The Center for the Future of the Health Professions is excited to present another monthly op-ed column for 2024, offering insightful perspectives on issues shaping the future of health professions. Established to provide policymakers at all levels and healthcare stakeholders with accurate and comprehensive data, our center aims to support effective planning for a sustainable future in healthcare. The United States healthcare system stands at a critical juncture, facing unprecedented challenges demanding a new breed of administrative leadership. As healthcare organizations grapple with decreasing reimbursement rates, staffing shortages, increased regulations, and rising patient expectations, the role of healthcare administrators has evolved dramatically from its early 20th century origins.

This month’s article traces the transformation of healthcare administration in America – from its roots in nursing and social work through the watershed moments of Medicare’s creation, the rise of managed care, and the Affordable Care Act – while examining how these historical shifts have shaped the competencies required of modern healthcare leaders. As we look toward a future marked by aging populations, technological innovation, and economic uncertainty, understanding this evolution becomes crucial for developing leaders capable of navigating the increasingly complex healthcare landscape.

Our guest author is Dr. Robert Clegg, chair of the Health Administration Department in the College of Graduate Health Studies at A.T. Still University. Most recently, Dr. Clegg was a professor/faculty lead for the health administration programs in the School of Health Sciences at Northcentral University in La Jolla, California. Before his academic career, Dr. Clegg worked in the not-for-profit healthcare sector for over 25 years, including as the chief quality and compliance officer at Copper Queen Community Hospital in Bisbee, Arizona. Dr. Clegg is also a proud veteran, serving as a Hospital Corpsman in the United States Navy for nearly 16 years.

Academically, Dr. Clegg earned both his bachelor of science in health science and a master of public health at Fresno State and a doctorate in human services with an emphasis in healthcare administration at Capella University in Minneapolis, Minnesota. He will also graduate with a master of law and business with an emphasis in healthcare law, compliance, and ethics from the National University in December 2024. Furthermore, he is a certified professional in healthcare quality (CPHQ) through the National Association of Healthcare Quality and a master certified health education specialist (MCHES) through the National Commission for Health Education Credentialing.

Philanthropically, Dr. Clegg proudly volunteers much of his time, talent, and treasure on the board of directors for the American Red Cross – Southern Arizona Chapter and serves on the Alumni and Volunteer Corporation, Inc., for Sigma Phi Epsilon Fraternity at Fresno State. On a personal side, Dr. Clegg enjoys exploring the country with his amazing wife in their travel trailer, riding his Harley-Davidson anytime, anywhere, and everywhere possible, playing softball, and trying to better his short game on the golf links.

Randy Danielsen, PhD, DHL(h), PA-C Emeritus, DFAAPA

Professor and Director

The Center for the Future of the Health Professions

A.T. Still University

Leading the way for a healthier America: The past, present, and future of health administration in the United States

With healthcare constantly changing, there is a growing need for healthcare leaders with the education, skills, and ability to adapt to the “new normal” of “doing more with less.” This often includes addressing the challenges of decreasing reimbursement rates, worker shortages, dwindling resources in exchange for more regulations, rising market competition, and increasing patient expectations. Couple this with advances in medical technology, new standards of care, changing patient demographics, and population growth, which require a new business model that includes cross-functional and cross-disciplinary learning and skill development. To keep up with the rapid pace the industry is changing, healthcare organizations need to become “learning organizations” at every level of the organization and in every aspect of the organization’s processes. This means establishing a culture of continuous learning that encourages each team member to perpetually transform and adapt to the shifting healthcare landscape.¹

During the early 20th century, hospitals in the United States were predominantly non-profit and owned by either religious organizations or the government. At the time, hospital administrators often derived from nursing, social work, or public health backgrounds. Following the passage of Titles XVIII and XIX, which created Medicare and Medicaid in 1965, there was an influx of funds into the healthcare system to pay for care for elderly and poor Americans. The sudden and rapid growth of a more structured healthcare system led to the emergence of the hospital administration profession. Consequently, there was a need for formalized health administration programs to educate future healthcare leaders.²

In the 1980s, healthcare began to be viewed more as a business with the rise of managed care and the shift from cost-based reimbursement to a fixed prospective payment system, especially for Medicare and Medicaid. As a result, more business courses were offered in health administration programs. This led to the development of the master in hospital administration (which would later become the master of health administration, or MHA) and master of business administration (MBA) programs with concentrations in healthcare. These programs offered academic courses in physician practice management, quality, and managed care, as well as courses emphasizing quantitative skills. During this period, the nation saw a significant increase in physicians filling executive positions and the need for C-suite leaders in not-for-profit hospitals to possess for-profit experience.²

Fast forward to the Affordable Care Act (ACA), which was signed into law in 2010. Aside from making health insurance more affordable and accessible for all Americans through health reform, this era brought forth the transition from fee-for-service reimbursement to value-based purchasing, risk sharing (e.g., bundled pricing), and the movement toward a vertically integrated healthcare delivery system, such as Accountable Care Organizations (ACOs), Independent Physician Associations (IPAs), and Physician-Hospital Organizations (PHOs). It also required healthcare leaders to develop a new set of competencies. This included management skills for specific areas, such as hospitals, ambulatory settings, and physician practices, as well as working knowledge of risk management and quality. This era also saw the move toward preventive medicine, wellness, population health management, and managing chronically ill patients, requiring a new set of competencies in predictive analysis, change management, physician relations, and quality and patient safety. As a result, many healthcare organizations and educational institutions that train healthcare leaders adopted competency models from several different professional organizations, including the American College of Healthcare Executives (ACHE), American Medical Informatics Association (AMIA), Healthcare Financial Management Association (HFMA), Healthcare Information and Management Systems Society (HIMSS), Medical Group Management Association (MGMA), and National Center for Healthcare Leadership (NCHL)².

