Section 4: Family-Centered Practice in Action

Top 3 Takeaways

1. A practice culture that prioritizes keeping pets with their families, in part by providing equitable access to care, is the foundation of family-centered practice.
2. Cost is the most significant barrier to care. Offering multiple types of payment options expands accessible care to more clients.
3. Implementing an SOC approach and maximizing the use of veterinary technicians and other team members establishes efficient care delivery.

Overview

This section describes some key elements that constitute a family centered practice. Although not exhaustive, the strategies listed below provide private practices with the tools needed to begin establishing a culture of improving access to care. For some practices, this may represent a cultural shift. Such shifts are—of course—challenging. However, the following steps can support such a transition.

Establish a Family-Centered Practice Culture

• Clearly articulate your practice’s goal of keeping pets with families whenever reasonable and possible
  • State your intention and goal, perhaps by creating a mission statement that is posted in staff areas.
  • Engage in training and discussion sessions to bring all members of the practice on board and foster a shared sense of purpose. Ensure that team members understand the “why” underlying the goal.
  • Make decisions based on this goal. Openly discuss with team members what nonjudgmental care looks like.
• Educate the team
  • Ensure that the entire staff understands their role and the practice’s wider role in helping preserve the human-animal bond.
  • Educate the team on barriers to access to care.
  • Educate the team on the principles of SOC and how to apply these concepts in practice.
• Develop written policies
  • Outline the steps that your clinic can take to help clients keep their pets with them. Develop these into standard operating procedures.
  • Create SOC guidelines for commonly seen medical conditions.
  • Conduct staff training on standard operating procedures and guidelines to ensure everyone is comfortable with the steps.
• Confront and dispense with old notions that run counter to the goal
  • Address harmful, commonly held beliefs that “you shouldn’t have a pet if you can’t afford one” or “just surrender the pet to the clinic if you can’t afford care” through open discussion and training to identify and understand biases.
  • Provide diversity, equity, inclusion, and belonging (DEIB) resources.
• Hold “keeping-pets-with-families” rounds
  • Allot time to discuss cases from a family-centric standpoint.
  • Identify cases with care barriers to overcome and discuss what the team did (or could have done) to achieve the goal.
  • Celebrate “wins” in the same way medical and/or surgical successes are celebrated.

Creating a change in culture takes work and time. For more information on culture change, see AAHA’s Culture Initiative at https://stage.aaha.org/practice-resources/healthy-workplace-culture/. For DEIB resources, see Resources at aaha.org/community-care.

Provide Multiple Types of Payment Options

Cost is the most common barrier to obtaining veterinary care.¹ Core to family-centered practice and keeping pets with families is the need to help families overcome this barrier when necessary. Importantly, providing payment options does not have to mean offering discounts or lowering your prices.

Instead, it means having a “toolbox” of payment options to offer when a client cannot afford to pay in full for services (Table 4.1). Having multiple types of payment options increases the team’s ability to work with clients and find the best option for them. Providing terminals that allow rounding up or adding a dollar can provide micro-funding to a nonprofit established within the practice or shared by multiple practices. Pet insurance can also help clients meet the cost of veterinary care, and offering information and education on how to select appropriate insurance plans for individual pets can raise clients’ awareness of this option.

Download Table 4.1 PDF

*Note a distinction between hard-credit check financing and soft-credit check financing. Equipping a practice with multiple types of tools and—if
possible—multiple options within each category potentially puts veterinary care within reach for more families. For more information on hard
versus soft credit checks, see Black M. What’s the difference between a hard and soft credit check? Forbes Advisor. Updated June 28, 2021.
Available at https://www.forbes.com/advisor/credit-score/soft-credit-check-vs-hard-credit-check/.

^†The examples in this table are not exhaustive. For more information, see Resources at aaha.org/community-care. For an extensive list of
payment options, see the Veterinary Innovation Council’s Access to Care hub at https://www.vetaccesshub.com/tools.

VMA, veterinary medical association.

Embrace an SOC Approach

SOC is a family-centered, experience-based approach to providing care for families hampered by barriers to care. The goal is to achieve the best possible outcomes for the pet, while also respecting any barriers the client may be facing.

