Section 5: One Health Scenarios

The following scenarios are intended to guide veterinary professionals through common challenges and potential solutions using the One Health System Roadmap (Figure 4.1). It is important to note that these examples address using a One Health approach after a situation arises. Ideally, relationships will be developed across the One Health spectrum prior, making reacting to similar situations much easier. As you read through these scenarios, consider how your practice could best prepare by proactively developing a One Health network and protocols.

Scenario A: Tackling Zoonotic Diseases Impacting the Whole Family

Crossover Diagnoses of Rocky Mountain Spotted Fever (RMSF) in Animal and Human Patients

Mark and Michelle Spencer, their 6-year-old child, Morgan, their 3-year-old child, Madison, and their active 4-year-old Labrador retriever, Max, have been seeing their veterinarian, Dr. Findley, since Max was a puppy. The Spencers enjoy outdoor recreation, including frequent hiking and camping near their home in Charlotte, North Carolina.

Presenting Situation

Michelle brought their dog, Max, to Dr. Findley for an urgent appointment because Max didn’t eat his breakfast and didn’t want to go for his usual walk. The family noticed that he “just seemed off,” and earlier that morning, he vomited in the backyard.

The registered veterinary technician (RVT), Alex, took the history and learned the family went camping the previous week. After returning home 3 days ago, they noticed engorged ticks attached to Max. Michelle removed the ticks with tweezers. Alex conveyed the information to Dr. Findley and documented everything in Max’s chart.

On physical examination, Dr. Findley found Max had pale mucous membranes and a fever (104°F; 40°C). Max was lethargic with slight tremors and vocalized during orthopedic examination, particularly when his stifles, tarsal joints, and elbows were palpated. No ticks were found. During the examination, Max vomited bile-stained fluid.

An in-house complete blood count and serum biochemistry panel revealed anemia, leukocytosis, thrombocytopenia, and elevated serum liver enzyme activities. Dr. Findley suspected that Max had contracted a tick-borne rickettsial disease and knew that Rocky Mountain spotted fever (RMSF), caused by the bacteria Rickettsia rickettsii, occurred in the area.

Dr. Findley explained the blood work and examination findings to Michelle and discussed the incidence of RMSF in North Carolina. Michelle noted that they had skipped Max’s monthly dose of flea and tick prevention for the last few months because they ran out and didn’t have time to obtain a refill. While waiting for confirmatory testing from the laboratory, Dr. Findley recommended that Max be hospitalized to receive fluid therapy, antiemetics, and antibiotic therapy.

Shared History

While presenting the treatment plan to Michelle, Dr. Findley asked if anyone else in the family was exposed to ticks during their camping trip. Michelle reported they had found attached ticks on both Morgan and Max during the trip. In fact, Morgan had been feeling unwell since they returned home and was currently being seen by her family health care provider to address a bad headache and vomiting. Dr. Findley informed them that should Max have RMSF, humans in the household might also have been exposed to infected ticks, and suggested they seek medical attention promptly and inform the provider their dog is currently being treated for possible RMSF.

Diagnostics for Infectious Disease: Use of Titers, PCR

Given the suspicion of a tick-borne disease, Dr. Findley commenced treatment with doxycycline and submitted Max’s blood for vector-borne disease serology and polymerase chain reaction (PCR) testing. The veterinary team planned to pair the acute serum specimen with a convalescent specimen collected 2 weeks later to confirm the diagnosis using an indirect fluorescent antibody (IFA) assay.

RMSF and Human Exposure Risks

The following day, the results of the vector-borne PCR panel were reported as positive for Rickettsia rickettsii DNA. Dr. Findley contacted Michelle with the results and urged Michelle to reach out to her family health care provider to discuss the possibility of a tick-borne infection. Michelle reported that Morgan had developed a rash and fever. Because Michelle felt overwhelmed dealing with a very ill family member as well as a sick pet, she asked Dr. Findley to contact the family’s health care provider to let them know about Max’s diagnosis.

