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ANIMAL ASSISTED THERAPY AS A REHABILITATION TOOL IN CORRECTIONAL
FACILITIES

By
Estera Kis

Under the Supervision of
Professor Doug King

An Honours Project submitted
in partial fulfillment
of the Degree requirements for the degree of
Bachelor of Arts – Criminal Justice (Honours)
Mount Royal University

Date Submitted: April 2020

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Copyright 2020
Estera Kis
ALL RIGHTS RESERVED

This work is completed entirely by Estera Kis. All rights are reserved to the information provided
within this document.

MOUNT ROYAL UNIVERSITY
CALGARY, AB. CANADA

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Abstract
It is essential to not solely focus on the punishment of incarcerated individuals, but to also focus
on the rehabilitation of inmates in order to successfully integrate them back into the community.
Recently, correctional institutions have begun integrating canine and animal training programs as
a non-traditional method of rehabilitation and therapy. Preliminary evidence demonstrates that
inmates benefit from these programs, learning life-enhancing skills and lowering the rate of
recidivism. This thesis will examine the effect of animal assisted therapy (AAT) on inmate
rehabilitation in correctional facilities. Evidence from a number of studies indicate that inmates
gain life enhancing skills and are able to improve their coping abilities to cater to their emotional
and social needs. In addition, exploring the effects and benefits to not only inmates but also to
society and the community, will significantly impact how AAT programs can be used as
intervention techniques within the correctional system. Focusing exclusively on punishment will
not work, incarcerated individuals need a program that instills a life changing attitude and this
program can be AAT.

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Dedication and Acknowledgments
I would first and foremost like to thank my supervising professor Doug King for not only
supervising my Honours thesis, but also for your patience and encouragement. Thank you for
keeping me motivated and supporting me throughout my degree. Your knowledge, diligence and
direction played a key role in my success.
Thank you to my parents for instilling in me a strong passion for learning and for
providing me with the care and support that allowed me to focus on my degree. This
achievement would not have been possible without your support—both emotional and financial.
You have been pillars of guidance and love throughout my whole life.
I would also like to thank my sister for always believing in me. You have inspired and
encouraged me to be the best student and sibling that I could possibly be. Your loving words and
unconditional love gave me the confidence to know that I could do anything.

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Table of Contents
Abstract

3

Animal Assisted Therapy as a Rehabilitative Tool

6

Methodology

6

Definitions

7

Limitations

7

Rehabilitation in Correctional Facilities

8

Mental Health Among Inmates

10

Does Rehabilitation Reduce Recidivism?

11

History of the Use of Animals in Institutions

13

The Presence of Animals
Animal Assisted Therapy in Correctional Institutions
Evaluation of Prison-Based AAT
Case Study

15
17
19
21

RPC and the St. John Ambulance Therapy Dog program

21

Participants

22

Data Collection and Analysis

23

Results

24

Discussion

26

Conclusion

30

References

31

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Animal Assisted Therapy as a Rehabilitative Tool
Animal-assisted therapy programs are becoming an increasingly common alternative to
more traditional forms of therapy in a number of different settings, such as hospitals, psychiatric
centres and correctional facilities. Research and case studies of animal-assisted therapy
interventions, which is a type of human-animal interaction therapy most often used with
populations affected by depression/anxiety, mental illness, and trauma, could provide a model of
how prison-based animal therapy programs can be extensively implemented in correctional
institutions, where the population suffers from high rates of mental health problems.
Methodology
The aim for this thesis is to determine the effect of animal assisted therapy programs on
inmate rehabilitation in correctional facilities. By conducting a comprehensive literature review,
this thesis will examine multiple scholarly articles, books and case studies that look at the
benefits of AAT programs within the prison systems around the world. This paper will also
examine a Canadian AAT program in order to determine the effects that an AAT program in
Canada has had on inmates. By way of inductive and unobtrusive secondary data collection, a
combination of pre-existing research, case studies, and news articles will provide a clear
illustration on how these programs can lower recidivism rates and improve cognitive and
behavioural wellbeing. The variables that will be addressed and measured in this thesis are
recidivism rates, mental and emotional wellbeing such as depression levels, and psychosocial
behaviours such as anti-sociability and aggression. It is important to define these variables.

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Definitions
Recidivism is the most common measure of correctional program effectiveness and it is
defined as the “tendency of a convicted criminal to reoffend” (Duwe, 2017, p. 2). Measures of
recidivism generally include rearrest, re-conviction, re-sentencing to prison for a new offence,
and a return to prison for a technical violation revocation (Duwe, 2017, p. 2).
In addition, this thesis will be looking at AAT as a form of cognitive-behavioural therapy
(CBT), which is defined as, “A psycho-social intervention that focuses on challenging and
changing unhelpful cognitive distortions and behaviours, improving emotional regulation, and
the development of personal coping strategies that target solving current problems” (Martin,
2019). In other words, cognitive behavioural therapy helps individuals learn how to identify and
change destructive or disturbing thought patterns that have a negative influence on behaviour and
emotions. This is the definition that will be used, and the measures examined will be emotions
and behaviours such as depression, anxiety, aggressiveness, and anti-sociability.
Limitations
Although there is quite a bit of information on AAT, there is a lack of research on animal
assisted therapy in prisons and the effect that these programs have on inmates. The lack of
information on AAT programs in correctional facilities means that the case studies examined may
not be representative or typical of the larger issue being investigated because most of the case
studies that examine AAT programs are very specific to the population being analyzed. For
example, one case study looks at an active AAT program in a Canadian psychiatric prison, while
another study looks at the effects of AAT programs on incarcerated women. In order to minimize
the limitations, this thesis will focus solely on the impact of AAT programs on incarcerated