Some key principles of SOC include the following:

• Contextualized Care: A context framework that incorporates the pet’s needs but also considers the family’s particular needs, goals, circumstances, and potential challenges such as transportation, mobility barriers, or primary language spoken.
• Experience-Based and Evidence-Based: The veterinarian uses clinical experience and judgment to develop a care plan that is appropriate for the individual pet. Experience-based practice is not a substitute for evidence-based practice, but it should be considered in concert with an evidence-based approach, particularly as it may sometimes reduce the need for costly diagnostics.
•  Tiered: The care plan may take a tiered approach, with more expensive or invasive procedures deferred until later if it makes sense for the particular case. In some cases, the best outcome may result from skipping sequential trial treatments for a more aggressive option that is ultimately more cost-effective and efficient.
• Dynamic: The care plan is based on a range of options that remain flexible and open to adjustment as needed based on the pet’s condition and the family’s situation.

SOC is a valuable tool for veterinarians who want to provide the best possible care for pets whose caregivers have limited financial resources. This approach respects the needs of both the pet and the family members. See Table 4.2 for some examples of SOC approaches in practice.

Download Table 4.2 PDF

For more information, see AlignCare’s Incremental Care Guide at https://pphe.utk.edu/wp-content/uploads/2019/07/AlignCare-Incremental-Veterinary-Care-Guide-Narrative-1.pdf.

*For all examples, the client would be briefed on the risks and benefits of all options and all discussions and decisions documented in the medical record.

^†Cooper ES, Owens TJ, Chew DJ, et al. A protocol for managing urethral obstruction in male cats without urethral catheterization. J Am Vet Med Assoc 2010;237(11):1261–6.

PCV/TS, packed cell volume/total solids; UA, urinalysis; USG, urine specific gravity.

Discussing Treatment Options with Clients

Client communication is essential for implementing family-centered practice and should consider the family’s overall quality of life when making recommendations and decisions.² Ensure that proper documentation in the medical record always occurs when discussing diagnostic and treatment options with clients and obtaining informed consent.

• Ask about the client’s goals. What are the client’s hopes and expectations for their pet’s health? A definitive diagnosis? Alleviation of pain? Pet back home as soon as possible?
• Understand the client’s financial situation. What is their budget for veterinary care? Do they have insurance?
• Explain the spectrum of options. Offer options for treatment and explain how each addresses the pet’s care and the client’s goals.
• Be clear and transparent about the costs of care. Provide accurate information on costs or the range of expected costs.
• Discuss payment options. Discuss any available payment options with the client, including payment plans, third-party payment plan providers, insurance, grant funds, and any other tools available to the practice.
• Discuss any other barriers to care. Remember that although cost is the most common barrier to care, it is not the only one. Be sure to discuss any other potential challenges the client may encounter when implementing the plan, such as lack of transportation or physical limitations.
• Be empathetic and understanding. Remember that pet caregivers may be facing difficult decisions and challenges outside the veterinary realm. Be patient and understanding while suggesting possible solutions.
• Listen. Consider an approach that is centered in compassion and deep listening, for example, listening without judgment, being present, not listening to respond, maintaining eye contact, not interrupting, and asking follow-up questions.^3,4

Optimize the Role of Veterinary Technicians

Veterinary technicians are integral to the veterinary care team. A well-trained technician can perform many important functions independently of a veterinarian (where permitted by state practice acts and regulations) and can extend a practice’s veterinary services. Empowering veterinary technicians to practice at their highest capacity also can increase job satisfaction and reduce turnover. Maximizing veterinary technicians’ skills and duties can help address barriers such as language, disability, clinic capacity to see patients, and cost.