Today, just as in the past, healthcare leaders must always put their patients at the organization’s center. This can only be accomplished by aligning the organization around a comprehensive business strategy including access to medically appropriate patient care, quality-driven outcomes, and financial stewardship.³ Proving medically appropriate quality care is vitally important for the success of any healthcare organization. Like most businesses, the financial success of a healthcare organization means bringing in more cash from the customer – which, in this case, is the patient – than what is paid for the services necessary to provide the needed services – that being, the care rendered to the patient. Furthermore, hospitals and physicians are compensated based on value-based purchasing and quality incentive payment programs, including Bridges to Excellence and CMS Quality Payment Programs, such as the Merit-based Incentive Payment System (MIPS), Advanced Alternative Payment Models (APMs), and Hospital Value-Based Purchasing (VBP) Program. These payment systems incentivize hospitals and providers based on population management and quality-driven patient care.²

When a business strategy is not working, healthcare leaders are responsible for identifying and explaining to their stakeholders – including the organization’s board of directors – any issues the organization is experiencing that might hinder its mission and the strategies to address these issues.⁴ In order to address the increasing challenges facing today’s healthcare environment, collaborative and distributive leadership styles have begun to emerge. Collective leadership is viewed by many as a fundamental approach to addressing complex, rapidly changing advances in medical technology and the growing number of specializations. It involves sharing knowledge and different viewpoints from multiple professionals to promote staff well-being and quality of patient care.⁵ Similarly, by leveraging shared responsibility and accountability, distributive leadership embraces a collective vision from multiple partners instead of relying on hierarchical and centralized structures of power often seen in traditional healthcare settings.⁴

The future of healthcare means that populations are living longer, and innovative technological applications are being implemented across the healthcare spectrum, all while uncertainty looms regarding the state of the U.S. economy. Due to the decrease in childhood mortality, safety and efficacy of medications, and increased focus on preventative care, life expectancy has increased dramatically over the past decade.⁶ Furthermore, artificial intelligence and machine learning (AI/ML) have dramatically changed how medicine is developed and how sick patients are diagnosed and treated.⁷ Lastly, increasing healthcare expenditures are expected to exceed economic growth in the United States, primarily due to high inflation, persistent clinical staff shortages, and lower economic growth.⁸ With such growth and uncertainty, the future of healthcare in the United States requires leaders who are well-educated and well-versed in the complexities of the healthcare industry. However, those with a global perspective, cross-industrial experience, and disruptive thinking can navigate the course of change.⁹

References

1. Herd, AM; Adams-Pope, BL; Bowers, A; Sims, B. Finding what works: leadership competencies for the changing healthcare environment. Journal of Leadership Education. 2016; 15(4), 217-233.
2. Love DB; Ayadi MF. Redefining the core competencies of future healthcare executives under healthcare reform. Administrative Issues Journal. 2015, 5(2), 3-16.
3. Loria K. The future of healthcare leadership: how healthcare is changing – and the new skills you need to thrive. Managed Care Executive. 2019, 14-17.
4. Wojtak A; Stuart N. Resetting the future of healthcare leadership. Healthcare Quarterly. 2021, 24(3), 1-3.
5. Silve JAM; Mininel VA; Agreli HF; Peduzzi M; Harrison M; Xyrichis A. Collective leadership to improve professional practice, healthcare outcomes, and staff well-being. Cochrane Database of Systematic Reviews. 2022, 10, Article SD013850, 1-17.
6. Altschuler GC. Why we are living longer [blog post]. Psychology Today. Published May 11, 2021. Accessibility verified October 16, 2024. https://www.psychologytoday.com/us/blog/is-america/202105/why-we-are-living-longer
7. Marr B. The ten biggest trends revolutionizing healthcare in 2024. Forbes. Published October 3, 2023. Accessibility verified October 16, 2024. https://www.forbes.com/sites/bernardmarr/2023/10/03/the-10-biggest-trends-revolutionizing-healthcare-in-2024/
8. Fleron A; Singhal S. The gathering storm: The uncertain future of U.S. healthcare. McKinsey & Company. Published September 16, 2022. Accessibility verified October 16, 2024. https://www.mckinsey.com/industries/healthcare/our-insights/the-gathering-storm-the-uncertain-future-of-us-healthcare
9. Walcott D. Shaping the future: The rise of the disruptive healthcare leader. Forbes. Published March 12, 2024. Accessibility verified October 16, 2024. https://www.forbes.com/sites/davidwalcott/2024/03/12/shaping-the-future-the-rise-of-the-disruptive-healthcare-leader/

The Center for the Future of the Health Professions is excited to present another monthly op-ed column for 2024, offering insightful perspectives on issues shaping the future of health professions. Established to provide policymakers at all levels and healthcare stakeholders with accurate and comprehensive data, our center aims to support effective planning for a sustainable future in healthcare.

This month, our column shines a spotlight on animal-assisted therapy (AAT), which represents a promising approach to managing dental anxiety, a significant barrier to oral healthcare affecting approximately 20% of Americans. While AAT has a rich history dating back to 1792 and has demonstrated numerous benefits in various healthcare settings, including cardiovascular, psychological, and cognitive improvements, its application in dentistry remains relatively unexplored.

Our guest author, Mai-Ly Duong, DMD, MPH, ’12, is an associate professor and associate director of special care dentistry at A.T. Still University-Arizona School of Dentistry and Oral Health (ATSU-ASDOH). Dr. Duong earned an Advanced Education in General Dentistry certificate from NYU Langone Medical Center in 2013. This program evolved her clinical skills to include computer-aided design and computer-aided manufacturing, sedation dentistry, and advanced periodontal/oral surgery. In 2016, she earned a master’s degree in education with a dental emphasis from the University of the Pacific. Her many accomplishments and contributions to the dental profession have earned her recognition as a master of the Academy of General Dentistry, a fellowship in the Special Care Dentistry Association, a fellowship in the American College of Dentists, a fellowship in the International College of Dentists, and a fellowship in the Pierre Fauchard Academy. On a personal note, Dr. Duong loves to sing. Her personal goals are to become fluent in Spanish and American Sign Language.

We look forward to your feedback and comments as we continue to explore the dynamic landscape of healthcare professions. Please direct any comments or feedback on this month’s digest to cfhp@atsu.edu.

