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Thelma Hodge MSW, LSW Jonathan Trauth, LISW-S

J. Trauth, 513-235-4325 jonathantrauth@gmail.com

� Dr. Benjamin Rush (19th century)

� Deemed father of American psychiatry

� American psychiatric textbook, Medical Inquiries and Observations Upon the Diseases of the Mind in 1812

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� Used with veterans after World War II

� First horticulture therapy program in a university was at Kansas State University in the 1970s (KSU)

� AHTA.ORG (1974-2013)◦ Current website

� Menninger Foundation teamed with the Horticulture Department at Kansas State University to provide training for undergraduate students in the mental health field

� This led to the first Horticultural Therapy curriculum in the U.S. (Relf, 2006)

First example of horticulture therapy mentioned by Dr. Benjamin Rush in a text:

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� Rush noted that labor, more than exercise, was shown to be more therapeutic, and more lasting in effect

� “digging in the garden” and “cutting wood”were found, by Rush, to be helpful to

“sufferers of mania” (Rush, 1812, pg. 226)

� Recovering addicts and alcoholics

� Eating disorders

� Depression

� Gaming addiction

� Attention Deficit Disorder

� Post Traumatic Stress Disorder

� Impoverished populations

*Horticulture therapy presents a type of phenomenological counseling approach sensitive to different styles of interaction.

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http://www.elsevier.com/a

bout/press-releases/research-and-

journals/food-insecurity-predicts-mental-health-problems-in-adolescents

� The Consumer Price Index for All Urban Consumers (CPI-U) increased 0.5 percent in March on a seasonally adjusted basis, the U.S. Bureau of Labor Statistics reported today

� Over the last 12 months, the all items index increased 2.7 percent before seasonal adjustment

� Recent economic developments have significantly and dramatically increased food prices worldwide

� Worldbank.org reports a 15% increase in food price since October 2010

**With all of this inflation, the time is ripe for **With all of this inflation, the time is ripe for **With all of this inflation, the time is ripe for **With all of this inflation, the time is ripe for horticulture therapyhorticulture therapyhorticulture therapyhorticulture therapy

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� Horticulture Therapy has proven to positively impact adolescents in recovery from addictions to drugs/alcohol

� This approach adds a new dimension to the Multi-Dimension Family Therapy model and correlates with the Twelve-Step Recovery model, i.e. service work.

� Urban farming in Cincinnati for Burundian Refugees

� Provides self-sustainability

� Ability to grow their local foods

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� HT could potentially be used for any person or

group that have a high need for food assistance

and low risk time investment

� Many people do not have transportation and are

on food stamps◦ They buy their food from convenience stores that are

within walking range that supply expensive unhealthy

food choices (obesity prevalence)

� One common theoretical framework used with HT is the ecological theory by Urie Brofenbrenner

� The ecological theory is a more holistic counseling approach:◦ concordance vs. discordance; person in

environment; and meaning making of current situations.

◦ looks at the body, mind, and spirit….

Source: Berk, L. (2008). Exploring Lifespan Development. Boston, MA: Pearson

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�Many current treatment models utilize a multidisciplinary team approach if they look at cases using the ecological perspective.

�Empowering a client to build a garden at home or use container gardening encourages a healthy way of life and the inexpensive ability to supply the home with fresh greens.

**The idea of recognizing the many dimensions of body, mind and spirit in recovery is gaining momentum.

� Family learning contracts

� Learning to use grounded natural resources

� self-sufficiency

� Stewardship of plants that give back the fruits of

their loving labor and hard work (synergism)

� Action-oriented, positively reinforced

� Widens the client’s options/coping strategies while

preparing them for higher levels of self

accountability and responsibilities that will help

them later in life

� Positive community response and involvement

� Too often, providers are accustomed to

“doing for and not teaching skills that move someone from dependence to independence

� Traditional approaches to community mental

health emphasized “Do anything the client needs you to do” or “Do whatever is necessary for the client…”

**The Idea is to EMPOWER the clients and “graduate” them with sustainable living skills

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CASE MANAGEMENT

�Case Management is a service that provides for the client’s basic needs in order to keep the client in the Community.

�Case managers can meet these basic needs with or without the client present.

�Case management often meets clients needs by “doing things for” the client, brokering services and linkage.

