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PerryStryker_Team Project: HT Practice

This presentation is for HORT 751 Human Issues in Horticultural Therapy, Fall 2013 at Kansas State University. My partner and I were to classify horticulture programs as being either Therapeutic Horticultre or Horticulture Therapy then discuss why.
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on 5 December 2013

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Transcript of PerryStryker_Team Project: HT Practice

Definition of Horticultural Therapy
Kathy Perry & Nick Stryker
HORT 751 Human Issues in Horticultural Therapy, Fall 2013
Team Project: Horticultural Therapy Practice

To distinguish horticultural therapy from other horticultural activities, Relf and Dorn (1995) identify three main elements that must be present (similar to other allied health professions):
- clients
- goals
- treatment activities

Relf, D. and Dorn S. 1995. Horticulture: Meeting the needs of special populations.
HortTechnology
5(2): 94-103.
Horticultural Therapy is the use of gardening related activities by a Registered Horticultural Therapist to achieve specific physical, psychological or cognitive goals for a client in a vocational, therapeutic or social setting.
Types of Horticultural Therapy programs:
Therapeutic
Vocational
Social
Haller, R. Vocational, Social, and Therapeutic Programs in Horticulture. 1998. In S.P. Simson and M. C. Straus (Eds.),
Horticulture as Therapy: Principles and Practice (pp. 43-68).
Binghamton, NY: The Hawthorn Press.
Chambers,N., Ciccantelli, L., & Wichrowski, M. (1998). Stroke, Spinal Cord, and Physical Disabilities and Horticultural Therapy Practice. In S. Simson & M. Straus (Eds.),
Horticulture as Therapy: Principles and Practice
(pp.93-98).
Binghamton, NY: The Hawthorn Press.
This is a case study of Bruce, an 18 year old male involved in a single-car accident who sustained a spinal cord injury. Bruce underwent treatment at the Rusk Institute of Rehabilitation Medicine and after regaining some upper body control, Bruce was referred to their HT program as another modality to practice and improve: his fine motor skills, his sitting balance, and to maximize function performance and overall well-being.

Bruce’s treatment goals were: increase strength and stamina, increase awareness and safety issues, increase dynamic sitting balance, and increase self-esteem and confidence by trying something new.

Bruce formed a friendship with the male HTR.

The occupational therapists created orthotic devices for Bruce; a strength of the HT program is it allowed him additional modalities to master the device.

I thought this was a good program for Bruce, however there did seem to be a weakness. Bruce discarded the orthotic devices he had worked to master in the HT program in favor of a full-time aid his family had the resources to hire.
The frames that proceed are examples of HT programs along with explanations why.
Therapeutic HT Program #1
NYU Medical Center's Rusk Institute of Rehabilitation Medicine.
Haas, K., Simson, S., & Stevenson, N. (1998). Older Persons and Horticultural Therapy Practice. In S. Simson & M. Straus (Eds.),
Horticulture as Therapy: Principles and Practice
(pp. 244-248). Binghamton, NY: The Hawthorn Press.
This is a case study of Sarah B who is seventy-one years old with progressing arthritis and a broken right hip living in a retirement community. Sarah had been living in her own apartment in the retirement community, however once she broke her hip she was moved to their nursing wing.The retirement community has a horticultural therapy program with a horticultural therapist who developed a therapeutic program for Sarah's recovery, the ideal outcome being Sarah’s return to her apartment in the retirement community.

Sarah’s rehabilitation plan was: to restore physical strength and mobility, to improve daily living skills, and to return to a semi-independent living situation.

An example is provided in the case study noting the progression of objectives leading to Sarah’s goal; I think this is a strength of the program, that example is:

Goal: To restore physical strength and mobility.
Objective 1: Sarah will water indoor plants with a half-full watering can while standing for ten minutes.
Objective 2: Sarah will water plants with a full watering can while standing independently for ten minutes.

Another strength of the program is the use of adaptive equipment which enabled further activities.

Sarah was walking in the retirement community's garden when she slipped on wet pavement and broke her right hip. Part of the responsibility for this accident is on the garden's maintenance team at the retirement community. This seems to have been the greatest weakness from this HT case study.

Therapeutic HT Program #3
This program is Horticultural Therapy, with a focus on Therapeutic Horticultural Therapy. The three elements that are needed to be called horticultural therapy appear to be present-clients, goals, and, although it is not specified in the article, horticultural therapists. Unfortunately, the article doesn’t state that the therapists are horticultural therapists, but it is known by this author than Matthew Wichrowski is a registered horticultural therapist.
 
General Goals- Application and reinforcement of various aspects of cardiac rehabilitation (e.g. graded exercise), wellness/stress reduction, and education to promote continuing rehabilitative avocational gardening activities once home.
 
Strengths: The relaxing atmosphere of the Rusk Institute Glass Garden in which the therapy takes place facilitates improvement of psychological wellness (stress reduction), while at the same time promoting graded physical activity. Family members are included in the activities.
 
Weaknesses: All patients appear to follow the same program, (general goals) rather than customizing the program to meet to their individual needs (individual goals/treatment plan). The article should state that the program is carried out by horticultural therapists.

