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Private Practice Startup Podcast
Episode 132: 3 Common Concerns Providers Have About Responding to Emotional Support Animal Requests
00:32:42
Rebecca Stone, LMHC
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- [00:03]
A
Welcome to the Private Practice Startup, where we inspire you from startup to mastery. We chat with entrepreneurs, experts in the mental health and business arenas, and successful private practitioners to give you the tools needed to make your dream practice a reality. Visit theprivatepracticestartup.com for awesome resources, free trainings, and so much more. Here are your hosts, Dr. Kate Campbell and Katie Lemieux.
- [00:27]
B
Hey, everybody. Welcome back to another episode of the Private Practice Startup podcast. I am Katie Lemieux and we are here today with Becky Stone, who is a licensed mental health counselor. And Becky's actually going to be talking to us today and you, of course, about three common concerns providers have about emotional support animals, which is great because Starduck Nation, you actually voted to hear this and I can't wait to hear this because I do have some questions about the difference between a service animal and a therapy animal. So we're going to get that all cleared up and talk a whole bunch more. But before we do that, we hope that you guys listened last week to our podcast with Alison Pigeon where we talked about masterminding. And interestingly enough, right before this podcast, I was on my mastermind it myself. So getting some mastermind juices flowing, which is always good for the business entrepreneurial mind. And if you've been listening to our podcast, you know that we are running a contest for all of April. We are so excited to be running this contest. This is the third week, so what's going to happen is we want you to head over to private practices startup.com head over to the Resources tab and get your free downloadable customizable attorney approved private practice HIPAA form. And so anyone? Is that a ton?
- [01:43]
A
Say that five times fast.
- [01:45]
B
Anyone? During the week of this podcast, what we're going to do is we're going to pull a name at random and you guys are going to get our peak package. So that's our 20 plus customizable attorney approved private practice forms. There you go, Kate. Yes, we're gonna have one lucky winner every week for the month of April. So.
- [02:02]
A
And that's a value of $511. Gotta put that out there. It's a big package to win.
- [02:09]
B
So a little bit about Becky. So officially, she's Rebecca. I guess that's what her parents call her when they're mad at her, but she likes to go by Becky. I'm Kathryn. And so isn't Kate.
- [02:19]
A
Actually, yes, I am.
- [02:22]
B
So she provides counseling services to clients as well as consulting for mental health professionals. Becky's presented about emotional support, anim in many capacities. And within her consulting, she strives to help mental professionals go from confused and stressed out about emotional support animal requests to competent and confident with ESA assessments while preparing their practices to welcome ESA requests along the way. So we are super excited to have her so officially welcome Becky.
- [02:49]
C
Thank you so much. I'm happy to be here. We're happy to have you. So let's just.
- [02:53]
B
I mean, let's just really, like, dive in. And I guess my first question for you is, like, how did you get interested in working with emotional support animals and really helping therapists do all of that?
- [03:04]
C
Sure, I think that's a fantastic question. So I actually sort of spent the majority of my time clinically working on a college and university campus. And of course, with students coming in and living on campus, they started asking about emotional support animals and bringing them on campus to live with them. And it was one of those things where we went, oh my gosh, you know, we've got to figure this out. So. So we as a campus came together and created a task force with many different professionals from many different departments to figure out exactly how we needed to respond to these requests within the laws, and then also from the counseling center within our ethics. So we brought all these people together, we did a bunch of research, we had some programs that we attended, and ultimately we came together and created this ESA policy, which actually ended up becoming an animal policy as a whole, because the university was animal or pet friendly. So we wanted to really make sure we had a comprehensive policy and procedure of how we were going to respond to these requests. So ultimately, that's sort of how I got involved is I was the counseling center representative, and I got to be really fortunate to have all of this different information that I was taking in from all of these different avenues like public safety or facilities, you know, really understanding all of these different aspects and how they were interwoven to make sure that we were supporting our students and their requests, as well as making sure that they were getting the disability support that they needed, the counseling support that they needed so that we could really help our students comprehensively and of course, you know, cover the university and making sure that we were doing the best that we could to stay within the bounds of laws and ethics. So ultimately, that's what this was sort of born out of. And I recognized when I shifted over to private practice that this was still a need. You know, there was lots of confusion out there. Of course, we hear lots of things in the media, usually negative. Right. So there's lots of scary things out there that professionals hear and it makes them usually pretty wary of responding to emotional support animal requests. So I wanted to be able to help clear up some of the misconceptions and really make sure that mental health professionals are aware, they're knowledgeable and they're prepared to be able to respond to these requests with a policy and procedure in place.