CPST�CPST focused on providing the client with basic skills and supports in order to enable the client to live in the least restrictive setting at the best possible functional level.

�Rather than “doing things for” the client, the CPST worker addresses the functional deficits of the client by skill building and supportive services.

�The goal of CPST is to get the client where he/she has achieved a greater level of self-sufficiency and no longer needs CPST services.

�…actions of the clinician designed to help the client achieve objectives

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� Help clients, when necessary, evaluate their response/need…

� Elicit from client’s personal coping strategies…� Assist clients in identifying goals, needs, etc.…� Help client develop list of empowering goals…

� Explore client’s own perception of…� Reinforce positive self-statements…� Encourage client to participate…� Model for client…� Assess client for…� Help client make connection between…� Assist in identifying cognitive messages

that client…� Employ horticulture therapy during next six

sessions to…� Assist client in identifying…

� Review methods of conflict resolution…

� Use therapeutic game to expand client’s awareness of…

� Suggest ways…

� Brainstorm some ways…

� Ask client to list…

� Train the client in alternative ways to…

� Help client differentiate between…

� Review ways…

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� Presenting issues, diagnoses, treatment plan and progress notes must correlate with each other.

� Document facts rather than opinions◦ “Child reports…”

� Describe observations (behaviors & symptoms) rather than speculations

� Be able to defend what you write� Use action words� Document how the client is participating in

treatment

� Document how the client is progressing and any changes in his/her conditions or needs

� Document client’s level of functioning in regards to his/her ability to engage in everyday activities

� When clinically pertinent, use direct quotes from the client

� Avoid slang, unless you are quoting the client

� Describe interactions in specific, observable, measurable terms

◦ Start and Stop Times need to be actual time, not rounded to the nearest 5 or 10 minute increment

◦ Services are billed in units:

� For counseling and CPST, the units are based on quarter hours and round as follows (for total minutes/day):

� 0 to 7 minutes = 0

� 8 to 23 minutes = 0.25

� 24 to 37 minutes = 0.50

� 38 to 52 minutes = 0.75

� 53 minutes to 67 minutes = 1.00

◦ Signatures must include credentials and handwritten (not word-processed) date.

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�Armstrong, D. (2000). A community diabetes education and gardening project to improve diabetes care in a northwest American Indian tribe. Diabetes Educator 26(1), 113-120. �Barnicle, T. & Stoelzle Midden, K. (2003). The effects of a horticultural activity program on the psychological well-being of older people in a long-term care facility. HortTechnology 13(1), 81-85. �Blair, D., Giesecke, C. & Sherman, S. (1991). A dietary, social, and economic evaluation of the Philadelphia urban gardening project. Journal of Nutrition Education 23:161–167. �Bunn, D.E. (1986). Group cohesiveness is enhanced as children engage in plant stimulated discovery activities. Journal of Therapeutic Horticulture 1:37–43. �Cimprich, B. (1993). Development of an intervention to restore attention to cancer patients. Cancer Nursing 12(4), 22-27. �Cooper Marcus, C. & Barnes, M. (1999). Healing gardens: Therapeutic benefits and design recommendations. Chichester, UK: J. Wiley. �Feenstra, G., McGrew, S. & Campbell, D. (1999). Entrepreneurial community gardens: Growing food, skills, jobs and communities, Publication 21587. Davis CA: University of CA- Davis.

� Friends Hospital (2005). Healing with plants: The wonders of horticultural therapy. Retrieved October 22, 2006 from http://www.friendshospitalonline.org/History.htm

� Galindo, M. & Rodrieguez, J. (2000). Environmental aesthetics and psychological well-being: Relationships between preference judgements for urban landscapes and other relevant affective responses. Psychology in Spain 4: pp.13-27.

� Gerlach-Spriggs, N., Kaufman, R.E. & Warner, S.B. (1998). Restorative gardens: The healing landscape. New Haven and London: Yale University Press.

� Hartig, T. (2003). Restorative environments: Guest editor’s introduction. Environment and Behavior 33 (4), 475-479.

� Haller, R. & Kramer, C. (Eds.). (2006). Horticultural therapy methods: Making connections in health care, human service, and community programs. Binghamton, NY: The Haworth Press.

� Hartig, T., Mang, M. & Evans, G.W. (1991). Restorative effects of natural environment experiences. Environment and Behavior 23(1), 3-26.

