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Making Connections Editor: Christine Capra
Program Manager, HT Institute

2021 Winter Newsletter

Horticultural Therapy is making an impact on people’s lives.
Read more about how it’s happening.

HTI Director’s Note:
HT as Nature-Based Therapy

By Rebecca Haller, HTM

Connecting with nature is fundamental to the experience of being human. We are inherently biophilic beings, so it is only ‘natural’ to see the current increase in purposeful and therapeutic practices that use outdoor activities to enhance human health. Horticultural therapy is one such practice. Gardening offers connections with other living biotic systems and is thus rich with opportunities for physical, psychological, cognitive and social growth as well as restoration and improved wellbeing. A new textbook on outdoor therapies includes horticultural therapy as one of the experiential therapeutic approaches that connects people and place/environment for enhanced health. Outdoor Therapies An Introduction to Practices, Possibilities, and Critical Perspectives, Edited by Nevin J. Harper and Will W. Dobud was just released by Routledge (Taylor and Francis) 2021. Drawing on experts world-wide, it provides perspectives on the use of outdoor therapy and introduces the reader to eight practices – from animal-assisted to wilderness therapies. My hope is that by writing the chapter on horticultural therapy, the book will introduce the practice to those who study nature-based therapies and encourage the use of HT as an effective treatment on its own as well as paired with other therapies. The book’s release is well-timed for a world that is reeling from a pandemic and has awoken to the need for natural connections. Well done, Nevin and Will.

Program Profile: HT in a Psychiatric Hospital

By Emilee Weaver

CRH team

As the world continues to fight Covid-19, it is hard to overlook the immense toll that is has taken on human health, finances, and our ability to socially connect with others. As we experience this unprecedented level of national isolation and struggle, it is important that we empathically recognize that there were (and still are!) millions of people who have experienced lifelong social isolation and poor health due to mental health issues prior to Covid-19. Our one-year nightmare has been some of their lifelong reality. Horticultural therapy serves many vulnerable populations, many of which reside in temporary or long-term inpatient facilities that must restrict their clients’ ability to access the outdoors at times. In most cases, Covid-19 has caused nursing homes, hospitals, rehabilitation centers, prisons, etc. to grant even less access to the outdoors due to cross contamination issues. It is in these ‘have not’ times that we feel most grateful for what we once had.

Central Regional Hospital (CRH) is the largest of three state-managed psychiatric hospitals in North Carolina. The secure, 400-bed facility provides mental health treatment for children, adolescents, adults, seniors, and forensic patients, those who have been deemed unable to proceed in a court of law due to their mental health diagnosis. In order to be admitted to CRH, an individual must pose an imminent threat to the safety of themselves or others, have a mental illness, and cannot be safely provided treatment at a lower level of care. Many of the patients have co-occurring physical, intellectual and mental health diagnoses. Our 12-year-old building was designed around the principle that sunlight plays an integral role in mental health and wellbeing, so 40-50% of the hospital’s ‘walls’ are windows. This year, Covid-19 has literally shed light on the importance of integrating vicarious access to the outdoors via windows, as patients have used them more than ever to mentally explore landscapes outside of their four walls.

Living Meaningful Lives

Courtyard

The primary mission of the hospital is to provide high-quality, integrated, individualized care to restore each patient to a level of health that allows them to live meaningful lives in the least restrictive environment possible. CRH’s horticultural therapy program has become a central figure in the culture of the hospital and finds its home in the Psychosocial Treatment Department. We began the program with one horticultural therapist four years ago and have gained one therapeutic horticulture position each year after that, bringing our team up to four full-time staff. There are three large courtyards (surrounded by walls but open to the sky) nestled into the heart of the hospital building, providing the only outdoor locations in which our 400 patients have access during their daily fresh air breaks. Patients may be treated for as short as a month and as long as a lifetime, so this puts an immense amount of responsibility into the hands of our HT staff to provide the most stimulating, engaging environments possible. Once patients have displayed safe behavior for several weeks after admission, they are permitted to apply for one of 130 paid patient jobs available at the hospital. Our HT staff facilitate three paid, vocational HT work crews, each with 5-8 patients per crew (18 total/day) when fully staffed. Patients who interview and are selected for the positions get paid to work 1-1.5 hours Monday-Friday. Each patient’s growth or decline towards established vocational and psychosocial treatment goals are documented daily by our horticultural therapists and relayed back to the treatment team for further assessment.