- [05:30]
B
Very cool. And Becky, you're actually in Florida as well, right?
- [05:33]
C
Yes.
- [05:33]
B
And so what university was this?
- [05:35]
C
This was over at Stetson University.
- [05:38]
B
Very cool. And I'm curious, I mean, I know that like every generation probably says, like, oh my gosh, this generation is so different. Like I could never imagine, like having my pet on college campus, but I actually think that's so cool. And I'm just wondering, are there any statistics with the emotional and well being of students and their ability to achieve academic success or other successes with having their animals on campus?
- [06:02]
C
That's a fantastic question. I'm not aware of any off the top of my head. I know that ESA research as a whole is sort of in its infancy and it wouldn't surprise me if some of the results around ESAs are a little bit questionable just given some of the registry and certificate sites out there that maybe they're not going about the legitimate way of getting an ESA letter. So we don't know right now how many people would say that they have an ESA that maybe don't qualify in terms of the law. So I would say some of those statistics are probably a little bit questionable if there are really any even out there at this point. But pets, certainly there's lots of research out there on the benefits of pets. And really ESAs are pets. So, you know, there's lots of things that come with the companionship and comfort from a pet. And it certainly can help reduce some of the stress levels, reduce cortisol, you know, all of those great things, and help with endorphins. You know, of course you're getting more active taking for instance, a dog out for a walk, stress relieving benefits of that, heart regulation, blood pressure regulation, all of these great things. So certainly it could be inferred that students could be more successful with the presence of an animal. It also helps with.
- [07:27]
A
Oh, go ahead, go ahead, finish your thought.
- [07:30]
C
Okay. I was gonna say it also helps with structure too. Having the responsibility of taking care of an animal, you know, helps students who might otherwise be out really late or sleeping in really long in the morning, you know, to get up and take care of the animal that they are responsible for so it can help with the regulation of schedules as well. That's great.
- [07:52]
B
I like that. Kim, what were you going to say?
- [07:54]
A
What a cool way to transition from being from like living with your parents and then this being the first time that you're living on your own independently to have that, you know, all those different resources there to really set you up for a more smooth and successful transition. So that's awesome that you guys really incorporated this and that you've also found this to be a really great niche for your own private practice. I was going to say, before we dive into any other questions, I have several myself. I want to take a quick break for our sponsors, so let's go ahead and do that now. If you're in private practice, you wear a lot of hats and some of those hats are totally great. But some like filing taxes and running payroll, for example, not so great. That's where Gusto comes in. They make payroll taxes and HR actually easy for small businesses like your private practice. Fast, simple payroll processing and benefits and expert HR support all in one place. Gusto automatically pays and files your federal, state and local taxes so you don't have to worry about it. Plus they make it easy for you to add on health benefits and even 401ks for you and your team. Let them wear one of your many hats. You have so many better things to do with your time. Listeners get three months free when they run their first payroll. Try a demo and see for yourself@gusto.com pps that's gusto.com pps knowing you need.
- [09:13]
B
Legal, ethical and competent paperwork is overwhelming, time consuming and let's face it, expensive. We're clinicians, not lawyers. We put in 100 plus hours of work scouring through the laws and ethics and paid thousands of dollars in expensive attorney's fees so you don't have to save yourself time, money and headaches.
- [09:31]
A
We're Kate and Katie from the private practice startup and we invite you to experience the quality of of our paperwork with our HIPAA form as our gift to you. Go to privatepracticestartup.com head over to our Resources tab and download the free HIPAA form today. You can also shop our a la carte and paperwork options under the paperwork tab. Enjoy. I'm curious, Becky, are there any type of regulations around what kind of animal can actually be considered an emotional support animal? Is it just dogs or cats or can like a crocodile or an alligator?
- [10:11]
C
We're down here in South Florida.
- [10:12]
A
You never know what kind of crazy stuff people might come up with.