� 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) 165-170.

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� Hill, C. & Relf, P.D. (1982). Gardening as an outdoor activity in geriatric institutions. Activities, Adaptations and Aging 3(1):47–54.

� Jarrott, S.E., Kwack, H.R. & Relf, D. (2002). An observational assessment of a dementia-specific horticultural therapy program. HortTechnology 12(3), 402-410.

� Jellicoe, G. & Jellicoe, S.(1995). Landscape of man (2nd ed.). London: Thames and Hudson, 1995.

� Kaplan, R. & Kaplan, S. (1989). The experience of nature. New York: Cambridge University Press.

� Kaplan, R. (2001). The nature of the view from home: Psychological benefits. Environment and Behavior 33 (4), 507-542.

� Kuo, F.E., Bacaicoa, M. & Sullivan, W.C. (1998). Transforming inner-city landscapes. Trees, sense of safety and preference. Environment and Behavior 30(1), 28-59.

� Kweon, B.S., Sullivan, W.C. & Wiley, A.R. (1998). Green common spaces and the social integration of inner-city older adults. Environment and Behavior 30(6), 832-858.

� Langer, E. & Rodin, J. (1976). The effects of choice and enhanced personal response for the aged: A field experiment in an institutional setting. Journal of Personality and Social Psychology 34(2), 191-198.

� Matsuo, E. (1995). Horticulture helps us to live as human beings: Providing balance and harmony in our behavior and thought and life worth living. Acta Horticulturae 391:19–30.

� Mooney, P.F. & Milstein, S.L. (1994). Assessing the benefits of a therapeutic horticulture program for seniors in intermediate care. In M. Francis, P. Lindsay & R.J. Stone (Eds.), The healing dimension of people-plant relations: Proceedings of a research symposium (pp.173-187). University of CA.

� Moore, B. (1989). Growing with gardening: A twelve-month guide for therapy, recreation, and education (pp. 3-10). Chapel Hill: University of North Carolina Press.

� Namazi, K.H. & Haynes, S.R. (1994). Sensory stimuli reminiscence for patients with Alzheimer’s disease: Relevance and implications. Clinical Gerontology 14(4), 29–45.

� 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), 15-30.

� Pothukuchi, K. & Bickes, J. (2001). Youth nutrition gardens in Detroit: A report on benefits, potential, and challenges. Detroit, MI: Wayne State University.

� Relf, P.D. (1978). Horticulture as a recreational activity. American Health Care Association Journal 4(5), 68–71.

� Relf, P.D. (2006) Agriculture and health care: The care of plants and animals for therapy and rehabilitation in the United States. In J .Hassink & M. van Dijk (Eds.), Farming for health (pp.309-343). The Netherlands: Springer.

� Relf, D., McDaniel, A. & Butterfield, B. (1992). Attitudes toward plants and gardening. HortTechnology 2:201–204.

� Rodiek, S. (2002). Influence of an outdoor garden on mood and stress in older persons. Journal of Therapeutic Horticulture 13: pp13-21.

� Rush, B. (1812). Medical inquiries and observations upon diseases of the mind. Philadelphia: Kimber & Richardson. Retrieved October 22, 2006 from http://deila.dickinson.edu/theirownwords/title/0034.htm

� Simson, S. & Straus, M. (1998). Horticulture as therapy: Principles and practice. Binghamton, NY: The Haworth Press.

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Cognitive Benefits: Cognitive Benefits: Cognitive Benefits: Cognitive Benefits:

�Enhance cognitive functioning Enhance cognitive functioning Enhance cognitive functioning Enhance cognitive functioning (Kaplan & Kaplan, 1989; Cimprich, 1993; Herzog, Black, Fountaine & Knotts, 1997)

�Improve concentration Improve concentration Improve concentration Improve concentration (Wells, 2000; Taylor et al., 2001)�Stimulate memory Stimulate memory Stimulate memory Stimulate memory (Namazi & Haynes, 1994).

�Improve goal achievement Improve goal achievement Improve goal achievement Improve goal achievement (Willets & Sperling, 1983).

