A New Continuing Education Experience

Education is only a ladder to gather fruit from the tree of knowledge, not the fruit itself. Anonymous

The ideas are many, the interest is high. Stewards of animals want well behaved family members. In fact, multiple surveys (CENSHARE, U of MN) have shown that 90 percent of the owners want some form of behavior management assistance with their pet. Behavior management is a veterinarian's duty (it usually starts with house training), to ensure a proper family fit for the pet. Obedience training is not behavior management, and I am not advocating veterinarians get into obedience training.

Behavior management is a life-style situation that practice staff members need to become involved in to extend animal lives and quality of family support for the animal they share their life with; it is also a client-bonding activity that makes practice fun again.

Yet, practices continue to "push" vaccinations, for diseases seldom, if ever, seen, and worry about feed store sales competition, rather than meeting their client's needs. Practices send thousands of reminders for distemper vaccinations, and seldom see a case; they send no reminders for behavior, yet see multiple cases each day. Even to the most casual observer, there is something wrong with this picture. This is called "wearing blinders" in some situations, but more often, it is just a lost opportunity to become indispensable within a community to your clients (not to mention the loss in net income associated with ignoring this need).

During recent practice consultations, as we discussed the merits of behavior management as an income center, it became clear that some practices that we support could not make the leap of faith from theory to reality. They knew a few resources, from pamphlets to the Promise head collar, and they knew that their clients needed the service, but they had not convinced themselves that they could charge for it. Some did not know the current theory, or had been confused by the brief articles in the literature which seemed disjointed. How to deliver it as a meaningful service, specifically a fee-for-service, needed to be based upon confidence of success and methodologies of marketing. It became evident that progressive practice management, marketing, and promotion techniques needed to be integrated into the academic pursuit of knowledge. We choose "Behavior Management as an Income Center" as our first attempt!

Methodology

The primary subject matter experts were Daniel Q. Estep, Ph.D., and Suzanne Hetts, Ph.D., both certified animal behaviorists (see Appendix C); their contemporary website, http://www.animalbehaviorassociates.com/, is consider one of the very best for practice staffs to gain comfort with what they can/should do! The business management and marketing vignettes were done by myself, and the client and staff marketing communication methods were done by L. Susan Bochatey, a long time colleague, on the last day of the 20-hour seminar. The vignettes were called "Mini-Management Moments" and were provided once mid-morning and once mid afternoon on the first two days of the course. On the last day, it was all tied together by providing break-out sessions where the participants actually started to integrate the behavior management ideas into their annual marketing plans. This first seminar was centered on behavior problem prevention, and there is a subsequent seminar in the planning to deal with resolving existing behavior problems. In 2000, AAHA teamed up with Dan and Suzanne to repeat these programs.

The training approach taken by this team was structured to be similar to that encountered in veterinary school. The first section was the basic sciences, the principles and systems which must be understood before application could be attempted. The second phase was the clinical years, where applications were made to real life experiences, but still within the context of the education process. The third phase was the reality of practice, where the basic sciences and clinical years must be integrated into practice with economics, people, programs, staff, clients, associate veterinarians, and community mores as mediating factors. Most every participant left wanting to know more about problem resolution. They were ready to attend the next seminar. This is the mark of a great continuing education experience. Any practice can simulate this same environment by training their trainers at regional continuing education conferences, using the new references offered by AAHA, or even at seminars like we outlined above, then making the time for a practice-specific, practical, in-service seminar.

Another way to look at this new method of training, combining the technical skills with management, marketing, and business alternatives, is to view the experience through some of the comments left behind in the seminar evaluations:

 "Excellent - a real effort was made to give us information we could take home........ so many handouts! It seemed every good idea was followed by a handout."

 "I was exposed to a whole new way of thinking."

 "Very good plan of action. Good combination of practical information combined with management and marketing. Good pace."

 "Liked (loved) concept of behavior prevention with animal behavior problems as well as seeing the staff as clients."

 "Excellent flow and content -- it was very helpful to know how to integrate these ideas into our practice."