- [10:14]
C
Yes. And there was one in the news recently of an alligator. Yes. So really, ESAs could be considered any kind of pet. So it could be a hamster, a snake, a lizard, you know, birds. So essentially the main differences, I'll maybe hop into that because I think that that'll help better answ comprehensively. So pets, of course, are any kind of animal. It's anything that someone deems their animal. Right. Some of them are domesticated, some of them are wild. So, you know, I might think of the emotional support peacock that we've probably heard of in the news. So, you know, anything that someone deems is their pet is their pet. Essentially. Emotional support animals are also pets. They're just prescribed, and I kind of air quote that prescribed to a person with a disability in order to help alleviate one or more symptoms associated with their disability. So when I say air quote prescribed, it's just because us as mental health professionals a lot of times don't technically prescribe. So it feels a little bit weird to hear that essentially we provide a letter of support for an emotional support animal. And so that really is any pet, again, that an individual identifies as alleviating one or more symptoms associated with their disability. So the person has to qualify for the disability first, and then they also have to be able to identify how this animal alleviates some of those symptoms and allows them essentially to live a fuller, healthier life just by their mere presence. So they're not actually trained to do anything. They're just there and they help the person that could be with regulating schedule, that could be heart rate, cortisol, all of those things that I mentioned, and many, many, many more. So it really is up to that person to identify how this animal helps them.
- [12:13]
B
And so, Becky, when you say disability, I think of ssdi, what is considered the disability?
- [12:20]
C
Yes. So it's really anything that significantly impairs their daily life. So when we think of that mental health, if there's a diagnosis that's not like a Z cod, something like that, something that is more longer term in terms of probably six months or more that's present, and they qualify for that diagnosis, mental health does identify as a disability. So if an individual, let's say, has major depression, right. And they identify their animal as helping them with the structure, with, you know, making sure that they're getting out of bed, let's say it's a dog, because that's pretty common. Right. The dog, you know, alerts them and says, hey, I need to go out, walk me. Right. So they're getting out, they're getting some socialization, possibly with other neighbors as they're out on their walk. The dog provides that companionship. Usually dogs are pretty excited when we come home, so they get the, you know, positive socialization with the animal themselves. So a whole list of things that this animal could provide for them that helps alleviate some of the symptoms of their depression or like a social anxiety.
- [13:35]
B
Or something like that.
- [13:36]
C
Absolutely.
- [13:37]
B
Okay, very cool. And so then just to kind of clearly define, then, a service animal.
- [13:43]
C
Right.
- [13:43]
B
Those are the distinctions. ESA and a service animal. What is that? Service animal?
- [13:47]
C
Yes. So a service animal is trained to provide a specific work or task for the individual with a disability. So let's say someone with ptsd, we'll kind of angle this in the psychiatric service animal realm. So someone with PTSD may have an animal that's a dog or a miniature horse are considered service animals. So they're the only animals that can be service animals. Right. They're very well trained, and they're able to sense a lot of these things. So someone with PTSD can have their dog that is trained to go into a building and basically clear it for the individual, or they could be there to help ground them if they're having some sort of dissociation associated with the ptsd. So really cool things that they could be trained to do for that individual with a disability. But they are very well trained. You will notice them. Let's say you're out at a restaurant. You'll notice that these dogs will be laying there not paying attention to anyone else in the restaurant. They're not interested in what they're eating. You know, people are eating around them, so you can tell that they're very disciplined. And essentially, if that's not the case, service animals do have off days. Right. But typically, you'll be able to see if that dog over there is acting up. They're probably not a service animal and likely shouldn't be there.
- [15:13]
B
Mm, very cool.
- [15:14]
A
Now, do you offer assessments for both the ESA and the service animal or just the esa?
- [15:20]
C
That's a fantastic question, too. So service animals, they could actually be trained by an organization, or they can be trained by the individual themselves. So when I assess for ESAs, I really identify what is it that they're wanting to gain from this. You know, with ESAs, they only have the right to be within housing or some cases on airlines. With a service animal, this animal is sort of like an extension of themselves and are really needed for the activities of daily living. So if you think of A seeing eye dog, for instance, you know, they're really required to go with them throughout the day to be able to assist and do those tasks. So if someone is having, let's say severe PTSD and they're having lots of dissociations or they have lots of anxiety about going out for safety reasons, you know, their likely going to benefit more from a trained service animal than an ESA that really can't go with them and help them with the daily living functions. So essentially, yes, I do assess for that as we're going through the process, but I don't actually do anything with the service animal side. I recommend that they seek out additional training or support for that. With those people that do specialize in service animals.
