Therapeutic Horticulture for Elders & Adults with Autism

By Siang Yu THAM

Let me introduce Siang Yu Tham, from Singapore.Siang Yu began her foray into horticulture when she worked in organic farms in France in 2013. She later returned to Singapore as a senior farm manager and head of education in an urban agriculture and foodscaping company. She has conducted horticultural therapy programmes for over 600 participants in schools, businesses and nursing homes, and conducted  research for the National Parks Board, National University Health System and Singapore Institute of Technology. She is now the founder of By Wind and Wave, a company which conducts nature-based programmes, and is also the caregiver of more than 50 edible and ornamental plants on her balcony. She is currently pursuing an Undergraduate Certificate in Horticultural Therapy at the University of Florida.

Vocational training for young adults with Autism

In 2016 and 2017, I conducted a vocational program at a local school for students aged 15-21 with autism. While the students could read, write and perform daily living skills, many of them exhibited deficits in communication, social interaction and emotion expression. The goal of the program was to equip the students with skills required in the agriculture industry as well as other job-related skills such as following instructions and communicating with others. Each programme lasted one academic year.

Working with a Program Team

The company I worked for was a service provider for the school and I was not an employee of the school. However, I was trained by the school on techniques for teaching students with autism, as well as strategies for supporting them. This included creating work schedules for the students, providing specific instructions and using visual supports. We set individual goals for the students and reviewed those goals periodically as part of the school’s assessment. The students also had a class coach who would join them during the sessions. He would advise me when he felt that the students could be pushed to do more or if they had any behavioral issues to be addressed.

Program Tasks

The students performed garden tasks such as watering, weeding, seed sowing, plant propagation preparing cuttings and harvesting. They produced potted plants which were sold to the public or planted in gardens managed by the company. Edible produce harvested by the students were also sold to restaurants.

At the start of each session, I would prepare an individualized work schedule for each of the students. A typical schedule would consist of:

• water 50 pots
• take 15 cuttings of a specific plant
• prepare soil mix
• prepare 5 pots of potting mix
• propagate 5 pots of plants
• clean up the work area, etc.

Throughout the program, the students learned to focus, work for longer periods (from the initial five minutes per task to 30 minutes) and communication skills such as asking for help.

Aids & Adaptations

In order to create a conducive work environment for the students, we made use of several learning aids:

• Visual instructions – we created step-by-step instructions for each task (e.g. watering, soil mixing, taking stem cuttings, etc.) and provided photos/diagrams for easy reference.
• Work schedule – each student had an individualized work schedule (as mentioned above) so they were able to anticipate what would happen during the session.
• Timming – some students performed better when given a set amount of time to perform each task. This was also helpful in training their stamina.

Outcomes

By the end of the program, the majority of the students were able to perform basic gardening skills, adhere to their work schedule and ask for help. Furthermore, many of the students who had difficulty focusing in the classroom displayed calm behaviors in the garden. However, it must also be noted that not all adults with autism thrive in the garden. There were too many stimulations in the garden for one of the students and he often needed to be isolated in order to calm down.

Therapeutic Horticulture with Seniors

Since 2018, I have been conducting therapeutic horticulture programs for seniors. The first program was conducted as part of a research by the National Parks Board (NParks) and the National University Health System. I started my own business conducting nature-based programs in 2019 and conducted a therapeutic horticulture program at the Society for the Aged Sick, a nursing home in Singapore. The program was part of a research project by occupational therapy students from the Singapore Institute of Technology (SIT).

Program goals

The program aimed to promote low intensity exercise and improve motor skills, stimulate memory, encourage positive social interactions and connect with nature, as well as to promote mindfulness.

Activities

Participants had weekly sessions where they performed tasks in the garden such as seed sowing, stem propagation, soil mixing, transplanting of seedlings and fertilizing. They also created nature artworks such as collages, painted flower pots and greeting cards with nature prints. For the program at the Society for the Aged Sick, the goal was to encourage residents to spend more time outside of their rooms, to have more social interaction and to practice fine motor skills. Throughout the program, I worked closely with the occupational therapist and the rehabilitation team to better understand the needs of the residents and design activities that could improve their motor skills to complement their rehabilitation sessions. During the last session, we had a cookout using vegetables the residents grew. One of the residents, a former chef, was praised by the other residents for his cooking and that was the happiest I’ve seen him.

Outcomes

The study by NParks-NUHS  found that therapeutic horticulture interventions may enhance immunity and prevent inflammatory disorders and dementia.

We saw positive interaction among the participants. They spoke to one another during the sessions, often offering suggestions and compliments to others. In the garden, the participants experienced successes and failures We practiced mindfulness and acknowledged the experiences, good or bad. One of the participants once commented, “That’s ok, that’s life. Don’t worry, be happy! We can plant it again.” Through their experience in nurturing plants, the participants have also learned to embrace all aspects of life, including death.

Moving Forward

Following the conclusion of the therapeutic horticulture program at the Society for the Aged Sick, I enrolled myself in the Undergraduate Certificate in Horticultural Therapy at the University of Florida because I felt that I needed more training in the use of horticulture as a therapeutic modality to support program goals. I have completed 3 out of 4 modules and I still have to complete my internship in order to attain  the certificate. However, due to the COVID-19 pandemic, I had to defer my internship. In the meantime, I am conducting online therapeutic horticulture sessions with other nursing homes.

My priority this year is to complete my internship in horticultural therapy and attain professional registration as a horticultural therapist. I hope to continue serving the elderly through my therapeutic horticulture programs, but another client population I would like to work with in the near future is adults with depression and anxiety disorders.

During the COVID-19 pandemic, Samaritans of Singapore reported a total of 3,826 calls in March 2020 seeking assistance for emotional distress, 23% more than it received during the same month last year. The US Disaster Distress Helpline also saw a 338% increase in call volume in March compared to the previous month. According to Singapore’s Ministry of Health (MOH), an average of 12,600 patients aged 15 to 34 years sought treatment for mental health conditions at public hospitals annually from 2017 to 2019 (Lim, 2020). While there are organizations which seek to provide support and intervention, there is little assistance and support available beyond counselling, psychotherapy and medication. Many patients also struggle to maintain employment while suffering from mental health issues such as depression and anxiety disorder (Goh, 2020). This could be due to disruptions caused by their mental health conditions or employers’ unwillingness to hire them once they have declared their conditions.

Horticultural therapy provides a non-traditional form of therapy for adults with depression or anxiety disorders. While traditional treatments such as medication and psychotherapy focus on the patient’s illness, horticultural therapy employs a strength-based model which focuses on the whole person rather than their illness. It also provides opportunities for social interaction within a group, unlike individual psychotherapy sessions. I hope to design a program that uses gardening to discover and support the individual strengths of adults with depression and anxiety disorders, thereby reaffirming self-esteem and improving employability.

If you are looking for education in the field of Horticultural Therapy see the curriculum at the Horticultural Therapy Institute and enroll in classes beginning this fall.

Reference

Goh, C.T. (2020, August 10). IN FOCUS: The challenges young people face in seeking mental health help. Channel News Asia. Retrieved from https://www.channelnewsasia.com/ 

Lim, X. (2020, May 6). Commentary: Our approach to mental health needs to change. COVID-19 will force us to. Channel News Asia. Retrieved from https://www.channelnewsasia.com/