Randy Danielsen, PhD, DHL(h), PA-C Emeritus, DFAAPA

Professor and Director

The Center for the Future of the Health Professions

A.T. Still University

Animal-assisted therapy in the dental setting

Introduction

Animal-assisted therapy (AAT) can be used in conjunction with, or in place of, sedation to reduce and manage anxiety during dental treatment. AAT is grounded on scientific evidence that the human-animal bond is mutually beneficial and is influenced by behaviors directly leading to positive health and well-being for both.²⁵ Because of this, AAT involves goal-centered interventions in which the animal meets, and is integral to, the treatment and healthcare process.

Although AAT is modern-day terminology and a growing field of study in psychology research, the use of animals for health benefits can date back to the beginning of mankind between cave dwellers and wolves.²¹ However, it was not until 1792 that the first case of animal therapy was documented in England when William Tuke found farm animals, such as rabbits and chickens, lessened the use of drugs and restraints.²² By the 19^th century, animals were used as companions in European mental health institutions to increase comfort in an already seemingly prison-like environment. ^{23, 24}

In 1919, the use of companion animals was first documented in the United States. Most notably canines were used in the psychiatric wings of hospitals.²⁴ In the 1940s, animals were used to help U.S. veterans recuperate and reduce any PTSD symptoms. By the end of the 20^th century, the use of animals in the healthcare setting had become prevalent, and the following terms were coined: animal-assisted therapy, animal-assisted interventions, and pet therapy.

Goals of AAT

Approximately 20% of Americans report a moderate to high level of anxiety about obtaining dental treatment. The most common reasons for avoiding dental treatment include fear of dental experience and previous negative dental experience.^{1, 19} Avoiding or delaying necessary dental treatment can lead to highly detrimental oral health consequences and inevitably reduces oral health-related quality of life.¹

With stress and anxiety comes the activation of an individual’s autonomic nervous system; this system prepares the body for the sympathetic fight-or-flight response.³ Self-induced regulation is necessary as it serves as a coping mechanism for the body under certain situations.⁴ However, continued sympathetic activation can contribute to coronary heart disease, reproductive dysfunction, and immunosuppressive disorders.⁴ Orally, chronic stress and autonomic activation can lead to decreased salivary flow rate, xerostomia, and increased levels of plaque formation, all of which contribute to risk for oral disease.⁵

AAT programs are designed to improve an individual’s physical, social, and emotional health and cognitive functioning.¹² AAT has shown cardiovascular, psychological, and cognitive benefits. Specifically, the use of AAT helps decrease anxiety, stress, and depression levels, decreases heart rate and blood pressure, improves self-esteem and mood, and lowers IgA levels.¹³ These changes have been seen with long- and short-term exposure to AAT. Consequently, nursing homes, hospitals, retirement communities, and many other institutions are implementing AAT.¹⁴ While AAT’s benefits are well documented in medical care facilities, AAT studies are virtually nonexistent in dental settings.

AAT in dentistry

In 2000, the American Academy of Pediatric Dentistry recommended distraction techniques to alleviate patient fear and anxiety related to dental treatment.¹⁵ Along with the other aforementioned benefits, Katcher & Friedmann (1980) reported that AAT can work as such distraction: petting an animal creates “a passive meditative focus on a non-threatening stimulus [that] can relax a person by lowering the body’s state of arousal.”¹⁶ In addition to tactile stimulation, AAT can provide deep pressure therapy (DPT) to anxious patients. DPT involves a dog using its weight and sometimes warmth to mitigate a psychiatric symptom, often either as a calming strategy or to minimize disengagement from the world. Similar to a weighted blanket for people with autism, DPT can relax and re-engage a person enduring an otherwise disabling symptom.¹⁷

One previous study attempted to show the benefits of AAT in a dental setting; however, their methods resulted in conflicting and inconclusive evidence of benefit.¹⁸  Many anecdotal experiences and case studies have shared the benefits of canine-assisted therapy in the dental setting. More properly designed studies need to be implemented to explore AAT’s effectiveness in a dental setting.

AAT’s benefits

1. Cardiovascular benefits
   The American Heart Association and the American Stroke Association report that an estimated 83.6 million Americans have been diagnosed with some cardiovascular disease (CVD). Further, CVD has been shown to increase premature deaths and nursing home admissions. Friedman and Thomas found that of the individuals who have experienced a myocardial infarction, those who owned pets had a higher statistically significant one-year survival rate than those who did not own pets.²⁶ The American Heart Association has assessed the existing evidence and concluded that pet ownership positively influences the presence and reduction of CVD. It is currently examining the causal relationship that may be present.²⁷ Other reputable institutions, such as the Mayo Clinic, have incorporated, and are also currently examining, the effects of AAT on CVD.   
2. Psychological benefits
   As previously alluded to, the positive benefits of AAT were first documented in psychology. It is also important to note that more than half of psychiatrists and psychologists indicate that they have prescribed companion animals (or pets) for their patients.²⁸ AAT has been shown to improve social and communication skills, reduce anxiety, improve mood, and facilitate empathic skills.²⁹ Some evidence has demonstrated that petting an animal reduces feelings of loneliness, depression, and insecurity.³⁰ This provides strong support for the use of AAT in the dental arena when so many individuals face anxiety.
3. Cognitive benefits
   AAT can catalyze communication, especially during psychotherapy sessions, because the presence of an animal makes the experience less threatening and more inviting. As previously stated, holding or petting an animal can provide physical comfort and a sense of security and safety.²³ Because of this, the use of AAT in dental treatment is further supported. Furthermore, physiological signs such as blood pressure and respiratory rate are also decreased or normalized when an individual is comforted and secure.²⁶

Types of AAT

Animals involved with AAT include dogs, cats, horses, dolphins, birds, rabbits, and fish. Dogs are the most common animals used for AAT. Often, canine-assisted therapy, feline-assisted therapy, or other smaller animals are used in healthcare facilities where the human or patient is receiving treatment. For example, a canine and his/her handler will visit a chronically ill patient in the hospital or long-term care facility.

Canine-assisted therapy is the most common type of AAT provided in the healthcare setting. They can be found in both short-term and long-term as well as group and individual settings. Feline-assisted therapy is often found in long-term facilities where they are seen more like pets due to their independent nature. They provide long-term facilities, a sense of continuity, and a homey feeling to the residents. 