When Alex shared concerns about possible staff exposure to RMSF and protocols for care in the hospital, Dr. Findley referenced the Centers for Disease Control and Prevention (CDC) guidelines and explained that RMSF is typically only transmitted by tick bites. Despite not seeing visible ticks, Dr. Findley treated Max with tick control medication to address any less visible stages of the tick life cycle.

Reaching Out to the Human Health Care Provider

With Michelle’s written permission, Dr. Findley called the family’s health care provider and shared that Max was a patient of the veterinary clinic and was being treated for RMSF. Dr. Findley shared the concern that other family members may have also been exposed and referred to the CDC’s webpage with guidelines for reportability. The physician thanked Dr. Findley and assured him that they would test and treat as needed.

Reaching Out to Public Health Officials

Dr. Findley found information about human risk factors and symptoms of RMSF on both the CDC website and the state public health department website. Although veterinarians are not required to report RMSF in North Carolina (this requirement varies by state), Dr. Findley decided to contact the local health department to let them know about the case and possible family exposures. The public health official said they would keep an eye out for laboratory testing from the Spencer family and reach out to the Spencers’ providers regarding the suspect case.

Reaching Out to Local Veterinary Medical Associations

Dr. Findley wanted to make sure colleagues in the region knew about the suspected RMSF case and asked the North Carolina Veterinary Medical Association to share the information with their members.

Treatment and Prevention

At close of business, Michelle arrived to pick up Max. His temperature had returned to normal since receiving his first dose of doxycycline, and he was eating in the hospital. A 2-week course of doxycycline was dispensed, along with refills and instructions on how to use Max’s flea and tick preventive. Alex provided Michelle with the practice’s information sheet on tick prevention and a link to the CDC’s recommendations for what to do after a tick bite. Alex also provided Michelle with the CDC RMSF information sheet. Michelle mentioned that she had picked up medication from the pharmacy and planned to start Morgan’s treatment immediately.

Follow-Up Care

In 2 weeks, Max returned for a convalescent blood sample collection for the immunoglobulin G IFA assay to confirm Dr. Findley’s diagnosis. Mark Spencer brought Max to the hospital for the follow-up visit. He shared that Max was back to his old self after just 2 days of doxycycline administration, and they completed the course of treatment. Mark reported that Morgan also felt better and expressed the family’s gratitude for Dr. Findley’s help in ensuring that they received the correct treatment early in the course of the disease.

Discussion and Debrief

After reading this scenario featuring a cross-over diagnosis involving both an animal and a human patient, discuss this case and others the veterinary team may face.

• What did the veterinary and human health care team do correctly?
• Would you have done anything differently?
• How can your team plan for similar situations in the future?
• What relevant resources does your local community offer?
  • Do you have the number for your local public health department and name of the person who works on zoonoses?
  • Do you have environmental health or park district contacts to call to recommend signage about ticks and tick-borne pathogen risks for pets and people?
• How can you increase client awareness about the risks of vector-borne diseases in your area?

Further Reading and Resources

Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain Spotted Fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis — United States. MMWR Recomm Rep 2016;65(2):1–44.

Centers for Disease Control and Prevention. About Rocky Mountain Spotted Fever. https://www.cdc.gov/rocky-mountain-spotted-fever/about/index.html.

Companion Animal Parasite Council. Rocky Mountain Spotted Fever. February 20, 2018. https://capcvet.org/guidelines/rocky-mountain-spotted-fever/.

TABLE 5.1: One Health Approach to Infectious Diseases Common to Humans and Companion Animals

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Scenario B: Compassionate Care for Older Adult Client with Cognitive Function Issues

Dr. Hart started seeing Mildred Watson and her chihuahua, Mr. Snuffles, several years ago. Mrs. Watson is an older adult, who over the years began showing signs of cognitive impairment and memory issues, with significant progression over the past year. Mr. Snuffles, an aged chihuahua, began his role as a loyal companion to Mrs. Watson more than 10 years ago.

