Butterfly Paws: Facility and Therapy Dogs for Kids – PediaCast 565

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  • The Butterfly Paws team visits the studio as we explore the role of facility and therapy dogs at Nationwide Children’s Hospital. These gentle, well-trained canines offer a healing touch and supportive care for kids who need it most. We hope you can join us!

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  • Butterfly Paws
  • Facility Dogs
  • Therapy Dogs

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Dr Mike Patrick: This episode of PediaCast is brought to you by the Butterfly Paws program at Nationwide Children's Hospital.

Hello everybody. And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 565. We're calling this one Butterfly Paws: Facility and Therapy Dogs for Kids. I want to welcome all of you to the program.

So, you might not initially expect to see a dog when you visit a children's hospital, especially if you do not attend children's hospitals very often. But facility and therapy dogs actually have an important role in pediatric healthcare. Of course, these are special dogs with a gentle temperament and lots of training, and they are accompanied by handlers who are sensitive to the medical needs of children.

These friendly canines offer a healing touch and supportive interactions. When young patients need them most. So today we're going to explore the Butterfly Paws program, which provides facility and therapy dogs at our hospital. But what exactly is a facility dog and how do they differ from therapy dogs?

How are these animals selected and trained and what exactly is their role? Or roles within the hospital. We'll stick around because we will have answers to these questions and more as we explore the Butterfly Paws program at Nationwide Children's Hospital. Of course, in our usual PediaCast fashion, we have several terrific guests to share their thoughts and experience with us.

Melissa McMillan is the program manager of Butterfly Paws. Rochelle Krouse is one of our dog handlers, both of them from Nationwide Children's Hospital. And Dr. Lisa Humphrey is with Palliative Care also at Nationwide Children's. Before we get to them, I do want to remind you the information presented in PediaCast is for general educational purposes only.

We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you're concerned about your child's health, be sure to call your healthcare provider. Also, your use of this audio program is subject to the PediaCast terms of use agreement, which you can find at PDA cast. org.

So, let's take a quick break. We'll get our experts connected to the studio, and then we will be back to talk about Butterfly Paws. It's coming up right after this.

Melissa McMillan is the Program Manager for Butterfly Paws at Nationwide Children's Hospital. Rochelle Krouse is a Dog Handler for Butterfly Paws and a Therapeutic Recreation Specialist with Inpatient Clinical Therapies at Nationwide Children's. Dr. Lisa Humphrey is the Medical Director of Palliative Medicine at Nationwide Children's.

She is also an associate professor of pediatrics at the Ohio State University College of Medicine. All three have a passion for supporting patients and families through interactions with facility and therapy dogs through the Butterfly Paws program at our hospital. Much more on that to come, but first let's offer a warm PediaCast welcome to our guests, Melissa, Rochelle, and Dr. Lisa, thank you all so much for visiting us today.

Melissa McMillin: Thank you for having us. Absolutely excited.

Dr Lisa Humphrey: Oh, thanks.

Rochelle Krouse: Yes. Thanks for having us.

Dr Mike Patrick: Yeah, we are really so excited that, uh, that all of you are here today. I think a great place to start is really Melissa. If you could just explain what is the Butterfly Paws program and what role does it play here at the hospital?

Melissa McMillin: Sure. The Butterfly Paws program is really here to provide compassionate care by utilizing a kennel of trained facility and therapy dogs. That primary goal is to provide comfort, joy, and therapeutic interventions to Our patients, families, and our staff. We know that the, that canines can provide just a healing touch that extends beyond our human approach sometimes.

And our, our goals are really to work on providing health and recovery within the organization and looking at providing support and emotional wellbeing to our patients, families, and our staff, empowering our teams, fostering some positive healthcare environments. Engaging our community because as I said, it takes a kennel of well-trained canines and, and it takes a lot of community support.

And establishing those public connections that help us to be able to provide this program within the hospital.

Dr Mike Patrick: So, so these are dogs that are in the hospital, engaging with patients and families. How did this program get started? You know, how, how old is it? And I would imagine in the, in the early days, like, cause I'm thinking.

