As part of your AAOT Foundation Learning, you have been asked to complete external learning in trauma-informed care and understanding trauma.

We have included this learning because Occupational Therapists working with assistance animals will frequently encounter people who have experienced trauma. Sometimes trauma will be directly related to the disability or functional difficulties for which an assistance animal is being considered. At other times, it may be part of the person’s history but not the reason they are seeking an assistance animal at all.

Trauma may arise from experiences including:

• violence or abuse;
• sexual assault;
• domestic and family violence;
• childhood adversity;
• war, persecution or displacement;
• accidents or serious injury;
• medical treatment;
• disasters;
• institutional experiences;
• loss and bereavement;
• workplace incidents;
• animal attacks;
• sudden illness or disability; or
• other experiences perceived by the individual as overwhelming or threatening.

However, trauma-informed practice is not about assuming that everybody has trauma, diagnosing trauma, or encouraging people to disclose traumatic experiences.

Instead, it asks practitioners to recognise that previous experiences can influence how somebody experiences services, relationships, environments, power, choice and safety.

For an AAOT, this is particularly important because assistance-animal assessment can involve the person’s home, body, disability, routines, relationships, vulnerabilities and experiences in the community.

Trauma-Informed Practice Is Not Trauma Treatment

There is an important distinction between being trauma-informed and providing trauma-specific treatment.

An OT can practise in a trauma-informed way without providing psychotherapy or attempting to treat PTSD.

Trauma-informed practice broadly means recognising the possible effects of trauma and designing professional interactions in ways that promote:

• safety;
• trust;
• transparency;
• collaboration;
• choice;
• empowerment;
• respect; and
• avoidance of unnecessary re-traumatisation.

Trauma-specific interventions, by contrast, are treatments specifically intended to address trauma-related symptoms and should only be provided within the practitioner’s appropriate scope, competence and professional role.

An AAOT should therefore not conclude:

“This person has trauma, so I need to get them to talk about it.”

Often, the opposite may be true.

You Do Not Need the Whole Trauma Story

An assistance-animal assessment does not require a person to recount every traumatic experience they have had.

Ask yourself:

Why do I need this information?

If the answer is simply that it helps you understand the person’s functional needs, you may only need to know the functional consequences, rather than the details of what happened.

For example, it may be relevant to know that someone:

• experiences nightmares;
• has difficulty sleeping;
• experiences panic in particular environments;
• becomes distressed when unexpectedly touched;
• avoids particular places;
• has difficulty being alone;
• experiences dissociation;
• has difficulty trusting unfamiliar people; or
• requires particular environmental adjustments.

It may not be necessary for an assistance-animal report to contain a detailed account of the assault, violence or other traumatic event underlying those difficulties.

Trauma-informed practice includes knowing when not to ask.

Trauma Does Not Tell You What Someone Will Be Like

Avoid assumptions such as:

“Trauma survivors are difficult to engage.”

“Someone with PTSD will want a psychiatric assistance dog.”

“This person is refusing because they are traumatised.”

People respond to trauma differently.

Someone may:

• want to discuss what happened;
• never want to discuss it;
• experience significant ongoing symptoms;
• experience few ongoing effects;
• describe themselves as traumatised;
• reject that terminology;
• want psychological treatment;
• not want psychological treatment;
• want an assistance animal;
• or have absolutely no interest in one.

The individual remains the expert on their own experience.

Behaviour May Have Meaning

Someone who appears:

• withdrawn;
• angry;
• guarded;
• controlling;
• avoidant;
• disengaged;
• highly anxious;
• reluctant to answer questions; or
• unwilling to participate

should not automatically be labelled “non-compliant”, “difficult” or “unmotivated.”

There may be many explanations.

Trauma-informed practice encourages the practitioner to consider:

“What might be happening for this person?”

rather than immediately asking:

“What is wrong with this person’s behaviour?”

Importantly, this does not mean that every behaviour should be attributed to trauma.

It means remaining curious rather than making premature conclusions.

Choice and Control Matter

Traumatic experiences can involve profound loss of control.