- [16:38]
A
A lot of people seem to have questions and assumptions and then also try to take advantage of the oh, how can I get my pet to fly with me situation. So can you enlighten us a little bit about what those standards are and requirements are?
- [16:54]
B
I recently got, I have to move into apartment and I don't want to pay my pet deposit fee.
- [16:59]
C
Yes.
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B
And I'm like, nope.
- [17:03]
C
Yeah, if you get that gut reaction right away, it's probably telling you something. Yeah. So again, people have to qualify for that disability. So I do have people that seek me out specifically for the ESA assessment and I actually have a structured process that I go through. So it's not a one time, here's your letter without going through a thorough process. But it's let's talk about it, let's assess, let's identify what this animal is doing for you so that we can go about this the right way. Right. There are lots of websites and registries out there. If you Google it, the first full page is going to be. The majority of them are these fake registry and certificate sites that frankly housing and airlines are becoming very aware of. And it's causing some pushback for these people that think they're going about it the right way, but they haven't. So essentially an ESA has to be prescribed by a medical doctor or a mental health professional. Right. So if they're going about it the right way, they're not going to have any problem going through whatever your process is. Right. In terms of assessment and so on. It's those that maybe give some pushback or they're like, but I just don't want to pay the pet deposit and the pet fee that probably shouldn't be actually going through that process because it's likely going to be that they don't fit that criteria.
- [18:25]
B
Yeah, that's where it was easy for me to say, like, oh, it's out of my scope of work. I don't know.
- [18:30]
C
Yeah, absolutely. Yeah. And ultimately, knowing that really a diagnosis has to be in place. We have to identify that it has a certain level of severity that impacts their daily living or their daily functioning, like sleep or things like that. As long as you're informed, it's definitely within your scope of practice to be able to follow through and provide that letter.
- [18:53]
B
That's good to know. Let's talk more about scope of practice and concerns, possibly about liability or something like that.
- [19:00]
C
Yeah. So I actually have an E course and one of the steps in that E course is to contact your liability insurance company and identify what it is that they say about emotional support animals. Because of course, every liability coverage is going to be different and their guidance is going to be different. And same thing with licensure. Right. Making sure that you actually qualify in terms of scope of practice to be able to diagnose and so on. So it's not as scary as it sounds. Scenes. It's just going through and doing your due diligence to make sure that you're covered in terms of liability, you're covered in terms of licensure, and generally speaking, we are not liable. Right. The majority of these liability insurance are going to say, no, you're fine because you're doing your due diligence. You have a policy and procedure in place to identify that they do meet the criteria for an esa. And from that point forward, the individual is responsible for their animal and the animal's behavior. So it would be really no different than a psychiatrist doing their due diligence to prescribe medication for an individual. What the individual does with that medication from that point forward is up to the individual. Does that make sense? Yeah.
- [20:17]
A
About how many times will you see a person as you're going through this assessment process to really get that good understanding about whether they're appropriate and meet the criteria? Sure.
- [20:27]
C
I actually require three session minimum so that I can get in and do their biopsychosocial. I can do some assessment and then I can also educate them about ESAs. I don't want to hand over a letter and just say, hey, bye, you know, good luck. I want to make sure that they understand what the laws are, what their rights and responsibilities are and the stressors really, that are associated with ESAs. Let's say flying, for instance. Airlines do have specific policies or procedures that can vary from airline to airline. So they need to be able to understand that it's their responsibility to reach out to that airline in advance, that they need to submit the required documentation usually at least 48 hours before their flight. And then of course, when they get there, they're going to have to find the animal relief area, they're going to have to make sure they're appropriately leashed or crated. They're going to maybe have to deal with some stigmas associated with ESAs and maybe side eyes that they're getting from other passengers. Right. So really making sure that they're really prepared for what this entails. Because I wouldn't want to hand over a letter to someone that maybe an ESA is actually going to cause them more stress or harm than good. Right. So that last session of the three, at least three, is always making sure that I educate them about what to expect.