1980s, for example, there may have been a little bit of pushback on having dogs in a hospital. Like, you know, is there a cleanliness issue and you think about public health stuff, but I'm sure that there's been evidence to show that the benefits of this are far outweigh any risks that there might be, but I'm just curious how this all got started.

Melissa McMillin: Yeah, that's a great question. We've had volunteer presence through Family and Volunteer Services probably about 18, 20 years ago. We had a small, a group of volunteers that came in and looks very different than today. We also have facility dogs that have been within our program since 2006. That was their first facility dog that we utilized.

And we partnered with Canine Companions, our local. Well, they're, they're beyond local, but they are local here to us. So, they provide those service dogs that help us support our patients directly. So, in March 2024, we took both of those programs that existed under volunteer services and under clinical therapies and put them under one umbrella called the pPaws Program.

And that is how we got started by being able to utilize not only just our facility dogs in one area and our therapy dogs in another, but putting that under one kennel, as I mentioned earlier. Of teams that we are looking at growing and expanding throughout the organization.

Dr Mike Patrick: So, as we think about the dogs, so Butterfly Paws has really just been since the pandemic, but we did have the two individual programs during the pandemic.

Were those on pause or did you do virtual visits or how did that work during COVID 19?

Melissa McMillin: Yes. Unfortunately, all those programs with our canines were on pause. We were just really working closely with epidemiology. At that time and not able to bring our dogs in over that, that period. So, we brought them back.

I don't know, I guess we're showing you can help me with that over the last two years, I believe we've started returning with all of our dog teams and expanding beyond facility dogs but increasing our therapy dog presence to include a staff pilot program as well.

Rochelle Krouse: Yeah, they were, I think Beck was home for a year before he was allowed to return to start seeing patients again.

Dr Mike Patrick: Yeah. So, Rochelle, we're hearing different terminology with regards to facility dogs and therapy dogs. What, what are the, what's the difference between those two groups of canines?

Rochelle Krouse: So, my dog, Beck, he's, uh, considered a facility dog. He is a dog that works directly with patients and is really like patient centered around what he does.

And he works with, as you said earlier, I'm with clinical therapies, uh, And I help use him on our rehab unit to help with patients, to help with motivation and help get them up and moving and help them progress towards their therapeutic goals that they're working on rehab. And as far as our therapy dogs go, they can have a variety of roles.

They, some of them are going up to units. Some of them are in the lobby area, being able to meet with patients and families and staff. So, they are. They can be used in a variety of roles to help with patients, families, and staff to help out here in the hospital with the different stressors that people might be facing.

Dr Mike Patrick: So, it sounds kind of similar. Is there, are there differences between those two? Like if I see a dog in the hospital, how do I know if it's a facility dog or a therapy dog, or does it really even matter?

Rochelle Krouse: I, I think the facility dogs are, are a little bit differently trained, a little bit more highly trained to kind of meet the needs of patients.

So, we want to make sure that they're safe to use directly with patients. We've got a lot of patients with different kinds of medical lines and equipment and things like that. So they're especially trained to be able to like tolerate being with a patient who maybe has a wheelchair or a walker or different kinds of medical equipment that they have to be cautious around and not being rambunctious or things like that that could potentially cause injury to a So I think that's one of, one of the main differences, although the therapy dogs are all very well trained and behaved as well, but they, some of them are a little bit more, more geared towards not only patients, but also families and staff to help with those stressors that they're facing.

Dr Mike Patrick: So, the facility dogs are actually the ones that are more highly trained. You know, trusted around patients and lines and wheelchairs and all those things. And the therapy dogs are really just in the hospital and interacting with folks because they're still well behaved, but maybe don't have as much experience being with patients, you know, in, in the hospital who have things going on.

Rochelle Krouse: Yeah. And I think Melissa could maybe give a little bit more information about that too.

Melissa McMillin: Yeah. Just to add on to that, the, our facility dogs, as I mentioned, we partner with canine companions. Yeah. Those are professionally trained dogs that are born and bred to be service animals. And the reason they're called facility dogs is because their job is to be provider.

They're working dogs that provide a service in a facility. And those dogs have been trained from birth to two years old before they're placed to do a specific job or job task. They come with about 50 commands and there's an extensive training process and bonding period with whoever that dog is going to be placed with in this, this process it's with Rochelle.

