Assistance Dog Providers Survey

_{Assistance Dog Providers Survey}

Form Approved

OMB No. 0920­xxxx

Expiration Date: XX/XX/20xx

Welcome!

Thank you for participating in the assistance dog providers survey for Project ROVER (Returning Our Veterans to Employment and Reintegration), a collaborative project between the National Institute for Occupational Safety and Health and West Virginia University. The goal of Project ROVER is to evaluate the effectiveness of using assistance dogs to improve the functioning of veterans with PTSD so as to ease their reintegration into the community and employment.

This survey should be completed by a person familiar with your organization's history and structure.

Your responses to the following questions will help us understand how providers are working to meet the needs of their clients, including Veterans.

Your participation in this survey is voluntary. You can exit the survey at any time. Your individual responses will be stored in a secure manner and will only be shared in a summary format with the overall survey results.

The survey may take approximately 30 minutes to complete.

We appreciate your cooperation and would like to include your organization's contact information in a public directory of assistance dog providers from across the nation. At the conclusion of the survey, you can indicate whether you would like to be included in this directory.

Selecting the "Start Survey" button below indicates that you have read and understand the information above and agree to participate in this survey. If you decline to participate, please end the survey now.

Please contact Project ROVER at 1­800­XXX­XXXX or [email protected] with any questions or concerns about this survey.

Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D­74, Atlanta, Georgia 30333_{; ATTN: PRA (0920­xxxx).}

Assistance Dog Providers Survey

_*1. The first set of questions will ask about your organization's size and make up.

_{Please enter the following information for your organization.}

_{Organization name}

_City

_State

Zip

_*^{2. How many years has your organization been in operation?}

_mlj

_{Less than 2 years}

_mlj

_{2 to 5 years}

_mlj

_{6 to 10 years}

_mlj

_{11 to 19 years}

_mlj

_{20 years or more}

_*3. Including yourself, approximately how many individuals currently work or volunteer at your organization?

_mlj

_{1 to 4}

_mlj

_{5 to 9}

_mlj

_{10 to 19}

_mlj

_{20 or more}

_mlj

_{Not sure}

_*4. In the next year, approximately how many additional employees or volunteers will your organization hire or recruit?

_mlj

_{1 to 4}

_mlj

_{5 to 9}

_mlj

_{10 to 19}

_mlj

_{20 or more}

_mlj

_{Not sure}

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Assistance Dog Providers Survey

_*^{5. Which of the following best describes your organization?}

_mlj

_{For profit business}

_mlj

_{Non­profit organization}

_mlj

_Government

_mlj

_Military

_mlj

_{Veteran­owned}

_mlj

_{Other, please specify}

^{6. How is your organization funded?}

_{(Check all that apply)}

_fec

_{Donations: Private individual}

_fec

_{Donations: Corporate or business}

_fec

_{Donations: Non­profit or charity}

_fec

_{Grants or contracts: Federal government}

_fec

_{Grants or contracts: State or local government}

_fec

_{Grants or contracts: Non­profit}

_fec

_{Contracts: Military, any branch of the armed services}

_fec

_{Insurance: Such as a private company, Medicare, or other third party}

_fec

_{Client fees}

_fec

_{Other, please specify:}

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Assistance Dog Providers Survey

_*7. Next, we would like to know about the services that your organization offers to its clients.

_{Does your organization have a waiting list for assistance dog placement?}

_mlj

_Yes

_{mlj No}

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Assistance Dog Providers Survey

_*^{8. Approximately how long do clients wait for an assistance dog?}

_mlj

_{Less than 6 months}

_mlj

_{6 to12 months}

_mlj

_{1 to 2 years}

_mlj

_{2 to 4 years}

_mlj

_{More than 4 years}

_mlj

_{Not sure}

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_{Assistance Dog Providers Survey}

^{9. Where has your organization placed dogs in the United States?}

_{(Check all that apply)}

_fec

_{Within your state}

_fec

_{In neighboring states}

_fec

_Nationally

_fec

_{Internationally}

_fec

_{Not sure}

^{10. What services are made available to clients of your organization?}

_{(Check all that apply)}

_fec

_{Locating dogs for placement with clients}

_fec

_{Matching dogs and clients}

_fec

_{Disability screening for clients}

_fec

_{Training and education for clients}

_fec

_{Financial support for clients}

_fec

_{Legal assistance for clients}

Other, please specify:

₅

₆

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Assistance Dog Providers Survey

11. Which specialized skills or tasks do you train dogs to perform for your clients?

_{(Check all that apply)}

_fec

_{Retrieving items}

_fec

_{Opening doors}

_fec

_{Turning lights on and off}

_fec

_{Carrying items}

_fec

_{Balance assistance}

_fec

_{Alerting to seizure}

_fec

_{Guiding (guide dog)}

_fec

_{Alerting to sounds (hearing dog)}

_fec

_{Providing contact comfort}

_fec

_{Alerting to approaching people}

_fec

_{Interrupting thoughts or behaviors}

_fec

_{Being present during sleep}

_fec

_{Calming when distressed}

_fec

_{Checking area prior to entering}

_fec

_{Other, please specify}

_*12. After placement, what types of follow­up support are provided by your organization?

