1. Why is there such an increased need for nature-based therapy?
Childhood is different today. Life is digital, fast-paced, and processed. At the same time, our biology, instincts, and needs as homo sapiens are the same as they have been for hundreds and thousands of years. It’s no wonder that we continue to witness a rise in attention, sensory, motor, and emotional differences.
We have always known (consciously and subconsciously), time outdoors in natural spaces is good for our mind, body, and spirit. As adults we feel it - we go on vacation to the mountains, to the lake, or to the beach. We give flowers or plants to friends to brighten their day. And we buy sun lamps in the winter season.
But as the divide between today’s lifestyle and our developmental capacity to keep up widens, the opportunity (or need) to re-connect and re-prioritize with nature also grows. I would not say there is an increased need for nature-based therapy as much as there is an increased need for skilled services across the board (mental health, physical health, therapy services).
Nature-based therapy, or skilled therapy services that are embracing a natural, outdoor setting for interventions is just one powerful way we can stack the deck towards progress and success in the things our clients and their families want to and need to do in their lives today and in the future.
2. What are the benefits of Nature based OT?
Occupational therapists work with children and their families to help them be their best in their own bodies, activities of their choosing, and within their family and cultural and community environments. There are tons of benefits of taking occupational therapy sessions outdoors, but 3 of my favorite:
- Nature is unpredictable. Developing resilience, flexibility, adaptability, and problem solving skills for relationships, school, play, and life is not easy. Outdoors the weather changes, trees fall, plants (and animals) die, risks arise, and discoveries are unknown. Every occupational therapy session outdoors is going to be different. But you know what? I (the therapist) didn’t make it rain, make the moss grow, or move the red ants to our favorite play spot. I don’t even know what we will discover in our session. But I (the therapist) can journey with my client through these unpredictable changes, using co-regulation and through a sensory-relationship lens to support a widening of the child’s capacity to respond and adapt … not only outdoors but to other unpredictable or unexpected circumstances in life.
- Nature is available. I love pediatric therapy clinics - especially the big, dynamic sensory gyms. They are so fun and so powerful and are a great match for many kids. It’s a place you go for a therapy session that lasts 30-60 minutes and the equipment is expensive (but oh so beautiful). On the flip side, nature is just outside your door and parks are readily available in most communities. What’s my favorite and most used therapy tool in my backpack? A $30 hammock from Amazon. I hang swings from tree branches; gather pine needles, sand, or leaves to crash into; roll or slide down hills; climb logs, trees, and stumps; and haul water, sticks, and dirt. My “sensory gym” might not look like the clinic, but it is dynamic, powerful, and available for both my therapy sessions and our families to continue to explore throughout their week (and life)!
- Nature is rich. It’s wild (pun intended) how well nature provides for our well being as humans. In all it’s richness, nature truly is generous in its ways to help us be our best when we are available and open to receive. I have found tremendous opportunities to work towards a wide range of skills outdoors with clients ….fine motor, gross motor, sensory processing, emotional regulation, executive functioning, social engagements, play skills, confidence, self-awareness, visual motor, visual perceptual, self-care skills, feeding skills, and even toileting.
3. How do you know if your child is a good fit for Nature Based OT?
The first question is actually would your child benefit from skilled occupational therapy services. And that’s a big question. Parents should first explore what occupational therapy is, who occupational therapists work with, and reflect on what is making me curious about this for my child. (Go to the American Occupational Therapy Association to learn more).
Second families should explore the resources and opportunities in their community for pediatric occupational therapy services. Although there is a beautiful, growing community of nature based therapists doing this work, there are still only a handful in comparison to traditional therapy settings. If there is not a nature-based therapy practice near you, it’s okay! You can (hopefully) still find a great occupational therapist to support your child to be their best (telehealth therapy services is also a thing if you are more rural). And you, as a parent, can ask questions about how you can support your child at the park, camping, or in the backyard.
If you discover a nature-based therapy practice near you, yeah! But you still want to be curious if this practice is a good match for you and your child. What are their values? What is their approach? What kind of services do they offer?
At Treeline we openly honor that we are not a good match for every family or every season. We believe in strengths. We believe neurodiversity is beautiful. We believe in relationships. We believe in getting messy. We believe in embracing all weather. I am intentional to speak to every parent up front about how the property we use is over 10 acres (factor to consider with elopement), includes an open body of water (factor to consider for physical safety), sessions happen rain or shine, and there are large sticks all over (factor to consider with big bursts of emotional expression). If these factors trigger hesitations or concerns, we talk about it. Sometimes we collectively decide it’s not a good setting YET. And sometimes we are able to collaborate and come up with a gentle, compassionate plan to make it a safe and successful therapeutic setting.
4. Tell us about some of the breakthroughs you have seen working on children in nature?
There are so many stories of progress that I have been blessed to be a part of through this work.