So, Rochelle went through an extensive training to be able to learn those commands and be able to manage her dog, to be able to support those very high-level skill of services and tasks driven. Opportunities within her patients. They are only patient focused and they are very goal directed. So that's how they, they are an additional treatment modality that we use to help our patients when our typical interventions aren't working. I often say we affectionately call them our highest-level dogs or our MDs within the hospital, because they have achieved that highest level of training. And then as Rochelle was talking about our therapy dogs are pets of our staff or volunteers. And they train their dogs themselves and work with agencies that we, we vet, such as Alliance of Therapy Dogs or Therapy Dog International.

And they've achieved not only that therapy dog registration, but they also have to pass our ability and our testing within the hospital. Because as you mentioned, not every dog will tolerate. Every area, eventually we want to get those dogs of our therapy dogs up to patient access, but you might have the great clinical skill, but the dog might tell us differently and say, we don't want to be up on those units.

And they want to support just those canine visits in our canine corner, which is our lobby area. So, there is a big difference between our therapy dogs and our facility dogs. And I think Lisa, you probably have a lot to offer with that because Lisa is Does have one of our, our therapy dogs that she uses very differently than how Rochelle utilizes the facility dog and in care.

Dr Mike Patrick: So, uh, regardless of if a given dog that you encounter in a hospital as a patient or a family member, you know, you can trust that these dogs have been selected and trained and that they are, uh, they're doing a job. You know, maybe you don't want to touch them without talking to the handler first. You know, there needs to be any boundaries set just as a.

As a patient or family in the hospital, that's going to be important. Dr. Lisa, what, what are some benefits then of having these dogs, whether it's a facility dog or a therapy dog in the hospital setting? What, what do patients and families get out of this?

Dr Lisa Humphrey: I think I can speak more to the therapy dog benefits.

I'll try Rochelle, but I want you to add on in. From a therapy dog perspective, it really allows me as a clinician who works with children who are often critically ill or chronically ill and often have very long hospital stays and they may miss their family pet. They may get sick of being labeled just the patient, right?

And they're starting to be stripped of all their other identities. Same with families, right? Families become parents, become patients’ parents, and, you know, they can lose a lot of their identity. I can bring my dog, Crisp, who is a therapy dog. He is actually one of the more trained therapy dogs because Canine Companions lovingly did raise him, but he had other plans for himself.

He's a little too social. But he fits the therapy dog role exceptionally well, because he's actually very, very well behaved, thanks to Canine Companions. Canine Companions. And then they released them to me, and I just try to hold on for dear life to all his good training. But the dog just loves to be petted and he seems to just sense when family or patients are having a rough day.

And so, he'll very naturally just go sit at the feet of a parent whose child might be in the ICU and just really having a hard day and maybe not even able to find the words and you see them just reaching down and petting. And as the research shows, right, you, you have a release of good hormones, and you just feel better after that presence.

So, there may be nothing I can say to fix the situation, but Crisp's presence can certainly just remind everyone of their humanity a bit and just really flush out the experience they're having here at Nationwide Children's. And I would say the same for staff, because Crisp really thinks his primary job is to herd all the staff into a better day.

Um, and he may not have an MD, but he has a PhD in happiness. And so, they really look forward to seeing him.

Dr Mike Patrick: Yeah, I bet. And you know, especially when you're thinking about an ICU setting where the staff, you know, it's really high-level critical thinking and you're on task all the time and it can be pretty stressful.

And so to have some of those feel good hormones released when you're in the midst of craziness, That was really important for the staff and then I would guess that that translates into improved patient outcomes just in terms of maybe I'm better suited to pay attention to all those details if I've also have some balance of feeling good and having the, the, the dog there.

Um, supporting me while I'm, while I'm doing my job of supporting the patient.

Dr Lisa Humphrey: Unlike the facility dogs, therapy dogs typically aren't expected to be working with patients around the floor as often. They really, you can watch Crisp sort of tuck her out a bit during the day. So I really try to target when I bring them up and I do, I focus on knowing what units are having a rough day, what families are having a rough day, and you know, with, with the intent of trying to fill the gas tank a little bit and anecdotally staff are absolutely telling me that they just feel like they can, you know, pick, pick themselves up and move on.

