by Nancy Wicks, OTR/L
Two days before the start of the 2017 ASLA Annual Meeting and EXPO, Nancy Wicks, OTR/L, an occupational therapist at the Resnick Neuropsychiatric Hospital at the University of California Los Angeles, hosted Amy Wagenfeld, PhD, OTR/L, SCEM, FAOTA, Affiliate ASLA, and Melody Tapia, Student ASLA, then a landscape architect student at the University of Massachusetts Amherst. The goal of the visit: to participate in a therapeutic garden group with patients on the adult inpatient unit.
The therapeutic garden group takes place each week on the adult inpatient psychiatric unit. It is an integral part of programming for acutely ill patients in recovery from a range of psychiatric diagnoses including schizophrenia, depression, bipolar disorder, and anxiety.
The program was started as a quality improvement project through the 4 East Unit Practice Council, which is multidisciplinary (Nurses, Occupational Therapists, Social Workers) using a quality improvement methodology called A4 Lean, which is one of the quality improvement tools used at UCLA. This methodology gives clinicians a structure to assess the current state of service provision and then implement changes.
The project is funded through the unit budget, with a very low initial set up cost of approximately $350, in large part because the large planter was already in place. The ongoing costs are lower than that, mainly involving small plant purchase, fertilizer, etc.
The group is co-led by occupational therapists and takes place on an outdoor deck within the locked, adult unit. Patients also have scheduled access to the deck throughout the day so they can enjoy the plants outside of group time as well. The group makes use of a large, existing raised planter which was part of the original building design. Initially planted by patients and clinicians in the spring of 2015, the planter contains herbs, succulents, and California natives, all with a strong sensory component.
While the original plants were put into the soil in a single session, establishing such a program for the inpatient psychiatric unit was the result of several months of interdisciplinary and quality improvement-focused work between occupational therapists, nurses, social workers, doctors, and patients. This collaborative approach is ongoing and remains key both to the therapeutic programming, and future development of the garden group program.
The garden group itself is a 45-minute session which is co-led by two occupational therapists, with an average of 7-8 patients participating each time. It is structured to include both indoor and outdoor time, with approximately 25 minutes of the time spent in the garden.
At the start of the group patients and clinicians meet indoors for introductions, orientation, and a discussion of tasks to be worked on in the garden. The group then moves outdoors to the garden where patients have opportunities to turn the soil, water, remove dead flowers and leaves, put in new plants, and take cuttings from the herbs with help from the co-leaders. Those who do not want to garden are able to enjoy garden books and magazines, or do nature-based coloring and painting. The session ends with reflective time indoors when patients have time to talk and share about the garden, including what tasks they enjoyed, what they observed, and to provide feedback and suggestions for future groups. At all times, safety is a priority so all plants are non-toxic and gardening tools are closely monitored.
From the inception of the program patients have responded positively to the garden group. Initial pre/post group feedback showed patients were feeling better after engaging in gardening activities. Clinical observations also noted improved social interactions and initiative as patients responded to the plants and participated in the tasks of the garden.
Key to the success of the program has been the patient-centered approach, interdisciplinary work, and leadership support. Moving forward, we hope this evidenced-based experience will raise awareness of the positive outcomes patients may show after this brief gardening intervention, and their interaction with soil and plants.
Amy Wagenfeld, PhD, OTR/L, SCEM, FAOTA, Affiliate ASLA, and Melody Tapia, Student ASLA, were hosted by Nancy Wicks, OTR/L, Susie Clinton, MS, OTR/L, Aimee Levine-Dickman, MA, OTR/L, Lynn Safenowitz, MS, OTR/L, and Ariel Schneider, LCSW, all clinical staff at the Resnick Neuropsychiatric Hospital at UCLA.