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males. This thesis will establish an understanding of how best to proceed in studying and
utilizing AAT programs as a rehabilitation tool in correctional facilities and will be utilized to
gain insights for later investigation into this topic.
Rehabilitation in Correctional Facilities
Canada’s incarceration rate, at 114 per 100,000 population, is one of the highest in the
‘developed’ world, lower than the United States (US), Britain or Australia but higher than all of
western Europe (The John Howard Society of Canada, 2020, para. 3). In the US, incarceration
rates are at a record high with 6.4 million people entangled in the criminal justice system, either
incarcerated in jails or in the community on probation or parole (Maruschak & Minton, 2020, p.
1). It is estimated that 95% of those incarcerated in state correctional facilities are eventually
released back into the community (Maruschak & Minton, 2020, p. 1). In the present time, there is
a major focus on punishment — the majority of criminal justice or correctional institutions are
punitive by nature — which makes it difficult to create effective rehabilitation programs. Critics
of a more rehabilitative approach to crime believe that justice should be harsh in order to deter
the public from committing crimes and they believe that rehabilitative programs would be less
likely to have that effect. However, there is very little evidence to suggest that long prison
sentences deter criminals.
It is essential to clearly define what is meant by the concept of rehabilitation. Cullen and
Jonson (2011) have offered the following definition of rehabilitation: “a planned correctional
intervention that targets for internal change and/or social criminogenic factors with the goal of
reducing recidivism and, where possible, of improving other aspects of an offender’s life.” There
are three main components of this definition, each of which carries with it a normative

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requirement: (1) Treatments with criminal offenders should be planned, containing features
created to reduce recidivism. (2) Treatments should identify the causes of crime (i.e., those things
that are “criminogenic”) and be capable of changing or curing them. And (3) treatments should
be directed toward human service and, whenever possible, seek to improve offenders’ well-being
(Cullen & Gendreau, 2000, p. 239).
Rehabilitation programs are intended to reduce recidivism among criminal offenders by
improving their behaviours, skills, mental health, social functioning, and provide access to
education and employment (National Institute of Justice, 2020). Offenders could become
participants in rehabilitation programs during a number of times in their involvement with the
criminal justice system, and programs are generally provided in conjunction with some form of
sanction such as incarceration or probation (National Institute of Justice, 2020). Thus, most
programs are delivered within correctional settings while the offender completes his or her
sentence, or in a community setting following the offender’s release (i.e., probation or parolebased programs).
In general, rehabilitation programs do not follow a common, well-defined treatment
protocol (Lipsey & Cullen, 2007). Instead, interventions and services may vary significantly by
program. However, all programs address at least one of the risk factors frequently associated
with offending such as mental health problems, substance use, education level, or employment
status (Lipsey & Cullen, 2007). The common types of treatment services provided by
rehabilitation programs include group work (structured via protocol or psycho-educational
content); cognitive behavioural therapy (CBT) or CBT-like components such as thinking skills,
relapse prevention, or anger management; counselling; academic work such as GED or college

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classes; employment-related (work-release, job placement, vocational training); supportive
residential (therapeutic community, halfway house); drug court or other specialized court;
multimodal, mixed treatments (individual case management); intensive supervision (reduced
probation or parole); or restorative interventions such as mediation, reparations, community
service, and victim-offender conferencing (National Institute of Justice, 2020).
Mental Health Among Inmates
Concern over the mental health of incarcerated individuals has a longstanding history in
North America, including the effects of incarceration itself (e.g. post-traumatic stress disorder),
as well as the social determinants contributing to incarceration such as injection drug use as a
risk factor for criminalization and HIV (Dell et al., 2019). As previously mentioned, the US
currently has the highest rate of incarceration in the world, including an overrepresentation of
offenders with mental health problems and a corresponding need for improved care (Al-Rousan
et al., 2017). Drawing on 2004 survey data, a study of the federal and state prison systems in the
US concluded that at the time “[a] significant portion of the prison population [was] not
receiving treatment for mental health conditions” (Gonzalez & Connell, 2014). In Canada, the
Office of the Correctional Investigator has also raised continual concern about prisoners’
inadequate access to physical and mental health care (Dell et al., 2019).
The prevalence of mental illness among incarcerated individuals is estimated to be as
high as 15%, compared to the prevalence rate of 2-3% in the normal population (Lamb &
Weinberger, 1998, p. 485). In addition to clinical disorders, offenders regularly display
psychosocial deficits, including poor social skills and emotion control. These deficits could be a
result of both poor functioning prior to incarceration and a loss of skills while incarcerated

