Gardens That Heal. Derrick R. Stowell, MS, CTRS, HTR UT Gardens Education Director

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1 Gardens That Heal Derrick R. Stowell, MS, CTRS, HTR UT Gardens Education Director

2 Learning Objectives By the end of the session participants will be able to identify three positive benefits of using gardening in a therapeutic setting. By the end of the session participants will be able to describe the differences between gardening, horticultural therapy and therapeutic horticulture. By the end of the session participants will be able to share at least two ways that they can use gardening in their practice or at home when working with their own adopted children.

5 What people say about gardening?

6 I kill everything I grow. I have a brown or black thumb. I am good a growing weeds.

7 Fact Anyone can garden! Mistakes can happen, but we learn from them. If you don t succeed at first, try again. Gardening is about learning about plants and yourself.

8 Gardening The act of growing or cultivating plants. Ornamental Edible

9 Why do we garden? To get outside To make our yard beautiful To grow our own food to eat To relieve stress To get physically active And much more..

10 Activity Time

11 Gardening as a leisure pursuit % of US households (US Census Bureau, 2012) % US households participated in food gardening (National Gardening Association, 2014) $3.5 billion (National Gardening Association, 2014) % of consumers grew edible plants (Garden Writers Association Foundation, 2014)

12 Horticultural Therapy Horticultural therapy is the participation in horticultural activities facilitated by a registered horticultural therapist to achieve specific goals within an established treatment, rehabilitation, or vocational plan. American Horticultural Therapy Association

13 Therapeutic Horticulture Therapeutic horticulture is the participation in horticultural activities facilitated by a registered horticultural therapist or other professionals with training in the use of horticulture as a therapeutic modality to support program goals. American Horticultural Therapy Association

14 Groups that can benefit from therapeutic activities List of populations that can benefit. Children in special education Individuals who have Autism Individuals with Intellectual Disabilities Seniors in assisted living facilities Homeless populations Individuals with addictions Veterans Individuals who are looking to develop vocational skills Hospitals At-risk youth Trauma

15 Benefits of gardening in therapeutic settings Cognitive Benefits Psychological Benefits Social Benefits Physical Benefits

16 Cognitive Attention Restoration Theory (ART) Concentration improves when spending time in nature. Kaplan, R. & Kaplan, S. (1989) Nature, Sports, Urban Natural setting showed highest levels of restoration vs. Urban settings showed the lowest Herzog, T., Black, A., Fountaine, K., Knotts, D. (1997).

17 Psychological benefits Recovery from mental fatigue, improved outlook, cope with stress (Maller et al., 2005) Gardeners reported recreation was most important followed by mental health, physical health, and nutrition for reasons to garden (Schmutz et al. 2014). Attention Restoration Theory (ART) Concentration improves when spending time in nature. Kaplan, R. & Kaplan, S. (1989)

18 Social Community involvement Increase connection to place Increased property value (Darton & McGuire, 2014)

19 Physical Gardening - moderate-intensity level activity CDC recommends 2.5 hours of moderateintensity each week Reduce risk for obesity, high blood pressure, diabetes, heart disease (Darton & McGuire, 2014) Eat healthier (Alaimo et al., 2008)

20 Increased social interaction 6-week Horticulture program and purposeful activity. Improved Quality of Life Life satisfaction, self-concept, health & social functioning, socio-economic factors Group dynamic accomplishment Sharing self-satisfying Learning rewarding opportunity Sensory contribution to well being Creative outlet for self-expression Perrins-Margalis, N., Rugletic, J., Schepis, N., Stepanski, H., & Walsh, M. (2000).

21 Improved mood & decreased heart rate Horticultural Therapy Program Looked at healthy lifestyles 60 minute sessions in greenhouse or garden Improved mood can have + effects on cardiac rehabilitation HT has been shown to reduce stress (BP, HR, cortisol levels) Wichrowski, M., Whiteson, J., Haas, F., Mola, A. & Rey, M. (2005).

22 Mental Power Stigsdotter & Grahn, 2002

23 Plants & People Ancient Egypt First prescribed use of gardens to treat mentally disturbed royalty (Simpson & Straus, 2003). Mesopotamia, 2000 BC Farden plots provided first designed gardens in a very arid landscape (Jellico & Jellicoe, 1995). Persia, 500 BC Gardens created to experience all the senses (Gerlach-Spriggs, Kaufman & Warner, 1998). France, 1100 AD St. Bernard described benefits of hospice garden at a monastery (Gerlach-Spriggs, Kaufman & Warner, 1998).