Some Key Ideas

It is not nice to tease the reader, so the following is a look at various segments of the technical aspects of Behavior Management, the first impressions:

 When a dog pulls an owner through the front door, behavior management is needed. A staff which is "tuned-in on behavior management" will address this situation before the client enters the consultation room, with something as simple as one of the new "head collars" which provides for almost immediate "power steering" and control of the animal.

 When a new puppy is presented, house training assistance must be provided, if the practice believes in behavior management. If this courtesy service appears on the invoice as a $30 behavior management consultation - courtesy - first visit, and is given as an overt fee reversal on the invoice, the tone and the price has been set for further encounters.

 The Behavior Management "New Pet" Owners Orientation, held in the evenings, or in good weather, outside for puppies and inside for kittens after Saturday appointments. Some offer this service as a one-time courtesy session. It is offered by certificates left at all humane society adoptions and pet store purchases, as well as new vaccination clients. It is a "staff" time to discuss the basics, from socialization, to handling, to grooming, to wellness care.

 The Socialization Classes - Group Therapy for Behavior Management - the animals in the group need to be within 3 weeks of age of each other, size is NOT an issue. This is a 4-5 week series of once a week classes, usually operated by practice staff. If the practice uses the PetCareTV Welcome Home CD, or the Linda White's Puppy Smarts CD, for their own educational awareness, they will have plenty of material for these classes, as well as individual family fit consults (Family Fit Consults, at $25-30 each, 20 minute sessions - the pet cannot take more than 20 minutes of this educational intensity). Additional details are provided later in this appendix.

The above four ideas are obvious. The family fit, animal socialization, and basic behavior management services can be offered by the most neophyte of staff members, if properly trained. While problem prevention is easy, in some of the more advanced behavior problems, referral is needed. The nice thing about behavior problems is that many of the referral cases can be done by telephone or even initiated by e-mail. The choice to participate is an individual commitment, and the market is there. The ability to meet the needs of the community is based in the practice philosophy. Whether your practice wants to "gather this fruit" or let it "lie and rot" is now up to you, but remember, over 5 million animals a year are euthanized because of behavior problems. Save lives or contribute to this number, the choice is yours.

The Behavior Management as an Income Center agenda is provided below:

 Gathering and Introductions

 Your Role in Behavior Counseling

 Behavior Development of Puppies and Kittens

 Puppy Classes

 MINI-MANAGEMENT MOMENT #1 (puppy clubs)

 Pet Selection

 MINI-MANAGEMENT MOMENT #2 (existing resources)

 Litter box "Training" for Kittens

 Crates and Confinement

 MINI-MANAGEMENT MOMENT #3 (resale perspectives)

 House training Puppies

 Destructive Behaviors

 Puppy and Kitten Aggressive Behaviors

 Introduction of Puppies and Kittens to Resident Animals

 MINI-MANAGEMENT MOMENT #4 (vaccination sequence alternatives)

 Puppies, Kittens, and kids

 Owner communication Skills

 PRACTICE MANAGEMENT and MARKETING PLAN

 Graduation

Mini-Management Moment #1

Implementation of Puppy Clubs and Kitten Carrier Classes

The Puppy Club can be different from the traditional Puppy Kindergarten course. While the Puppy Kindergarten is usually a trainer's introductory program offered as a fee for instructional service covering multiple weeks, the Puppy Club is more social one-time event (like new owner orientation, but with the puppy), designed for a nurse technician to help bond clients to the practice, so it is usually a "courtesy service" offered puppy owners. Some believe a fee-for-service program carries with it a liability and implied contract agreement, so they prefer a social program with no fee to reduce the perceived liability and implied contract concerns.

The total spectrum of integrated packages is offered here as a method to assist practices in understanding that it is not a single service or a set program. Behavior management services are a multi-faceted process: of bonding a client to the practice, of meeting the needs of the owner (e.g., 90 percent of new owners desire assistance with behavior management of their pet), and of expanding the professional image of the practice team. It is an opportunity to be a leader in your community.