This program is Horticultural Therapy, with a focus on Therapeutic Horticultural Therapy. The three elements that are needed to be called horticultural therapy appear to be present-clients, goals, and, although it is not specified in the article, horticultural therapists. Unfortunately, the article doesn’t state that the therapists are horticultural therapists, but it is known by this author than Matthew Wichrowski is a registered horticultural therapist.
 
General Goals- Application and reinforcement of various aspects of cardiac rehabilitation (e.g. graded exercise), wellness/stress reduction, and education to promote continuing rehabilitative avocational gardening activities once home.
 
Strengths: The relaxing atmosphere of the Rusk Institute Glass Garden in which the therapy takes place facilitates improvement of psychological wellness (stress reduction), while at the same time promoting graded physical activity. Family members are included in the activities.  

Weaknesses: All patients appear to follow the same program, (general goals) rather than customizing the program to meet to their individual needs (individual goals/treatment plan). The article should state that the program is carried out by horticultural therapists.


Wichrowski, M.J. (1998). Horticultural Therapy and Cardiac Rehabilitation.  In M.D. Buchert, J. Tarran, and R. Wood (Eds.)  Towards a New Millennium in People-Plant Relationships  (pp.  262-268). International People-Plant Symposium: Sydney, Australia.
Wichrowski, M.J. (1998). Horticultural Therapy and Cardiac Rehabilitation.  In M.D. Buchert, J. Tarran, and R. Wood (Eds.)  Towards a New Millennium in People-Plant Relationships  (pp.  262-268). International People-Plant Symposium: Sydney, Australia.


Therapeutic HT Program #2
Murrey, G.J., Wedel, A., & Dirks, J. (2001) . A horticultural therapy program for brain injury patients with neurobehavioral disorders.
Journal of Therapeutic Horticulture
, 12, 4-8.
The following frames discuss Therapeutic Horticulture programs along with explanations why they are not HT.
Therapeutic HT Program #4
This article describes a program at the Minnesota Neurorehabilitation Hospital that is horticultural therapy. The three required elements are present: 1. the program is run by a registered horticultural therapist, who is also a physical therapist, 2. the clients are people who have sustained traumatic brain injuries, and 3. general HT goals are identified.

The program is primarily therapeutic horticultural therapy, with some aspects of vocational horticultural therapy.

The general goals of the HT program are as follows:
1. To reduce levels of agitation and aggressive behavior.
2. To increase self-initiated meaningful activity.
3. To facilitate physical, occupational, and other rehabilitation therapies in a non-confrontational manner and in a natural setting.
4. To develop/increase prevocational and vocational skills.

Strengths: The article is written in a professional manner. The HT program is highly integrated into the total rehabilitation program for the clients, with the HTR being an integral part of the team. The garden area is also used as a therapeutic garden, in which other disciplines (PT, OT, Psychology) can work on their specific goals.

Weaknesses: Customized patient-specific HT goals, in addition to general goals, would strengthen the program.
Minnesota Neurorehabilitation Hospital Therapeutic HT Program
Shoulders, H. & Wray, A. (1995). A study in horticultural therapy: Matt’s seed story.
HortTechnology
, 5(2), 115-117.
This program is Horticultural Therapy, with a focus on vocational horticultural therapy.
The program is led by a registered horticultural therapist , Matt is a client with a head injury,
and his horticultural therapy goals are specific to developing vocational skills related to his interests and abilities in the area of horticulture.
Vocational HT Program #1 Tangram Rehabilitation Network, Maxwell, TX
Vocational HT Program #2
VA Hospital, Brockton, Massachusetts
Therapeutic HT Program #5
Perkins School for the Blind, Horticultural Therapy Program, Watertown, MA
ttp://support.perkins.org/site/PageServer?pagename=PerkinsInsight_Horticulture_InsideStory
The renowned program at the Perkins School for the Blind can be identified as a Horticultural Therapy program, as it is managed by an HTM, it serves students who with sensory impairments, such as blind, deaf, or deaf/blind, and goals are individualized according to the needs and age of the student. For example, for young children (e.g. preschool), goals may relate to therapeutic sensory exploration of textures, smells, and tastes of plants. For high school students, the goals may be more oriented towards learning vocational skills. Academic concepts, such as plant genetics, are also incorporated into the therapeutic approach. Therefore, the type of program is variable, depending on the needs of the student; however, it appears to be primarily therapeutic.

The program appears to have many strengths, including a state- of -the- art greenhouse and HT classrooms, and management by an HTM. It has long been a leader in the use of horticultural therapy for people with sensory and developmental disabilities. A weakness may be that the outside garden design is somewhat haphazard, comprised of raised beds placed without a coherent plan, which could be confusing for orientation and mobility.
Student at Perkins Making Apple Sachets
Comparison and Categorization
of 12 Reviewed Programs
that use Horticultural Activities
Program: HT, Type-vocational,
HTR (Jocelyn Hand, HTR) runs HT programs for veterans, with goals focusing on developing vocational and community reintegration skills.