And I would say one of the maybe unexpected or maybe unresearched things that I increasingly notice is his ability to create community. So certainly, every floor has an identity but when you're having a bad day, and the dog comes and maybe twelve people come up. And they're just having a moment together and honestly parents join in on that right, so we have in it.

Encounters whereby all are together creating community and. I have to believe community can only do benefit right when you're, when you're going through something difficult like this. Yeah, yeah, Melissa.

Melissa McMillin: Yeah, I, I just will echo what Lisa said and what Rochelle is sharing. I think everything we do at Nationwide Children's Hospital is rooted in evidence and really what Lisa was talking to.

There are a lot of studies out there that tell us just after five minutes of seeing or interacting with a facility dog or a therapy dog reduces a stress marker or those cortisol levels. And I definitely, too, can see that when I'm with any of our volunteer teams that we're working on training and getting up to patient care units, people just gravitate, and the dogs are magnets, and I think that there's studies, too, that report that there's greater work fulfillment and positive description of work-related stress associated with the dogs.

So, those connections are so powerful. And I think really unexpected to me too, as I have had one of our facility dogs that is slowly retiring into that therapy dog role, being able to experience that has just been so joyful because people establish connections. That are really, really positive. And then when you can do that on a social level, then that helps you really work through those challenging, difficult conversations that we encounter in healthcare.

And it's just been such a joy to be able to watch that.

Dr Mike Patrick: You know, I think it, when people think about a therapy and facility dog program like Butterfly Paws, probably the first thing that sticks in their mind is as an important thing is. Selecting the dog, the training of the dog, the temperament of the dog, all, all of those things.

But as a program manager, Melissa, I would imagine your staff is equally important. Because you really have to read the room or the lobby, but in terms of what's going on with the patient and the family and the staff, and also how is the dog doing like you're really juggling a lot of social, emotional intelligence to try to figure out what the best tactic is.

Is that a good description of what these folks need to do?

Melissa McMillin: It is a good description. And I think that's something to be mindful of that. There's a very extensive application process on every level and every tier. We want to make sure that whether it's a volunteer staff or a facility dog staff member, that we're putting those dogs in the right spaces and for the right reasons and for the right times.

It sometimes. Is really when you're talking canines and dogs, they're going to tell you what they want to do. And we have to be mindful of that. They have some, some volunteer teams that actually are also physicians in the hospital, and they have such great clinical disposition because they're MDs. But their dog does not want to tolerate being on an inpatient unit at this time.

So, we really try to partner with the person, the human, and the canine to put everybody in those bright health situations to be successful in really supporting the hospital, including our patients, families, and the staff.

Dr Mike Patrick: Yeah, yeah, absolutely. Rochelle, what does a typical day look like from the dog's perspective?

Is this a full nine to five kind of job five days, six, seven days a week, or do they get breaks? Like what, what does their day look like?

Rochelle Krouse: Yeah. So, I work on Monday through Friday during the week with patients and Beck comes in with me pretty much every day. Every once in a while, he'll get a day off, but he comes in with me every day.

Every day is going to look a little bit different depending on, you know, What I have going on for my caseload, what kind of goals I'm working on with my patients for the day, so every day will look a little bit different, so he typically comes with me to see most of my patients during the day to help in, help us meeting our therapy goals, so there may, there may be sessions where he's Kind of just hanging out and there as a presence and then there's other sessions where he is kind of working on Kind of focused on patient goals for the session So some of it might just be more for relaxation and coping and some of it might be Hard at work doing things like fetch or other tasks that a patient might need to use to help them meet their goals.

So, there's definitely times like if I notice that he's getting tired, I might give him a break in the office where he has a space to lay down and relax. And then there's, there's sometimes back-to-back sessions that he's going to with me and working, working his tail off.

Dr Mike Patrick: You know, when, when dogs are first trained and I am by no means an expert in this at all, but as I think about training, usually food is involved with training animals because it's a really high motivating factor.

But I would imagine that as these dogs are trained, maybe you don't want food to be the motivation because you don't necessarily want to, you know, be treating them, you know, with kibble in the, in the exam rooms or in a patient room. Uh, so how, how exactly are these dogs trained from a, you know, from a practical standpoint?