Tulip courtyard in Summer

Our early-morning horticulture crew is responsible for watering and maintaining the raised beds and gardens in the three internal courtyards at the hospital, named Tulip, Dogwood, and Sunflower Courtyards. The other two horticulture crews are responsible for maintaining our indoor growing operation, and our outdoor vegetable gardens and perennial/shrub nursery. The indoor growing space is used to grow houseplants that are sold at five plant sales that we hold throughout the year. Equipped with light benches and heat mats, we also grow a large portion of the annual flowers and vegetables that we require for planting our courtyard programming spaces each spring. This practice saves us money and provides more work for patients during slow, winter months. The outdoor nursery is used to grow perennials and shrubs that are sold at our spring plant sale and as requested individually by staff members throughout the year.

Self-determined Therapeutic Delivery Style

Raised bed

The structure of the hospital’s psychosocial treatment program mimics that of a college quarter system. The patients choose four treatment groups a day that target the unique goals that have been set by the patient and their interdisciplinary treatment team. As such, patients enjoy the opportunity to self-determine which therapeutic delivery style they will receive, thus increasing their sense of personal autonomy, dignity and respect throughout the treatment process. There are four therapeutic horticulture treatment groups that are offered each day within this system, all of which target different types of treatment goals. Each group can accept 12 patients a session, for a total of 48 patients receiving therapeutic horticulture psychosocial treatment interventions per day. Once a three-month group quarter is complete, a new set of patients are admitted to the groups and the process repeats. This process ensures that we are working with willing participants who have an interest in horticulture.

Recently, the hospital was granted funding to build a 40’ x 23’ greenhouse for patient programming. We are scheduled to break ground in 2021. The greenhouse will expand our growing capabilities at the same time as adding a ‘store front’ to sell plants and value-added products that we have developed. The store front will provide patients the opportunity to learn industry standard quality control, money handling, and customer service skills. Though we enjoy a large amount of support and creative license from hospital administration, our growth is due (in large part) to our ability to educate and engage CRH staff at ALL levels of power. We intentionally practice the art of approachability and build personal relationships with the diverse group of individuals within our community. As a result, staff and patients alike share stories and comments about how the gardens and programming have positively affected their unique experiences at CRH- especially during this vicious pandemic. This act of professional commitment and open-heartedness has enabled us to model the values that we ask of our patients and gain buy-in from the CRH community as a whole. The more we actively support our community’s needs, the more they support our growth, and this is why we are not just engrained into the soil, but into the culture of Central Regional Hospital.

Emilee Weaver (formerly Emilee Vanderneut) is a graduate of the HT Institute and the community employment program manager at the division of state operated healthcare facilities, Central Regional Hospital in North Carolina. 

HT Institute Update

The HT Institute moved all of it’s fall 2020 classes online and had nearly 40 graduates of the program, including one student from Italy, complete their final class in September. In addition 90 students began the program by completing Fundamentals of Horticultural Therapy in three separate sections of the class. The second class in the series, Horticultural Therapy Techniques, is full for the first section but a few spaces remain in the second session for those who have completed the Fundamentals class. Tentative dates have been set for fall 2021 Fundamentals classes with the hopes of offering two sections face-to-face and one online. Stay tuned for more details.

For questions email Christine Capra at: [email protected] or call 303-388-0500.

Tips for Practice:
How to Execute a Profitable Plant Sale

By Emilee Weaver

You too can grow your plant sale with a few simple steps. For the past four years, I have managed a horticultural therapy program at a 400-bed psychiatric hospital in North Carolina (see program profile for more details). With the enduring dedication of my HT team and patients, we have grown our spring plant sale profits from $1,000 our first year, to $6,000 our third year. We also hold several, smaller holiday sales throughout the year and have doubled or tripled our profits through rigorous planning, product development, and a dynamic, responsive approach to marketing products to our specific target audience. Now in our fourth year, we have sales down to a science, making $1,000 per sale with products that fit on only three 6’ long tables. I’d like to share some of our guiding principles in hopes that they might spark some ideas for your own therapeutic horticulture program:

1. Focus on Your Strengths

It is better to be the best at producing 5-10 products than to be the worst at producing 20 products.

Fig. 1.1 Stretched tomato seedling
Fig. 1.2 Robust tomato seedling, Professional Standard.