- [21:51]
B
I love how comprehensive you are and really, you know, going through the whole process but really educating them. I know that you said you have the E course for mental health professionals. Do you have one for, you know, people who are looking to do wanting an esa?
- [22:05]
C
That's a fantastic idea. I have thought of it. I haven't gone that route yet. I want to make sure that I'm preparing as many mental health professionals as possible first so that we can go about this the right way and making sure that we're protecting our clientele. You know, we're not just giving away a letter to somebody who we think just could help them without actually going through a structured process. Right. I do think that it could be beneficial for the general public or people who are seeking ESAs to have some more resources. I do have some blog posts on my website that are public facing, but I haven't created a course or anything like that yet. I do have a public facility Facebook group, or rather it can be found. Right. It's closed Facebook group for mental health professionals. But I've had quite a few individuals who are ESA advocates or people who are seeking ESAs that actually try to request to join. But I'm only allowing in the mental health professionals at this point just so I can help educate them and answer questions and things of that nature.
- [23:13]
A
And I have another question for you. This has been so helpful by the way, just to clarify these different aspects and what the process looks like. So thank you so much. And then also, once you give someone the approval and they've gone through this assessment process, they get their letter from you. Is there any sort of a follow up process maybe six months or a year down the road to refresh their documentation and reassess, or is it just kind of like a one and done once they go through that initial assessment?
- [23:42]
C
Yeah, that depends really on the policy or procedure that's set up. So that could vary from professional to professional and how they decide to respond to the requests. For instance, psychologists, the APA has said, hey, you know, this is blurring the lines between provider and assessor or therapist and assessor. So there are going to be some people that are just sort of a one and done. They assess and then refer out for ongoing treatment. Or there are some that are going to incorporate that into their therapeutic approach with the individual. And there can certainly be ways that you can achieve both of those roles of just assessing or assessing as you're going through the therapeutic process with an individual. So it's kind of a gray area. You know, it depends on how the individual decides with their ethics they're going to approach this. For me, I have had the majority of my people that come in specifically looking for ESA assessments. Stay with me. So, you know, they go through the required three sessions and then they get their letter and they're like, but I also want to work on the issues associated with this. Right. Which is sort of the hope. We don't want to just say, here's your letter K. Good luck. Bye. So they've stuck around and they've worked on some of their concerns. I've also had some that come with to me from other providers that aren't ESA informed and I do their assessment and I send them back to their therapist. As far as renewing the letter, within the law, it's typically said that these letters are good or valid for a year. So after that point they should come back and get another letter. And it would be another full assessment to see if they still meet criteria and if it's still something that, you know, they really can benefit from.
- [25:34]
B
That's awesome. So speaking of the letter, what kind of goes into this letter?
- [25:38]
C
Yeah, so really we need to identify that they have a disability, that they have an animal that they've identified to be their ESA and that we're sort of endorsing it. So it's really a very short and sweet letter. It's really the minimum necessary. Right. We always try to go back to that. The minimum necessary to disclose. So a lot of people will think, oh, I need to identify the specific diagnosis or I need to list out the symptoms or the things that this animal helps alleviate. But that's not the case. We really just need to acknowledge that, yes, they meet the criteria. And the individual has requested to have an esa. There is some legal guidance that says we don't want to identify the specific animal because that could sort of imply that we've assessed the animal themselves in some way and that would definitely be outside of our scope of practice. Right. The majority of us, I would venture to say, are not animal trainers, behaviorists, you know, things like that. So we are not actually assessing the animal themselves, just the individual and that they have a disability and they've identified that these symptoms are alleviated just by the animal's presence. So, you know, if you really were hard pressed by, let's say, a housing authority that says, you know, we need to know which animal they're going to be identifying as their esa, you can just you know, push back a little bit if you really think that they're being sort of hard on the client about it. Or you can just say, well, they've identified their ESA as their dog, but not like Bella the dog. Right. So we don't want to necessarily be quote unquote, endorsing the animal themselves. Does that make sense?
- [27:19]
B
Yeah. Okay, now I have a really important question.
- [27:22]
C
Okay.
- [27:22]
B
Do you have any animals yourself and if so, what are their names?