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(Fournier, Geller & Fortney, 2007, p. 91). This is consistent with previous literature on
prisonization, a process in which incarcerated individuals adopt the customs and culture of a
correctional institution (Peat & Winfree, 1992, p. 210). One of the most distinguished studies of
the psychosocial effects of incarceration is the Stanford Prison Experiment, in which
psychologically healthy individuals in a prison-simulation study adopted the role of an inmate,
becoming blindly subservient and suffering intense psychological trauma (Haney, Banks, &
Zimbardo, 1973). Due to these deficits, rehabilitative programs are often incorporated to increase
desired behaviours and attitudes among offenders and to provide inmates with education and
training in psychosocial skills (Pearson et al., 2002, p. 478).
Does Rehabilitation Reduce Recidivism?
Recidivism is the most common measure of correctional program effectiveness. Research
has demonstrated that a majority of released prisoners reoffend, especially when measured as a
rearrest within at least three years of release from prison (Langan & Levin, 2002, p. 62). In a
study of more than 400,000 offenders released from prisons in 30 different states in 2005,
Durose, Cooper, and Snyder (2014) reveal that 68 percent were rearrested within three years and
77 percent were rearrested over a five-year follow-up period (para. 2). Durose, Cooper, and
Snyder (2014) also discovered that recidivism rates were higher among males, non-whites,
younger offenders, and those with longer criminal histories (para. 4), which is consistent with
previous research exhibiting that gender, race, age, and criminal history are among the strongest
predictors of recidivism (Gendreau, Little, & Goggin, 1996, p. 578).
Notably, recidivism data can help to revise rehabilitation programming for offenders. It is
worth mentioning that a small group of chronic or repeat offenders commit a large proportion of

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crime (Ahsan, 2019). Knowing this, data that identifies the types of offenders that are reconvicted most often can help to target specific groups of offenders when developing
rehabilitation programs. Numerous studies show that a wide range of rehabilitation programs can
reduce recidivism rates when they target the causes of recidivism (Ahsan, 2019). Further,
research shows that offenders recommit crimes due to their socioeconomic status, effectiveness
of their parole officers, length of time incarcerated, seriousness of crime, their education level,
and general willingness to commit crime (Ahsan, 2019). However, an offender’s willingness to
recommit crime can be changed through programs that address cognitive and behavioural issues
that help offenders create positive peer relationships, which enlarge their circle of support and
make them feel more accountable for their actions (Ahsan, 2019). Their attitudes change from
viewing crime as a necessity or normalcy to knowing that they have support outside of their
criminal network. In other words, offenders are less likely to resort to crime because their social
circle deters them from it. Furthermore, education and vocation programs at correctional
institutions help inmates develop skills that increase their employability when released from
prison, which makes it easier for them to have an income and pay for living expenses without
returning to crime (Ahsan, 2019).
An analysis released by the National Institute of Justice (2020) examined a series of
studies of inmates in rehabilitation programs aimed at improving their behaviours, skills, mental
health, social functioning, and provided access to education and employment. It found that,
“Overall participation in adult rehabilitation programs is associated with a statistically significant
reduction in recidivism” (National Institute of Justice, 2020). However, certain types of treatment
services were more successful at reducing recidivism than were others. Successful programs that

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included group work (structured via protocol or psycho-educational content), CBT or CBT-like
components, counselling, or that used drug court or other specialized court models were
associated with a statistically significant reduction in recidivism (National Institute of Justice,
2020). However, it added that, “There were no statistically significant reductions in recidivism
found for other types of rehabilitation programs,” such as work-related programs, academic
programs, supportive residential programs, intensive supervision (such as reduced probation or
parole caseloads), and multimodal/mixed treatments such as individual case management
(National Institute of Justice, 2020).
Effective rehabilitation programs commonly use treatment methods that are based on
behavioural and social learning theories of change. Behavioural theory suggests that individuals
are conditioned to behave in a certain way based on experiences with reinforcement and
punishment (Skinner, 1965). In contrast, social learning theory posits that people learn
behaviours from one another, through observation, imitation, and modelling (Bandura, 1997).
Thus, rehabilitation programs are designed to reduce criminal behaviours through the positive
reinforcement of conventional behaviours learned through observation or modelling (Lipsey &
Cullen, 2007). For example, a program may help a participant learn how to manage his or her
anger by modelling appropriate responses instead.
Overall, looking at 634 independent effect sizes, Lipsey (2019) found a statistically
significant mean effect size of 0.203 for recidivism. This finding illustrates that adult offenders
who participated in rehabilitation programs showed reductions in criminal offending, compared
with control group adult offenders who did not participate.