�Improve attentional capacity Improve attentional capacity Improve attentional capacity Improve attentional capacity (Hartig, Mang & Evans, 1991; Ulrich et al., 1991; Ulrich & Parsons 1992; Ulrich, 1999; Taylor et al., 2001)

Psychological Benefits: Psychological Benefits: Psychological Benefits: Psychological Benefits:

�Improve quality of life Improve quality of life Improve quality of life Improve quality of life (Willets & Sperling, 1983; Waliczek et al., 1996)

�Increase selfIncrease selfIncrease selfIncrease self----esteem esteem esteem esteem (Moore, 1989; Blair et al., 1991; Smith & Aldous, 1994; Feenstra et al., 1999; Pothukuchi & Bickes, 2001)

�Improve sense of wellImprove sense of wellImprove sense of wellImprove sense of well----being being being being (Relf et al.1992; Ulrich & Parsons, 1992; Galindo & Rodrieguez, 2000; Kaplan, 2001; Jarrott, Kwack & Relf, 2002; Barnicle & Stoelzle Midden 2003; Hartig, 2003)

� Reduce stress Reduce stress Reduce stress Reduce stress (Ulrich & Parsons, 1992; Whitehouse et al., 2001; Rodiek, 2002)

� Improve mood Improve mood Improve mood Improve mood (Wichrowski, Whiteson, Haas, Mola & Rey, 2005; Whitehouse et al., 2001)

� Decrease anxiety Decrease anxiety Decrease anxiety Decrease anxiety (Mooney & Milstein, 1994)� Alleviate depression Alleviate depression Alleviate depression Alleviate depression (Relf, 1978; Mooney & Milstein, 1994; Cooper

Marcus & Barnes,1999)� Increase sense of control Increase sense of control Increase sense of control Increase sense of control (Relf et al., 1992)� Improve sense of personal worth Improve sense of personal worth Improve sense of personal worth Improve sense of personal worth (Smith & Aldous, 1994)� Increase feelings of calm and relaxation Increase feelings of calm and relaxation Increase feelings of calm and relaxation Increase feelings of calm and relaxation (Moore, 1989; Relf et al.,

1992)� Increase sense of stability Increase sense of stability Increase sense of stability Increase sense of stability (Blair et al., 1991; Feenstra et al., 1999;

Pothukuchi & Bickes, 2001)� Improve personal satisfaction Improve personal satisfaction Improve personal satisfaction Improve personal satisfaction (Blair et al., 1991; Smith & Aldous,

1994; Feenstra et al., 1999; Pothukuchi & Bickes, 2001)� Increase sense of pride and accomplishment Increase sense of pride and accomplishment Increase sense of pride and accomplishment Increase sense of pride and accomplishment (Hill & Relf, 1982;

Matsuo, 1995)

Social Benefits: Social Benefits: Social Benefits: Social Benefits: �Improve social integration Improve social integration Improve social integration Improve social integration (Kweon, Sullivan & Wiley, 1998)�Increase social interaction Increase social interaction Increase social interaction Increase social interaction (Langer & Rodin, 1976; Moore, 1989; Perrins-Margalis,�Rugletic, Schepis, Stepanski, & Walsh 2000).�Provide for healthier patterns of social functioning Provide for healthier patterns of social functioning Provide for healthier patterns of social functioning Provide for healthier patterns of social functioning (Langer & Rodin, 1976; Kuo,�Barcaicoa & Sullivan, 1998)�Improved group cohesiveness Improved group cohesiveness Improved group cohesiveness Improved group cohesiveness (Bunn, 1986)

Physical Benefits: Physical Benefits: Physical Benefits: Physical Benefits: �Improve immune response Improve immune response Improve immune response Improve immune response (Hartig, Mang & Evans, 1991; Ulrich et al., 1991; Ulrich & Parsons 1992; Ulrich, 1999)�Decrease stress Decrease stress Decrease stress Decrease stress (Rodiek, 2002)�Decrease heart rate Decrease heart rate Decrease heart rate Decrease heart rate (Wichrowski, Whiteson, Haas, Mola & Rey, 2005)�Promote physical health Promote physical health Promote physical health Promote physical health (Ulrich & Parsons, 1992; Kweon, Sullivan & Wiley, 1998;�Cooper Marcus & Barnes, 1999; Armstrong, 2000; Rodiek, 2002)�Improve fine and gross motor skills and eyeImprove fine and gross motor skills and eyeImprove fine and gross motor skills and eyeImprove fine and gross motor skills and eye----hand coordination hand coordination hand coordination hand coordination (Moore, 1989)