24 Early Documentation of Benefits United States, 1812 Benjamin Rush, Father of American Psychiatry, signed the Declaration of Independence Worked at Institute of Medicine and Clinical Practice at the University of Pennsylvania Documented how physical work including digging in a garden would help patients recover from manic episodes (Rush, 1812 p. 226)

25 Philadelphia, 1813 Friends Hospital America s first private psychiatric hospital 1879 built first greenhouse therapeutic use (Friends Hospital, 2014) 1800 s Children s Aid Society documented the positive impact of growing flowers had on disadvantaged youth in NY (Campbell, Knox & Byrnes, 1897, p. 307)

26 Advancement World War I & II Returning soldiers took part in horticulture activities as diversions to their injuries 1940 s Garden clubs brought horticultural activities to VA Hospitals Led to more organized plant-based activities for veterans (American Horticultural Therapy Association, 2012) Programs documented reduced hospital stays (Simpson & Straus, 2003)

27 Program Planning Safety Assess all the risks in what you are doing. Develop SOP Lesson Plans Gardens?

28 Activity Time

29 Safety freedom from harm or danger: the state of being safe the state of not being dangerous or harmful a place that is free from harm or danger: a safe place

30 Safety Your number one goal should be safety! Safety of participants and safety of program leaders.

31 You Can t make your program 100% safe Nature is unpredictable People are almost as unpredictable as nature

32 First consider what are the risks involved Physical injury Psychological injury Plan for Safety Second what can you do as a program leader to reduce the potential for injury? ex. Some populations may attempt to eat materials you work with. You would need to identify that potential and no work with toxic materials with that population.

33 Plan Third write down policies and procedures for your program. what do you do when someone get s injured during a program? who do you contact if a participant becomes violent?

34 Prevent Prevention helps to keep injuries from happening. Be proactive. Things to consider Nature Plants People Tools Materials

35 Nature Be sure to prevent sunburn by having participants wear sun hats, sun screen, and avoid being outside in the hottest part of the day. Consider mobile shade structures Some people on certain medications or with certain medical conditions are sensitive to sun exposure.

36 Nature Plan your program to avoid being outside in extreme temperatures. Have backups/indoor activities in the event of bad weather. Be aware of any insect allergies. Some participants may not be able to communicate discomfort. Talk with staff or caregivers about mosquito repellant or other ways to control pests.

37 Plants Know that plants can cause skin irritations. Use gloves. Choose plants that don t have sharp leaves. Some plants may cause allergic reactions. Example Ficus sap is latex. Avoid latex due to potential latex allergies. Do not use poisonous plants in your program. Here are some links to poisonous plant information: s.pdf

38 People Know the population you are working with. This will help tell you how much supervision your program needs. Some participants may need 1:1 participant to leader assistance. Be aware of any sensory issues participants my have including textures, sounds, and temperatures. Research shows that horticulture has calming effect. But some participants may be easily agitated depending on their diagnosis.

39 Teach tool safety. Use adaptive tools when available for specific populations. Sharps! Make a list of any sharps you are using in your program. Keep a count sheet. Tools Count before and after each session. This will insure any sharps that could be used to harm participants are managed and secured.

40 Remember to know what is in the materials you are using to avoid any injury. Visit the websites of companies who make the materials you use to download their SDS sheets. This information can be vital if an accidental ingestion or exposure to a product. Ex Materials

42 What makes an activity therapeutic? Can any activity be therapeutic? If you plan properly any activity can be therapeutic Must have defined goals and objectives for a specific population See the next slide for examples Is every activity appropriate for all populations? No You must understand unique characteristics of the population you are working with Some activities may be dangerous Other activities may not be appropriate based on the groups goals

43 What makes an activity therapeutic? Example : Activity Container Planting Non-Therapeutic Group Therapeutic Group Type of Group Master Gardeners Adults who have Autism Goals To teach Master Gardeners how to design, plant and care for a container garden. To follow 1 and 2 step directions. What could you measure? Participant satisfaction, leader effectiveness, ability of participants to plant their container Participant s ability to follow directions given verbally, directions given visually How would you measure? Program survey, observation of creation of containers Use a chart to count how many times each participant followed directions Safety issues? Possible allergic reactions to plant materials Some participants may become very agitated when working with soil or plants due to sensory issues, possibility of participant ingesting soil or plant material, allergies to materials, physical injury to self or others using sharp tools

44 Lesson Plans Help you to organize your programs Help others understand what your program does If you are out sick another staff should be able to pick up your lesson plan and implement it

45 Use a format that is easy to understand. Every lesson may include: Program Name Program Date Population Served Person Leading the Activity Activity Name Goals & Objectives Procedure Materials Adaptations Safety Considerations Lesson Plans

46 Writing Goals Have no more than one or two goals for an activity It is best to have 2-3 objectives for each goal Goals can be individual or group focused

47 Write SMART Objectives: Specific Measurable Attainable Realistic Timely Writing Objectives

48 Writing Objectives Objectives should answer the following: Who? Will do what? To what extent? By when?

49 Who? Program leaders need to be clear about who is completing the objective. This could be an individual or a group. Ex. Writing Objectives Participants individuals or the entire group The group will do.. Participants will do

50 Will do what? Writing Objectives What task are you wanting the Who to complete? Ex Fill container Remove weeds Stay on task Follow directions Pick up a tool Grasp a tool

51 To what extent? What level of proficiency? How will you measure completion? Ex. Good examples 4 out of 5 times for 15 minutes Needs work Writing Objectives correctly What is correctly? Who makes that determination?