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History of the Use of Animals in Institutions
The concept of utilizing animals in institutions is not new. Its origin can be traced to the
notion of the human-animal bond (HAB), a term first used by pioneers such as Konrad Lorenz
and Boris Levinson whose work significantly impacted the scientific community in the 1970s
and 1980s, primarily in the field of veterinary medicine (Hines, 2016, p. 7). After being
originally referred to as pet therapy or pet-facilitated therapy, they were characterized by the
Delta Society as "animal-assisted activities" (AAA) and "animal-assisted therapy" (AAT) (Hines,
2016, p. 7). Pet Partners (formerly Delta Society), a leading international, non-profit organization
that provides training for AAA and AAT practice, defines AAA and AAT in the following way:
AAA provides opportunities for, “Motivational, educational, recreational, and/or therapeutic
benefits to enhance quality of life.” AAA is delivered in a variety of environments by specially
trained professionals, paraprofessionals, and/or volunteers, in association with animals that meet
specific criteria (Marino, 2012). AAT is a goal-oriented intervention in which an animal that
meets specific criteria is an integral part of the treatment process. AAT is directed and/or
delivered by a health/human service provider working within the scope of practice of his/her
profession (Marino, 2012).
AAT is distinguishable from AAA in that it has a specific therapeutic objective and is
delivered as part of a highly specific treatment plan. On the other hand, AAA involves a more
casual interaction between animals and humans and can be provided by a broader range of
individuals than AAT (Marino, 2012). Although Pet Partners distinguishes AAA and AAT, in
actual practice the two are often conflated and may overlap substantially. In AAT and AAA, the
animal serves a number of roles from companionship to caregiver to social facilitator and

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reinforcement. Despite this ambiguity, Pet Partners is clear about the key point, which is that
although it is often used as an adjunct to other forms of therapy that includes the presence of a
human, AAT and AAA are based on the premise that the animal makes a therapeutic difference to
the subject (Marino, 2012).
The implied mechanisms of action include mental stimulation, physical stimulation,
physiological effects, and general motivating effects (Marino, 2012). Therefore, according to Pet
Partner’s arguments, the effects of an animal in the presence of a human should be differentiable
from the effects of just a human on the subject and differentiable from the effects of another
novel stimulus and a human (Marino, 2012). As is the case with many other disciplines that are
still in the beginning stages of professional development, there is no general agreement on how
AAT is to be conducted. There is an abundance of variations, depending on setting and target
population (Deaton, 2005, p. 48). In addition, a wide variety of animals are used, ranging from
small animals such as birds, fish, rabbits, dogs and cats to larger animals such as horses and farm
animals, even dolphins (Deaton, 2005, p. 49). AAT can take place in numerous settings,
including long-term care facilities, nursing homes, hospitals, schools, as well as correctional
institutions.
Cusack (1988) proposed in the beginning stages of the development of AAT that,
"Animals can be vitally important for the fringe groups of society; prisoners, the physically
challenged, and the mentally ill" (p. 33). He further stated that perhaps most important, “Pets
seem to bring out the best in us. If there is a capacity for affection, compassion, for empathy or
tenderness overlooked by our human fellows, a pet has an uncanny ability to ferret it out" (p.33).
Similarly, Beck and Katcher (1983) found that, "When people face real adversity...affection from

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a pet takes on new meaning. Then the pet's continuing affection is a sign that the essence of the
person has not been damaged" (p. 31). These conclusions support the idea that animal-assisted
therapy in prison can encourage inmates to feel human again — a first step towards healing and
change.
The Presence of Animals
The significance of animal-assisted interventions of all kinds is that the live animal is a
highly specific component of the therapy. That is, without the animal there is no animal-assisted
activity of any sort. The entire industry is founded on the assertion that involvement of a live
animal in any kind of activity or therapeutic intervention (no matter how complex or
multidimensional) is critical to its identity (Marino, 2012). There is a longstanding general sense
among practitioners and researchers that activities and interventions involving animals may have
nonspecific positive effects on both patients and normative populations of subjects. Yet, there
have also been continuing doubts and controversies about the strength and specificity of the
effect of animals on human health and welfare (Marino, 2012). In other words, there remains
questions about the validity of AAT.
In a review, Johnson, Odendaal and Meadows (2002) recognized the importance of
obtaining empirical evidence for AAT and stated that, “Advocates of programs using animals
have begun to see empirical documentation as a critical factor in widespread acceptance of
animal-assisted therapy as beneficial interventions for patients” (pp. 422–423). They cautioned
that, “ … Better designed experiments are needed to enhance the credibility of animal-assisted
interventions ...” (p. 438). Since then, there has been an increase in published peer-reviewed
studies of AAT reinforcing and strengthening claims of therapeutic efficacy.

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The interaction between the animal and the human could provide a wide range of
psychological and physical benefits for humans. These benefits could be explained by different
reasons such as the biophilia hypothesis, which is described as the genetically based propensity
of humans to seek connections with other living organisms or an increase in oxytocin levels,
which induces antidepressant and calming effects (Villafaina-Domínguez et al., 2020). In
addition, previous studies have shown a positive physiological response after being in contact
with animals. For instance, an increase in beta endorphins or dopamine production were found in
humans (Odendaal & Meintjes, 2003). Moreover, oxytocin levels seemed to increase. This is
relevant since oxytocin is a peptide hormone and neuropeptide, released by the posterior
pituitary, with antidepressant and calming effects (De Cagna et al., 2019). This could be the
reason why AAT can help reduce anxiety, depression, blood pressure, or cortisol, as well as
increase mental and physical wellbeing.
Animal Assisted Therapy in Correctional Institutions
Individuals involved in the criminal justice system are often exposed to violence,
traumatic experiences, or have been through critical life events. Thus, as previously mentioned,
the prevalence of mental health issues among sentenced prisoners is higher than that in the
general population (Villafaina-Domínguez et al., 2020). Specifically, the prevalence of
psychiatric disorders such as stress, anxiety or depression is relatively high in correctional
facilities. Due to the large number of individuals in prison, which account for more than 10
million individuals worldwide and the large proportion of physical and mental health issues
compared to the general population, there is a strong need to create programs that help to reduce
offender infraction rates and violence and increase physical and mental health (Villafaina-