However, other types of therapy, such as equine-assisted therapy and dolphin-assisted therapy, require the human or patient to travel to the animals’ establishments. Having patients participate in grooming, feeding, and riding the horse has shown significant improvements in health and healing. Further, having patients interact, feed, and swim with dolphins has also shown increased response to physical therapy and psychological treatment.

Challenges of utilizing AAT

Sanitation

Infection control is a primary concern in all healthcare facilities. Therefore, when incorporating AAT as a strategy to improve patient well-being, it is essential to ensure the animal and handler follow all the guidelines set forth by the CDC to properly and safely reduce the risk for infection during AAT activities. These guidelines include, but are not limited to, the following:

• Establish and enforce proper hand-washing protocols.³¹
• Identify and treat any illness or wound that the AAT animal experiences in a timely manner.³¹
• Ensure that the AAT animal receives routine and regular veterinary visits, including up-to-date with all recommended vaccinations.³¹
• Regularly bathe and groom the AAT animal within 24 hours of interacting with patients.³¹
• Provide adequate time for the AAT animal to exercise and relieve themselves prior to interacting with patients.³¹
• Provide a healthy diet for the AAT animal.³¹
• Maintain an up-to-date record that shows the completion of an animal-assisted certification program.³¹

Animal welfare

Just as humans are prone to burnout, animals can also experience burnout or fatigue if overworked. Therefore, the Delta Society has created standards and in-depth guidelines to protect animals involved with AAT.³² These should be thoroughly reviewed and implemented into any AAT program.

To reiterate the CDC guidelines, the animal must be well cared for from a general health standpoint. The animal must also have time to enjoy being a pet. They must be trained to understand when it is time to work with patients and when it is time for them to play. When they are ill, proper action should be taken to restore their physical and mental health.

Selection process

Animals involved with AAT must be properly trained to prevent bad outcomes due to miscommunication. They should have mastered basic obedience skills and behave in a predictable manner. They must also enjoy being around people and being touched or held. Because dogs have been domesticated and can learn how to respond appropriately to voice commands, they are the most common type of AAT animal.

On the contrary, the patient receiving the AAT should be considered. Their preferences may indicate which type of animal will yield successful outcomes. The patient’s allergies to certain types of animals should be identified and avoided. Any animal with which the patient reports a poor history should also be avoided. 

Conclusion

Because AAT has been highly successful in the medical arena, it is not surprising that it is slowly being incorporated into dentistry. As more and more institutions incorporate the use of AAT as a means to reduce anxiety, it can be argued that the use of AAT can be used in the following ways:

1. To desensitize patients to a new dental office.
2. To alleviate anxiety during consultations in the dental office.
3. To reduce anxiety about invasive dental treatment.
4. To help reduce anxiety during the induction of deep or general sedation.
5. To help transition a patient from a deeper to a more conscious sedative state of mind.

There is a rich body of evidence showing the powerful effect the human-animal bond can have on health and well-being. Therefore, AAT programs have the potential to be a significant part of patient-centered treatment. It is important healthcare providers recognize, explore, and develop this strategy because it can have life-changing effects on the patients they care for.

References

1. Tellez M, Kinner D, Heimberg R, Lim S, Ismail A. Prevalence and correlates of dental anxiety in patients seeking dental care. Community Dentistry and Oral Epidemiology. April 2015;43(2):135-142.

2. Delta Dental. 2008. Managing your anxiety about going to the dentist. Available at: https://www.deltadentalins.com/oral_health/anxiety_visit.html. Accessed March 29, 2016.

3. Sadi H, Finkelman M, Rosenberg M. Salivary cortisol, salivary alpha amylase, and the dental anxiety scale. Anesthesia Progress. 2013 Summer 2013;60(2):46-53.

4. Knight W, Rickard N. Relaxing music prevents stress-induced increases in subjective anxiety, systolic blood pressure, and heart rate in healthy males and females. Journal of Music Therapy. Winter 2001 2001;38(4):254-272.

5. Kambalimath H, Dixit U, Thyagi P. Salivary cortisol response to psychological stress in children with early childhood caries. Indian Journal Of Dental Research. April 2010;21(2):231-237.

9. Porritt J, Marshman Z, Rodd H. Understanding children’s dental anxiety and psychological approaches to its reduction. International Journal of Paediatric Dentistry / The British Paedodontic Society [And] The International Association of Dentistry For Children. November 2012;22(6):397-405.

10. Sayed A, Ranna V, Padawe D, Takate V. Effect of the video output of the dental operating microscope on anxiety levels in a pediatric population during restorative procedures. Journal of the Indian Society Of Pedodontics & Preventive Dentistry. January 2016;34(1):60-64.

11. Potter C, Jensen D, Kinner D, Tellez M, Ismail A, Heimberg R. Single-Session Computerized Cognitive Behavioral Therapy for Dental Anxiety. Clinical Case Studies. February 2016;15(1):3-17.

12. Pet Partners. (2005). Learn:Terminology. Retrieved from: www.petpartners.org

13. Morrison M. Health benefits of animal-assisted interventions. Complementary Health Practice Review. January 2007;12(1):51-62.

14. Ernst L. Animal-Assisted Therapy: An Exploration of Its History, Healing Benefits, and How Skilled Nursing Facilities Can Set Up Programs. Annals Of Long Term Care. October 2014;22(10):27-32.

15. Havener L, Gentes L, Agrawal S, et al. The effects of a companion animal on distress in children undergoing dental procedures. Issues In Comprehensive Pediatric Nursing. April 2001;24(2):137-152.

16. Katcher, A.H. & Friedmann, E. Potential health value of pet ownership. Comprehensive Continuing Education. 1980;1(2), 117-121.

17. Burrows, K. E., Adams, C. L., & Spiers, J. (2008). Sentinels of safety: service dogs ensure safety and enhance freedom and well-being for families with autistic children. Qualitative Health Research, 18(12), 1642-1649. doi:10.1177/1049732308327088

18. Schwartz A, Patronek G. Methodological issues in studying the anxiety-reducing effects of animals: Reflections from a pediatric dental study. Anthrozoös. 2002;15(4):290-298.

19. White A, Giblin L, Boyd L. The prevalence of dental anxiety in dental practice settings. Journal of Dental Hygiene. 2017; 91(1): 30-34.