52 Writing Objectives By when? By the end of the session By the end of three sessions By the end of the program Needs to be specific so you can document.

53 Writing Objectives Examples of an objectives: Participants(Who?) will pull weeds(will do what?) for at least 15 minutes(to what extent) by the end of the session(by when?). Participants(Who?) will fill 3 containers with soil(will do what?) to the correct level as determined by the leader(to what extent?) by the end of the session(by when?).

54 Activity Time

55 Working with children/youth

56 Therapeutic Gardens Help Children in Trauma Vogel Alcove - Dallas, TX Wildlife garden and vegetable garden Social/emotional concepts, empathy, sharing cooperation Sensory reduce cortisol/adrenaline levels Increase attention span Combine music and art Motor skills

57 SafeNet Erie, PA Nature s Influence on Traumatized Children Encourage creativity, reduce anxiety and even significantly reduce learning problems. The garden allow children to: Climb and crawl Dig in an unstructured sandy area Build with natural materials Imagine and retreat

58 Kalabala Bindu Garden and the Sri Lanka Butterfly Peace Garden Social trauma due to ethnic conflict Brings children to learn in a garden setting Serving Sinhalese and minority Muslim community

59 Childsavers Garden for mental health and wellbeing of children. Life cycles life and death Each child grows something of their own. Nurture and caring Bond between adult and child.

60 Kitchen Garden Programs and Changing Brains Ferry, K. (2017). Kitchen Garden Programs and Changing Brains. The Neuropsychotherapist. 5(1)

61 Kitchen Garden Cont. Neuroscience research time away from artificial light and outdoors improve brain development Exercise production of neurochemicals that help with stress reduction, positive mood, sleep hygiene, and general well-being Abused children insecure attachments, adoption of brain schemas, withdraw, hyperarousal, anxiety, demanding behaviors

62 Kitchen Garden Cont. Positive setting to calm and down-regulate heightened emotions Sunshine and soil microbes book serotonin production Try new foods, life skills, development and learning, engagement, behavioral expression, and personal growth,

63 Kitchen Garden Cont. Interaction, connectedness, teamwork Trust attachments Challenge but achievable activities Regulate heightened emotions Job skills Elements of choice

64 The Garden of Hope: Horticultural Therapy with Traumatized Children Horticultural therapy for traumatized children, ages 6-17 years Kennedy Krieger Center for Child and Family Traumatic Stress One minute session per week Child Behavior Checklist (CBCL) & Culture Free Self-Esteem Inventories, third edition (CFSEI-3). Baseline 2 months prior Reassessed six months, and nine months. 200 children Discontinued several years ago do to therapist leaving

65 Bacteria and emotional regulation Soil bacteria work in similar way to antidepressants. Paddock, C. (2007, April 2) Medical News Today Mycobacterium vaccae

66 Mycobacterium vaccae Reduce anxiety in mice Increase serotonin Love form of bacteria fed "Identification of an immune-responsive mesolimbocortical serotonergic system: Potential role in regulation of emotional behavior." C.A. Lowry, J.H. Hollisa, A. de Vriesa, B. Pana, L.R. Brunetb, J.R.F. Huntb, J.F.R. Patonc, E. van Kampena, D.M. Knighta, A.K. Evansa, G.A.W. Rookb and S.L. Lightmana. Neuroscience Available online 28 March 2007 doi: /j.neuroscience

67 Garden Space? Use therapeutic design elements. Costs and space issues. Containers and inside activities.

68 Therapeutic Design Elements Marcus & Sachs, 2013 Safety Accessibility Physical & emotional comfort Positive distraction Engagement with nature Maintenance

69 Therapeutic Design Elements Mental Health Facilities Safety Objects used to harm Elopement Balance security and privacy Shade Avoid threatening material

70 Resources Marcus, C. C., and Sachs, N. (2013) Therapeutic Landscapes: An Evidence-Based Approach to Design Healing Gardens and Restorative Outdoor Spaces. Hoboken, NJ: Wiley & Son s, Inc. Winterbottom, D., & Wagenfeld, A. (2015) Therapeutic Gardens: Design for Healing Spaces. Portland, OR: Timber Press AHTA -