Presenting Problem

Over the past few years, Dr. Hart has closely monitored Mr. Snuffles’ heart murmur and stage B1 myxomatous mitral valve disease (MMVD), a condition that commonly affects older, small-breed dogs. During a routine checkup, Dr. Hart diagnosed Mr. Snuffles with mild congestive heart failure, stage C MMVD, a progressive condition requiring medication, lifestyle adjustments, and frequent monitoring. However, during the visit, Dr. Hart noticed that Mrs. Watson seemed more disoriented than usual. She expressed confusion about Mr. Snuffles’ diagnosis and was unable to verbalize the treatment plan after it was discussed. Dr. Hart shared these observations with Mrs. Watson, who acknowledged she had been struggling more with her memory lately.

Mrs. Watson’s cognitive decline presented a significant challenge in communication and comprehension, particularly regarding complex medical information. Dr. Hart knew it was crucial to ensure that Mr. Snuffles received appropriate care and that Mrs. Watson was able to consent to and carry out the treatment plan. This required a heightened focus on her communication style and strategies.

Simplified Communication: Dr. Hart used clear, simple language when explaining Mr. Snuffles’ condition and treatment. She avoided medical jargon and broke down information into small, manageable pieces.

• Instead of saying “mild congestive heart failure,” Dr. Hart explained, “Mr. Snuffles’ heart isn’t pumping as well as it should. This means we need to give him some medicine to help his heart work better.”
• She provided short, concise instructions for administering medication: “Give Mr. Snuffles this pill every morning with his food.”

Written and Visual Aids: Mrs. Watson shared she was having trouble retaining verbal information, so Dr. Hart provided a written summary of the diagnosis and treatment plan. The take-home information was in patient-centered language and included simple diagrams to illustrate key points.

The handout included steps for medication administration, signs that might indicate a worsening of Mr. Snuffles’ condition, and a contact number for the clinic in case of questions.

Involving a Caregiver: Recognizing Mrs. Watson’s difficulties, Dr. Hart asked Mrs. Watson if there were aspects of Mr. Snuffles’ care where a trusted caregiver or family member might be able to help, or if there was someone who regularly assists her that could be trained to help with Mr. Snuffles.

Mrs. Watson mentioned her neighbor, Laura, often helps her with daily tasks. With Mrs. Watson’s permission, Dr. Hart reached out to Laura, explaining Mr. Snuffles’ condition and ensuring she understood the treatment plan. They formulated a strategy to help Mrs. Watson remember to give Mr. Snuffles his medications, including suggesting the use of blister packs to keep his medication organized. Mrs. Watson had also shared difficulties connecting with her primary care office about her worsening memory. Dr. Hart offered to call Mrs. Watson’s primary care provider with her observations, but Mrs. Watson declined this offer and did not give her consent to contact her human health care provider. Dr. Hart let her know that the offer remained open for the future, should Mrs. Watson change her mind.

Regular Follow-Ups: To monitor both Mr. Snuffles’ health and Mrs. Watson’s ability to manage the treatment plan, the clinic’s customer service representative (CSR) scheduled regular follow-up appointments and planned regular appointment reminders. These visits provided the opportunity to monitor and adjust treatment as needed and provide ongoing support; however, the team was aware that increasing the frequency of visits could create a financial and logistical burden for Mrs. Watson. With Laura’s help, the team was able to offer some telehealth check-ins to decrease this burden. The team was also vigilant for indications of a decline in Mrs. Watson’s ability to safely care for Mr. Snuffles or herself and were prepared to connect Mrs. Watson to additional resources such as a social worker if needed.

Transportation/Access to Clinic Visits: Staff watched for any potential changes in Mrs. Watson’s ability to get to the clinic and helped her find alternatives if transportation was not available.

Discussion and Debrief

After reading this scenario featuring a client with cognitive impairment, discuss this case and others the veterinary team may face.

• What did the health care team do correctly?
• Would you have done anything differently?
• How can your team plan for similar situations in the future?
• What relevant local resources does your community offer?
• How might ethics and drivers impact how a human health practitioner and a veterinary practitioner would address this situation?
• How can you communicate your openness to helping pets stay in homes and continue to receive veterinary care despite the challenges a client may face?

