2023 Spring Newsletter

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

HTI Director’s Note:

By Rebecca Haller, HTM

Build Good Foundations

Start with the basics of structure, pathways, soil, and year-round plants.

The most effective horticultural therapy garden encompasses these essentials. It is also accessible, it invites you in, it creates a sense of place, and offers interest and opportunities for participation. To function best it has excellent care, something we will discuss in the next newsletter. For structure, a good design encompasses some framework for the foundation of any garden.

As any real estate agent with tell you it is important to think “location, location, location.” Can participants and others find and easily approach the space? Is it close to parking or adjacent to a building used for other activities? Can the horticultural therapy garden be seen from the building to add to the interest in participation as well as beauty to indoor spaces?  Are there restrooms nearby?

Create enclosure and a sense of place through carefully designed entrances and boundaries. For some applications, such as when safety is paramount, those boundaries must provide physical confines. For others a mere suggestion of enclosure, such as with plant material or placement of garden beds, is more desirable. Entrances identify that a person is arriving at a destination and can be as simple as a couple of potted plants flanking a pathway or as elaborate as a beautifully crafted wall or fence with a gateway. Any scope or type of entry provides a transition to the garden and can serve to help those who enter shift gears to a life-enhancing garden or therapeutic experience.

Speaking of pathways – wayfinding should be straightforward. Consider who is served in the program to match the complexity of paths and routes to the needs and capacities of those users. It is helpful to think about a balance between intricacy and places to explore with intuitive simple-to-grasp directions.

Other keys to good foundations in any garden are the woody plants as well those that persist with year-round interest. It may be tempting for a horticultural therapist to concentrate on the annual plantings and those that are most advantageous for active gardening, but the trees and shrubs are essential for structure and shade, human comfort, inspiring clients to walk outside, for seasonal displays and fragrance, and for living ceilings and walls. Plan for and invest in these before the more changeable annuals and vegetables, etc. They will also play an important part in creating a therapeutic space as well as fodder for future session activities.

Now, let’s get to the soil – the foundation of all life. Feed it. Make and use compost. Minimize digging and turning the soil to help with carbon sequestration. Set up clear pathways to avoid trampling the very thing that gives life to the plants we grow. Give it the honor and prominent place it deserves in your programming by allowing and encouraging participants to be active gardeners of the soil as well as the plants.

Enjoy springtime in the garden.

Program Profile: Therapy Gardens for Seniors
A Tale of Two Gardens

By April Ellis, LCSW, HTR

An Internship Journey

After looking near and far for an internship, I realized I would need to accept the advice given to me by many horticultural therapists (HT): find an off-site supervisor and create my own. Luckily, I knew the perfect place.  I’ve had the pleasure of working at a geriatric psychiatric hospital in San Francisco for eight years. The 12-bed hospital is a secured wing inside a larger skilled nursing facility (SNF). On one side of the building, patients’ rooms look outside to bare ground, a sidewalk and two overgrown Acacia trees. For years my fellow staff members and I had dreamed of making a garden space where we could take our patients. Going outside, breathing fresh air, and seeing the sun are the patients’ most common requests.

For my internship I designed and created therapeutic gardens for both populations – one for the skilled nursing residents, the other for senior psychiatric patients. Horticultural therapy programs were designed and each week 2-3 programs were provided to each population. I was honored to be advised on the gardens design by renowned therapeutic landscape architect, Clare Cooper Marcus. I was also incredibly fortunate to have Trish Hildinger, HTR as my off-site internship supervisor. It was because of her superior organization and program design skills that this internship was possible.  Malcolm Hillan, a distinguished horticulture professor at San Francisco City College, was my advisor on the project. Owing to his counsel, everything planted in the garden has continued to thrive.

It took three months to design and create the two garden areas. Safety and accessibility were the guiding principles. All the plants that were used have a sensory component, are non-toxic and grow well in foggy San Francisco. Furniture was sourced from yard sales, Craigslist, or Amazon. Plants and seeds were purchased from local nurseries or donated by staff members and residents. My labor was augmented by my wonderful co-workers who rolled up their sleeves to saw, nail, dig and haul. We also had a dynamite group of volunteer 8^th graders who worked wonders painting furniture.

Creating a horticultural therapy internship is as challenging as it is rewarding. Quite frankly it was physically strenuous and financially demanding, and working with the intricacies of administration was sometimes interesting. But it is an incredible feeling to build something beautiful with co-workers. It lifts my spirits every time I look out a patient’s window and see a peaceful, verdant wonderland. I’ll never forget the first butterfly I saw land on a freshly planted flower in the garden. Or the way a resident’s face lit up when she pruned the pansies, her favorite flower when she was young. Or the severely depressed gentleman who threw back his head and laughed after eating a fresh ripe strawberry he picked in the garden. The memory of the difficulties has faded; the joy resulting from them is what I remember most. How grateful I am to do this work.