Rochelle Krouse: Yeah. So, they, I, I believe when they are early on in their training, that they do use some food as motivation, but then they weaned them off of that because they really want them to be motivated by the work and not by the food. They're very big on keeping these dogs healthy and working as long as they can.

So, their canine companions give us specific rules. Like they don't really, they don't want us giving them treats. They don't want them eating human food. Like, cause a lot of dogs, if they're given those treats or start eating human food or eating food off the ground or things like that, they get into some really bad habits and not necessarily sanitary habits or might get overweight from eating too much or things like that.

So, it's the ultimate goal is to. Make them, you know, work for, for the work because they want to, and to keep them as healthy as possible.

Dr Mike Patrick: So, they're getting feel good chemicals released in their brain, just like the patients and families are because they really truly enjoy interacting with people and that's their reward.

And so really you do have to have the right temperament dog views that as a reward, which is certainly not all dogs. Melissa, you had a point to make.

Melissa McMillin: Yeah, I think I just to, to clarify, you know, the facility dogs are full time dogs, they have been trained as working animals, so they are engaging in patient therapy four hours a day.

And then when we have our volunteer or our staff therapy dog teams, those dogs only tolerate two hours a day. That's how we, and I think Lisa mentioned that a little bit, but. We do have a very rigorous policy in place to make sure that we're, uh, fulfilling the requirements of our epidemiology, too, and we don't want our teams feeding or watering dogs here on campus, um, the, part of the, the onboarding is really to disseminate whether or not the dogs are going to be able to tolerate that, so we work really closely with all of our teams to make sure That those dogs are going to be able to manage that.

We don't want them sniffing in patient rooms or going towards patient food or staff food. And so, they are very, very well trained in every, every level, whether it's the therapy dog or the facility dog to be able to manage that.

Dr Mike Patrick: Have you, have you ever had to say, you know, tell a dog that maybe you're not quite right for this job?

Melissa McMillin: Sure. We, as I mentioned before, we have a, you know, the requirements for all the, all the facets of the kennels of our teams and our therapy dogs. Some of, you know, the volunteers want to come in here and they want to volunteer and their dog just, they don't pass our screening tests. We have another Butterfly Paws, you know, kind of good citizen test that we have to screen the dogs to make sure that they can tolerate this environment.

And we offer other solutions for them that might be more suited to making sure their dog is successful in a different environment to do that. So, we work very closely with trying to set everybody up to be successful. Um,

Dr Mike Patrick: Now, is this only dogs? Is there any plan for other animals with paws? Like, you know, could, could you have a therapy cat or a facility cat or, you know, hamsters or something, or are dogs the only option.

Melissa McMillin: Yeah, that's a great question. And we get that often. Lots of people were saying, when are we going to get cats or are we going to get horses or therapy horses? So, we work really closely with our veterinary therapists. Team at the research center and they help provide us oversight in developing some of those, the standards of the, the regulatory stances for our canines, but we will not utilize anything at this point, who knows in, in the long-term picture, but at this point we'll stick with canines.

Dr Mike Patrick: I, so I have a cat at home by the name of Carmen who will sit, climb and spin on command, but it's got to be food. There's only food motivation and I don't think that would work. So, I will try to work on the, the emotional, you know, as a reward, but I don't, I don't think that's going to go well. So, I get it.

Melissa McMillin: Between a cat and a feline or a dog canine.

Dr Mike Patrick: Yes. Yeah, absolutely. Rochelle, as we think about, uh, facility dogs, you know, we've talked about how just their presence can be comforting and, uh, and stress relieving, do they have some specific tasks that facility dogs do that actually help patients in a more physical way?

Rochelle Krouse: Yeah. So, as we said before, I'm part of the clinical therapies team and I work primarily on our rehab unit. So. These patients are here for various illnesses or injuries, and they're working really hard on getting their independence back, so that can be really challenging and frustrating, sometimes painful.

So having the dogs here is so motivating for these patients to be able to get their life back and get their independence back. So, some of the tasks that I use Beck to do are things like, for example, if a patient's working on standing balance or endurance, we might have them do a standing task with the dog, so fetch, for example, is one activity we do a lot of, so that patient's working on standing and balance, reaching, some dynamic kind of balance activities.