Further Reading and Resources

National Institute on Aging. Talking with your older patients. https://www.nia.nih.gov/health/health-care-professionals-information/talking-your-older-patients.

Wollney EN, Armstrong MJ, Bedenfield N, et al. Barriers and best practices in disclosing a dementia diagnosis: A clinician interview study. Health Serv Insights 2022;15:11786329221141829.

Recommended Strategies for Communicating with Individuals with Cognitive and Memory Issues ¹

Maintain Eye Contact and a Calm Environment.
Provide a quiet, distraction-free setting to help the client focus better. Maintain eye contact and use a calm, reassuring tone.

Repeat and Reinforce Information.
Repeat essential points multiple times during the conversation and reinforce them with written notes and visual aids. Ask the client to repeat what they understand to confirm comprehension.

Patience and Empathy.
Remain patient and empathetic and understand the client may become frustrated. Provide emotional support and reassurance to build trust and alleviate anxiety.

Positive Language.
Frame instructions positively, saying “Do this” instead of “Don’t do that” because positive language is easier to process and follow for individuals with cognitive impairments.

TABLE 5.2: One Health Approach to Older Adult Clients

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Scenario C: Respectful Strategies and Accommodations for ADA-Eligible Clients and Patients

Presenting Problem

Joe scheduled a new client appointment with Dr. Garcia for his dog, Snoopy. The CSR noted in the schedule that Snoopy was an assistance dog and informed Charlie, the credentialed veterinary technician (CrVT) assigned to Dr. Garcia. Before the appointment, the team members took time to remind themselves that they can ask just two questions about working and assistance dogs recognized by the Americans with Disabilities Act (ADA): (1) Is the dog a service animal required because of a disability? and (2) What work or task has the dog been trained to perform? In addition, the team looked into best practices for working with service pets, including the following:

• Talk directly to the client
• Ask before coming into physical contact with the assistance animal
• Make accommodations as requested by the client
• Do not make assumptions

Making Accommodations During the Appointment

Joe arrived with Snoopy and received paperwork to sign for consent to treat. He explained his low visual acuity and barriers to reading the form. The CSR asked Joe how best to guide them to the examination room. Joe asked the CSR to walk just in front of him on the opposite side of Snoopy, who would follow and guide Joe. After Joe entered the examination room, the CSR described the room, then read the forms aloud for him and offered to email him a copy to keep on file after he signs.

During the examination, Dr. Garcia learned that Snoopy is a 3-year-old golden retriever who joined Joe about a year ago. Joe shared countless ways Snoopy changed his life—he is getting out more, is making new friends, and just loves the dog. He admitted he couldn’t imagine not having Snoopy with him. Joe explained that he wants to accompany Snoopy for any procedure because Snoopy is not used to other handlers.

Understanding the Role of an Assistance Animal

Joe made today’s appointment because he was worried Snoopy may be injured or in pain. He explained he felt a difference in Snoopy’s gait on walks and heard him whimper when he jumped. Dr. Garcia’s orthopedic examination was consistent with a ruptured cranial cruciate ligament. He spoke with Joe about the indication for surgery and,  in the meantime, recommended rest and pain management. Because an orthopedic injury may impact Snoopy’s ability to perform his duties, Dr. Garcia asked Joe questions about how much running, jumping, and walking Snoopy’s daily work required.

Accommodations for Home Care

Dr. Garcia collaborated with Joe on a plan to rest Snoopy as much as possible, provide pain management, and limit jumping and running, while knowing Snoopy must walk with Joe to and from his job each day—which involves navigating a short flight of stairs. Dr. Garcia had a frank conversation with Joe about Snoopy’s recovery and let him know that Snoopy would not be able to work for 6–8 weeks after surgery. He recommended Joe develop a plan for emotional and mobility support during this period. In addition, the veterinary team offered to contact a social worker to assist in finding him additional support services.