The Puppy Club has been done in many formats (for fee or courtesy), but the most exciting is the one conducted by the veterinary practice's paraprofessional team. It is an opportunity for the staff to talk to clients in the evening, 60 minutes maximum since the puppies have a 15 minute maximum tolerance, and help them become better stewards of their companion animal. The Kitten Carrier Class is an extension of this concept since we want the owners of all critters to bond to the practice with this "value added" service. Please keep the kittens and puppies on different nights.

The classes are formatted around the expertise of your staff. The nurse technician discusses common post-neonatal questions, nutrition, hygiene, and wellness issues. Socialization is simply getting the animals used to coming to the practice without always receiving an injection. The reason this concept requires multiple visits, besides for the familiarity associated with smelling other animals, being handled by other people, and traveling often by car without pain is the subject matter which includes the following:

 It is an opportunity to help the owners deal with feet (nails), ears (plucking and cleaning), tails (anals), teeth (brushing), and other anatomically awkward appendages.

 It is the time to discuss parasites (prevention as well as control), nutrition (diets and treats), and behavior management (e.g., Gentle Leader - Promise head collar).

 In puppies, if behavior management includes floor work by group, try to keep the class members (puppies) within 5 weeks of age of each other. Again, the simplest of concepts are only used for 10-15 minutes at a time, then the puppies are allowed to "rest" while other subjects are discussed with the owners.

The attendance has no requirements, for the pet or the owner. There are no strings attached. It is a low investment for a practice (utilities, two hours of technician time, and initial refreshments). If the social period really takes off, the participants may even offer to bring refreshments. Let them feel needed! If at some point in the process, clients want to know more about behavior specifically for their pet, they can be referred to either the practice appointment schedule or an area behavior specialist.

The nurse technician's fee approximates the practice Family Fit consultation, about $25-$30 for 20 minutes, with weekly review appointments until the behavior has been modified. Some progressive practices are now booking 55 staff-based behavior management appointments per month. Please see the sample forms and invitation cards provided for initial implementation ideas for your practice. We will discuss integration of this idea into an overall program later in this seminar.

Resources for staff development include:

 PetCareTV Welcome Home CD, http://www.petcaretv.com/page.php?page=36

 Linda White's Puppy Smarts CD, http://www.puppysmarts.com/

 Suzanne Hetts & Dan Estep, http://www.animalbehaviorassociates.com/

 Wayne Hunthausen, http://www.westwoodanimalhospital.com/

 Ian Dunbar, http://www.training-dogs.com/ian-dunbar.html

 http://www.apdt.com/default.aspx

Mini-Management Moment #2

Implementation of Existing Resources

You don't need to reinvent the wheel! For Pet Selection, the AVMA has produced and kept updated a beautiful series of color brochures (about $12 to $16.00 per 100) www.avma.org/animal_health/brochures/pet_selection.asp. You just need to invent the delivery system in your community. The Delta Society (206/226-7357) has the starting point, Pet Partner Trainer Training. The Delta Society was formed as an international clearing house of human-animal bond programs, from assistance animals to pet libraries in schools; they have evolved to assistance and therapy animal programs. In Australia, the Delta Dog Program provides excellent training for what "normal behavior" should be. Your practice may know what is needed, or you may want to look at existing resources for ideas. Either way, don't start from scratch. Learn from those who have gone before. Please review the resources provided at the end of Mini-Management Moment #1.

Some have started their "Pets by Prescription Program" (a Delta Society term) in the school, by doing in-service orientations to teachers and counselors using the historical success stories from Delta Society (stuttering children, insecurities, etc.). Others have offered "third party" not-for-fee assistance to pet stores and humane societies in the area, to assist their clients in getting the right pet for the family (e.g., Bassets are cute, but are not for joggers). The "third party" assistance to pet stores relieves the store from the liability perception caused by clerks just recommending an animal "to get rid of it from inventory."

The early literature carried ideas from Dr. Ron Whitford on how he set his wife up in a non-profit corporation (cost about $50,000, including facility) specifically to place well puppies and kittens in the community. Besides for the adoption fee, his wife's corporation requires they receive all care from her husband's clinic. They are now shipping about 50 percent of the TN animals to New York for placement (another fee for service from the non-profit corporation). The AVMA Trust saw this as excessive liability, so this concept has fallen into disfavor.

