Play as Panacea, Part 2

Dell Children’s Medical Center of Central Texas image: Jody Horton
Dell Children’s Medical Center of Central Texas
image: Jody Horton

Part 2: Transforming Lives & Communities

Healthcare Environments

The importance and effectiveness of outdoor therapy, play, and immersion in nature has been widely embraced in recent years and continues to gain prominence in the healthcare industry. As noted nearly 20 years ago, patients are less likely to exhibit signs of depression especially where access to natural light and opportunities for physical exercise are present [1].

One hospital network in Central Texas, Seton Healthcare Family, has eight major facilities in the region and all include some form of healing garden [2]. The 3-acre healing garden at Dell Children’s Medical Center of Central Texas—a leading pediatric hospital that was the world’s first LEED Platinum for Healthcare project—is by far the largest of those eight and is integrally intertwined with the institution’s success. The healing garden provides patients, families, and caregivers a literal and figurative escape from the rigors of hospital life that has proven to be restorative and cherished by all. Indeed, probable outcomes from the appropriate use of nature are benefits that will more than likely be experienced in the reduction of anxiety/stress or a buffering of subsequent stressful episodes by the patients, staff, and visitors alike [3].

Dell Children’s Medical Center of Central Texas image: Jody Horton
Dell Children’s Medical Center of Central Texas
image: Jody Horton
Dell’s Children’s Medical Center of Central Texas image: Jody Horton
Dell’s Children’s Medical Center of Central Texas
image: Jody Horton

Dell Children’s healing garden affords fanciful passive and active recreational features including abundant textured and brightly colored surfaces; a peek-a-boo wall maze with circular walls in varying heights and colors; a human sundial; a 2-ton granite ball floating on water, allowing children to safely spin a massive object with ease, providing a therapeutic sense of triumph and accomplishment; and a central pond with aquatic plant material, living organisms, and rockwork creating a small waterfall, which affords a tranquil and restorative ambiance. Speaking to the efficacy of the healing garden, Dell Children’s Manager of Environmental Stewardship Michele Van Hyfte was quoted in a February 20, 2015 article in the Austin American-Statesman focused on Dell’s healing garden, in which she noted that studies have shown patient healing time is decreased and well-being is enhanced by the presence of nature, and that “there is enough evidence that [healing gardens] should be part of the continuum of care” [2].

Originally opened June 2007, Dell Children’s tremendous success spurred expansion efforts that concluded in May 2013 and included the addition of a third patient bed tower, adding 72 beds to the overall facility. This effort also included healing garden renovations and a new main entry sequence into the healing garden from the hospital, among other enhancements. The overall Dell facilities showcase the power of outdoor therapy in the healing process and another beneficial play application.

Dell Children’s Medical Center of Central Texas image: Jody Horton
Dell Children’s Medical Center of Central Texas
image: Jody Horton

Educational Environments

Play serves an integral role in childhood development and provides a valuable complement to traditional in-the-classroom learning. Informal play can support cognitive, social, and emotional development in addition to the development of physical skills. For example, children who regularly have positive personal experiences with the natural world show more advanced motor fitness, including coordination, balance, and agility [4, 5]. Additional research has shown that children with Attention Deficit Hyperactivity Disorder (ADHD), when provided appropriate contact with nature, show an improvement in their ability to concentrate [6].

One entity with unique appreciation for the power of play and outdoor experiences is the Nature Explore Program (NEP), a research-based initiative led by the Arbor Day Foundation and Dimensions Educational Research Foundation. The NEP provides research-based workshops, outdoor classroom design services, and hands-on, field-tested resources to schools; nature centers; national forests, parks and wildlife refuges; zoos; arboretums and early childhood programs.

Riverstone’s Big Adventure Park image: Jody Horton
Riverstone’s Big Adventure Park
image: Jody Horton

A prominent example exists in East Los Angeles, California, where the establishment of a certified Nature Explore Outdoor Classroom at the Fourth Street Early Childhood Center has transformed an under-resourced community and otherwise nature-deficient neighborhood. Prior to the outdoor classroom’s creation, many children had no place outdoors in their neighborhood that was safe to play. The outdoor classroom’s impact was profound and multifaceted. In interviews with the NEP, Fourth Street Early Childhood Center teachers “spoke of how cooperative social skills that are taught at other schools are developed naturally during play in the outdoor classroom; of children making their own discoveries about nature and wanting the learning to continue inside; of the lack of fighting, behavioral problems and injuries; of children creatively adjusting teacher-designed projects when outdoors” [7].