We're also doing a lot of like cognitive and communication tasks. So, I might have them learn how to give a command, use their voice, recall commands, sequence commands. So, you're looking at a lot of those communication and cognitive tasks. And then we're also looking at different kinds of like. Motor skills, such as, like I said, reaching before, before grasping a toy, reaching to pet the dog, holding a hairbrush and brushing the dog.

And we can do this in a lot of different ways to help a patient work on standing or sitting or dynamic balance and those communication and cognitive goals. So. Those are some examples of some of the tasks that we have the dog help us with.

Dr Mike Patrick: Very, very interesting. How do you ensure the safety and wellbeing of the dogs?

Because, you know, on the one hand we think about the dog's behavior and is this safe for patients on the other hand, you know, there are some, some kids, especially younger kids that may want to try to pull tails and hug a dog and, you know, maybe not act appropriately and in another circumstance it might get bitten because of their behavior.

Um, so how, how do you keep the dog safe from, from the children?

Rochelle Krouse: So, I always meet a patient before I would bring the dog in. So, I can assess what that patient's behavior is, what kind of reactions they might have. And I ask questions like do they have a pet? How do they do with dogs, things like that.

So, we kind of do some pre assessment to see. If the dog is appropriate in that sense, and if there is potential risk for any sort of behavior, we just monitor that and we make sure we're bringing these dogs into a safe environment. And if for some reason. A patient starts escalating or anything like that.

We make sure to remove the dog from that situation to keep them safe, but we definitely do the, the pre assessment and evaluate whether it's appropriate for that patient or not. Another thing we look at is if anyone is in on any sort of. Precautions for an illness such as droplet precautions, contact precautions, things like that.

We do not bring the dogs in to see these patients due to risk of infection control.

Dr Mike Patrick: So, the therapy dogs then at the end of the day, or the two-hour work shift. Goes home then with the, the staff member who, who owns that pet, the facility dogs, where do they go at night?

Rochelle Krouse: The facility dogs go home with their handler.

So, I'm the handler of our facility dog Beck and he comes home with me every day.

Dr Mike Patrick: Okay. So, he's, he's the facility dog, but he kind of feels like your personal pet too. And I'm sure that that also strengthens the bond that the two of you have so that you can do that job. Um, and Dr. Lisa, uh, do you have any success stories that you can share with us just to put it on a personal level and, you know, not, you know, we don't want to get too specific because we want to keep HIPAA in mind, but are there some, uh, positive outcomes in general that you have, that you have witnessed?

Dr Lisa Humphrey: Absolutely. You know, being a palliative medicine doctor, I get to see lots of joy, it's been actually in and of itself a success story of the dog for our team, that we can witness people's joy, staff and otherwise, as we move through, but when you think about more specific things, I would say a couple weeks ago, there was a child who got suddenly very, very sick.

The commotion got very, very fast and, you know, energetic. And at the end of it, some staff were just very emotionally exhausted and other parents on the unit and other caregivers on the unit had sort of as a bystander kind of experienced it as well. And, and Chris was there and, you know, he probably spent 45 minutes on the unit.

And I just sort of moved from one room to the next and offered if people needed to come out and just get some loving. And it was one, again, one of those times of community where you just sort of felt everyone, you know, Especially, you know, when you think about families and staff in that level of acuity, really, neither of them can necessarily afford to sort of let all the emotion out and, and just have it be there.

Sometimes they have to, like, eek it out so they can, they can manage the tasks they still need to accomplish as caregiver or a healthcare provider. And it's nice to see the dog just letting them kind of eke it out, you know, and it's not like I'm coming up behind them, ask them how they're feeling, and would they like to like, you know, have a mini therapy session with me.

So that's really nice. And I would be a miss if I didn't tell the absolutely lovely story. I get the honor, well, I unfortunately can't share her name, but I, I have the honor of working with a very remarkable patient who is receiving therapy for a long time now for her cancer. And she made it her personal mission that the hospital should have therapy dogs, including writing letters and being very articulate.

So, she was actually got to be one of the first patients that Crisp went and saw, and she was pleased as punch. And every day she was there for therapy, he would just jump up on her bed. Granted, for anyone listening, she was a particular type of patient who didn't have any immune issues. And so, the dogs allowed because I too need to protect patients and crisp.