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Domínguez et al., 2020). These intervention programs, which should be focused on psychosocial
well-being, can be an effective way to maintain both staff and inmates’ safety within correctional
facilities, while also reducing the likelihood of recidivism. In this regard, AAT programs are a
promising solution for these purposes.
Specifically, canine-based AAT programs consist of providing care and training for dogs,
and sometimes, it includes vocational or educational components to enhance employability for
offenders (Villafaina-Domínguez et al., 2020). These types of interventions have been proven to
have positive effects on inmates. For instance, offenders who participated in a dog-based AAT
program required less medication, were less violent to others, were less depressed, improved
their social behaviours, and had fewer infractions, while at the same time their self-esteem was
increased and their stress levels were decreased (Koda et al., 2015). In addition, since high
dropout rates of behavioural intervention could be expected in this population, the inclusion of
animals can increase adherence and motivation (Villafaina-Domínguez et al., 2020), which could
be a key factor to consider.
Animal-based programs are common in prisons in the US. More recent, Cooke &
Farrington (2016) identified 290 correctional institutions offering canine-based programs. The
programs commonly involved inmates caring for and training dogs affiliated with rescue
organizations, and frequently with dogs that may otherwise be euthanized. Other programs have
inmates training puppies and adult dogs for service and therapy work (Dell et al., 2019). The
perception of inmates contributing to the good of others, either for the animal or broader human
community, has made this form of prison-based programming popular (Dell et al., 2019). The

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rehabilitative focus on the animals (i.e. giving them a second chance at life) has also been cited
by participants as an important feature of the programs (Dell et al., 2019).
In contrast, there are few animal-based programs in Canada’s federal correctional system.
Among the six that exist, four are clinical-based approaches and two are dog-training programs,
which acknowledge their potential therapeutic benefits (Dell et al., 2019). A modified visiting
therapy dog program operates at Stony Mountain Institution, the PAWSitive Support Canine
Assisted Learning Program is offered at Drumheller Institution and an AAT program is at the
Regional Psychiatric Centre (RPC), which will be examined in depth below (Dell et al., 2019). In
addition, the Nekaneet Horse Program is offered at the Okimaw Ohci Healing Lodge for women.
It is a blend of Cree protocol and equine therapy, including traditional indigenous spiritual
teachings. As shared above, evaluated animal-based programs in Canada and in the US, where
the majority of research has taken place, near exclusively focuses on canine training by offenders
(Dell et al., 2019).
Evaluation of Prison-Based AAT
There is limited research on the effectiveness of prison-based AAT, and no peer-reviewed
studies have been undertaken in Canada. The majority of research that does exist is specific to
canine training programs in correctional facilities. Although training programs and visiting
programs have distinct goals and objectives, the impact of the human–animal interaction and
bond is common to both (Cooke & Farrington, 2016). Keeping this in mind, a 2016 review of
AAT programs specifically in non-prison contexts for adaptability to the prison environment,
suggested that when taking into consideration the animal roles in each evaluated study, offenders
may benefit most from AAT that creates a stronger bond between inmate and therapist, as well as

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a safe, non-judgmental environment “to express past experiences, reveal feelings and fears, and
initiate conversations about how to mindfully react to and cope with life situations. These
patient-animal interactions resulted in self-awareness, comforting support, and retention of
learned therapy skills, important foundational components to positive mental health” (Allison &
Ramaswamy, 2016, p. 477).
A 2016 systematic review and meta-analysis of the existing AAT prison literature,
specific to dog-training programs, and based on ten studies meeting inclusion criteria, concluded
that the programs had a beneficial effect on inmates (Cooke & Farrington, 2016). Other research
conducted on prison dog-training and pet visitation, however, has produced less supportive
findings, and is often critical of AAT study methods (Gilger, 2007). Despite limited, conflicting
and often incomparable research results, inmates participating in a variety of forms of AAT
typically report psychosocial benefits, including reduced depression and increased confidence,
self-esteem, trust, self-control and pride (Hill, 2020; Currie, 2008; Turner, 2007; Deaton, 2005).
Prison administrators have also reported that animal programs result in a lower rate of
disciplinary infractions for participants and an improvement in institutional tension levels (Hill,
2020; Turner, 2007). In fact, 60 of the 61 administrators responding to Furst’s (2006) survey
indicated that they would recommend animal programs to their colleagues. The scarce research
on the impact on prisoner recidivism rates has been found to be supportive (Weaver, 2015), but
oftentimes inconclusive and, if apparent, declining with time after release (Hill, 2020).
Even though there is a shortage of research specific to prison-based AAT, a meta-analysis
conducted by Nimer and Lundahl (2007) examining 49 studies of mainly US AAT programs,
found support for their effectiveness. In addition, Mercer, Gibson & Clayton (2015) reported on