20. Jackson J. Animal-assisted therapy: the human-animal bond in relation to human health and wellness. 2012. Winona State University

21. Urichuk LJ & Anderson D. Improving mental health through animal-assisted therapy.

Alberta, Canada: Chimo Project. 2003.

22. Macauley BL. Animal-assisted therapy for persons with aphasia: A pilot study. Journal

of Rehabilitation Research and Development, 2006; 43(3), 357-366.

23. Fine,A (ed.). Handbook on animal-assisted therapy; Theoretical foundations and

guidelines for practice (3rd ed.). San Diego, CA: Academic Press. 2010.

24. Allderidge PH. A cat, surpassing in beauty, and other therapeutic animals. Psychiatric

Bulletin, 1991; 15, 759-762.

25. American Veterinary Medical Foundation. AVMA Policies: Animal-assisted interventions Definitions. 2018. https://www.avma.org/KB/Policies/Pages/Animal-Assisted-Interventions-Definitions.aspx

26. Friedman E, Thomas SA. Pet ownership, social support and one-year survival after acute myocardial infarction in the Cardiac Arrhythmia Suppression Trial (CAST).

Am J Cardiol. 1995;76(17):1213-1217

27. Levine GN, Allen K, Braun LT, et al; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing. Pet ownership and cardiovascular risk: a scientific statement from the American Heart Association. Circulation. 2013;127(23):2353-2363.

28. Guarneri M. The Heart Speaks: A Cardiologist Reveals the Secret Language of Healing. New York, NY: Touchstone; 2006.

29. Bánszky N, Kardos E, Rózsa L, Gerevich J. The psychiatric aspects of animal assisted therapy [in Hungarian]. Psychiatr Hung. 2012;27(3):180-190.

30. Cangelosi PR, Embrey CN. The healing power of dogs: Cocoa’s story. J Psychosoc Nurs Ment Health Serv. 2006;44(1):17-20.

31. Centers for Disease Control and Prevention. Guidelines for Environmental Infection Control in Healthcare Facilities: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). www.cdc.gov/hicpac/pdf/guidelines/eic_in_hcf_03.pdf

32. Delta Society. Standards of practice for animal-assisted activities and animal-assisted therapy. 1996.

This summer, hundreds of new ATSU students from across the globe embarked on their journey to become the next shining stars in the healthcare field. Traveling to Kirksville, Missouri; Mesa, Arizona; and Santa Maria, California, these aspiring professionals took their first steps toward careers dedicated to improving the health and wellness of their communities.

Medical and dental students received their white coats after their first week of orientation, while audiology, physical therapy, physician assistant, and occupational therapy students received their white coats further into their programs as they prepare for clinical rotations and patient care.

The white coat, representing professionalism and ethical responsibility, has been worn for more than 100 years by physicians and has since been adopted by other health professions. The white coat ceremony, which involves a formal “robing” or “cloaking” of students, marks a significant milestone in their professional education. It symbolizes the transformation from layperson to healthcare professional – much like a star emerging from the nebula, ready to shine its light on the world.

ATSU-CHC CCPA program

“I felt really proud of myself and my classmates. We worked really hard to get here and I’m very proud to have my family watching me. It’s been a long journey – I’ve thought of this a really long time and it’s finally happening.”
–John Janisko, PA, ’25
ATSU-CHC

“It just means the world to me, especially as a young black girl seeing other black girls become doctors, that I can be part of the representation … so another girl who looks like me can have faith that she can get here too.”

–Francisca Okeke, OMS I
ATSU-SOMA

“It felt like a dream come true. I’ve been in the admissions process for a really long time, and I’m finally able to start dental school soon, and I’m excited for the journey ahead. It’s a dream to be able to receive my white coat.”

–Nia Moquino, D1
ATSU-ASDOH

From the moment students enter their academic program at ATSU, they are immersed in a rigorous educational environment, whether in a physical classroom or online. Their daily lives are filled with assignments, research, group activities, after-hours study sessions, and eventually for many, clinical rotations and patient care.

Students across campuses and programs submitted their personal photos, offering a glimpse into their journey through their eyes. Their experiences, depicted in the following photos, show the dedication, teamwork, and camaraderie essential in the health professions.

The various phases of studying

Making great achievements

Away from campus

Matching outfits and unbreakable bonds

Kirksville, Missouri, will always hold a special place in the heart of ATSU Board of Trustees member Michelle Mayo, PhD. A first-generation college student, Dr. Mayo attended Truman State University and earned a bachelor’s degree in political science and a master’s in education. During her time in Kirksville, Dr. Mayo met former ATSU board member Bertha Thomas and Dwayne Smith, PhD, interim president of Southern Connecticut State University.

“I was in Kirksville for eight years. I met some wonderful people who really poured into me and saw more in myself than what I saw in me,” she says. “They really played a pivotal role in where I am today. I’m very grateful to have crossed paths with Bertha and Dwayne. Not only were they my mentors, but even today, they are some of my very closest friends and confidants.”

After completing her undergraduate and graduate degrees, Dr. Mayo stayed in Kirksville an additional two years, which she says inspired her to work in higher education. She then moved to Indiana and received her doctorate in educational policy from Indiana University.

“I once again had people pour into me,” she says. “That’s where I really found my passion for addressing issues of access and equity for underserved communities.”

Dr. Mayo has worked at a variety of universities, including Marquette University in Milwaukee, Harris-Stowe State University in St. Louis, and North Carolina Central University in Durham. She now works for California State University-Monterey Bay as the associate provost for student success and dean of undergraduate studies.

In her current role, Dr. Mayo is responsible for academic support and curating the undergraduate experience. She has also connected the university with the National Institute for Student Success. Dr. Mayo’s extensive experience in higher education led Thomas to recommend her for ATSU’s Board of Trustees back in 2016. Dr. Mayo was hesitant to join at first because of her lack of experience in the medical field, but she’s glad she took the risk.

“I’ve had an opportunity to meet people from various walks of life that under normal circumstances I would not have had the opportunity to meet,” she says. “It’s only made me a better person, and I’ve been able to deal with issues of access and equity, one of my passions for working in higher education.”