• Technician-only appointments. Depending on state regulations, veterinary technicians may administer vaccines, perform certain diagnostic tests, place microchips, administer medications, and much more.
• Patient intake. A thorough history is vital, especially when practicing SOC. Veterinary technicians can gather pertinent details from clients before a veterinarian gets involved with the case, which saves time and costs.
• Client education. Veterinary technicians can answer questions and educate pet caregivers about their pet’s condition and treatment plan. This can include discussing any potential side effects of the treatment and troubleshooting issues like difficulty medicating. Veterinary technicians can help address barriers like disability by working with the client to offer feasible options.
• Protocols. Protocols for common conditions and situations enable veterinary technicians to act independently. For example, veterinary technicians could handle upper respiratory infections, feline lower urinary tract disease, and uncomplicated vomiting/diarrhea through written protocols for diagnostic procedures and client communication before the veterinarian becomes involved to diagnose and prescribe treatment. These ideas represent just a few ways to optimize the skills and job duties of veterinary technicians, but there are many others. Be sure to comply with state practice acts and regulations that define scope of practice for veterinary technicians, as these can vary by state. For more information, see the AAHA Technician Utilization Guidelines at aaha.org/technicianutilization.

Offer Telehealth Options When Legal and Appropriate

Telehealth often helps overcome logistical and financial barriers. Implementation requires awareness of state and local regulations as veterinarian-client-patient relationship (VCPR) regulations vary by state, as well as an understanding of federal VCPR requirements. See the resources available from the American Association of Veterinary State Boards at aavsb.org to learn about specific state regulations.

Telehealth can address a few important aspects of access to care, including:

• Mobility issues. When getting to the veterinary hospital presents a significant barrier to care, telehealth options open doors for these clients.
• Time. Telehealth can be more convenient for clients who work long hours or have commitments that make it difficult to visit a veterinary clinic during regular business hours.
• Continuity of care. Telehealth appointments can promote improved access, convenience to families, and comfort for pets, resulting in more consistent care.

For more information on implementing telehealth options in practice, see the AAHA/AVMA Telehealth Guidelines for Small-Animal Practice at aaha.org/telehealth.

Train Multiple Staff Members for Financial Conversations

Training multiple team members to have financial conversations with clients benefits both clients and practice staff alike.

• Improved customer experience. Clients benefit from consistent access to someone who can help them navigate the financial aspects of veterinary care. This support can be especially important for clients who are feeling overwhelmed or stressed about the cost of care.
• Destigmatization. Providing multiple staff members who are comfortable talking about money creates a more open and welcoming environment. Clients may be more empowered to discuss their financial concerns without feeling like it is an embarrassing secret only discussed with certain people.
• Increased client satisfaction. Clients appreciate open and honest conversations about the cost of care. When they feel heard and understood, they are more likely to be satisfied with the care received.
• Improved financial outcomes. When clients know their financial options, they are more likely to make informed decisions about their pet’s care. This can lead to better financial outcomes for both the client and the clinic.
• Reduced stress. Talking about finances can be stressful for both clients and staff. By training multiple staff members in financial conversations, the clinic creates a more supportive environment for everyone involved, and no single person must bear the stress alone.

Offer Multilingual Support

Language can be another barrier to obtaining veterinary care. Practices in areas with a significant population of non-English speakers should offer communication support in clients’ primary languages. This improves communication, builds trust, increases satisfaction, and attracts new clients.

• Hire bilingual staff members. If possible, this is the most effective way to offer language support. Compensate staff for providing translation services in addition to their other responsibilities.
• Seek out community language services and/or community volunteers. Some community nonprofit organizations may offer language services.
• Use translation services. There are several translation services available (e.g., Google Translate and Jeenie.com) that can translate documents, emails, and phone calls. These services can be a good option if a practice does not have bilingual staff members or if team members need to communicate with clients who speak a language not commonly spoken in the area.
• Create multilingual resources. Include multilingual intake forms, educational materials, and signage. These resources help clients who do not speak English understand what is happening at the veterinary clinic and make informed decisions about their pet’s care.
• Train staff on how to communicate with non-English speakers. Such training includes teaching them how to use translation services and effective communication strategies.
• Train staff on how to communicate with deaf and hard-of-hearing clients.

The 2024 AAHA Community Care Guidelines for Small Animal Practice are generously supported by CareCredit, Hill’s Pet Nutrition, IDEXX,  Merck Animal Health, and Pawlicy Advisor.