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the operation of a special therapeutic unit within a British prison, where prisoners visited with
chickens, ducks, goats, miniature ponies and dogs. Semi-structured interviews with prisoners and
staff revealed that the presence of the animals fostered a sense of responsibility, built trust,
enhanced communication and decreased self-harm and aggressive behaviour (Mercer, Gibson &
Clayton, 2015).
Case Study
RPC and the St. John Ambulance Therapy Dog Program
This study is the first of its kind to explore the goal of a canine AAT program in a
Canadian correctional institution. It is also unique in that it is analyzing and examining an AAT
program that was explicitly offered to benefit inmate mental and emotional well-being. The
purpose of the study is to determine whether the goal of the St. John Ambulance Therapy Dog
program, which is to provide love and support, is achieved within a psychiatric prison setting and
if so, how are inmates’ correctional plans supported through the resulting human–animal bond
(Dell et al., 2019, para. 5). Both love and support are important aspects of mental well-being, and
both are lacking for prisoners given the negative experience of incarceration.
Regional Psychiatric Centre (RPC) is a mixed-gender, multi-level secure forensic
psychiatric facility. It has a capacity for 204 prisoners, with the majority being male (Dell et al.,
2019, para 14). It is a hybrid facility, serving as both a correctional facility operated under the
federal Correctional and Community Release Act and as a hospital subject to legislation and
regulation by the Province of Saskatchewan (Dell et al., 2019, para. 15). Individuals at RPC are
both inmates convicted of a criminal offence and sentenced to a period of incarceration over two

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years and patients of a psychiatric hospital where they receive intense and chronic mental health
care (Dell et al., 2019, para 15).
The goal of the St. John Ambulance Therapy Dog program is to provide love and support
to individuals with whom the dogs visit under the guidance of their handlers (St. John
Ambulance, 2015, para. 3). The volunteer program has been active in Canada since 1992 and in
Saskatchewan since 2007. The RPC AAT program consists of 24 sessions over approximately
eight months (Dell et al., 2019, para 16). Each session is directed by an RPC mental health
clinician alongside a therapy dog and handler team. Underlying mental health oriented skills in
line with inmates’ correctional plans are identified at the start of the program and revisited
midway, with an inmate choosing a skill to focus on at the start of each individual session (Dell
et al., 2019, para 16).
In general, the first five minutes of a session are assigned to the inmate to re-acquaint
with the therapy dog, followed by skill development through experiential learning opportunities
with the dog, then five minutes of visiting with the dog to conclude the session (Dell et al., 2019,
para 16). In practice, more than one mental health oriented skill may be the focus of a session.
For example, an inmate worked with a handler and therapy dog on basic obedience such as
commands like sit and heel, to increase their focus. The clinician also linked this during the
session to the inmate practicing calmness (Dell et al., 2019, para. 16). At the completion of the
AAT program, the inmates received a certificate of completion signed with a dog’s paw and a
plush dog. They also have an opportunity to take part in a booster session to visit with the
therapy dogs every three months while incarcerated at RPC (Dell et al., 2019, para. 16).

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Participants
A small group of carefully selected inmates (n = 3) received weekly 30-minute one-onone AAT sessions with their RPC mental health clinician (Dell et al., 2019, para. 18). The
participants were chosen based on an internal referral process (from a staff member on an
inmate’s unit) and personal review of inmate such as mental health and/or problematic substance
use background; likes dogs; non-violent history toward animals; and no current physical threat to
animal or handler (Dell et al., 2019, para. 18). The cohort consisted of one female and two males,
with an average age of 48, the average length of their current federal incarceration was 12 years
and their average length of time at RPC was 6 years (Dell et al., 2019, para. 18). All of the
participants were convicted of violence-related crimes and were identified as high risk and high
needs and identified by their clinician to not be making progress on their correctional plans (Dell
et al., 2019, para. 18).
Participant 1 (female) presented with a pattern of overly compliant behaviour
interspersed with outbursts directed at others and self-harming incidents. The mental health
oriented skills identified for her AAT program were learning to calm herself, increasing her
focus, abstaining from being disrespectful when angry and respectfully sharing with others how
she feels (Dell et al., 2019, para. 20). Inmate 2 (male) was withdrawn and had socially isolated
himself. His AAT program skills were to decrease loneliness, increase his self-esteem and have
positive interactions with others (Dell et al., 2019, para. 20). Inmate 3 (male) presented with
aggressive patterns of behaviour. In his words, “I am provoked to [an] angry [state], and my
anger got progressively worse, and then I act out my aggression” (Dell et al., 2019, para. 20). His
program skills were to be more relaxed, increase his confidence, be less stressed, establish trust

