Gail Farmer Director of Education
Children spend 1% of their free time outdoors
Hofferth, S. and Sandberg, J. ( 1999). Changes in American Children’s Time, 1981-1997, University of Michigan Institute for Social Research. Children spend 7.5 hours per day in front of screens.
Rideout, VJ et al. Kaiser Family Foundation Report. 2010 Angora Park 57th St. & Baltimore Ave.
Childhood has Retreated Indoors “...we will not fight to save what we do not love” -Stephen Jay Gould Angora Park 57th St. & Baltimore Ave.
Childhood has Retreated Indoors Sitting is the New Smoking
Diabetes Hypertension Asthma Obesity Depression Vitamin D deficiency Angora Park 57th St. & Baltimore Ave.
Childhood has Retreated Indoors
Nature Rx Big Goal and Potential Outcomes Nature Rx Big Goal and Potential Outcomes
Value of urban Green space
Get more Healthy Social Phila families Behaviors Capital active in green spaces
Nature connection Nature Rx Systems Thinking
Urban planning
Environmental Municipalities Orgs
Social workers
Clinicians Municipalities
Urban planning Public health agencies and Health orgs – Social workers social orgs determinants of health
Environmental Orgs Nature Rx Strategic Planning & Implementation
Stakeholder & Partner Organizations
Non-Profit Organizations National Environmental Education Foundation Smith Memorial Playground The Circuit Coalition Philadelphia Play Works Bicycle Coalition of Greater Philadelphia The Workshop School Health Promotion Council Physicians for Social Responsibility Dela. Valley Assoc. for the Education of Young Children WGBH Boston/ PBS Kids
Gov’t Agencies Philadelphia Department of Public Health PA Dept. of Conservation and Natural resources US Forest Service, Phila Field Station John Heinz Wildlife Refuge at Tinicum National Park Service Delaware Valley Regional Planning Commission Philadelphia Planning Commission, Healthy Communities
Academic Institutions University of Pennsylvania University of the Sciences Drexel University
Businesses Well Coin Let’s Go Outdoors Nature Rx Barriers to Getting Outdoors
Barriers Time constraints Perception of safety Maintenance of parks Crime Access Values Behavior change
Nature Rx Barriers to Getting Outdoors
Barriers Time constraints Perception of safety Maintenance of parks Crime Access Values Behavior change
Nature Rx Barriers: Safety 2013 White Paper on Safety in Philadelphia Parks and Rec Centers:
“What are the ingredients or features that create a safe park?”
#1 response: “engagement/interaction”
Rated higher than “physical environment” or “security”
Nature Rx Barriers to Getting Outdoors
Barriers Time constraints Perception of safety Maintenance of parks Crime Access Values Behavior change
Nature Rx Barriers: Access
2013 PA Outdoor Recreation Survey:
“What is the single most important thing that parks and outdoor recreation organizations could do to help you participate in outdoor recreation in Pennsylvania?”
“information dissemination” was in the top 3 most-cited answers
Nature Rx Barriers: Access
2008 UPENN study:
32% of subjects living within a ½ mile of one of 6 parks/rec centers studied in the city, reported never having visited the park.
WHY? Top 3 answers:
1. Time 2. Work Commitments 3. Didn’t know the park existed
Nature Rx Barriers to Getting Outdoors
Barriers Time constraints Perception of safety Maintenance of parks Crime Access Values Behavior change
Nature Rx Barriers: Values
CHOP Community Needs Assessment asked parents:
“What is your primary source of health information?”
89% - physician or health care provider
Rated higher than friends, family, internet Nature Rx Barriers to Getting Outdoors
Barriers Time constraints Perception of safety Maintenance of parks Crime Access Values Behavior change
Nature Rx Barriers: Behavior Change
• Tools and strategies for changing behavior has been well studied
• There are some great evidence- based models we could look at and apply to our intervention
H
Nature Rx: Go Out and Play Nature Rx Goals & Objectives
Goal 1 Increase public awareness about the health benefits of nature and outdoor play. Objective 1.1: Educate clinicians about the health benefits of nature through educational materials and training
Objective 1.2: Educate patients and their families about the health benefits of nature through, conversations with their primary care clinician, educational materials and promotional media
Objective 1.3: Permeate pilot communities with messaging about the health benefits (and fun) of nature Nature Rx Goals & Objectives
Goal 2 Enable Philadelphia families to find & engage in accessible and meaningful opportunities for outdoor play. Objective 2.1: Provide clinicians with training, tools and resources that make it easier to talk to patients about the health benefits of nature and outdoor play and direct them to their local nature assets.