The Gardens:

The Wellness Garden

Philosophy: A vibrant outdoor area, with many places to do activities both standing and sitting, colorful uplifting, invigorating the senses with interesting sights, smells, sounds of birds, tastes of the herbs from the planters all around. A place to be active, to socialize, create, nurture, and enjoy.

Design:

• Grow bags in vibrant colors, planted with vegetables, herbs and flowers.
• All planters were raised to ideal height for seated gardening.
• A high table to complete activities while standing up.
• A bright blue table of standard height for seated activities
• Raised garden bed that accommodates a wheelchair to fit under it.
• Sink/table combination connected via hose to a water faucet.
• Turning barrel composter
• Cold frame with heated pads for germinating seeds

Activities: Harvesting herbs, veggies, flowers, and seeds from the garden. Sorting and storing seeds.  Germinating home-grown seeds.  Transplanting seedlings. Weeding pots.  Making flower arrangements. Turning the compost barrel.

The Healing Garden

Philosophy: A calming location where patients can relax in nature, talk with their providers (psychiatrist, social worker, assistants), or walk off their anxiety. Utilizing soothing colors and sounds. A quiet place of contemplation, a place to give the anxiety a rest, to let the breeze blow, to focus on the fascinating configuration of a succulent, or on trimming strawberries or watering the pansies.

Design:

• Three seating areas with tables and chairs
• Outdoor chess set.
• Shelving with items to create Fairy Gardens
• A round worktable, lowered for accessibility
• Birdseed feeders, hummingbird feeders and bird baths
• A two-tiered water fountain with solar powered motor
• Two 55-gallon rainwater barrels
• Three-tiered planters with strawberries and pansies

Activities: Making floating flower mandalas and Fairy Gardens. Watering plants with water from the barrels. Mindful walking paths. Sand play therapy.  Harvesting strawberries. Cultivating succulents. And, of course weeding.

Overall Tips:

Access to the garden is all-important. It can be a gorgeous place, but if it’s not easily accessible, it will be under-utilized. One of the challenges with this location was that the doors leading to the gardens are alarmed with a shrill alarm. Ensure that access to your site is easy and those authorized are comfortable accessing it. Fear of setting off alarms may keep staff and patients away.

When proposing therapy gardens to management, use as many visual aids as possible. For these gardens I took pictures of the site and created color mock-ups with photoshop of the completed site. I also made three dioramas showing the completed gardens.  If possible, have the team visit another therapy garden to show them what is possible.

The most powerful promotional tool within a facility is the excitement of staff, residents, and patients. Word of mouth travels fast, and if management hears others being excited, they may be more inclined to approve projects. At my facility, staff and residents watched each phase of the gardens as they were built. They would call advice out their windows as we worked. Staff brought in all kinds of plants from their yards to populate the garden. In fact, most of the succulents in the Healing Garden came from our medical director’s backyard.

Involving staff and residents in the creation of the gardens is wise. Not only do many hands make for light work (especially helpful with our river rocks project) but they feel a sense of ownership. Once the garden is completed, it may be possible to teach staff in other disciplines (i.e. activities department, as well as physical and occupational therapy) how to use the gardens when they provide therapy to their patients.

April Ellis is a licensed clinical social worker at the geriatric psychiatric hospital located in the San Francisco Campus for Jewish Living. She’s a proud HTI graduate and a newly registered HTR. Images of the gardens and programs mentioned in this article can be found at www.aprilellislcsw.com, Email: [email protected]

Fall 2023 Fundamentals of HT classes: Enroll Today

This fall your horticultural therapy journey begins with Fundamentals of Horticultural Therapy offered both in an online or face-to-face format. This class is a pre-requisite for the remaining three classes in the HT certificate at the Institute and is available in three different sections. Students need only attend one section:

Fundamentals of HT I
Coastal Maine Botanical Gardens (face-to-face)
Oct. 12-15, 2023
Deadline for enrollment: Sept. 12

Fundamentals of HT II
Online (mountain time zone)
Oct. 26-29, 2023
Deadline for enrollment: Sept. 26

Fundamentals of HT III
Online (mountain time zone)
Nov. 9-12, 2023
Deadline for enrollment: Oct. 9

“Providing students, the necessary tools to do the work of HT is the mission of the Institute and continues to allow students to follow their passion for connecting people and plants, to improve lives, to make a commitment to the training and work, and professionally conduct themselves which will lead to their success,” said Haller.

The remaining three classes in the HT certificate will be held in 2024 with one section of each class being offered online and one face-to-face. Dates and locations to be announced later this spring.

For more information on the Horticultural Therapy Institute or to enroll in the Fundamentals of HT class go to www.htinstitute.org or email [email protected].

For more questions contact [email protected] or 303-388-0500.