Page 24
and have more positive feelings and thoughts (Dell et al., 2019, para. 20). Overall, the mental
health oriented skills identified for the inmates’ AAT programming mainly concentrated on the
acknowledgement of emotions and feelings.
Data Collection and Analysis
Data was collected and analyzed from multiple sources to understand inmates’ lived
experiences and their meanings within the framework of the AAT program goals – connection
with therapy dogs and support for the correctional plans – as well as in relation to the empirical
evidence located within the AAT, human–animal bond, prisoner and human health literature
(Dell et al., 2019, para. 23). The post-AAT program session data collection instrument was
designed based on the goals of the AAT program plus a review of the existing AAT literature.
The qualitative interview guide was designed to add insight and context to the individual session
data at the midway and end points in the AAT program (Dell et al., 2019, para. 23).
Following each of the 24 AAT sessions, questionnaires with four to five qualitative
questions and four to five quantitative questions were completed by the inmates (n=48), handlers
(n=54) and RPC clinicians (n=48) (Dell et al., 2019, para. 24). Semi-structured inmate, handler
and clinician interviews (average 45 minute each) were conducted midway through the program
(after session 12) and at its completion (Dell et al., 2019, para. 24).
Results
This present case study met the St. John Ambulance Therapy Dog program goal: the
inmates connected with the therapy dogs through their perceived offering of love, comfort and
support (Dell et al., 2019, para. 27). This connection was understood to be mutual, to develop
over time and to be lasting. Love was experienced primarily by the inmates as affection from the

Page 25
dogs and support was experienced as unconditional acceptance from them (Dell et al., 2019,
para. 27). When asked in the questionnaire to provide an example of feeling comforted/loved by
the therapy dogs, all participants indicated that it was the connection they established with the
dogs, followed by affection received from the dogs, and happiness from being with the dogs
(Dell et al., 2019, para. 27). When the clinicians were asked to provide examples from their
observations of the inmates and therapy dogs interacting, they similarly identified affection,
followed by connection, happiness and unconditional acceptance.
When asked in the questionnaire to provide an example of feeling supported by the
therapy dogs, the inmates described the affection they received, followed by the dogs’
unconditional acceptance, their mutual interactions and being in a safe, trusting and comfortable
emotional “space” when interacting with the dogs (Dell et al., 2019, para. 25). For the inmates,
there was overlap in their experience of love/comfort and support. For example, Inmate 2 shared:
“I felt comforted and loved by them […] I feel a lot of feelings of being wanted” (Dell et al.,
2019, para. 25). Receiving love, comfort and support from the therapy dogs appears to have
positively impacted the inmates’ emotional states. Inmate 1 described the impact her interactions
with the dogs had between AAT sessions. “When I am upset, they [pictures of the dogs] ease me
and calm me,” she reported, “it distracts me from self-harm, distracts me from triggers, helps me
move on” (Dell et al., 2019, para. 25).
There was also positive behaviour change disclosed by the inmates, including selfreflection about their conduct. Inmate 2 shared: “I can be an A-hole when I want to be. I did not
want to act that way around the pooches […] No, because they just will not put up with a whole
lot of that” (Dell et al., 2019, para. 25). He went on to share, comparing the start to the end of the

Page 26
AAT program: “I feel like I am two different people. I certainly do.” Asked who the new,
different person is, he replied “Very confident in the dog’s eyes” (Dell et al., 2019, para. 25).
There was evidence that the development of a human–animal bond in the sessions, and its
consequent facilitation of inmates’ recognizing their feelings and emotions, contributed to
improved inmate behaviour (Dell et al., 2019, para. 26). This was acknowledged by both the
AAT program participants and mental health clinicians, and distinctly supports the inmates’
correctional plans. Inmate 1 stopped self-harming, Inmate 3 stopped exploding with aggression
toward others and Inmate 2 was able to form a social relationship with another inmate (Dell et
al., 2019, para. 26). Similarly, a case study of a canine training program with male inmates in the
US identified a positive effect on behaviour (Currie, 2008). Of interest to this study is Mercer,
Gibson & Clayton’s (2015) finding from an animal-based program that concluded a decrease in
participants’ self-harming behaviour.
Overall, the development of a human–animal bond seems to have supported and
encouraged inmates’ cognitive-behavioural correctional plans through increased recognition of
their feelings and emotions (Dell et al., 2019, para. 27). This bond affected inmates’ improved
emotional states and behaviour. Building a connection and supporting the inmates correctional
plans were the goals of the RPC AAT program. However, a larger sample size and a bigger time
frame is required to determine whether these promising results can be replicated and to
comprehend the potential lasting effects of AAT (Dell et al., 2019, para. 27).
Discussion
The key themes identified in the case study above, as well as insight gained from existing
literature, suggests that a prison-based AAT program that emphasizes inmate mental well-being,