Study your local competition and aim to match or exceed their quality level. There is no excuse for producing a low quality plant product. There are ways to produce industry-standard plants with clients of every ability level, so don’t settle with ‘good enough’ and rely on the kindness and/or sympathy of customers to buy a subpar product. Show customers (and your clients!) that you take yourselves seriously and experiment with techniques until you get them right. If you never get it right, ditch it! Buying stout tomato seedlings (Fig 1.2) from a wholesaler and selling them at retail prices offers a smaller profit margin, but that is better than offering spindly, stretched seedlings (Fig 1.1) from your operation that undermine your quality standards. Stay within your limits and find creative ways to expand only as your own ability level, time, budget, and client skill level change and grow 

2. Identify Your Customer-Taylor to their Needs

Listen to your customers. Most people have access to large box stores that have affordable, ‘run of the mill’ plants for sale. Find a niche market. While some customers may be satisfied with an ordinary plant palette, you have the opportunity to teach your market what plants to love and desire with your carefully curated offerings.  In 2019, my team planted showy, 9’ tall ‘Thailand Giant’

Fig. 1.3 Tall ‘Thailand Giant’ Elephant Ear

(Fig 1.3) and vigorous ‘Pink China’ elephant ears in our gardens to create a lush tropical feeling. We received a positive, awe-struck response to these elephant ears from our patients and employees. As a result, we purchased a large number of elephant ear plugs (five varieties) and are growing them out for our 2021 spring plant sale. We anticipate selling out of all 150 elephant ears within 1.5 hours of opening our plant sale (based on past sale trends we’ve meticulously documented). Your own market wants to reveal itself to you. What is it saying?

3. A Picture is Worth a Thousand Words

Fig. 1.4 Interpretive signage
Fig. 1.5 Shoe holders turned into care card holders

I have found that the average plant sale customer does not know what they are hoping to buy. Their curiosity for plants and attraction to color lure them in and it isn’t until something captivates them that they make a purchase. Providing adequate signage is an effective way to interpret and guide customers through your products. A simple sign that says, “Great Hostess Gift for the Holidays!” will spark the minds of your customers and create a ‘need’ they may not have originally conceived.

(Fig 1.4)  If a plant is not in bloom, print and laminate a colorful picture of its flowers and display it near the plant. Group complimentary annuals and/or perennials on the same table and encourage customer to buy them as a set. Better yet, provide simple plant-specific ‘care cards’

(Fig 1.6) that remove the guess work and equip customers with the information they need to be successful.

Fig. 1.6 Example of care card                           

4. Never Underestimate the Power of ‘Bling’!

Autumn bling

In this article, ‘bling’ can be defined as anything that you add to beautify a plant. Bling helps a plant become a ‘product’ in a customer’s mind because it clarifies the purpose of the plant. Colorful plant ‘sleeves’ and ribbon can be purchased for cents apiece and increase the perceived value (and profit!) of the plant by $1.00-$5.00 on average. We have found that adding bling also promotes multi-plant purchases. Sourcing cheap, yet interesting tins or ceramic pots from a wholesale provider can also increase perceived value and profits. Add plant picks with holiday-specific slogans and images to upgrade the plants’ relevance to the customer. Picks can be purchased at a very cheap price and can also be made by clients during slow seasons. Get creative!

Though therapeutic horticulture has been around for many, many years, we need to remember that the communities that therapeutic horticulture programs serve often have very limited knowledge of the work we do with patients and why it is important. A plant sale is a visible display of what a practitioner and their immensely talented clients are capable of.

Valentine’s bling

Every plant sale that my team provides for our hospital community is a direct reflection of the pride that we have in ourselves, our commitment to excellence, and the legitimacy of HT as a treatment modality and profession. I encourage you to take a moment to determine exactly what message you’d like to send to your own host community with your programs’ endeavors. Which parts of your heart and mind can you manifest into the world through plants? My favorite poet, Mary Oliver encourages us,

“The world offers itself to your imagination, calls to you like the wild geese, harsh and exciting-over and over announcing your place in the family of things.”

Be imaginative. Be experimental. Be thorough.

2020 CRH Valentine’s Day Plant Sale

Announce your place in this ever-worthy field day-by-day, client-by-client, sale-by-sale. You are your most reliable product, so you determine your worth.

Emilee Weaver (formerly Emilee Vanderneut) is a graduate of the HT Institute and the community employment program manager at the division of state operated healthcare facilities, Central Regional Hospital in North Carolina. 

HTI Kudos:

Student receives HT credentials:

Congratulations to HTI graduate, Jennifer Kampf, HTR who recently received her professional registration through the American Horticultural Therapy Association. She is continuing  studies and in the process of completing a Master in Social Work at the University of Minnesota, Duluth. She said she strongly recommends her HTR internship experience,  dividing her training between working with Pam Young at the Bryn Mawr Rehabilitation Center in Philadelphia and with Libba Shortridge at Skyland Trail in Atlanta.

In addition to Jennifer, five additional HTI students received their credentials recently. We are proud of their efforts and look forward to their contributions in the field.