Tips for Practice:
Evidence-Based Practice with Elders

By Amy Fee Bruzzichesi, MSW

My journey into horticultural therapy began in 1992, when as a social work internship student at an Alabama continuing care retirement community (CCRC), I helped the assisted living residents repurpose a bleak courtyard into a functioning flower and vegetable garden. Because this community housed people who mainly came from rural areas, there was a wealth of gardening and growing knowledge, and my role was mostly to get the supplies they needed to transform their community space. We had slices of the first fresh tomatoes at my farewell lunch, and I never forgot how good it felt to reconnect people to growing things.

I now work with elders in a spectrum of settings: individuals at home, memory care facilities, long-term care, and adult day health. Although the participants are quite different in each setting, some of the best evidence-based practices I’ve found translate to most of our encounters, and hopefully you’ll find them useful as well.

Meet People Where They Are

This is an old social work phrase that tops a lot of best practice lists (Sheafor, Horejsi & Horjesi), but it really bears repeating: it makes a big difference to learn about your participants before diving into the day’s HT plans. This can be challenging if, like me, you are only with the group for a short period of time but taking a few minutes to connect with each person and understand how they are doing that day allows you to adjust anything that may not be a good fit. With memory care participants, this brief interaction establishes you as a friendly visitor and sets the tone for the session– as it does for any group!

Orientation is Important

For elders in care, there are several cues we can give as HTs that help our participants to orient to who we are, the day, and the season; in fact, our interactions provide a useful framework for orientation when we select seasonal plant materials and activities (Masuya & Ota).

I always wear a wood-slice nametag pin so that a person who may not remember has another opportunity to call me by name. When working in care facilities, I bring my materials with me in a collapsible wagon which I decorate with seasonal garlands with summer flowers, fall leaves, or winter greenery. This isn’t just to be festive, but to subtly orient anyone who sees me to what my purpose is in their space, as well as which season, we are in.

Lastly, I not only start each session by verbally mentioning the day, date, and season, but I introduce seasonal plant material and talk about the plants we are growing and where they are in the growth cycle.

Communicate with Co-Providers

Often in my sessions, occupational, physical, and speech therapists will accompany their patients into the HT space and use our session to co-treat. This is helpful when it can happen, because the other professionals may get an opportunity to see a reluctant OT patient become an enthusiastic garden team member while accomplishing their OT goals. I send the week’s HT plans to co-providers so that they can evaluate whether they would like to schedule their sessions concurrently with the HT group. Co-treatment is a valuable way for other disciplines to meet their goals with participants in a dynamic and attractive setting while keeping participants active and engaged long enough to realize forward movement (Hazen).

Make it Real and Relevant

With elders in care, sometimes the usual round of activities can feel contrived or not directly meaningful (Gurski). We can all remember sitting in primary school thinking that something aimed at the whole group was just not very interesting to us. For HT sessions, introduce the activity in terms of relevance to the people, the season, the goals for the garden, or anything else that will help participants individually connect to what you are doing. For example, last year in one group, we planted fragrant herbs, took care of them in the garden until our expected frost date, then harvested them, dried them, and made drawer sachets to keep or give at the holidays. The process was rewarding, and participants had a basketful of handmade, self-selected sachets to enjoy or give away at the end, rather than something that they had little connection to.

Practice Modifications

If a proposed activity requires mobility, hand strength, fine motor skills, sharp vision, or any other skill that a participant may not have, write the modifications into the HT plan so that you and any other staff or volunteers can successfully offer assistance for maximum self-efficacy. Demonstrate the modifications to helpers and participants so that they choose a modification before handing it over for someone else to do! Resources like Rothert’s The Enabling Garden are valuable for starting to think about modifications, and visiting other programs virtually or in person is helpful to learn how people with different needs can participate actively in the HT setting.

Discourage Learned Helplessness by Offering Choice

Learned helplessness is a state which occurs when a person has undergone repeated stress and come to believe that they cannot control or change their situation. For people in care, this state comes about after finding that they have fewer and fewer choices regarding the details of their daily lives, and they become accustomed to allowing caregivers to manage most of the decision-making. Also, people with dementia are unlikely to initiate activities, but many readily respond affirmatively when offered options (Gigliotti et al.)

HT encounters offer a low stress setting where people can reclaim some agency over their decisions (D’Andrea et al, Sheafor, Horejsi & Horejsi) and exercise self-determination: even something as simple as selecting a preferred plant color, a pepper over a tomato, or where they would like to sit in the space, can help overcome some of the learned helplessness that often becomes part of their lives. Be sure to create as many opportunities as possible for participants to make choices, and when the answer is “I don’t care, choose for me,” gently but firmly insist that they pick one! It’s best to offer two choices to someone overwhelmed by decision-making, rather than having to choose from a large array.