In her almost nine years with the board, Dr. Mayo got married and moved twice. When she initially joined the board, she lived in St. Louis and moved to Durham shortly thereafter. She helped ATSU develop pipeline programs with North Carolina Central University by introducing students to the Physician Assistant Studies program and subsequently informing them about ATSU’s other academic offerings. She hopes she can translate what she’s learned about student success at the undergraduate level and apply it to ATSU.

“It’s been rewarding for me to share a piece of what I know with ATSU and see what I have to share be taken seriously and utilized within the University,” she says. “I hope I’ve been able to bring that whole world of student success as the point of focus for a professional school so we can continue to enhance our students’ experiences.”

“ATSU is fortunate to have the skills, knowledge, and talents of a rising academic leader in Dr. Mayo. She makes us a better university by bringing innovative and timely ideas pertaining to academics, student life, and operations.”

– Dr. Craig M. Phelps, ATSU chancellor

2000s

Melinda Brown, MHA, ’09, was elected to the Carl Junction School District School Board in April. She also serves as the Missouri School Boards’ Association delegate. Brown is director of the Gipson Center for Healthcare Leadership at Missouri Southern State University and resides in Carl Junction with her husband, Mark Brown, DO, ’11. Their children are Zakory; Maggie, a master of public health student at ATSU-CGHS; and Ashdyn.

2010s

Antoinette “Toni” Farmer-Thompson, DHEd, ’10, was named president of Strayer University in Virginia. She is the first Black woman to hold the position. Dr. Farmer-Thompson joined the university in 2021 as its provost and chief academic officer. She previously served as chief financial officer and chief operations officer of educational outreach and student services at Arizona State University.

Gabriel Anders, DO, ’14, received critical care board certification from the American Board of Internal Medicine, an independent physician-led, nonprofit organization. Dr. Anders is a physician at Bothwell Regional Health Center in Sedalia, Missouri.

Vivek Babaria, DO, ’14, was one of 20 spine surgeons featured in the North American Spine Society’s SpineLine spotlight of specialists under 40. Dr. Babaria specializes in interventional spine and sports medicine and uses advanced ultrasound technology. In addition to his degree from ATSU, he received extensive training at University Hospitals Cleveland Medical Center and OSS Health.

Justin Silverstein, DHSc, FASNM, FASET, ’14, was appointed clinical assistant professor of neurology at the Zucker School of Medicine at Hofstra University/Northwell Health.

Christine Beeson, DO, FAAP, ’16, is board certified in the pediatric specialty of child abuse and neglect. In April, she joined faculty on the Child Abuse team at the University of Oklahoma-Tulsa. Dr. Beeson sees children for suspected abuse and neglect and is the fellowship’s educational director.

Sondra DePalma, DHSc, PA-C, ’18, a graduate of ATSU-CGHS, led research resulting in the article, “Medical Malpractice Payment Reports of Physician Assistants/Associates Related to State Scope of Practice Laws and Regulations,” which was awarded the JMR Award for Distinguished Scholarship by the Federation of State Medical Board’s Journal of Medical Regulation in recognition of an outstanding objective, scholarly contribution.

Andrea Hartford, DO, ’18, joined Women’s Excellence as one of the newest members of its Clarkston, Michigan, medical team.

2020s

Brittany Helmbrecht, DHEd, ’20, was named interim dean of professional studies and applied sciences at Chadron State College in Chadron, Nebraska. Previously an associate professor, Dr. Helmbrecht has been a member of the college’s faculty since 2015. In addition, she is president of the Northwest Nebraska Trails Association, secretary of Bike Walk Nebraska, a member of the American College of Health Association, and a certified group fitness instructor by the American Council on Exercise.

Christa Lo, DHSc, MPAS, PA-C, ’20, joined the University of North Texas Health Science Center at Fort Worth’s School of Health Professions as associate dean. She’ll also serve as faculty in the Physician Assistant Studies program. In addition, she acts as a site visitor and commissioner for the Accreditation Review Commission for Education for the Physician Assistant.

Cheri Jrolf, DMSc, MPAS, PA-C, ’22, received the 2024 American Mother of the Year award for Florida from American Mothers Inc., an organization encouraging and highlighting mothers across the U.S. Dr. Jrolf is a mother of five and is a board-certified physician assistant with more than 28 years of clinical experience. She is a champion of foster care awareness and has advocated for children born with neonatal abstinence syndrome.

Hot Mess to Hot Mom: Transformational Tools for Thriving After Childbirth and Beyond

By Tara De Leon, MS, ’09, ATSU-ASHS

Brave Healer Productions, March 2024

As a mother, personal trainer, and professor of health, fitness, and exercise studies, De Leon aims to help women who have given birth become HOT (healthy, on it, and thriving). This book features authentic stories and expert tools from women who know what it’s like to run on little sleep in a body they no longer recognize. Chapters include gentle exercises for postpartum recovery, single steps for getting great sleep again, healthy eating strategies, recovering one’s body confidence, and more.

Matt Heeren, JD, understands the importance of community involvement. While Heeren serves ATSU as chief operating officer & general counsel, he also serves the Kirksville, Missouri, community with his time and talent. He is a former member of several local boards, past president of Kirksville Regional Economic Development Inc., and his personal favorite, youth soccer coach.

Heeren began coaching in 2013 when his son started playing soccer at the local YMCA. At the time, the YMCA soccer club mainly held practices for a few dozen kids with occasional games. When his players wanted more opportunities to develop their soccer skills, he was asked if he would help the club grow, to which he agreed. His vision was to grow the sport in Kirksville by establishing a local league for youth and, eventually, offering competitive travel opportunities for players who wanted to play soccer in high school.

“I am so passionate about teaching kids early on the power of their own influence,” Heeren says, “the power that influence can have on themselves and, just as importantly, the power that influence can have on other people.”

Heeren lectures his players about this concept, and to put words into practice, he encourages intergenerational training, where players of all ages play together. The older players take responsibility for teaching the younger players and being good role models. He also tells his players if he could go back to high school and change one thing, it would be to firmly learn the power of his influence on others.