Healthcare and disability systems can unintentionally reproduce similar dynamics when professionals:

• make decisions without consultation;
• insist upon unnecessary disclosure;
• touch without warning;
• use unexplained procedures;
• speak about the person rather than to them;
• involve other professionals without explanation;
• pressure someone to accept an intervention; or
• imply that funding depends upon agreeing with the practitioner’s recommendation.

Where possible, provide meaningful choice.

Explain:

• what you are doing;
• why you are asking questions;
• what information you need;
• who will receive your report;
• what will happen next;
• what the person can decline;
• and what alternatives exist.

Consent Is Ongoing

Consent is not simply a form signed at the beginning of an assessment.

Someone may agree to:

• an assessment;

but not necessarily:

• every question;
• every physical assessment;
• every person attending;
• every photograph;
• every discussion of trauma;
• every proposed intervention; or
• an assistance animal itself.

Consent should be considered throughout the professional relationship.

A person is allowed to change their mind.

“They Asked for an Assistance Animal” Does Not Mean They Must Continue

This is particularly important in AAOT practice.

A participant may originally request an assistance animal and later say:

“I don’t want one anymore.”

That should not automatically be interpreted as:

lack of insight, avoidance, non-compliance or trauma interfering with decision-making.

Perhaps they learned more about:

• the responsibility;
• training requirements;
• costs;
• public attention;
• animal-care demands;
• limitations;
• alternative supports; or
• what living with an assistance animal actually involves.

They may simply have changed their mind.

A successful assessment can conclude:

An assistance animal is not what this person wants.

Professional success should not be measured by how many people proceed to an assistance animal.

Safety Means More Than Physical Safety

Trauma-informed practice often discusses safety, but safety can mean different things to different people.

A practitioner might consider an environment physically safe while the participant experiences it as threatening.

Relevant factors may include:

• who is present;
• noise;
• proximity;
• doors and exits;
• unexpected touch;
• gender of professionals;
• uniforms;
• authority figures;
• medical environments;
• animals;
• smells;
• particular equipment;
• privacy;
• unpredictability; or
• previous experiences.

You do not need to understand every reason for a person’s preference before respecting a reasonable request.

Assistance Animals Can Affect Feelings of Safety

For some people, an assistance animal may support a sense of security or confidence in the community.

But this requires careful professional reasoning.

There is an important difference between an animal performing a legitimate disability-related assistance task and an animal being used for protection or security.

An assistance animal should not be trained to:

• threaten people;
• guard aggressively;
• attack;
• intimidate;
• bite; or
• perform personal-protection work.

If somebody says:

“My dog makes me feel safe.”

explore what that means.

Perhaps the animal:

• responds to escalating distress;
• interrupts a particular behaviour;
• retrieves medication;
• provides a trained grounding response;
• wakes the person from nightmares;
• assists them to exit an environment;
• performs another trained disability-related task; or
• simply provides companionship.

Those are different functions and should not be conflated.

Trauma Does Not Automatically Mean an Assistance Animal Is Appropriate

A trauma history or PTSD diagnosis does not automatically establish that someone needs an assistance animal.

The AAOT still needs to consider:

• occupational performance;
• functional impairment;
• existing supports;
• environmental barriers;
• the person’s goals;
• alternatives;
• proposed animal tasks;
• feasibility;
• risks;
• sustainability; and
• animal welfare.

The question is not:

“Does this person have enough trauma to qualify for a dog?”

It is:

“What are the person’s functional needs, and is an assistance animal an appropriate component of addressing them?”

Consider Alternatives Before Assuming the Animal Is the Answer

As with every assistance-animal assessment, an animal should not automatically be the first intervention considered.

Depending upon the person’s needs, alternatives or complementary supports might include:

• environmental modifications;
• assistive technology;
• psychological support;
• occupational strategies;
• sensory supports;
• human assistance;
• communication supports;
• changes to routines;
• community supports;
• medication management by the appropriate practitioner; or
• other interventions.

An assistance animal may eventually form part of the person’s support system.

It should not become a substitute for appropriate treatment, safeguarding or environmental change.