Sometimes, we as HTs must also educate facility staff and volunteers about the importance of self-determination in our activities so that they don’t fall into their roles of doing things for their clients, and instead, facilitate with us so that our participants can successfully meet the goal of self-efficacy.

Be Yourself

It can be challenging or even intimidating to work with a population that has several compromises in their daily functioning, whether those are cognitive, physical, social, emotional, behavioral, or a combination. Everyone responds best to authenticity, and as practitioners, we can create safe spaces for participants to be themselves when we model that behavior. This also creates space for sharing, being vulnerable without judgment, and most importantly, room to grow!

Amy is an HTI graduate with 30 years experience in social work with elders and their families. In addition to work with private clients living at home and attending day health programs, she works at the North Carolina Botanical Garden in Chapel Hill facilitating outreach programs in long-term health and memory care facilities. Amy is also an extension master gardener volunteer with Alamance County Cooperative Extension in North Carolina.

Read More:

Chalfont, Garuth, and Alex Walker. Dementia Green Care Handbook of Therapeutic Design and Practice, 2013.

D’Andrea, Sj., Mitchell Batavia, and Noah J. Sasson. “Effect of Horticultural Therapy on Preventing the Decline of Mental Abilities of Patients with Alzheimer’s Type Dementia.” Journal of Therapeutic Horticulture, January 1, 2008, 9–13.

Eddison, Sydney. Gardening for a Lifetime: How to Garden Wiser as You Grow Older. Timber Press, 2011.

Gigliotti, Christina M., Shannon Jarrott, and Diane Relf. “Horticultural Therapy for Persons with Dementia: Using an Environmental Press Perspective to Integrate Theory and Research.” Journal of Therapeutic Horticulture XIV (2000): 8–16.

Gurski, Caryl Gormly. “Horticultural Therapy for Institutionalized Older Adults and Persons with Alzheimer’s Disease and Other Dementias: A Study and Practice.” Journal of Therapeutic Horticulture 15 (2004): 25.

Hazen, Teresia M. “Horticultural Therapy in the Skilled Nursing Facility.” Activities, Adaptation & Aging, May 29, 1997. https://doi.org/10.1300/j016v22n01_05.

Masuya, Junko, and Kikuko Ota. “Efficacy of Horticultural Activity in Elderly People with Dementia: A Pilot Study on the Influence on Vitality and Cognitive Function.” International Journal of Nursing & Clinical Practices 1, no. 1 (September 13, 2014). https://doi.org/10.15344/2394-4978/2014/101.

Rothert, Gene. The Enabling Garden: A Guide to Lifelong Gardening. Taylor Trade Publishing, 1994.     Sheafor, Bradford W., Charles R. Horejsi, and Gloria A. Horejsi. Techniques and Guidelines for Social Work Practice. Allyn & Bacon, 2000.

HTI Kudos

Congratulations to a new HTR in California

Congratulations to HTI graduate, April Ellis, HTR who recently received her professional registration through the American Horticultural Therapy Association. April continues to work at the San Francisco Campus for Jewish Living’s geriatric psychiatric hospital where she is a social worker and leads horticultural therapy groups.  She will be leading groups in the skilled nursing units through the ElderGrow program which just secured a grant for services in San Francisco. She is volunteering with UCSF’s Health in Nature program. She is also on the conference planning work team for the upcoming AHTA conference, and would like to encourage all readers to consider presenting their current projects at the conference!

HTI Graduate Featured by the Royal Horticultural Society

It’s Eleanor Moriarty Wroath here in England, I thought you might like to see that the RHS (Royal Horticultural Society) Campaign for School Gardening featured me and my therapeutic gardening work with a local elementary school, as part of their nationwide “Big Seed Sow” program encouraging the nation to get out sowing and growing. Read more about it in my newsletter. They’ve been featuring me and my work on their social media as well and possibly a podcast. I’ve also been broadening my work with an online support platform for miscarriage and baby loss,  called The Worst Girl Gang Ever, delivering online gardening workshops for wellbeing and will be creating content as  part of their online  “Pathway to Recovery” program. 

I am continuing to work at TWIGS Community Garden in Swindon 2 and half days a week and am now administrator for their Facebook page. We have recently received two significant funding sums which will enable the ‘Garden of Hope’ to be finally completed  and for me to run a bereavement support group there. The work is growing and reaching a wider audience which I am really happy about. I have 450 followers on Instagram now. Congratulations Eleanor we are proud of our HTI students!

Another HTI student achieves professional registration!

Sarah Thompson is a recent graduate of HTI and said her experience inspired her to pursue professional registration. She completed her internship at a memory care facility in her hometown of Boise, ID. During her internship, Sarah witnessed firsthand the significant and positive impact that a connection with plants has on an individual’s level of health and happiness. Sarah is now under contract with the memory care facility as a registered horticultural therapist and there are plans to expand the program this year! Congratulations Sarah.