How Service Dogs Provide Support

Emotional support animals and service dogs are two different breeds, so to speak. Much more than loving pets with a purpose, highly trained service dogs spend months learning how to best help their handlers perform major life tasks despite physical or psychiatric challenges. For handlers and service dogs alike, intense commitment to working together leads to life-changing partnerships.

Working Animals, Not Pets

The Americans with Disabilities Act spells out the types of tasks service dogs perform. Guiding people who are blind, pulling a wheelchair and alerting people who are deaf are examples. Protecting a person having a seizure, calming a person with PTSD during an anxiety attack and reminding a person with mental illness to take prescribed medications also qualify.

Service dogs perform some pretty amazing feats, says Dr. Carol (C.J.) Betancourt, a retired physician, service-dog user and co-founder of the Arizona-based Foundation for Service Dog Support. "We have quite a few clients with seizures who have gotten dogs," Betancourt says. "Many of the dogs are able to detect the seizure before it happens. They can warn the person so they will sit down or lay down on the floor." Dogs usually stay with the person during the episode, she says, and are trained to run and get help or bark once it's over.

People with diabetes may benefit from having a service dog who can alert them to hazardous high and low blood sugar levels. "We'll usually take saliva samples during the training: one of when the sugar is high and one of when the sugar is low," Betancourt explains. "Our dogs are trained to spin around; to go in a circle in one direction if it is high and in the opposite direction if it is low."

When patients develop a mobility challenge, Betancourt would like her fellow physicians to broaden their treatment options. "Instead of automatically ordering them a wheelchair, a service dog ought to be part of the dialogue," she says.

[See: Was That a Seizure?]

About three years ago, Detective Scott Sefranka of the Phoenix Police Department nearly died in a shooting. His physical recovery from the gunshot wound to his abdomen took months after much of his intestines were removed. More surgery to a fractured arm, nerve damage and back issues were additional physical reminders.

"What I didn't really expect at all that was the mental issues I suffered," Sefranka says. "I had developed PTSD. I developed anxiety about not wanting to leave the house. I didn't want to go to work. I didn't want to associate with people at work. I basically tried to stay hidden."

His results from cognitive behavioral therapy and EMDR, often used to treat post-traumatic stress disorder, were mixed. Digestive issues limited medication options. His wife started researching service dogs, but because the FSDS program centers on golden retrievers (who shed), the couple looked elsewhere at first. But they found too-long wait lists and too-high costs at other service foundations. Eventually, they bought their own service dog -- a poodle named Digby -- and training commenced.

Following roughly 18 months of basic then individualized training, Digby now helps Sefranka by retrieving objects, opening doors and performing a variety of other physical tasks, including serving as a balance and brace when the detective struggles with hip stability related to the bullet's exit-wound damage.

Digby also helps Sefranka deal with his mental health concerns. "He can actually pick up and sense when I have anxiety issues," he says. "He'll act as a distractor either by licking me or nudging me. Since I don't take the medications, I need grounding a lot of times. He'll lay across me or put pressure on me, which helps ground me back to reality."

For Sefranka, PTSD means regular bouts of nightmares, night tremors, anger issues, isolation and depression. "Digby's really been a key component in me moving forward," he says. "Since I got him, I've been able to go back to work. I've been able to go back out in public and kind of resume my life as normal."

[See: 7 Ways Pets Can Make You Healthier.]

Animal Distinctions

Canine Companions for Independence, based in Santa Rosa, California, works with clients with disabilities from a wide range of conditions including spinal cord injury, post-polio syndrome, multiple sclerosis and cerebral palsy. "Almost anything that results in a person using a wheelchair, walker or scooter," says CEO Paul Mundell. They also place the Labradors they breed as hearing dogs and facility dogs, which are trained to work with professional caregivers in settings like hospital rehabilitation units.

They also place dogs called skilled companions. "It's typically the child and one or both parents and the dog who form the team," Mundell says. "Often we make those types of placements either with children who have Down syndrome or autism or another disability but for whom a service dog isn't yet an option, maybe because they're too young to independently handle a dog."

Emotional support animals are different in that, for one thing, they don't have to be dogs. "It's an animal whose presence provides emotional or psychological comfort to the person," Mundell says. "It has no special training." While emotional support animals are recognized under the Fair Housing Act, he says, their owner's rights are much more limited.

Mundell's group "strongly opposes" websites where anyone can obtain an online certificate and a doggie vest with a patch to get pets access to public places where service dogs are allowed. "The biggest misconception is that passing your pet off as a service dog is somehow a victimless crime," he says. Instead, he says, dogs who aren't properly trained might attack other dogs, be disruptive or leave messes in stores or restaurants -- and create backlash for legitimate service teams.

Training a true service team is expensive. "From birth of the puppy to placement ... costs us a little over $50,000," Mundell says. "That cost covers essentially 10 years of service. We don't pass that cost along -- graduates pay nothing."

[See: 14 Ways to Protect Seniors From Falls.]

Awareness and Respect

When a person with a service dog team approaches a public facility, staff members may only ask two questions, according to the ADA: "Is the dog a service animal required because of a disability?" and "What work or task has the dog been trained to perform?"

"Those of us with service dogs who use them in a legitimate manner -- we're just like anyone else in society," says Sefranka, whose now serves on the FSDS board. "We're not trying to game the system. We're not trying to pull the wool over anyone's eyes because we just want to have our dog with us. In many instances, these are animals that provide a medical function and are a medical necessity."

Lisa Esposito is a Patient Advice reporter at U.S. News. She covers health conditions, drawing on experience as an RN in oncology and other areas and as a research coordinator at the National Institutes of Health. Esposito previously reported on health care with Gannett, and she received her journalism master's degree at Georgetown University. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.