- One child that was burnt out in the clinic and dreaded going to “do exercises”. This child discovered great joy in the outdoor setting, independently choosing to make countdown chains until the next “forest day” and taking responsibility (on their own) to set out clothes and pack a bag the night before.
- A teen that aspires to work for a lawn business in the future. They were able to work on the dynamic balance, postural control, motor skills, cognitive skills, and pre-employment skills they desired all within their interests outdoors.
- A child that felt so deeply that anything less than success caused big, real emotions … resulting in avoidance of any time of game play. With compassion and collaboration, we were able to explore, play, and engage with and in nature slowing building regulation while stretching his capacities. Now this child will choose to play simple outdoor games with friends and simple games with his parents at home!
- One child I worked with thrived on immediate gratification with adult prompts and felt “bored” all the time outside. Through skilled strategies, this child transformed into a child that seeks creative outdoor play adventures.
- A child that experienced a big release of emotions whenever they tripped or got their hands even a tiny bit dirty (to begin with it occurred multiple times in a session) began to joyfully play in the mud kitchen without concern when dirt or mud splattered on their skin.
5. Do most insurance plans cover Nature Based OT?
When considering reimbursement, it’s most important to remember that occupational therapists that are taking their occupational therapy sessions outdoors are first and foremost, occupational therapists providing a skilled, healthcare service. The setting / location of that service just happens to be outside. Occupational therapists (as a profession) work across many locations, from hospitals, clinics, homes, schools, the community, and more. So celebrating and embracing the rich opportunity to work outdoors, in natural wild spaces is just one of many locations occupational therapy professionals work.
So yes, if an insurance plan covers occupational therapy services, it should cover occupational therapy services provided outdoors. Of course I can’t possibly speak for all insurance plans so a family should always contact their insurance company to ensure they understand the opportunities and limitations of their coverage. Treeline Enrichment does not work directly with any insurance companies (for a variety of reasons), but we do provide families with a Superbill, a comprehensive document with treatment codes, payments received, service details and more to help a family seek at least partial out-of-network reimbursement for their child’s therapy costs.
6. Tell us about your path to becoming a Nature OT
In early 2018 I happened to listen to a podcast that discussed the book “Balanced and Barefoot” by Angela Hanscom. I was immediately curious and not only did I read that book (quickly) I went down the rabbit hole and started to read LOTS books (“How to Raise a Wild Child”; “Last Child in the Woods”; & “Free to Learn”). I was initially motivated because of my own parenting journey (my kids were age 2, 5, & 8 at the time) and I wanted to learn and do better for my own kids and the kids in my community. Simultaneously I was a little burnt out in my professional work, longing for a pivot that would serve my clients and their families with more meaning, effect, and connection. So when I was unable to find ANY outdoor, play-based, child-led opportunities for my kids in all of Central Florida (in 2018) - I took the leap, quit my job, and launched Treeline Enrichment February 2019 … initially only offering forest play enrichment programs as a licensed TimberNook Provider. I actually stepped away from skilled therapy services for about 6 months and it was really powerful for my growth as a professional, pausing to reconnect with play, nature, and childhood joy.
But I was also acutely aware that some children were struggling, even in the context of a grand, sensory-motor, child led forest play program like TimberNook. One child that longed for social connections but responded by biting whenever he was happy or frustrated. One child that experienced big deep emotions whenever her hands or clothes got dirty. One child wanted to follow his curiosities deep into the forest so much so that he was unable to tune into established boundaries or directions resulting in significant safety risks. Or one child that threw materials and his personal belongings anytime something felt unexpected to him, such as not being first, mom packing strawberries when he thought he was getting blueberries, or the play mud kitchen water got used by someone else. Many, many, many children make huge gains in their development through forest play enrichment programs, like TimberNook, but sometimes it’s not enough and a child needs more, skilled support to thrive. I had over 15 years of experience as a pediatric occupational therapist → I knew how to help these kids!
So in January of 2020, I began to offer small group occupational therapy services and in May of that same year, I added individual OT services. By adding occupational therapy services outdoors, Treeline was and is able to offer a full continuum of programs & services for kids individually (OT), in small groups (OT), or in large groups (TimberNook - not OT), helping kids become more strong, confident, and resilient for success throughout life.
7. How do people find you if they wish to connect?
Treeline Enrichment is on social media @TreelineEnrichment - our communication on these platforms is geared towards families, forest play, and skilled OT services for kids in West Central Florida. Local families should check out more details about our programs and services at www.TreelineEnrichment.com
Professionals and therapists that are interested in taking their work outdoors should join me on Instagram @NatureBasedTherapists → an account co-created and managed with Marika Austin, owner and occupational therapist at Bearfoot OT in San Francisco. We love supporting the growing nature based therapy community and through that social media page we share about nature-based therapy as a whole and we aim to elevate all of the great work and voices of nature based therapists everywhere.