While handing the discharge instructions to Joe, Charlie realized Joe wouldn’t be able to read the medical labels and instructions provided. They asked Joe what accommodations or modifications were needed to make the medication instructions and dosing accessible to him. Joe asked for emailed instructions so that his voice-assisted computer could read them aloud. Charlie offered to add several rubber bands around the bottle, so Joe can distinguish Snoopy’s medication from any others in the home.

In a few days, Charlie reached out to Joe to check on Snoopy and share the number of a veterinary physical therapist who could come to Joe’s home for postoperative rehabilitation therapy for Snoopy. They recommended that Joe provide the list of verbal cues Snoopy knows to the surgery facility to make his overnight hospitalization easier.

A veterinary orthopedic surgeon performed a tibial plateau leveling osteotomy (TPLO) 2 weeks later. This allowed Joe to make arrangements for his mobility and access during the postoperative period.

Snoopy’s recovery was uneventful, and he returned to Joe after the surgery. During a follow-up call, Joe told Charlie that Snoopy seemed to be struggling with not being able to accompany Joe to work and was barking abnormally and showing other signs of anxiety. Charlie asked Joe to bring Snoopy in to assess the possible need for anxiolytics or sedatives and to discuss options for other low-impact tasks Snoopy could perform to decrease his stress levels.

Recognizing Zoonotic Risks Associated with Working and Assistance Animals

When Snoopy arrived, Dr. Garcia suspected an infection at the incision site and mentioned it to Joe. He asked Joe if there was anyone immunosuppressed in the household. Joe shared that he takes immunosuppressive medication and asked if he could be at risk of acquiring Snoopy’s infection. In response, Dr. Garcia recommended culturing the incision before starting any antibiotics to ensure proper treatment and minimize the risk of selecting for resistant bacteria. Culture results received a few days later were positive for a multidrug-resistant methicillin-resistant Staphylococcus pseudintermedius (MRSP).

Dr. Garcia immediately called Joe to start Snoopy’s treatment and discuss the potential for zoonotic transmission. He recommended that Joe contact his health care provider should he experience any illness. He shared that MRSP can be present on the skin of healthy dogs. Charlie emailed comprehensive recommendations including hand hygiene and wound care guidance along with instructions for decontamination of bedding and other household items. Charlie checked in with Joe weekly to monitor Snoopy’s recovery. They also provided Joe with contact information for a social worker for further support and resources.

Dr. Garcia contacted the veterinary orthopedic surgeon about the MRSP infection to ensure that the surgical team was aware of a potential exposure.

Six months later, Joe brought Snoopy in for his checkup and vaccines. Snoopy had fully recovered from the TPLO surgery and showed no signs of infection.

Discussion and Debrief

After reading this scenario featuring a guide dog patient and a client with no or low vision, discuss this case and others the veterinary team may face.

• What did the health care team do correctly?
• Would you have done anything differently?
• How can your team plan for similar situations in the future?
• What relevant local resources does your community offer?
• What training needs to take place for your team to understand ADA-related issues and accommodations?
• How can you ensure the client doesn’t face the same ADA-related issues at every visit?

Further Reading and Resources

Grigg EK, Hart LA. Enhancing success of veterinary visits for clients with disabilities and an assistance dog or companion animal: A review. Front Vet Sci 2019;6:44.

Rodriguez KE, Bibbo J, O’Haire ME. The effects of service dogs on psychosocial health and wellbeing for individuals with physical disabilities or chronic conditions. Disabil Rehabil 2020;42(10):1350–8.

US Department of Justice Civil Rights Division (USDOJ). Service Animals. https://www.ada.gov/topics/service-animals/.

Weese, JS. MRSA: Methicillin-resistant Staphylococcus aureus in dogs and cats. Veterinary Information Network. Revised 2017.   https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4952889.

Zlotnick M, Corrigan V, Griffin E, et al. Incidence of health and mbehavior problems in service dog candidates neutered at various ages. Front Vet Sci 2019;6:334.

TABLE 5.3 One Health Approach to Disability Accommodations

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Scenario D: Safe Place and Support for Humans and Animals Affected by Intimate Partner Violence

Jenny adopted Buster as a puppy from the shelter right after graduating from college 10 years ago. Since then, the veterinary team at All Friends Animal Hospital got to know both Jenny and Buster over the years as she started her career, bought a house, and met and married her husband, Jack.