So, he has a very specific patient he can go into regardless watching her smiles and her being able to experience that was just absolutely remarkably.

Dr Mike Patrick: That that is an amazing story. And I love. The, the persistence in writing letters and asking, because in life, a lot of times when we want to do, we have a vision of something we want and want to do, and we're going to meet obstacles and we're going to meet barriers and that persistence.

And, uh, overcoming those, uh, barriers and boundaries, and then seeing something come to life that you had in your mind, that is amazing. And not only for that particular patient, but for all the other patients and families that are going to benefit from that persistence. So, whoever that is, please extend, you know, my congratulations.

And that is just, that is amazing and such important work. And, uh, I would think that the parents have a little something to do. With that as well, just in terms of, you know, raising a child to, uh, to be persistent and impassioned for sure.

Melissa McMillin: Absolutely.

Dr Mike Patrick: Yeah.

Melissa McMillin: You know, I think for me, it's been a great opportunity.

I've had a facility dog for over 10 years here and it's been great to, Rochelle commented about how she uses Beck like with that physical mobility kind of patients. And I think it's been just really fun to see. When none of our traditional interventions work, how our facility dogs have been able to get the patient to progress with their therapy goals.

I can think particularly I've had a cardiac patient that I can't share his name, his name was Isaac, and he was not having any kind of ability to engage or regulate his emotions or behaviors with any of our medical staff. So, we call out the big dogs sometimes to be able to accelerate those treatment goals.

And it was just really great to see this little 10-year-old that was screaming, yelling, hollering and afraid of pain. To be able to use the, our facility dog HUD to help that patient regulate his behaviors as Rochelle talked about using appropriate voice tone. And as Lisa mentioned with a therapy dog is just being able to create an environment that they have some control over and using those special canines that can help the patients.

Our, our weather is essential sometimes to be able to accelerate that treatment process and create healing and his father, Isaac's father still will say this was the instrumental piece that helped him to be able to get up and move, be able to get him to absorb some, some of that fluid around his heart that was the instrumental piece in, in getting him moving forward to getting him discharged.

So, I think it's just really important when we look at all the different kennels of our dogs is to recognize they have such a unique power that extend beyond our human approach and having a program like this that's supported by our organization is just reaching so many people. And as we mentioned earlier, too, it just, it, it connects everybody in a different way that we just can't do so.

Just, it's been a, been a really, uh, a fun journey for me with the facility dogs, but also seeing those therapy dogs create such a dynamic approach.

Dr Mike Patrick: Yeah. I just, I love that so much, Melissa. It's not only the patients and families and staff at the hospital that benefit, but really the entire community can benefit from this program.

How can listeners and particularly those here in central Ohio. Get involved with this program, support the program. What, what is the, the role of the community in all of this?

Melissa McMillin: Yeah, well, that is a great question. And it gets asked often, and we have lots of different tiers of how we partner with the community, but not only our external community, but our internal community.

We, we try to match, as I said, the dogs, we look at their safety. We look at the, the appropriateness of the volunteer to be able to be in a medical setting and the dogs to, to maintain all the vaccinations and things that they need to do to keep everybody safe. But I think one of the things to keep in mind, programs like this are not reimbursable or charged to a third-party reinsurance, you know, so we don't get ability to cover the cost of our program and our dogs, and all the things associated with that with them without the, uh, philanthropy approach. And then, so we, we look for a community that if anybody wants to get involved, you know, certainly donations to support the Butterfly Paws program really help us accelerate expanding and furthering our reach.

To all the areas of our hospital. We've are starting inpatient kind of right now, because we look at those as kind of those patients that are very vulnerable and don't get to go home to be with their pets, but we really want to expand all of our services out to our outpatient and ambulatory areas. So, philanthropy is definitely an important piece of how we connect with our, our community and our partners.

And then two is if you're interested in doing it, we're looking for great volunteers and great, great therapy dogs that don't bark, lunge, bite, nip, and can tolerate being around other dogs. So, if interested, you know, go out and work on getting your dog certified as a therapy dog and then consider, you know, Volunteering here to help continue reaching those that need it most.