Public Attention Can Be Difficult

An assistance animal can make an otherwise invisible disability highly visible.

Members of the public may:

• stare;
• ask questions;
• approach;
• photograph the animal;
• attempt to touch it;
• ask intrusive questions about disability;
• challenge access;
• or create conflict.

For somebody with a trauma history, this increased attention may be significant.

An intervention intended to increase community participation could potentially make some environments more difficult.

This does not necessarily make an assistance animal unsuitable.

It means the consequences need to be considered before recommending one.

Matching the Animal Matters

Trauma-informed practice also affects animal selection.

For example, a person may be uncomfortable with:

• large dogs;
• sudden barking;
• particular breeds or appearances;
• jumping;
• rapid movement;
• physical pressure;
• licking;
• being approached from behind; or
• unexpected physical contact.

Conversely, another person may strongly prefer particular characteristics.

These preferences should not automatically be dismissed as irrational.

A technically capable animal may still be a poor match if its characteristics repeatedly cause distress to the person it is intended to assist.

The Animal Is Not a Therapeutic Tool Without Needs of Its Own

Trauma-informed practice remains subject to animal-welfare principles.

An animal should not be expected to absorb unlimited distress because doing so appears beneficial to the handler.

Consider:

• whether the animal understands the task;
• whether the task is appropriate;
• whether the animal can disengage;
• workload;
• rest;
• signs of stress;
• veterinary health;
• behavioural welfare;
• the environment;
• and whether the human-animal relationship remains sustainable.

The person’s trauma does not justify compromising the animal’s welfare.

Both matter.

Trauma Can Affect Animal Care

Trauma-related difficulties may sometimes affect:

• routines;
• leaving home;
• sleep;
• concentration;
• memory;
• motivation;
• financial stability;
• attending appointments;
• maintaining training; or
• providing consistent animal care.

This does not automatically mean the person cannot have an assistance animal.

Instead ask:

What support would make the arrangement sustainable?

This may involve:

• family;
• support workers;
• trainers;
• veterinarians;
• reminders;
• care plans;
• contingency arrangements; or
• other practical supports.

The appropriate question is whether the animal’s needs can reliably be met—not whether the person can do everything independently.

Trauma and the Human–Animal Relationship

Animals can become extremely important within someone’s life following trauma.

This can be positive.

However, practitioners should also consider whether the relationship creates vulnerabilities.

For example:

• What happens if the animal becomes ill?
• What happens when the animal retires?
• What happens when the animal dies?
• Is there a backup plan?
• Does the person have other sources of support?
• How will retirement be approached?
• Is the person being prepared for the working life of the animal to end?

Assistance animals are living beings with finite working lives.

Planning for retirement, illness and loss is part of responsible assistance-animal practice.

Loss of an Assistance Animal Can Be Profound

The retirement, serious illness or death of an assistance animal may involve several losses simultaneously.

The person may lose:

• a companion;
• disability support;
• independence;
• routine;
• confidence;
• community access;
• a working partnership;
• part of their identity; and
• a relationship that may have lasted many years.

For some people, the loss may also interact with previous traumatic experiences.

Practitioners should avoid minimising this as:

“just losing a pet.”

At the same time, significant grief should not automatically be pathologised.

Appropriate support should be individualised.

Be Alert to Significant Distress and Risk

During assistance-animal work, a person may disclose:

• hopelessness;
• thoughts of self-harm;
• suicidal thinking;
• significant deterioration in mental health; or
• another immediate safety concern.

Trauma-informed care does not mean attempting to manage serious mental-health risk outside your competence.

Know:

• your professional responsibilities;
• organisational procedures;
• applicable legal requirements;
• appropriate referral pathways;
• and when urgent assistance is required.

Suicide awareness is addressed specifically in a later AAOT foundation topic.

Avoid Re-Traumatisation Through Professional Processes

Sometimes the system, rather than the intervention itself, causes unnecessary distress.