“I never realized that as a high schooler. The middle school kids admired me and my teammates and wanted to be just like us,” Heeren says. “What an opportunity to make the world better by simply learning early the power of your own positive influence, but I never realized I had it until I was much older.”

At just 7 years old, Heeren’s father passed away. The many important lessons Heeren would have learned from his father, he instead learned through youth sports and the coaches who cared about him and his future. When Heeren became a coach, his only goal was to support local kids and help them envision their potential. His mindset and leadership led to his recognition as Missouri Girls Recreation Coach of the Year and Regional Girls Recreation Coach of the Year in 2021, followed by National Girls Recreation Coach of the Year from U.S. Youth Soccer in 2022.

Today, Heeren’s vision for the club is complete. It serves as a consistent feeder of strong soccer players – and principled students – for the high school soccer program, with dozens of volunteers supporting the local recreation and competitive travel teams. Currently, more than 300 kids participate in the local soccer club, and the sport has grown so popular, there are more interested high school players than there are spots available.

“I told my players’ parents from the very beginning we are playing soccer, but don’t tell the kids the importance of all of this has nothing to do with soccer,” Heeren says. “It has to do with finding a passion, creating a process, finding mentors, and working hard. If you do that, then success will come in anything, not just soccer.”

ATSU

Nelida Acosta, Hometown Scholars coordinator, strategic university partnerships, received the 2024 Outstanding Migrant Health Center Board Member award from the National Association of Community Health Centers. Acosta was recognized for her commitment to Adelante Healthcare in Phoenix and for advancing migrant health initiatives.

Don Altman, DDS, DHSc, EdD, ’12, was promoted to vice chancellor, academic support.

John Dougherty, DO, was appointed chief strategy officer, effective July 1. Located in St. Louis, he will oversee development of ATSU real estate initiatives in St. Louis and Mesa, Arizona. Dr. Dougherty earned his doctor of osteopathic medicine degree from Kansas City University’s College of Osteopathic Medicine (KCU-COM). His leadership roles have included interim dean of KCU-COM Joplin campus, dean of Touro University Nevada, and founding dean and chief academic officer of Noorda College of Osteopathic Medicine.

Brenda Jackson, senior administrative assistant, academic affairs, received the Employee Excellence Award for Arizona and California campuses for the second quarter of 2024.

Holly Klusmeyer, project manager, assessment & accreditation, graduated from the Teaching & Learning Center’s 2024 Introduction to Educational Technology course.

Stephanie McGrew, MHA, assistant director, diversity & inclusion, received ATSU-CGHS’ 2024 Alumni of the Year award.

Kim Perry, DDS, MSCS, was promoted to chief partnership officer.

Dalton Rolland, associate director of sustained giving, development, received the Missouri campus Employee Excellence Award for the second quarter of 2024.

Michael Shoop was promoted to specialist in Academic Technologies.

Julie Speer, PhD, MS, was promoted to assistant director of the Teaching & Learning Center.

Lisa Windy, MAcc, was promoted to director of student accounts in Finance.

ATSU-ASDOH

Desmond “Des” Gallagher, BDS, MA, was appointed dean of ATSU-ASDOH, effective Sept. 11. He previously served as associate dean for clinical services at University of the Pacific Arthur A. Dugoni School of Dentistry in San Francisco.

Dr. Gallagher earned a dental degree from University of Wales College of Medicine School of Dentistry, postgraduate diploma in clinical dentistry from Trinity College Dublin School of Dentistry, and master’s degree in dental education from University of the Pacific. He completed seven years of active military service with several operational tours. After military service, he established a dental office. He began teaching as a part-time clinical instructor before joining University of the Pacific in 2012 as a group practice leader and course director.

Daniel Lebedies, specialist, graduated from the Teaching & Learning Center’s 2024 Introduction to Educational Technology course.

Kimberly Lovell, MEd, instructor, dental hygiene, predoctoral education, graduated from the Teaching & Learning Center’s 2024 Introduction to Educational Technology course.

Mitzi Wasden, DDS, MS, adjunct faculty, predoctoral education, completed the Teaching & Learning Center’s Level Up! certificate program to become an ATSU-certified health sciences educator.

ATSU-ASHS

Shelley Baltodano, AuD, assistant professor, audiology, graduated from the Teaching & Learning Center’s 2024 Introduction to Educational Technology course.

David Doubblestein, PT, PhD, CLT, Cert MDT, LLCC, assistant professor, director of progress, physical therapy, received the 2024 ATSU-ASHS Scholar of the Year award during the ATSU-ASHS faculty assembly in May.

Nicolette “Nikki” Harris, DAT, LAT, ATC, CSCS, ’17, assistant professor, director of student recruitment, athletic training, received the 2024 National Athletic Trainers’ Association Ethnic Diversity Advisory Committee Bill Chisolm Professional Service Award. Dr. Harris was recognized for her contributions to the development and enhancement of ethnically diverse athletic trainers.

Pamela Kays, PT, DPT, EdD, assistant professor, director of curriculum, physical therapy, received the 2024 ATSU-ASHS Educator of the Year award during the ATSU-ASHS faculty assembly in May.

Ivonne Maldonado De la Rosa, PhD, CCCSLP, assistant professor, speech-language pathology, received the 2024 ATSU-ASHS Faculty Service of the Year award during the ATSU-ASHS faculty assembly in May.

Kelsey Picha, PhD, ATC, associate professor, interdisciplinary health sciences, was coauthor of “Exploring the Use of a Social Determinants of Health Focused History Script to Facilitate Patient Conversations,” which received the 2023 Outstanding Manuscript Award from the Athletic Training Education Journal.

Adam Story, PT, DPT, OTR/L, OTD, MTC, assistant professor, occupational therapy, received the 2024 ATSU-ASHS Junior Faculty of the Year award during the ATSU-ASHS faculty assembly in May.

Malathy Venkatesh, PhD, CCC-SLP, assistant professor, speech-language pathology, graduated from the Teaching & Learning Center’s 2024 Introduction to Educational Technology course.

Cailee Welch Bacon, PhD, ATC, associate professor, athletic training, received the 2024 Professional Development Excellence Award from the National Athletic Trainers’ Association Professional Development Committee. Dr. Welch Bacon was recognized for her outstanding contributions to athletic training continuing education and professional development.