Similarly, the NEP has seen the power of the outdoor play in military settings, a particularly high-stress environment for children. Fort Hood in Killeen, Texas is one of the world’s largest military installations at 214,000 acres. Fort Hood offers no preschool for the population of the base, requiring many children to attend school off-base at institutions like Education Connection, a comprehensive program offering a variety of educational and therapeutic services; 80 percent of Education Connection’s students have special needs. However, Education Connection also has a Nature Explore Outdoor Classroom—and the impact has been extraordinary. Tracy Hanson, the school’s founder/owner, told the NEP that the outdoor classroom “has already brought many benefits to children, their teachers, and the families … ‘You can just see the stress levels are down,’ Hanson said. She notes that children sometimes protest when it’s time to go inside, because they’d rather stay outside. ‘But to see that a child doesn’t want to come in makes me feel good’” [8].

Dell Children’s Medical Center of Central Texas image: Jody Horton
Dell Children’s Medical Center of Central Texas
image: Jody Horton

Due to soldiers’ demanding schedules, some children are dropped off at the school as early as 5:30 a.m., and time on their own is often rare. Nicki Luther, director of Education Connection, told the NEP that “time outdoors plays an important role in their lives. This is the place where they can play freely, being themselves, forgetting their many other responsibilities.” In the uniquely stressful situation of living a highly regimented lifestyle amid military-style conditions, informal outdoor play provides an invaluable respite for children and a source of joy in what can be exceptionally trying circumstances for children.

As the extraordinary power of play continues to gain recognition for its transformational capabilities—in terms of personal development, well-being, and community cohesion—the prevalence of immersive, creative play environments, both in traditional and non-traditional play settings, will continue to increase, to the betterment of both individuals and communities.

Dell’s Children’s Medical Center of Central Texas image: Jody Horton
Dell Children’s Medical Center of Central Texas
image: Jody Horton

Missed Part 1 of Play as Panacea? Read it here.


[1] Lewy, A. J., Bauer, V. K., Cutler, N. L., Sack, R. L., Ahmed, S., Thomas, K. H., et al. (1998). Morning vs Evening Light treatment of Patients with Winter Depression. Archives of General Psychiatry, 55 (10): 890-896.

[2] Lindell, Carolyn. Home Matters: Dell Children’s Healing Garden. Austin American-Statesman. February 20, 2015. Accessed February 2, 2016.

[3] Grahn, P., Martensson, F., Llindblad, B., Nilsson, P., & Ekman, A., (1997). UTE pa DAGIS, Stad & Land nr. 93/1991 Sveriges lantbruksuniversitet, Alnarp.

[4] Fjortoft, I. (2001). The natural environment as a playground for children: The impact of outdoor play activities in pre-primary school children. Early Childhood Education Journal, 29 (2): 111-117.

[5] Ulrich, R. S. (1984). View Through a Window May Influence Recovery from Surgery. Science, 224 (4647), 420-421.

[6] Taylor, A., Kuo, F. & Sullivan, W. (2001). Coping with ADD: The surprising connection to green play settings. Environment & Behavior, 33 (1), 54-77.

[7] Lane, Dexter. Nature Transforming Teachers and Children. June 25, 2015. Accessed February 10, 2016.

[8] Lane, Dexter. A Nature Explore Outdoor Classroom in Support of Our Military Families. May 14, 2015. Accessed February 10, 2016.

by Jeff Lindstrom

2 thoughts on “Play as Panacea, Part 2

  1. Stephanie Saulmon April 6, 2016 / 6:28 pm

    Could you please list who the landscape architects are on these projects? Thanks!

  2. Jeff Lindstrom April 12, 2016 / 1:59 pm

    These are projects from the various offices of TBG Partners

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