Dr Mike Patrick: And we will put a link to, to the donation page for Butterfly Paws. So, if folks do want to support that financially, it'll be in the show notes for this episode, 565 org, another link that we're going to have, and this is a really important one, uh, since this is an audio podcast and you know, other than barking, we really couldn't have dogs on.

Uh, this program, but we do have a link that is called meet the dogs. And so, if you click on that link over in the show notes, we do have featured some of our, of our facility and therapy dogs so that you can check them out. And again, that'll be in the show notes over at PediaCast. org. Have you had anybody from other children's hospitals who have heard about the Butterfly Paws program and maybe have been in contact of, you know, how do you get started with this?

How do you manage? This sort of program has that been an experience that you've had up to this point, Melissa?

Melissa McMillin: It has. Yeah. So, we have lots of people looking at us and kind of being a, you know, a template to how to operationalize a program like this. I think you mentioned it takes a lot. We have big resources internally with our epidemiology, legal, human resources teams that are on part of our executive committee.

Yeah. To help us establish all the policies and procedural aspects and application aspects of the program So we have a lot of different organizations kind of looking to us to be able to provide support to on getting programs like this started.

Dr Mike Patrick: Yeah, I think that's so important. And 80 percent of our audience is actually outside of central Ohio.

So, for, for listeners out there, you know, you can always check with your local children's hospital and see if there is a similar program. And if there's not, maybe you can be the one to write those letters over and over again. And then if you head over to the Butterfly Paws page at Nationwide Children's Hospital and we'll have a link to that in the show notes as well.

I'm sure there's contact information there and I hope that I don't overwhelm you with, uh, contacts, but it's such an important program and I think it makes such a difference for staff and patients and families. So, it is really an important thing and Melissa and Rochelle and Dr. Lisa, thank you so much for being a part of this program, bringing this great resource to the children of central Ohio and elsewhere who come in and get care at our hospital.

So, thank you all so much for being here today.

Melissa McMillin: Thank you, Dr. Mike. We really appreciate it and appreciate the opportunity to share with you.

Rochelle Krouse: Thank you so much for having us.

Dr Mike Patrick: We are back with just enough time to say thanks once again, to all of you for taking time out of your day and making PDA cast a part of it. Really do appreciate that. Thanks again to our guests this week, Melissa McMillan, the program manager of Butterfly Paws and Rochelle Krouse, one of our dog handlers with the Butterfly Paws program, both from Children's Hospital and Dr. Lisa Humphrey with Palliative Care. Also, at Nationwide Children's. There is one more link that I wanted to mention, and this is a pretty important one. You'll remember that we've talked about canine companions several times in terms of a selecting and training, uh, facility dogs, and we'll put a link. To Canine Companions so that you can find out more about the programs that they offer over in the show notes for this episode, 565 over at PediaCast .org.

Don't forget. You can find us wherever podcasts are found. We're in the Apple and Google podcast apps. Also, iHeartRadio, Spotify, SoundCloud, Amazon music. You name it. YouTube and most other podcast apps for iOS and Android. Our landing site is PediaCast .org. You'll find our entire archive of past programs there, along with our show notes, our terms of use agreement in the handy contact page, if you would like to suggest a future topic for the program, reviews are helpful wherever you get your podcasts, we always appreciate when you share your thoughts about the show and we love connecting with you on social media, you'll find us on Facebook, Instagram threads, LinkedIn, and Twitter X.

Thanks. Simply search for PediaCast. Also, don't forget about our CME program. It is similar to this one. It's called PediaCast CME that stands for continuing medical education. It is similar to this program. We do turn the science up a couple of notches and offer free continuing medical education credit for those who listen.

And that includes physicians, nurse practitioners, physician assistants, nurses, pharmacists, psychologists. Social workers and dentists. And since Nationwide Children's is jointly accredited by many professional organizations, it's likely we offer the exact credits you need to fulfill your state's continuing medical education requirements.

Shows and details are available at the landing site for that program, PediaCastCME. org. You can also listen wherever podcasts are found, simply search for PediaCast CME. Thanks again for stopping by and until next time, this is Dr. Mike saying, stay safe. Stay healthy and stay involved with your kids. So long, everybody.

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