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Bringing Behavior to General Practice

I was Doomscrolling through Facebook last week and stumbled across some questions under SVBT (Society of Veterinary Behavior Technicians). One of the members was asking for help developing her clinic's behavior program and it seemed like a pretty popular topic. I had the opportunity to speak with her one-on-one yesterday, and I thought it might be helpful to outline some of the common ways you can bring behavior to your practice.

Before we start looking at specifics, a few words of advice:

  • Make sure your management team is on board and objective protocols are developed.

  • Create long term goals and short term, achievable goals with set timelines and measurable outcomes.

  • Training humans is just like training animals. Start with small achievable goals and build on your little successes.

  • Have a team lead with several assistants to help support to goal(s) for that week.

  • Some people will give you resistance and that's okay. It's not a personal attack on YOU. Change is hard.

Step 1 - Approach to Patient Care

Essentially, step 1 is bringing Fear Free and Low Stress Handling into your practice. You aren't going to focus on "big kid" behavior services right out of the gate. We need our team to start out being away that behavior IS a part of veterinary medicine. Focus on training body language, minimal restraint techniques, and effective team communication. Develop hard stopping points for any species you work with. For example, in the Fear Free paradigm, they teach to stop when a cat struggles for 2 seconds and a dog struggles for 3 seconds. Start there. Ask management to pay for your core management team to go through at least Level 1 of the Fear Free Program. The rest of you can then share your knowledge with those under your supervision.

Step 2 - Start Prescribing PVPs

Now that you know what stress looks like and when you need to stop pushing a specific treatment, you'll need to implement alternatives. The quickest and easiest way is to start prescribing anti-anxiety medications. Most of this will be on your doctors since they need to familiar with anxiolytics, how they work, how to pick the right ones, and feel comfortable signing their name on that prescription. Get management to sign them up for some Continuing Education in psychotropics or schedule a learning session with a veterinary behavior professional (*waves* I'm totally available for this...). Most clinics start with trazodone, but there's also clonidine, gabapentin, alprazolam, or even just over the counter products.

Step 3 - Develop Sedation Protocols

There will inevitably be patients that 1.) are too far gone for low stress handling to help and 2.) don't respond profoundly enough to oral sedation to allow for a safe examination. Enter, injectable sedation. Low stress handling and PVPs are still important for these cases as we want to administer their medications as smoothly as possible. Stress absolutely blocks the effects of sedatives. Explore "walking sedation" techniques, develop sedation protocols that will work for high stress animals, and develop alternatives for older or sickly patients. A word of advice... unless contraindicated ALWAYS use ketamine in your sedation protocols for highly fearful/aggressive patients. It's the only drug that can reliably cut through that adrenaline rush.

Step 4 - Happy Visit

We have a plan in place for neurotypical patients, those that are slightly stressed, and those that are going to take someone's arm off. Now, we start implementing protocols that can help reduce stress and the need for PVPs in those low- to middle-tier stressed animals. Happy Visits are a great place to start. Schedule 15 minute visits during quiet times of the day where families c

an just bring their pet in, hang out for a bit, eat some treats, then go home. The goal here is to help uncouple hospital = danger. If 9/10 nothing happens at the vet, then the 1/10 something does, the animal's anticipatory stress will be significantly lower. Most clinics offer these for free.

Step 5 - Cooperative Care

Now we're finally getting into the meat of your behavior program. We have Happy Visits, know how to prevent stress, and now we're going to work on training patients to actively work with their team for medical care. Alicea and Monique wrote a whole book on Cooperative Veterinary Care. I recommend reading through this plus at least 1-2 basic training books before really implementing Cooperative Care.

I recommend starting with patients that are well known and owned by families that have been married to the practice for a long time. Offer to work with their pets for free to get yourself some practice and make a positive impact on the pet's medical care. Once you have a good system in place, you can start charging for your time.

Step 6 - Preventative Behavior

Like other aspects of medical care, prevention is the best medicine. You can start fleshing out your Puppy and Kitten programs to support normal behavioral development. Have Puppy and Kitten Talks, send home resources, set up socialization classes, etc. There is so much opportunity here and setting up their young pets off on a good foot will tie your clients to the practice for years.

Step 7 - Intervention Behavior

Hopefully by now your behavior education has come along pretty well. You're comfortable with normal behaviors, basic training principles, and helping fearful pets be successful in the veterinary clinic. Now might be the time to start developing Behavior Consultation for pets with established problems. The most important piece of advice here: Know what you know and recognize what you don't. There is no end of terrible advice and information out there, don't add to it.

Obviously, there is a lot more to it, but this is a basic roadmap. Based on the feedback from this post, I'm considering setting up a remote, roundtable discussion about how you actively implement some of these changes. Until then, I figured this was a good jumping off point!

Good luck!

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