_{(Check all that apply)}

_fec

_{Training new skills for dogs}

_fec

_{Correcting behavior problems of dogs}

_fec

_{Assistance with finding equipment or supplies (for example, harnesses or assistive technology)}

_fec

_{Financial assistance for clients}

_fec

_{Legal assistance for clients}

_fec

_None

_fec

_{Other, please specify:}

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Assistance Dog Providers Survey

_*^{13. Approximately how long is follow­up provided after placement?}

_mlj

_{Less than 6 months}

_mlj

_{6 to 12 months}

_mlj

_{Over 1 year}

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Assistance Dog Providers Survey

_*14. For the following question, please indicate whether your organization serves the age groups listed and, if so, how the number of clients in each age group has changed over

the past 5 years.

	Do Not Serve	Increased	No Change	Decreased
Children (ages 0 to 12)	nmlkj	nmlkj	nmlkj	nmlkj
Adolescents (ages 13 to 17)	mlj	mlj	mlj	mlj
Adults (ages 18 to 64)	nmlkj	nmlkj	nmlkj	nmlkj
Older adults (ages 65 and over)	mlj	mlj	mlj	mlj

15. Next, we will ask you some information about the dogs trained at your organization. What dog breeds are trained most often at your organization?

_{(Check all that apply)}

_fec

_{Golden Retriever}

_fec

_{Labrador Retriever}

_fec

_{Standard Poodle}

_fec

_{German Shepherd}

_fec

_Boxer

_fec

_Newfoundland

_fec

_Goldendoodle

_fec

_Labradoodle

_fec

_{Not sure}

_fec

_{Other, please specify}

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Assistance Dog Providers Survey

16. What dog breeds are preferred by your clients?

_{(Check all that apply)}

_fec

_{Golden Retriever}

_fec

_{Labrador Retriever}

_fec

_{Standard Poodle}

_fec

_{German Shepherd}

_fec

_Boxer

_fec

_Newfoundland

_fec

_Goldendoodle

_fec

_Labradoodle

_fec

_{Not sure}

_fec

_{Other, please specify:}

^{17. How does your organization obtain dogs?}

_{(Check all that apply)}

_fec

_{In­house breeding program}

_fec

_{Shelter/Rescue}

_fec

_Donations

_fec

_Purchase

_fec

_{Other, please specify:}

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Assistance Dog Providers Survey

_*18. The next few questions will ask you about services your organization provides to

^Veterans.

_{Does your organization serve military Veterans?}

_mlj

_Yes

_{mlj No}

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Assistance Dog Providers Survey

_*^{19. How has the number of Veteran clients changed over the past 5 years?}

_mlj

_Increased

_mlj

_{No change}

_mlj

_Decreased

_mlj

_{Not sure}

^{20. Does your organization serve Veterans with any of the following conditions?}

_{(Check all that apply)}

_fec

_{Mobility impaired}

_fec

_{Blindness or visually impaired}

_fec

_{Deafness or hearing impaired}

_fec

_{Seizure disorder}

_fec

_Diabetes

_fec

_{Traumatic Brain Injury (TBI)}

_fec

_{Depression or mood disorder}

_fec

_{Posttraumatic stress}

_fec

_{Anxiety, fears, or phobias}

_fec

_{Not sure}

_fec

_None

_fec

_{Other, please specify:}

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_{Assistance Dog Providers Survey}

^{21. In your experience, which dog breeds do Veterans prefer?}

_{(Check all that apply)}

_fec

_{Golden Retriever}

_fec

_{Labrador Retriever}

_fec

_{Standard Poodle}

_fec

_{German Shepherd}

_fec

_Boxer

_fec

_Newfoundland

_fec

_Goldendoodle

_fec

_Labradoodle

_fec

_{Not sure}

_fec

_{Other, please specify:}

_*22. Has your organization incorporated dogs into vocational therapy or tasks specifically related to returning Veterans to work?