Consider whether your assessment requires the person to:

• repeatedly tell the same traumatic story;
• obtain multiple letters describing deeply personal events;
• prove their disability repeatedly;
• recount trauma to professionals who do not need the details;
• attend unnecessarily confronting environments; or
• disclose sensitive information in documents that will circulate widely.

Where possible, minimise unnecessary repetition.

Use existing evidence appropriately.

Collect the information you actually need.

Document sensitively.

Documentation: Functional Information Rather Than Unnecessary Detail

Trauma-related information should be documented carefully.

An assistance-animal report might appropriately state:

The participant experiences trauma-related nightmares resulting in significant sleep disruption and daytime occupational impairment.

It may not need to provide a detailed account of the event responsible for those nightmares.

Ask:

Does the reader genuinely need this information to make the decision for which this report is being prepared?

If not, consider leaving it out.

Trauma-Informed Practice Does Not Remove Professional Boundaries

Being compassionate does not require:

• becoming someone’s therapist when that is not your role;
• being available at all times;
• keeping dangerous secrets;
• agreeing with every request;
• avoiding difficult conversations;
• recommending an assistance animal you consider inappropriate; or
• acting outside your competence.

Clear and predictable professional boundaries can themselves support safety and trust.

Interdisciplinary Practice

Some situations require input from professionals with expertise beyond the AAOT’s scope.

Depending upon the circumstances, this might include:

• psychologists;
• psychiatrists;
• GPs;
• counsellors;
• social workers;
• specialist trauma services;
• domestic and family violence services;
• sexual-assault services;
• occupational therapists with relevant specialist expertise;
• veterinarians;
• animal behaviour professionals;
• assistance-animal trainers; or
• other appropriate professionals.

Collaboration should occur with appropriate attention to consent, privacy, safeguarding and professional responsibilities.

What This Means for an AAOT

Your external trauma learning provides a foundation for approaching assistance-animal practice differently.

Consider:

Do I actually need to know the details of this person’s trauma?

Am I providing meaningful choice and control?

Have I explained why I am asking this question?

Am I interpreting behaviour too quickly?

Could my assessment process itself cause unnecessary distress?

Has the person changed their mind about wanting an assistance animal—and am I respecting that?

What functional problem is the proposed animal actually addressing?

Could an alternative or less intensive intervention address it?

Will an assistance animal increase unwanted public attention?

Is this particular animal appropriate for this particular person?

Can the animal’s welfare needs be sustainably met?

What happens when the animal becomes ill, retires or dies?

Am I documenting sensitive information that the reader does not actually need?

Does this situation require another professional?

The central principle is:

Trauma-informed practice is not about finding trauma everywhere. It is about creating professional practice that recognises the possible effects of trauma while preserving safety, choice, dignity, autonomy and appropriate professional boundaries.

Continue This Topic in Your Reflective Workbook

You have now completed the foundation material for:

Topic 11 — Trauma-Informed Care

Please complete the recommended external Trauma-Informed Care / Understanding Trauma learning identified in your AAOT Foundation Learning requirements and then refer to the corresponding section of your AAOT Foundation Learning Reflective Workbook.

The workbook will ask you to apply this learning to realistic assistance-animal situations involving:

• trauma and occupational participation;
• apparent disengagement or refusal;
• consent and choice;
• unnecessary trauma disclosure;
• assessment processes;
• trauma-related functional needs;
• assistance-animal tasks;
• alternatives to assistance animals;
• public attention and visibility;
• animal matching and welfare;
• interdisciplinary practice;
• changing one’s mind about an assistance animal;
• serious distress;
• retirement, illness and loss of an assistance animal; and
• sensitive professional documentation.

Some scenarios may involve people whose behaviour has previously been described as “difficult”, “defiant” or “non-compliant.” You will be asked to consider whether a trauma-informed approach changes how you understand the situation—and equally importantly, when it would be inappropriate to assume trauma explains the person’s behaviour.

You may return to these activities throughout AAOT as your understanding develops. Your reflections may also contribute to your Capstone Portfolio, Capstone projects and later integrated case work.

Once you have completed or commenced the corresponding workbook activities, continue to Topic 12 — Vision-Related Practice.