71 References American Horticultural Therapy Association. (2012) American Horticultural Therapy Association Definitions and Positions. Retrieved August 1, 2013 from Alaimo, Katherine., Packnett, Elizabeth., Miles, Richard A., Kruger, Daniel J. (2008). Fruit and vegetable intake among urban community gardeners. Journal of Education and Behavior 40:2, Campbell, H., Knox, T.W., & Byrnes, T. (1897) Darkness and Daylight; Lights and Shadows of New York Life. Hartford, CT: The Hartford Publishing Company. Retrieved November 24, 2014 from Darton, J., Mcguire, L. (2014). What are the physical and mental benefits of gardens? Michigan State University. Retrieved 1/31/2016 from enefits_of_gardening. Friends Hospital (2014). A Journey Through Time. Retrieved November 24, 2014 from

72 References Gerlach-Spriggs, N., Kaufman, R.E. & Warner, S.B. (1998). Restorative gardens: The healing landscape. New Haven and London: Yale University Press. Garden Writers Association Foundation. (2014). Garden Trends Research Report: October 2014 Survey. Ramsey, NH:Techno Metrica. Haller, R. L., & Kramer, C. L. (2006). Horticulture Therapy Methods. Boca Raton, FL: CRC Press. Herzog, T., Black, A., Fountaine, K., Knotts, D. (1997). Reflection and attentional recovery as distinct benefits of restorative environments. Journal of Environmental Psychology 17(2) Jellicoe, G. & Jellicoe, S.(1995). Landscape of man (2nd ed.). London: Thames and Hudson, Kaplan, R. & Kaplan, S. (1989). The experience of nature. New York: Cambridge University Press.

73 References Maller, Cecily., Townsend, Mardie., Pryor, Anita., Brown, Peter., St. Leger, Lawrence. (2005). Healthy nature healthy people: contact with nature as an upstream health promotion intervention for populations. Health Promotion International. 21(1). Marcus, C. C., and Sachs, N. (2013) Therapeutic Landscapes: An Evidence-Based Approach to Design Healing Gardens and Restorative Outdoor Spaces. Hoboken, NJ: Wiley & Son s Moore, B. (1989). Growing with Gardening: A Twelve-Month Guide for Therapy, Recreation, and Education. Chapel Hill, NC: UNC Press National Gardening Association. (2014). Garden to Table: A 5-Year Look at Food Gardening in America. Retrieved January, 10, 2016 from Table.pdf. Niemeyer, S. K. (2010). Ergonomically labeled trowel verses standard design: a randomized counterbalanced study of preferences and effects on wrist range of motion in women with arthritis (master s thesis). Retrieved 8/18/15

74 References Paddock, C. (2007, April 2). Soil bacteria work in similar way to antidepressants. Retrieved from Perrins-Margalis, N., Rugletic, J., Schepis, N., Stepanski, H., & Walsh, M. (2000). The immediate effects of group-based horticulture on the quality of life of persons with chronic mental illness. Occupational Therapy in Mental Health 16(1), Rush, B. (1812). Medical inquiries and observations upon diseases of the mind. Philadelphia: Kimber & Richardson. Retrieved November, 24, 2014 from Simpson, Sharon & Straus, Martha C. Horticulture as therapy: principles and practice (Routledge, 2003). Schmutz, U., Lennartsson, M., Williams, S., Devereaux, M., Davies, G. (20014). The benefits of gardening and food growing for health and wellbeing. Garden Organic and Sustain. Retrived 1/30/2016 from t.pdf Stigsdotter, U. A., & Grahn, P. (2002). What Makes a Garden a Healing Garden?. Journal of Therapeutic Horticulture

75 References Tebben, A. B., & Thomas, J. J. (2004) Trowels labeled ergonomic versus standard design: preferences and effects on wrist range of motion during a gardening occupation. The American journal of occupational therapy, 58(3), p Throckmorton, E., & Powell, J. (1992). Adapting Garden Tools to Overcome Physical Challenges. Oregon State University Extension Service. Publication # EM 8504 U.S. Census Bureau. (2012). Statistical Abstract of the United States. Retrieved January 5, 2016, from ables/arts.pdf US Department of Justice (2010). ADA Standards for Accessible Design. Retrieved 1/5/2016 from Wichrowski, M., Whiteson, J., Haas, F., Mola, A. & Rey, M. (2005). Effects of horticultural therapy on mood and heart rate in patients participating in an inpatient cardiopulmonary rehabilitation program. Journal of Cardiopulmonary Rehabilitation 25(5),

Prepared by: American Horticultural Therapy Association (AHTA) Copyright 2007 Editor: Elizabeth R. Messer Diehl, ASLA, HTM

Prepared by: American Horticultural Therapy Association (AHTA) Copyright 2007 Editor: Elizabeth R. Messer Diehl, ASLA, HTM Definitions and Positions Introduction Over the past decade many people have become