Josh and Friends: The Healing Power of the Human–Animal Bond

For the past 15 years, the Josh and Friends Project has been an enduring source of comfort to children aged between 2 and 9 years, who face anxieties related to medical procedures, surgery, chemotherapy, or other treatments arising from illness or injury. Founded by Knoxville, Tennessee, veterinarian Randy Lange, the Josh and Friends Project captures the inimitable qualities of the human–animal bond to influence positively a child’s psychologic and physiologic outlook in anticipation of as well as throughout medical treatment and recovery. Child comfort and wellness are at this unique program. When Lange’s 9-year-old daughter’s surgery at the local children’s hospital drew near, he recognized a familiar frightened, anxious gaze. It was the same fearful look that oftentimes was displayed by pets and their owners at the Lange Animal Hospital.

To better deal with his daughter Jessica’s questions and trepidation about surgery, Lange sought literature and other established means to help ease her growing distress. After reviewing the existing literature to help prepare children for the hospital, he determined that none actually dealt with the realities a child faces when going into the hospital. Lange had witnessed many times the incredible power of the human–animal bond in helping families deal with crises. It was that connection that would provide the foundation for Josh and Friends.

While visiting Jessica in the hospital, Lange could not help but notice the number of children alone in their rooms. It was then he first learned of the term “drop-offs.” Whether the circumstance was a single parent with more than 1 child or a parent with multiple jobs, the resulting byproduct was a child feeling fearful and isolated.

Vowing to create something affirmative, uplifting, and that thematically embraced the spirit of overcoming adversity, Lange wrote the book I’ll Be O.K. The story is about Josh, a fun-loving golden retriever puppy that goes to Dr Rick’s animal hospital because he is sick. The narrative and illustrations depict Josh’s adventure in getting well. The story chronicles the different stages Josh experiences going into the hospital, including the fear and anxiety felt prior to diagnostic tests or surgical procedures, the feeling of hopelessness (and sometimes helplessness) when an injury or illness suddenly forces itself into Josh’s (or, a child’s) life and, quite simply, the fear of the unknown. It is that fear that can have a negative impact on the eventual outcome of a child’s hospital stay. The book shares the positive, reinforcing message of I’ll Be O.K. throughout, and encourages children to believe in and trust the doctors, nurses, and hospital staff who are charged with their hospital care. Like Josh, child readers gain courage to get well sooner.

I’ll Be O.K. is paired with a plush version of Josh that provides a tactile, huggable component. The book and plush puppy combine to form the I’ll Be O.K. Gift Set—a therapy tool. The plush Josh has weighted paws and appropriate size to have a real substantive presence. Josh becomes a constant physical companion throughout the child’s hospital stay and medical recovery. Unlike a therapy dog in the traditional sense, Josh is more akin to, and symbolic of, the unconditional love, comfort, and devotion provided by a family pet.

Melson and Fine report that children very often respond well to animal puppets and plush toys.1 Analytically, the play experience can be very revealing into a child’s unconscious behavior. Children seem to respond more calmly and appear more willing to express their inner feelings by interacting with the toy animal. Many play therapists commonly use puppets as a method to help children explore their feelings by allowing them to act them out. That being said, it seems only logical that children with chronic health problems would feel safe talking through a friendly-looking animal and may use the play experience to support his or her healing.1 The bond between a child and Josh is best illustrated by a little boy in southern California, by the name of Michael. Diagnosed at the age of 3 with neuroblastoma, now in remission, Michael faced numerous treatments with Josh by his side. During a gathering of Josh and Friends constituents that included child patients, families, fundraisers, medical professionals, and the Josh and Friends team, Michael’s mother emotionally described how his Josh was “God-sent” and how Michael and Josh went through all of his procedures together. Michael’s intravenous port was mirrored by Josh’s, as were his surgical scars, bandages, and identification bracelet. They wore masks together, got shots together, and also overcame the embarrassing time when they had to wear a diaper. To Michael, Josh became a companion and best friend. During Michael’s crime-fighting Make- A-Wish experience, Josh was Robin to Michael’s Batman.

Sharon Riesen, MD, head of the residency program at Loma Linda Children’s Hospital in California, calls the gift set her “mind–body medicine tool.” She adds that when presented properly, Josh’s story in I’ll Be O.K. and the plush version of Josh can be “concretely linked in the child’s mind such that the plush Josh becomes a living, breathing thing…a companion.” To Riesen, there is a difference between just a toy and a therapeutic tool: Although a stuffed animal, in itself, is oftentimes used successfully to provide a degree of comfort to a sick child, the set—Josh plush and I’ll Be O.K.—becomes a therapeutic collaborator, the child’s unwavering partner in facing fears…transferring the idea that if Josh can get through his medical procedure, then so can the child. It is for that reason that Josh and Friends does not distribute the plush Josh independent of the book. The Josh and Friends Project would not be complete without a real-life main character, Josh. Lange’s beautiful, red bandana–clad canine is the third golden retriever Josh to represent Josh and Friends. Josh is the embodiment of all the best characteristics of the breed. He has become a hit at pediatric and veterinarian conferences across the United States. The familiar “There’s Josh,” is repeatedly heard at American Academy of Pediatrics, National Association of Pediatric Nurse Practitioners, and American Veterinary Medical As - sociation (AVMA) gatherings. This amazing dog personifies the loving and supportive Josh puppy in I’ll Be O.K.

Over the years, the Josh and Friends Project has gained overwhelming support from the pediatric community (hospitals, hospital foundations, private practices), veterinarians and veterinary organizations (AVMA, Student AVMA), civic groups (the American Legion Family [Legionnaires, Sons of the American Legion, and Auxiliary], Kiwanis, Sertoma), and others.

For the past 8 years, veterinary schools from around the country have competed in the Josh Challenge. Through various student-initiated fundraisers, these future veterinarians have raised money to purchase Josh and Friends Gift Sets to distribute directly to sick children in their local area. The challenge engages students in helping children through the use of the human–animal bond.

Lange’s daughter, Jessica, the catalyst and inspiration for Josh and Friends, is now in her first year of a medical residency in Winston-Salem, North Carolina, at Wake Forest University’s Baptist Medical Center. Lange’s resolve to help provide comfort to children is as strong as it has ever been. The Josh and Friends Project looks to the next 15 years with the spirited enthusiasm of our namesake golden retriever, Josh.

For further information about the Josh and Friends Project: visit www. joshandfriends.com or look for Josh and Friends on Facebook.

Reference

1. Melson GF, Fine AH. Animals in the lives of children. In: Fine AH, ed. Handbook on Animal-Assisted Therapy: Theoretical Foundations and Guidelines for Practice. San Diego, CA: Elsevier Press; 2010:223-247.