- Although this paper does not give us *specific* data that ESA's can help someone, I think this paper does an excellent job of presenting some guidelines for what a client and their therapist/doctor should go through before deciding to get an ESA. 
- I hope this paper can help clients and therapists/doctors make more careful decisions about ESA's because, from the paper I read, it sounds like that isn't the case right now.

Clinical Framework Paper on Emotional Support Animals: Final Conclusions

- animal best suited for specific behaviors needed
- reasonable expectations for animal/enjoyment of animal when delivering 
- strong bond between humans and ESA
- human skilled in animal support
- individual living needs appropriate for the animal

Santa Clara University

- Eligibility/indication
- animal selection
- routine assessments
- animal welfare

Emotional Support Animals: Additional Ethical Considerations

Ferrell, J and Crowley, S.L. (2021). Emotional Support Animals: A Framework for Clinical Decision-Making. Professional Psychology: Research and Practice, 52 (6), 560-568. https://doi.org/10.1037/pro0000391

Emotional Support Animals: A Framework for Clinical Decision-Making

- Legal barriers to pets in residence
- severe or chronic mental disorder
- therapist-client relationship
- if ESA can treat symptoms
- benefits of ESA greater than the burden of taking care of ESA
- therapist level of expertise with animals

Eligibility and Indication Guidelines for Emotional Support Animals

Animal Selection Guidelines for Emotional Support Animals

- ESA still helps to treat target symptoms
- behavior patterns of animal and human (safe/harmful)
- needs of individual and animal
- counting education for therapist/doctor/etc.

Routine Assessment Guidelines for Emotional Support Animals

- often left out of ESA Conversations but *important* because animals can't give consent to be a part of treatment
- access to food/water
- adequate shelter
- place to rest 
- safety
- healthcare
- engage in natural/enjoyable behavior
- voluntary relationship

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