From the beginning, Jenny was always cheery and talkative. The veterinary team noticed her kindness and devotion to Buster. Team members found each appointment enjoyable and wished that every client took as good care of their four-legged family member as she did.

Several months ago, Jenny brought Buster in for his routine wellness examination. Her husband accompanied her for the first time. Rather than catching up with the veterinary team as she typically would, she was much quieter than usual. The team also noticed that Jack made the decisions for Buster’s care and cut Jenny off if she tried to ask a question. While he seemed to be nice enough, the veterinary team sensed tension between them. Buster’s examination found him in good health, but the veterinarian, Dr. Zayid, observed that Buster avoided getting close to Jack and kept his focus on Jenny.

Recognizing Signs of Suspected Abuse

The next time Jack and Jenny brought Buster in for an appointment, Buster arrived injured. Dr. Zayid also noticed that Buster had fleas and had lost weight. Jenny mentioned that Buster now lived in the yard because Jack hated Buster’s hair all over everything. Jack responded, “Jenny worries about everything when she doesn’t need to. It’s frustrating to hear her go on and on about Buster.” Though he said he thought the “dog was fine,” Jack agreed to radiographs to further assess Buster’s injuries.

Radiographs showed broken ribs in various stages of healing. Dr. Zayid decided to keep Buster in the back in a kennel while she returned to the room to talk to the family. When she asked further questions about Buster’s injuries, Jack said Buster kept trying to jump the fence, and he must have fallen and broken his ribs. However, Dr. Zayid recognized that repeated falls could not have caused Buster’s injuries. The CrVT assisting Dr. Zayid, Amanda, had also noticed bruising around Jenny’s wrists and mentioned this privately to Dr. Zayid when they were back in the treatment area. While in the room, Dr. Zayid said they needed some help keeping Buster calm and asked Jenny to accompany Amanda to the back of the clinic. She then escorted Jack to the front reception area and asked him to wait there.

Dr. Zayid was concerned that Jenny and Buster were victims of intimate partner violence (IPV) and knew that their state is one of the states that considers practicing veterinarians a mandated reporter of suspected animal abuse—requiring a report to local law enforcement within 24 hours. She decided that attempting to separate Jack and Jenny to speak to Jenny alone would be the best approach in this situation.

Having studied One Health perspectives on intimate partner violence, Dr. Zayid knew that violence toward companion animals in the household is also often present. Abusers will assault the family pet or any animal to intimidate and invoke fear in their partner and other members of the family. Violence directed at the family pet often continues alongside abuse of other family members, and the family pet may be the only source of comfort for IPV victims. Out of fear and concern for their pet, it is not uncommon for an individual to stay in their living situation unless they can take their pet with them.

Taking Action

After leaving Jack in the front area, Dr. Zayid returned to the back where Jenny was sitting with Buster and invited Jenny into her office. She told Jenny they were concerned about her and Buster’s safety and asked if she wanted help. She reassured Jenny that she was there to support her and that she deserved to feel safe. Dr. Zayid also let Jenny know that she was required by state law to report any suspected animal abuse to the proper authorities. Jenny disclosed that Jack had threatened her earlier that day, and she was afraid to return home but did not want the police involved. She was open to getting the hotline number for domestic violence. Dr. Zayid provided Jenny with a number for a local domestic violence shelter that also accepted pets, and Jenny called them from the clinic phone. An advocate was able to advise Jenny and Dr. Zayid on the next steps to get Jenny and Buster to safety.

Supporting Staff Mental Health Needs

During a debrief the next day, the veterinary team realized that IPV is probably more prevalent than many realize, so Amanda volunteered to gather helpful resources for easy access when needed (see Further Reading). She also reached out to a local advocacy organization and arranged staff training on IPV.