Page 27
alongside that of animal and community well-being, merits further exploration. It would be
worthwhile to evaluate other AAT programs with a larger sample size and a diversity of inmates.
It would also be valuable to do a follow-up study of this cohort of inmates. Findings from the
RPC case study should accumulate institutional interest in AAT given its ability to address
criminogenic risks and needs as well as improve inmate safety through reduction of aggression
toward others and harm to self (Usher, Power & Wilton, 2010). A recent systematic review of
randomized control trials of AAT on psychosocial outcomes found that AAT may be beneficial
for many different people, especially inmates (Maujean, Pepping & Kendall, 2015).
Inmates are to a great extent, disconnected from love and affection while incarcerated.
Most obvious, this includes physical affection from other humans (an exception would be a
conjugal visit or a hug during a scheduled visit). Familial relationships where love, comfort and
affection are most likely to exist for inmates are usually strained and incarceration facilitates
both a physical and an emotional disconnect for inmates with the “outside world.” For example,
there is limited access to telephone calls and visits. It is also possible that familial love and
affection do not exist on the outside for the inmate, considering high rates of childhood physical
and emotional neglect and other adverse childhood experiences among inmates (Dutton & Hart,
1992). The importance of emotional development in childhood on future emotional health is well
established.
AAT literature acknowledges the domesticated dog’s innate ability to offer and receive
nurturance (Levinson, 1984). Dogs are commonly viewed to present with non-judgmental
warmth, and companionship and bonding, which in turn nurtures the ability of humans to receive
and offer love and trust (Arkow, 2011). Cooke and Farrington (2016) note that within a prison

Page 28
setting, the human need to love and be loved is difficult to achieve and that, “[f]or many
offenders, participation […] may be their first exposure to unconditional love and acceptance,
which allows them to express their emotions in a healthy manner” (p. 858). Additionally,
referring to Beck and Katcher’s work, Furst (2006) shares that, “[f]or inmates who live lives
absent of touch and acceptance, animals are able to stimulate a kind of love and caring that is not
poisoned or inhibited by the prisoners’ experiences with people” (p. 412). In the study of therapy
dogs visiting at RPC, Dell and Poole (2015) concluded that the dogs can assist in supporting
individuals with trauma histories during informal visits.
The literature also supports that animals can trigger happy memories, improve mood and
elicit a sense of happiness, joy and general well-being (Arkow, 2011). This is especially
important in the prison context where inmates frequently shut down their feelings, and more so
the longer they are incarcerated (Leigey & Ryder, 2015). Rekindling positive feelings in inmates
can help them with feeling human again. The AAT literature in prisons, even though limited,
identifies a positive impact on mood and behaviour change.
As previously established, inmates commonly experience limited support while
incarcerated, both emotional and practical. As mentioned, inmates are physically separated from
their familial and other outside supports. Oftentimes, these supports disregard the inmates
because of the pain, damage and stigma associated with their crime and incarceration (Dell et al.,
2019, para. 30). Inmates themselves frequently dissociate from outside networks and available
supports and isolate themselves as a form of emotional defence. AAT literature identifies social
support as a key contribution from therapy animals to individuals who are psychosocially at risk

Page 29
(Fine, 2010). The work of Arkow (2011), for example, refers to therapy dogs as “a form of stress
reducing or stress-buffering social support” (p. 2).
In Canada, a correctional plan is created for inmates upon admission to a federal
institution by Correctional Service Canada (CSC). The plan outlines a risk management strategy,
drawing upon dynamic and static risk factor information about inmates’ lives and crimes (CSC,
2019). CSC (2019) assesses and rates offenders’ needs in relation to mental health, learning,
substance abuse, and other topics. CSC (2019) also rates how willing offenders are to act
responsibly, to work on their correctional plan, and to address the issues that led them to commit
crimes. Finally, CSC (2019) rates how able offenders are to live in society without committing
crimes in the future. Cooke and Farrington (2016) assert that despite a scarcity of research on
AAT programs in prison environments, many of the benefits identified in the literature are
specific to risk and protective factors related to not re-engaging in criminal behaviour.
As shared, CSC’s (2019) correctional plan suggests programming for inmates (e.g. family
violence, substance abuse), with much of it situated within a cognitive-behavioural skill
development framework. CBT is a form of psychotherapy, focused on altering individuals’
negative thought patterns and corresponding behaviours (Beck & Beck, 2011). CBT concentrates
on individuals’ experiences and how these experiences link to how they think; it acknowledges
that human feelings and emotions influence behaviour (Beck & Beck, 2011). AAT’s focus on
mental health oriented skills development is rooted in inmates’ emotions and feelings, and its
corresponding experiential learning component is a unique complement to CBT programming. A
recent study examined CBT with and without a dog present for anxiety and trauma disorders in
the general population, and “[t]he results suggest that dogs can lower acute distress without

Page 30
compromising emotional processing or therapeutic mechanisms, and may actually improve longterm outcome for some individuals” (Hunt and Chizkov, 2014, p. 457).
Conclusion
At a time when correctional institutions are becoming more expensive to operate and
there is little change in the rate of recidivism, new methods should be explored to alternative
rehabilitation and therapy programs. As reviewed in this thesis, there is empirical and anecdotal
evidence that animals and essentially, AAT programs, can influence and affect the atmosphere of
prisons and provide meaningful experiences for inmates. These programs are imperative to
inmate rehabilitation because they promote life enhancing skills such as coping skills, increase
community involvement and responsibility and enhance the overall quality of life. In spite of the
lack of research on the overall effectiveness of AAT programs, there is reasonable evidence that
they can be profoundly successful and valuable to incarcerated individuals. In AAT programs,
inmates learn new skills while being involved physically, mentally and most often emotionally. It
has been established that animals can promote a change within an individual which cannot be
easily matched by traditional methods.

Page 31
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