_mlj

_Yes

_{mlj No}

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_{Assistance Dog Providers Survey}

^{23. What needs has your organization addressed for Veterans returning to work?}

_{(Check all that apply)}

_fec

_{Retrieiving items}

_fec

_{Opening doors}

_fec

_{Turning lights on and off}

_fec

_{Carrying items}

_fec

_{Balance assistance}

_fec

_{Alerting to seizure}

_fec

_{Guiding (guide dog)}

_fec

_{Alerting to sounds}

_fec

_{Providing contact comfort}

_fec

_{Alerting to approaching people}

_fec

_{Interrupting thoughts or behaviors}

_fec

_{Present during sleep}

_fec

_Calming

_fec

_{Checking area prior to entering}

_fec

_{Not sure}

_fec

_{Other, please specify:}

Page 14

Assistance Dog Providers Survey

_*24. For the next series of questions, we are interested in whether you train service dogs, professional therapy dogs, visitation dogs, or support dogs, and aspects related to this training.

We are defining these types of dogs as follows:

A service dog performs specialized skills directly related to the handler's disability. Service dogs meet the standards for public access as protected by the Americans with Disabilities Act (ADA).

A professional therapy dog is handled, utilized, or supervised by a health or human services professional in a therapeutic setting. Although they may have specialized skills, they are not service dogs or visitation dogs.

A visitation therapy dog provides support, comfort, and companionship to individuals in settings such as hospitals and nursing homes. They are not service dogs nor professional therapy dogs, and do not have public access rights.

A support dog provides emotional or physical support or assistance related to the handler's disability, usually only in the handler's home (they may have very limited public access rights). They are not service dogs, professional therapy dogs, or visitation therapy dogs.

_{Given the above definitions, does your organization train service dogs?}

_mlj

_Yes

_{mlj No}

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Assistance Dog Providers Survey

_*^{25. Approximately what percentage of your dogs eventually become service dogs?}

_mlj

_{0 to 19%}

_mlj

_{20 to 39%}

_mlj

_{40 to 59%}

_mlj

_{30 to 79%}

_mlj

_{80 to 100%}

_mlj

_{Not sure}

_*26. Since the founding of your organization, approximately how many of your dogs became service dogs?

_mlj

_{0 to 49}

_mlj

_{50 to 99}

_mlj

_{100 to 199}

_mlj

_{200 to 299}

_mlj

_{300 to 399}

_mlj

_{400 to 499}

_mlj

_{500 or more}

_mlj

_{Not sure}

_*^{27. In the past year, approximately how many of your dogs became service dogs?}

_mlj

_{0 to 9}

_mlj

_{10 to 19}

_mlj

_{20 to 29}

_mlj

_{30 to 39}

_mlj

_{40 to 49}

_mlj

_{50 or more}

_mlj

_{Not sure}

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Assistance Dog Providers Survey

_*^{28. In the next year, approximately how many of your dogs will become service dogs?}

_mlj

_{0 to 9}

_mlj

_{10 to 19}

_mlj

_{20 to 29}

_mlj

_{30 to 39}

_mlj

_{40 to 49}

_mlj

_{50 or more}

_mlj

_{Not sure}

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Assistance Dog Providers Survey

_*29. Does your organization train professional therapy dogs?

A professional therapy dog is handled, utilized, or supervised by a health or human services professional in a therapeutic setting. Although they may have specialized skills, they are not service dogs or visitation dogs.

_mlj

_Yes

_{mlj No}

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Assistance Dog Providers Survey

*30. Approximately what percentage of your dogs eventually become professional therapy dogs?

_mlj

_{0 to 19%}

_mlj

_{20 to 39%}

_mlj

_{40 to 59%}

_mlj

_{60 to 79%}

_mlj

_{80 to 100%}

_mlj

_{Not sure}

*31. Since the founding of your organization, approximately how many of your dogs became professional therapy dogs?

_mlj

_{0 to 49}

_mlj

_{50 to 99}

_mlj

_{100 to 199}

_mlj

_{200 to 299}

_mlj

_{300 to 399}

_mlj

_{400 to 499}

_mlj

_{500 or more}

_mlj

_{Not sure}

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Assistance Dog Providers Survey

*32. In the past year, approximately how many of your dogs became professional therapy dogs?

_mlj

_{0 to 9}

_mlj

_{10 to 19}

_mlj

_{20 to 29}

_mlj

_{30 to 39}

_mlj

_{40 to 49}

_mlj

_{50 or more}

_mlj

_{Not sure}

*33. In the next year, approximately how many of your dogs will become professional therapy dogs?

_mlj

_{0 to 9}

_mlj

_{10 to 19}

_mlj

_{20 to 29}

_mlj

_{30 to 39}

_mlj

_{40 to 49}

_mlj

_{50 or more}

_mlj

_{Not sure}

^{34. With which health and human services professionals have your professional therapy}

dogs been placed?