- [27:26]
C
I do. I have a six month old puppy named Gracie. She is a border collie and hound mix.
- [27:34]
A
Very cool.
- [27:35]
C
Yeah.
- [27:35]
B
So interesting thing about Kate and I, we do share a brain and Kate has a Pomeranian, a black Pomeranian, Roxy.
- [27:42]
C
Roxy.
- [27:43]
B
And we are in my family, we're pit advocates. So we have Charlotte. And then we, over a year ago we adopted another rescue pit bull. And interestingly enough, her name is Rossi.
- [27:53]
C
That's awesome.
- [27:55]
B
She came with that name and we kept her name. So.
- [28:00]
C
So fitting, right?
- [28:02]
B
So fitting that we would both have dogs named Roxy.
- [28:04]
A
Yes, I know, it's pretty funny. Becky, this has been so helpful. Thank you so much for coming on and really helping us to have a good understanding of this. And I know that Startup Nation is going to find this really, really useful as well. What do you want to have our listeners take away from what you shared today?
- [28:19]
C
I think the main point is that as long as you are informed, you're knowledgeable, you're competent, and you're confident about emotional support animal related information, you can certainly incorporate this into your practice and it can be great to have this because a lot of the clients out there that really genuinely can benefit from an emotional support animal are unfortunately getting trapped in those registry or certificate sites that are not the legitimate ways to go about it. So we can really be Better advocates for our clients by adding in ESA services to our existing services so they can go about this the right way and that we're essentially not doing harm. You know, we're helping to support and advocate our clients and their autonomy in order to get the ESA letter the right way.
- [29:09]
B
And also too, if they are wanting to be more, get more help. Is you have an E course. So what do you share about your E course?
- [29:16]
C
Yes, so I have an E course for mental health professionals. It's called oh no, sorry. From oh no to yes, I can. Responding to and evaluating emotional support animal requests. I put it that way because a lot of us are like, oh no when we get an ESA request. Right. But yes, I can is ultimately what we want to get people toward. Right. Is that we can respond to these without just a simple no. This is outside my scope of practice. We want to be able to respond with a. Let's talk about it. I do have a policy and procedure in place. Let's see if you fit the criteria and then be able to evaluate and move forward with that.
- [29:55]
B
I know that you have a giveaway and I want you also to share your Facebook page group, I think it is. So what is your giveaway?
- [30:01]
C
Yeah, so my giveaway is actually a free sample lesson of the E course and it's a summary of the overarching differences between service animals, emotional support animals, therapy animals, and pets. Because these things are a little bit convoluted, a little bit overlapping in certain cases. I actually cover a summary of those differences and I have a downloadable chart in there as well, so it can be a nice desk reference so that you understand the differences. Awesome.
- [30:30]
B
Well, Becky, it's been such a pleasure having you here today. And you know, one of the things I think that comes to my mind is back in episode 121, we had Juan Santos talking about immigration evaluations. And if you know anything about our podcast, Kate and I are always preaching about niche and ideal client. And I think this is a great way with what Becky introduced and in suggesting for emotional support support animals, like, if this is a niche that you feel called to do, awesome. I would definitely recommend taking her course because she has a great wealth of information and knowledge. And we'll also include in the show notes the link to Juan's podcast about the immigration evaluations. And we hope you guys join us next time. For Zoe Hogan, another request by you guys is you guys wanted to hear her talk about getting your private practice ready to scale into another source of income. I get chills when I say this because I just love talking about money and saving and income. But before we sign we want to make sure that you guys check us out in Facebook and we also had our Startup Nation superhero shout out that we wanted to just shout out Jolene. And Jolene says love this podcast, just starting out and these ladies are so supportive and down to earth. I know she's shouting us out but girl, we're shouting you back out right there. So we are so here to help you, support you and your journey from startup to mastery. So Startup Nation, have a fantastic and inspired day. Thanks again to Becky and we'll see you guys on the next podcast. Don't forget to get your HIPAA form so you can have a potential to win the Peak package for the month of April 2019. We'll see you guys later.
- [32:04]
A
Thanks for joining us on the Private practice startup. Visit theprivatepracticestartup.com for awesome resources, free trainings, attorney approved private practice paperwork and so much more.
- [32:19]
C
Sam.