Objective 2.2: Provide patients and families with resources and incentives that make it easier to find and be active in their local parks, trails and green spaces. Nature Rx Goals & Objectives
Goal 3 Deepen our understanding of how this type of intervention impacts physician and patient behavior and values. Objective 3.1: Determine if the referred patients and families follow-up with/interact with the recommended park space
Objective 3.2: Perform a process evaluation with physicians to evaluate the usability and acceptability of the Nature Rx electronic health record tool and how it might be improved
Nature Rx Community Engagement
Engaging community members in planning & implementation • Focus groups • Advisory group Nature Rx Education and Information
Informed by communities
What we’ve done:
Surveys of park users
What are currently doing:
• Feasibility study among Clinicians
• Needs assessment of patient families at the care centers
• Focus Groups with community members
Educate patients and their families about the health benefits of nature through:
• Conversations with their primary care clinician
• Developing educational materials
• Promotional media
Nature Rx Education & Information Nature Rx Resources
Sharing resources & materials with neighborhood centers Nature Rx Park & Trail Audits
Developed and refined audit tool Nature Rx Park & Trail Audits
Cobbs Creek & 3 summer interns Karabots Catchments Visited all public & private parks, trails and green space in Northwest and West Catchment Areas
>100 parks audited thus far
NW Philly Catchment
South Philly Catchment Digital Resource Development
Nature Rx Website – free and open to public, accessible for clinicians in the office for use with patient families
Searchable database of park pages
Searchable database of park & trail events and programs
Connected to Plum Landing activities and resources
Nature Rx Education and Information Nature Rx Nature Rx Clinical Intervention
Medical Professional Training
•Help professionals to move from “what” to do to “why, when, where and how.”
• In-person training and online resources
Nature Rx Clinical Intervention
Engaging clinicians in park & trail programming Nature Rx
Clinical Toolbox
• Clinical workflow for Primary Care Professionals
• Incorporated into EMR
• Brief universal screening and intervention (similar to Reach Out and Read)
• Tools for intensive counseling for patients with highest potential to benefit Nature Rx Clinical Intervention
Nature Navigator
• Based on Managed Problem Solving (MAPS) intervention developed at Penn (Gross et al.)
• Counseling Protocol •Systematic identification of barriers •Personalized identification of solutions
• Validation through research
• Role filled by trained professional at Nature Rx/SCEE
• Meets a felt-need among medical professionals
• Patients may be referred by medical provider or self.
• Expandable and replicable
Collaborating with community organizations on park/trail programming Nature Rx Implementation
• Pilot Sites • Roxborough/Manayunk Care Center • Cobbs Creek Care Center • Karabots Care Center • South Philadelphia Care Center
• Patient population • Well-Child Visits (age 5-12) • High Potential Benefit • Overweight/Obese • ADHD • MD/NP Discretion
CHOP CLINICS FOR PILOT
Roxborough Cobbs Creek Karabots South Philly Pilot Clinics: Demographics
COBBS CREEK - WEST PHILLY KARABOTS- WEST PHILLY 0%2% 0% 0%0%3% 1% 1% 1% 4% 0% 7%
AMERICAN INDIAN_AK NATIVE
ASIAN
BLACK
NATVE HAWAIIAN_PACISLAN
TWO_OR_MORE
95% UNKNOWN 86% WHITE
ROXBOROUGH – NW PHILLY SOUTH PHILLY CLINIC 0% 2% 0% 10% 26% 23%
0% 1% 8% 45% 66% 18%
1% 0% Pilot Clinics: Demographics
COBBS CREEK - WEST PHILLY KARABOTS- WEST PHILLY 1% 1%
26% 25% MEDICAID PRIVATE SELF-PAY
73% 74%
ROXBOROUGH - NW PHILLY SOUTH PHILLY CLINIC 1% 1%
16%
29%
70%
83% Nature Rx 3 Year Pilot
Year 1: • Roxborough Primary Care • Cobbs Creek Care Center
Year 2 adding: • Karabots Care Center • South Philly Care Center Year 3: • all four CHOP Care Centers
Targeting 20% of well-visit patients yrs 1 & 2; 30% yr 3: • Reaching 21,000 patients by year 3
Nature Rx Evaluation and Outcomes
Studying the effectiveness of the Nature Rx intervention
Dr. Michelle Kondo, USDA Forest Service Dr. Amy Hillier, UPENN Nature Rx Evaluation and Outcomes
• Do doctors use materials and resources to engage in more meaningful counseling on health benefits of outdoor play?
• Does intervention enable patient families to actually spend more time in parks, trails and/or greenspaces?
• Does the intervention change a patient families values on the importance of outdoor play?
Funding Partners:
Nature Rx Thank you!
Nature Rx Questions?