Strengths: HT appears to be a valued part of the vocational rehabilitation process, according to Youtube videos and the press clipping.
Weaknesses: Specific HT goals for patients not specified. Other than the press clipping, HT is not visibly promoted on the VA website.

http://www.enterprisenews.com/news/x359563736/HEALING-GREENS-Local-vets-find-solace-in-horticultural-therapy
Clopton, C. (1998) Horticulture Therapy in a Therapeutic Farm Community
Therapeutic Horticulture Program #1
The Hopewell Inn of Ohio does not employ a HTR; the article states horticulture programs are overseen by a "horticulture work team leader". Additional research of their website on 11/19/13 also did not reveal an HTR on staff.

I do think the measurable objectives created to achieve patient goals along with weekly progress notes is well done.If an HTR was employed my classification would change and this would be a Therapeutic program type.
Therapeutic Horticulture Program #2
Stewart, S.(2003) Horticultural Therapy for Patients with Eating Disorders at the Homeworld Health Centre, Guelph, Ontario.
The article does not go into specific detail on goals created for the patients. The article illustrates the program as a helpful socializing activity which gives the patients a break from more intensive treatments. If more detail was provided on specific goals for patients I would then classify this as a HT program operating as a social program type.

Also, participation is only one hour a week for four weeks, then patients can choose if they want to continue. This does not seem like enough time to participate in a HT program where objectives can be created and progress documented.
Cornille,T., Gohrer, G., Phillips, S., Mosier, J.(1987) Horticultural Therapy in Substance Abuse Treatment.
Therapeutic Horticulture Program #3
A HTR is not mentioned on staff, however the article was written in 1987 so I wonder how many HTR's existed or how significant the debate was over HT or TH. Also, specific treatment goals are not mentioned. Overall goals for the patients' stay are mentioned and the authors noted horticulture has impacted these areas. I would like to have read specific goals or a case study. Finally, patients participation is one hour per week for six weeks, like the previous frame, I question if that would be enough time to work toward goals and to document progress.

Establishing work groups based on the patient’s admission week is creative. It sounds like this model is successful for handling the high turnover of patients since inpatient stay is 42 days.

An example of a wheelchair accessible garden
Therapeutic Horticulture Program #4
Coastal Maine Botanical Garden, Boothbay, Maine
Program: Therapeutic Horticulture; it began in 2010 as a pilot program of non-treatment goal oriented series, especially designed for people with disabilities.

Coastal Maine Botanical Gardens’ Therapeutic Horticulture Coordinator Irene Brady Barber offers programs in the Lerner Garden of the Five Senses for groups and individuals. Irene is a horticulturalist and a landscape designer who is currently working on an HT certificate at the Horticultural Therapy Institute. Once Ms. Barber completes her HTR, the program appears that it will fall under the category of Social Horticultural Therapy.

Strengths: The program is well endowed and funded by generous supporters. The program is also supported by fees charged to the participants for their involvement. The garden itself is beautiful, and built with full accessibility, including raised table-like planting beds for easy wheelchair access, vertical gardens, wide paths, railings along the beds to ease mobility.

Weaknesses: Although Ms. Barber is not yet a HTR, the brochure and website still call some of the classes horticultural therapy. Once she becomes an HTR, she will be able to better define her goals for the Social Horticultural Therapy Program, which appear to be related to fostering well being in a low stress atmosphere.
Wheelchair Accessible Raised Bed at the Coastal Maine Botanical Garden

A New Leaf, Broken Arrow, Oklahoma
Letter from the Greenhouse Manager at a New Leaf:

Hi Kathy,

I was forwarded an email from our office manager, Emily. I understand you are doing a project about horticulture therapy.
We do not have any registered

horticultural therapists here even though that’s what we do
. Most of our job coaches don’t have much experience working with plants when they get here, they just want to work with our clients. I am the greenhouse manager here at A New Leaf and manage a training process that teaches the coaches how to work with plants in a way that our clients can understand and enjoy. I must admit it is a constant challenge trying to find things that match every individual’s capabilities that equates to meaningful work. That is also part of the fun of working in this type of environment.

If you would like to talk to me some more about this stuff, feel free to email me back. I’m always available.

Thanks,


Rob Bieloh
Greenhouse Manager
Program: Therapeutic Horticulture with a vocational emphasis, since there is not an HTR on staff.

Mission & Philosophy
A New Leaf’s Mission is to provide individuals with disabilities life skills and marketable job training through horticultural therapy, vocational placement and residential services to increase their independence and individual choices.

Strengths: The program has been established since 1979, and appears to have a prominent place in the community.
Weaknesses: Although they do not employ an HTR, they advertise their services as horticultural therapy (see letter).
In conclusion, you have seen the key elements that must be present in a program to distinguish therapeutic horticulture from horticultural therapy.
Even though a horticulture program is labeled as therapeutic horticulture it is still a meaningful program for the participating individuals.
The value of the HT label creates a standard for this growing profession as it works to gain acceptance amongst other professionals and the public.
Class definition, Human Issues in Horticultural Therapy, Kansas State University, Fall, 2013
The End.

Thank you!
Therapeutic Horticulture Program #5
Full transcript