_{(Check all that apply)}

_fec

_{Occupational Therapists}

_fec

_{Physical Therapists}

_fec

_{Psychologists}

_fec

_{Physicians or Psychiatrists}

_fec

_Counselors

_fec

_Nurses

_fec

_{Social Workers}

_fec

_{Other, please specify:}

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Assistance Dog Providers Survey

*35. Does your organization train visitation therapy dogs?

A visitation therapy dog provides support, comfort, and companionship to individuals in settings such as hospitals and nursing homes. They are not service dogs or professional therapy dogs, and do not have public access rights.

_mlj

_Yes

_{mlj No}

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Assistance Dog Providers Survey

*36. Approximately what percentage of your dogs eventually become visitation therapy dogs?

_mlj

_{0 to 19%}

_mlj

_{20 to 39%}

_mlj

_{40 to 59%}

_mlj

_{60 to 79%}

_mlj

_{80 to 100%}

_mlj

_{Not sure}

*37. Since the founding of your organization, approximately how many of your dogs became visitation therapy dogs?

_mlj

_{0 to 49}

_mlj

_{50 to 99}

_mlj

_{100 to 199}

_mlj

_{200 to 299}

_mlj

_{300 to 399}

_mlj

_{400 to 499}

_mlj

_{500 or more}

_mlj

_{Not sure}

_{*38. In the past year, how many of your dogs have become visitation therapy dogs?}

_mlj

_{0 to 9}

_mlj

_{10 to 19}

_mlj

_{20 to 29}

_mlj

_{30 to 39}

_mlj

_{40 to 49}

_mlj

_{50 or more}

_mlj

_{Not sure}

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Assistance Dog Providers Survey

*39. In the next year, approximately how many of your dogs will become visitation therapy dogs?

_mlj

_{0 to 9}

_mlj

_{10 to 19}

_mlj

_{20 to 29}

_mlj

_{30 to 39}

_mlj

_{40 to 49}

_mlj

_{50 or more}

_mlj

_{Not sure}

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Assistance Dog Providers Survey

*40. Does your organization train support dogs?

A support dog provides emotional or physical support or assistance related to the handler's disability, usually only in the handler's home (they may have very limited public access rights). They are not service dogs, professional therapy dogs, or visitation therapy dogs.

_mlj

_Yes

_{mlj No}

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Assistance Dog Providers Survey

*41. At your organization, approximately what percentage of your dogs eventually become support dogs?

_mlj

_{0 to 19%}

_mlj

_{20 to 39%}

_mlj

_{40 to 59%}

_mlj

_{60 to 79%}

_mlj

_{80 to 100%}

_mlj

_{Not sure}

*42. Since the founding of your organization, approximately how many of your dogs became support dogs?

_mlj

_{0 to 49}

_mlj

_{50 to 99}

_mlj

_{100 to 199}

_mlj

_{200 to 299}

_mlj

_{300 to 399}

_mlj

_{400 to 499}

_mlj

_{500 or more}

_mlj

_{Not sure}

_{*43. In the past year, approximately how many of your dogs became support dogs?}

_mlj

_{0 to 9}

_mlj

_{10 to 19}

_mlj

_{20 to 29}

_mlj

_{30 to 39}

_mlj

_{40 to 49}

_mlj

_{50 or more}

_mlj

_{Not sure}

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Assistance Dog Providers Survey

_{*44. In the next year, approximately how many of your dogs will become support dogs?}

_mlj

_{0 to 9}

_mlj

_{10 to 19}

_mlj

_{20 to 29}

_mlj

_{30 to 39}

_mlj

_{40 to 49}

_mlj

_{50 or more}

_mlj

_{Not sure}

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Assistance Dog Providers Survey

*45. For all dog types trained by your organization, approximately what percentage successfully complete the requirements of your program (and eventually become either a service dog, a professional therapy dog, a visitation therapy dog, or a support dog)?

_mlj

_{0 to 19%}

_mlj

_{20 to 39%}

_mlj

_{40 to 59%}

_mlj

_{60 to 79%}

_mlj

_{80 to 100%}

_mlj

_{Not sure}

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Assistance Dog Providers Survey

*46. We would like to include your organization's contact information in a public directory of assistance dog providers from across the nation as a service to Veterans and others searching for an assistance dog.

Would you like for your organization to be included in the on­line directory (housed on the

_{West Virginia University webpage)?}

_mlj

_Yes

_{mlj No}

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_{Assistance Dog Providers Survey}

Thank you for participating in the Project ROVER survey!

_{The information provided will help us to Reintegrate Our Veterns to Employment and Reintegration.}

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