ATSU-CGHS

Jeff Alexander, PhD, FAACVPR, ACSM-CEP®, was promoted to professor of health sciences.

Candace Ayars, PhD, associate professor, health education, received ATSU-CGHS’ 2024 Professor of the Year award for the second consecutive year. Dr. Ayars retired in June after 12 years with the College.

Doug Brtek, EdD, received ATSU-CGHS’ 2024 Adjunct of the Year award for health professions education.

Jeffrey Chaffin, DDS, MPH, MBA, MHA, was promoted to associate professor of dental public health.

Lihua Dishman, DBA, MBA, FACHE, associate professor, health administration, received the 2023-24 Service Award from the American College of Healthcare Executives.

John Fick, EdD, MS, FACHE, associate professor, health administration, was appointed to the Association of University Programs in Health Administration/Health Administration Press Editorial Board for a three-year term.

Marisa Hastie, EdD, MS, ACSM EP-C, PN-1, FACSM, dean, was appointed to American College of Sports Medicine’s Exercise is Medicine Underserved and Community Health Committee for a three-year term.

Clair Lunt, DHSc, MN, RN, ’19, received ATSU-CGHS’ 2024 Adjunct of the Year award for nursing.

Sue McDaniel, MS, instructional designer, received ATSU-CGHS’ 2024 Adjunct of the Year award for health sciences.

Patrick Palmieri, DHSc, EdS, MBA, MSN, ACNP, RN, ’12, adjunct faculty, health sciences, received ATSU-CGHS’ 2024 Michael Samuels Impact Award.

Scott Rankin, DDS, MS, received ATSU-CGHS’ 2024 Adjunct of the Year award for public health.

Matt Rhea, PhD, professor, kinesiology, retired in June after 18 years with the College.

Michael Ryan, PhD, MS, ’19, received ATSU-CGHS’ 2024 Adjunct of the Year award for kinesiology.

Jason Salas, MAEd, instructional designer, received ATSU-CGHS’ 2024 Outstanding Employee Award.

Daniel Smith, PhD, MBA, associate professor, public health, ATSU-CGHS, was awarded funding from the ATSU Community Health Workgroup Quality Improvement & Research Pilot Project Grant as primary investigator for an innovative community health project aligning with ATSU’s strategic focus on improving community health research outcomes.

Kathie Thomas, DHA, ’16, MPH, ’11, received ATSU-CGHS’ 2024 Adjunct of the Year award for health administration.

ATSU-CHC

Eric Sauers, PhD, ’97, dean and professor, was invited to serve as a member on the Santa Maria Valley Chamber of Commerce board of directors. His three-year term began July 1.

ATSU-KCOM

Sumitra Miriyala, PhD, MBA, MPH, FAHA, associate professor, anatomy, completed the Teaching & Learning Center’s (TLC) Level Up! certificate program to become an ATSU-certified health sciences educator. In addition, Dr. Miriyala graduated from the TLC’s 2024 Introduction to Educational Technology course.

ATSU-MOSDOH

Herbert Silva, DMD, FICD, assistant professor and director, dental comprehensive care unit, clinical education, received the Distinguished Humanitarian Award from the International College of Dentists during its 90th annual convocation in September.

ATSU-SOMA

Breanne M. Jaqua, DO, MPH, ’17, associate professor, clinical science education, was selected for the class of 2024 National Academy of Medicine Fellowship in Osteopathic Medicine.

Briana Langston was promoted to senior administrative assistant of continuing education.

Maurice Lee, MD, MPH, FAAFP, assistant professor, clinical science education, graduated from the Teaching & Learning Center’s 2024 Introduction to Educational Technology course.

Melchiorra Mangiaracina, DO, was promoted to course director of osteopathic principles & practice.

A.T. Still University’s Center for the Future of the Health Professions is celebrating its eighth year of operation. As we reflect on our journey thus far and look toward the future, it is important to highlight the Center’s origin. Founded in 2017 by Norman Gevitz, PhD, the Center was established with the goal of providing policymakers and stakeholders in healthcare systems with reliable and comprehensive data and research on the healthcare workforce. This invaluable information enables effective planning for a sustainable future and optimal utilization of available resources.

Under the leadership of director Randy Danielsen, PhD, PA-C Emeritus, along with program administrator Mandy Weaver, MBA, and Steering Committee member Len Goldstein, DDS, PhD, the Center has made significant strides in achieving its vision of becoming a national and international network and resource focused on the future of health professions. Specifically, the Center aims to bring greater visibility to ATSU as a leading institution in healthcare innovation, research, and education.

Moving forward, the Center has set ambitious goals, including the publication of a monthly electronic digest, periodic research reports, and informative one-pagers based on recent data and regulatory changes. Additionally, the Center will continue to host panel discussions with experts on various health policy topics.

One of the highlights from the Center’s past initiatives was a panel discussion in 2018, which brought together faculty members and leaders from each of ATSU’s health professions programs to explore the impact of accreditation on health professions education and its future trajectory. The Center has also published numerous peer-reviewed op-ed articles in the Digest, featuring insights from ATSU faculty and leaders on the future of various health professions.

Recently, the Center appointed three distinguished members to the Steering Committee: Marisa Hastie, EdD, MS, ACSM-EP, PN-1, FACSM, James Keane, DO, MEd, and Mai-Ly Duong, DMD. Their expertise and perspectives will further enhance the Center’s efforts in shaping the future of health professions education.

Looking ahead, the Center is gearing up for a major initiative focused on advancing ATSU’s mission and vision through osteopathic philosophy. This initiative, known as the “ATSU Interprofessional Osteopathic Anthology,” is poised to make a significant impact in the coming year.

The monthly digest produced by the Center is distributed to all ATSU faculty and a select group of external leaders in various fields.

We welcome your input on future topics for the Center and recommendations for individuals to include on our external distribution list. Your participation and support are crucial as we continue to drive forward in shaping the future of healthcare professions education. Please email us at cfhp@atsu.edu to share your thoughts.

Stay tuned for more updates and developments from the ATSU Center for the Future of the Health Professions.