veterinary setting often must utilize whatever space is available as there is no office set aside for Veterinary Social Work services.  Some students may sit with client services in the front of the hospital.  While conducting outreach some students may utilize the doctors’ desk area and phone if the doctors are working in ICU or are absent.  An empty exam room may be used when meeting for supervision or for a debriefing.  Social work students meet with clients while the client is visiting in ICU or in the exam room.

Students may also be involved in macro-level interventions at the hospital or community level.  The students participate in and prepare presentations to staff on: compassion fatigue, burnout, pet-loss, communication with clients, and stress management.  Presentations may include requested speakers on subjects similar to how to recognize and respond to suspected animal abuse.  Students are asked to generate ideas on improving the program in its response to client need and comfort, organization of euthanasia procedures, and present their ideas, concerns, and recommendations to the field instructor who communicates to administration.

The field instructor teaches the students utilizing a variety of methods. For the first few weeks, each student is encouraged to read as much as possible about the human-animal bond, bereavement due to pet loss, and stress management within the veterinary profession.  The students are encouraged to shadow Brittany McPherson, LBSW and Sandra Brackenridge, LCSW, as they interact with and support clients.  Brackenridge provides formal supervision with the students in individual and group sessions several times per week during the first portion of the practicum.  McPherson serves as site supervisor when Brackenridge is not present, but does not provide formal supervision.  During supervision, the students are instructed in the human-animal relationship, bereavement due to pet loss, pets and family dynamics, assessment, and evaluation.  At least one practice behavior, activity and/or ethical concern is discussed weekly to educate in accordance with each school’s learning contract and to cover the core competencies.   In order to prepare the students for direct client contact, role-playing is utilized.  By the end of the fourth week, students should receive permission to directly engage clients who are bereaved or who have been referred by staff for support.  Engagement may occur by phone or in person, and students are encouraged to record their interaction in writing or with audio. Recordings and verbal reporting are shared in supervision, and Brackenridge shares suggestions for enhancement of skills.  A student will carry a caseload of clients with whom they will make regular contact either in person, by email, or by phone.

The pet-loss support group is currently offered one time per month, and students observe the group for the better part of their first semester.  They are encouraged to facilitate the group at least once before the semester ends.  Masters students, rather than the Bachelors students, provide debriefing services as they have experienced at least one internship developing their skills and knowledge of assessment.

In order for social work field placements in veterinary services to grow in numbers across the country, recommendations for establishing a new internship within this setting include:

• Establishment of credibility with potential veterinary sites by the prospective field instructor.  Credibility must involve the instructor having experience within the field of pet loss and/or veterinary medicine.  Experience might at least include having completed a similar internship at a school of veterinary medicine or within a private veterinary hospital.
• Contact prospective hospitals (the administrator or owner). Once contacted, further explain the job of a veterinary social worker, while also offering education on social work training, licensure, ethical code, and skills.  Explain the services that may be offered to veterinary clients and staff.  Ask for a meeting, and follow up with an email or letter and enclose your resume.  Follow up on the inquiry and answer any questions or reservations the facility may have.
• Meet with hospital administrators, owners, and/or human resources.  Explain what services will be provided and the benefits to the hospital and staff of the services.  Provide a realistic picture of accountability and responsibility; that is, the school and the field instructor should be responsible for the students’ education, and behavior on site with clients.  Learn what is expected from other staff in regard to professionalism, dress code, background checks, and work hours.  Students should never be required to provide any medical services (no handling of animals whatsoever), and they should never be involved in monetary aspects of the business.  Provide copies of learning contracts so that administrators may understand the requirements of students, and provide a sample job description and work schedule for yourself and the students.
• Give a presentation to staff of the hospital before or very soon after the internship begins.  The presentation should focus on introductions and a thorough explanation of veterinary social work.  The services that will be provided by the student and the field instructor should be outlined.  Staff should be informed about the hierarchy and to whom questions/complaints should be directed. All staff should also be informed about how to refer clients for services.

In summary, the authors of this paper hope that with specialized training social workers will come to be regarded as commonplace among staff in large veterinary medical facilities.  Medical social work was not an accepted and expected area of service delivery until the 1980’s in most medical institutions (NASW, 2005) but with frequency the specialty grew to be customary.  In each veterinary setting of Brackenridge’s experience, staff and administration quickly realized how much easier their jobs became after social workers began supporting clients.  The authors hope that future research will provide evidence that the presence of social workers within veterinary medicine is key to the diminishment of staff compassion fatigue and burnout.

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Aycock, N., & Boyle, D. (2009). Interventions to manage compassion fatigue in oncology nursing. Clinical Journal of Oncology Nursing, 13(2), 183-191. doi:10.1188/09.CJON.183-191

Boyle, D. (2011). Countering compassion fatigue: A requisite nursing agenda. Online Journal of Issues in Nursing, 16(1). doi:10.3912/OJIN.Vol16No01Man02

Cohen, S. P. (2002). Can pets function as family members? Western Journal of Nursing Research, 24(6), 621-638. doi:10.1177/019394502320555386

Hart, L. A., & Hart, B. L. (1987). Grief and stress from so many animal deaths. Companion Animal Practice, 1, 20-21.

Keene, E. A., Hutton, N., Hall, B., & Rushton, C. (2010). Bereavement debriefing sessions: An intervention to support health care professionals in managing their grief after the death of a patient. Pediatric Nursing, 36(4), 185-190.

National Association of Social Workers. (2005). NASW standards for social work practice in healthcare settings. Retrieved from https://www.socialworkers.org/practice/standards/naswhealthcarestandards.pdf

Serwint, J. R. (2004). One method of coping: Resident debriefing after the death of a patient.  The Journal of Pediatrics, 145(2), 229-234. doi:10.1016/j.jpeds.2004.04.055