Again, the pet selection assistance is usually a courtesy service, based on the concepts that happy clients will return to the practice for pet healthcare. It starts the bonding even before the pet enters the family.

Mini-Management Moment #3

Implementation of Retail Sales Resources

Very seldom does any practice consider behavior management a retail sales opportunity -- thank goodness. Behavior management is as close to a pure service as is surgical time for a doctor. Regardless, there is some retail sales associated with behavior management, but they must be kept in perspective.

Crate sales are a very helpful aid when a pet is sent home on restricted activity. They are also very helpful when introducing a new animal to a resident animal. Some practices move enough crates through their facility to be able to price them lower than the community discount stores (WalMart, PetsMart, etc.) but approximately equal to an appropriate target. This retail service is especially important when instructing clients how to size crates and how to use them for behavior or healthcare management.

Leashes and collars are another resale line which goes underutilized. Some practices make the client relations team (receptionists) accountable for the display and stocking by giving them a cut of the action. You would be surprised how displays improve and sales increase. A specialized offering like the Gentle Leader Head Collar and Harness systems need to be seen as only part of a training management system. The head collar is designed to use only instinctive pressures (why is the only animal we train by choking "man's best friend"?), and can get a client to return to the practice frequently. As such, the head collar should be retailed for only slightly over cost (in quantity, they are not available for less than $13.00 per system, so a $18.00 resale would be adequate in a family fit consultation environment. The head collar alone is less than $9.00, so resale could be only $14.00). The money is made on the subsequent training sessions - and - as the Pet Parent of the now well-behaved patient becomes bonded to the practice.

The Kong Toy is a very unique training tool, it does not have an equivalent shape in most homes, so the pet does not mistake household items for their toy. It comes in various sizes, is durable, dishwasher safe, and can be filled with food for training.

One-stop shopping is needed in many communities, and in others, it is not needed. The choice is a strategic practice concern. It is my opinion that a companion animal practice should never replace outpatient exam space with retail space. It can't produce net income as well as professional healthcare delivery. Better use of waiting room or reception space is a different issue.

Mini-Management Moment #4

Implementation with Vaccination Programs

Most practices start with a full exam with every puppy or kitten vaccination, fees for a rabies-distemper visit approaching $100, while the newspaper advertises multiple sources for getting a $26 rabies-distemper alternative, where do you expect the average uninformed pet owner to go? As an alternative Puppy/Kitten program:

 First vaccination, doctor's consultation & house training information

 (offer to send home numbered videotape for family viewing)

 (qualifies client/patient for puppy club)

 Second vaccination, nurse technician exam and socialization information

 (offer to send home numbered videotape for family viewing)

 (qualifies client/patient for puppy club)

 Third vaccination, nurse or doctor's consultation and family-fit information

 (offer to send home numbered videotape for family viewing)

 (qualifies client/patient for puppy club)

 Behavior management awareness is provided by the nurse technician after the doctor leaves the consult room. The behavior consult needs to be scheduled for later with the nursing staff. This sets the tone for later efforts in dental, nutrition and parasite control counseling.

 Number your various "send home" videotapes to ensure tracking, not a rental, just a loaner.

 Puppy club or a puppy kindergarten should be made available through the first six months of age (to the neutering decision, OHE or castration). In some practices, this is a "prescription" concurrent with the second vaccination.......it is an expectation, and when priced reasonably, we see an 85% acceptance rate in most communities.

 The invoice should specifically state the behavior counseling effort: house training, socialization, family-fit, or whatever was conducted.

Some practices provide a pet-specific "pet population control credit" (deducted from the standard OHE/castration fee) with each vaccination, redeemable with appointments made between four to six months of age. This not only builds the appropriate expectations within the client's mind, it also gives the impression of a preferred client benefit and brings the surgery into a more competitive price range. Build and deliver the program that provides the "added value" for clients.

Suggested Indications to Do a Behavior Medical Work-Up