Part 2 - Behavioral Triage

May 13, 2018

When we first meet a new client, they tend to have several presenting complaints. Even if they only have one obvious concern, on closer look it tends to be several. It’s impossible to tackle everything at once. As we all know, changing behavior is about more than just training away what the family doesn’t like. It’s a process. It takes  time, patience, and empathy. All things that are in short supply these days and especially in this area. Clients often need a lot of educating if not RE-educating. I could easily spend 6 hours with a family going through everything, but they’re probably going to turn off about an hour in. For this reason, it’s important to prioritize their concerns.

 

This process is called behavioral triage. It’s a term borrowed from emergency medicine. If I have a critical patient enter my hospital, I need to quickly assess damage, prioritize problems, and get rolling with treatment. Let’s say for example, I have a hit by car (HBC). This dog is a mess. He has a couple mangled legs, he can’t walk, he’s breathing heavily, there’s blood everywhere, he’s just a disaster. By just glancing at this critter, I would say the broken leg is the most obvious injury. However, if I don’t take a closer look and realize he’s in shock and I just deal with his broken leg, I’m going to lose that patient. A dog can live for days in a kennel with a broken leg, but they can’t live if their circulatory system fails. Stabilize first, then fix the leg. Triage requires we assess the problems present, prioritize which needs to be addressed first and which can wait, and only then prescribe our treatment plan for each issue in turn. 

 

Let’s take a look at assessing problems. This is what we discussed in our last article. First of all, preliminary questionnaires are super important in behavior. Clients hate them, but they give us so much detail. Not only that, it gives the family time to think about their response, come up with questions, and get them thinking. Start all new assessments with a questionnaire. Tailor it to your needs, but you need to have one. You can use the provided answers to come up with more pointed questions for your actual meeting. You’ll waste less time collecting a history and have more for actually helping the family. During your conversation, make sure you’re watching that patient. It’s true that they may not act exactly the same way with you there, but you can still pick out a lot of clues to their personality. Do they startle easily? Do they jump up on you? Seek attention from their family? How does the family respond to the dog? Keep all this information in mind for when you develop your training plan. Finally, make sure you’re truly listening to the owner. This is something I emphasize all the time. People do not say things “just to say them.” Even the really chatty ones will have a subtle question nestled in their 20 minute rant. Look beyond the surface of their words and see if you can identify what they’re actually asking. Additionally, even if you don’ think it’s important, it is to the client and you need to address it. People need to feel heard. If you don’t listen, they’ll find someone who will. 

 

So, we finally have our full history. I have a sense of the family’s goals and a picture of what the end result should look like. How do we get their though? One step at a

 

time. We prioritize. There four categories I need to investigate. I look at the human animal bond. Is it still intact? Are there any safety concerns? Could this dog hurt someone? Do any of the complaints have a similar underlying cause? Finally,  what can I manage for now while working with other things? Let’s take look at each one in detail. 

 

The human-animal bond was first described in 1998 and as the “mutually beneficial and dynamic relationship between people and other animals.” We call it the “HAB” for short. The HAB is the glue that holds families together, this is what keeps that pet in the home. If the HAB is damaged, or worse, non-existent, there is no drive to fix the problem. The family probably just wants to get rid of the dog. No matter what, this is our #1 priority. We work on the HAB by helping the family empathize with their pet. Help them understand why this is happening in the first place. They’re not malicious creatures, they just don’t know what you want. Put it in perspective for them. Another tactic is to help the family teach a really easy skill. More than any other activity, training will strengthen that bond. Force free training is reinforcing to not only the animal, but also the human. It’s fun

and gives the people and pet some common ground on which to stand. 

 

Assuming the human-animal bond is in okay shape, we next focus on safety risks. I also prioritize the type of safety issues based on the risk for damage and how easy it might be to manage. My order is children,  adult family members, themselves,  housemates, visitors, outside the home, and specific situations. Above all, I don’t want anyone else getting hurt. I don’t want to put the animal in the situation that they feel the need to hurt someone. We identify safety risks and put strict management into place. Keep the animal separated from the target, avoid interacting with them in those specific situations, remove the target from the home.

 

So we’ve made it past that bond and safety; assuming neither of those are an issue, I’ll try to figure out if there is a common denominator. These tend to be emotional or environmental in nature. When I say emotional, there is some underlying emotional response such as fear, frustration, or panic. When we talk about environmental, that means the animal has inappropriate access, accidentally learned the wrong thing, or is not getting enough enrichment. For example, I might have a dog “mouths” when petted, shrinks away from things on his neck, and bites when his feet are being dried off he probably has some body handling issues. We teach him to tolerate handling, everything else goes away. Focus on the underlying cause, the motivation, and the problem behaviors go away.

 

Finally, what can I manage? Any behavior I can easily manage, I will. First off, management does not teach anything. It simply makes it easier to teach new skills. Management is about manipulating the environment so that the problem behavior, ideally, does not manifest at all. While that’s not 100% realistic, we do what we can. Management can be categorized as the overall prevention of over arousal or managing one specific behavior. So arousal is the intensity of an emotion the animal is experiencing, it doesn’t necessarily tell me what kind. I can have a super happy dog or a really scared dog and their both high arousal emotions. When animals experience high arousal, that’s often when they start getting in trouble. High arousal stops the logical side of the brain from functioning and all decision making becomes part of that reactive, emotional, fight or flight type response. Generally, highly emotional decisions are bad decisions. Bad decisions are bad behavior and bad behavior is why I’m meeting with these people in the first place. So management can be considered a category, overall prevention of arousal. The other way we manage is to pick specific behaviors that, when combined, can increase arousal or equal and overall “bad decision.” For example, does the dog bark out the front windows? Let’s cover them up. Does the dog jump up on visitors? No visitors. Does the dog attack other dogs? Don’t go near other dogs. The more they repeat the unwanted behavior, the more default it becomes, the easier it is to perform, and the harder it is to teach new skills. Until I can teach the animal how to properly respond in these situation, I need to manage them as much as possible.

 

At this point, we have fully assessed the situation, we know what the problems are, and we have prioritized our tasks. Now, we build our battle plan. 

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