A staff member approached the practice manager at the end of the day to discuss how this was a personal trauma trigger for her and requested mental health leave for the following day. After first making sure the staff member was not in any danger, the practice manager provided her with mental health resources from the company’s Employee Assistance Program policy.

Discussion and Debrief

After reading this scenario featuring suspected IPV affecting both the client and the patient, discuss this case and others the veterinary team may face.

• What did the health care team do correctly?
• Would you have done anything differently?
• How can your team plan for similar situations in the future?
• What relevant local resources does your community offer?
• How will you handle things on the next visit or if/when the legal report comes to light with the client and/or the perpetrator?
• What safety plan do you have in place for your staff, clients, and patients?

Further Reading and Resources

ASPCA. Recognizing and reporting animal abuse and neglect.
ASPCA.org. https://www.aspca.org/investigations-rescue/recognizing-and-reporting-animal-abuse-and-neglect.

AVMA. The veterinarian’s framework for identification and response to suspected or known animal maltreatment. 2023. AVMA.org. https://www.avma.org/sites/default/files/2023-10/awf-animal-maltreatment-report2023.pdf.

Cleary M, Thapa DK, West S, et al. Animal abuse in the context of adult intimate partner violence: A systematic review. Aggress Violent Behav 2021;61(101676):101676.

Cornell Law School. Domestic Violence and Workplace Model Policy Toolkit. Cornell.edu. https://www.lawschool.cornell.edu/academics/experiential-learning/clinical-program/gender-justice-clinic/domestic-violence-and-the-workplace-model-policy-and-toolkit/.

Ferguson S. What are the signs of domestic violence? Psychcentral.com. February 17, 2022. https://psychcentral.com/lib/symptoms-of-domestic-violence.

Hamberger LK, Rhodes K, Brown J. Screening and intervention for  intimate partner violence in healthcare settings: creating sustainable system-level programs. J Womens Health (Larchmt) 2015;24(1):86–91.

Larkin M. When domestic violence arrives at the clinic door. AVMA.org. August 19, 2018. https://www.avma.org/javma-news/2018-09-15/when-domestic-violence-arrives-clinic-door.

Mota-Rojas D, Monsalve S, Lezama-García K, et al. Animal abuse as an indicator of domestic violence: One Health, One Welfare approach. Animals (Basel) 2022;12(8):977.

National Coalition Against Domestic Violence (ncadv.org).

National Domestic Violence Hotline at 1-800-799-SAFE or text START to 88788.

Otteman K, Fielder L, Lewis E. Fighting against animal cruelty. Veterinary Practice News. https://www.veterinarypracticenews.com/vets-role-animal-cruelty//a>.

Purple Leash Project (https://www.purina.com/purple-leash-project): assists domestic violence shelters by funding pet-friendly renovations.

Rivas C, Vigurs C, Cameron J, Yeo L. A realist review of which advocacy interventions work for which abused women under what circumstances. Cochrane Database Syst Rev 2019;6(6):CD013135.

Tong, L. Identifying non-accidental injury cases in veterinary practice. In Practice 2016;38(2).

URIPals. Escaping domestic violence as a pet owner. Urban Resource Institute. 2015. https://urinyc.org/wp-content/uploads/2019/10/URIPALS_whitepaper_2015_FINALweb.pdf.

Vatnar S, Bø K, Leer-Salvesen K, et al. Mandatory reporting of intimate partner violence: a mixed methods systematic review. Trauma Violence Abuse 2021;22(4):635–55.

Waalen J, Goodwin MM, Spitz AM, et al. Screening for intimate partner violence by health care providers: barriers and interventions. Am J Prev Med 2000;19(4):230–37.

Wisch R. Table of veterinary reporting requirement and immunity. Animal Legal and Historical Center, Michigan State University College
of Law. 2023. https://www.animallaw.info/topic/table-veterinary-reporting-requirement-and-immunity-laws.

Zonta International USA Caucus (https://zontausa.org/): information on local area resources and needs to combat domestic violence.

TABLE 5.4: One Health Approach to Suspected IPV and Animal Abuse

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The AAHA One Health Guidelines are generously supported by Merck Animal Health.