Horticultural Therapy at the Wyoming State Hospital

My name is Cynthia Conk and I am a Certified Therapeutic Recreation Specialist (CTRS) and have worked at the Wyoming State Hospital for 18 years. I am currently assigned to the forensic unit and have been the Program Manager of the greenhouse for five years. Prior to my participation in the certification program at the Horticultural Therapy Institute (HTI), the main focus of activities at the greenhouse was “to keep the plants alive.” When I started classes at the HTI I learned how fortunate I was to have a greenhouse. Even though the heating and cooling system needs some work and the fiberglass is deteriorating I don’t complain anymore. I’m grateful to have a greenhouse that provides us with the plant material we need for our program. The hospital is in Evanston, Wyoming and at 6500 feet we are able to lengthen our growing session and have a year-round program. WSH provides mental health services for the citizens of Wyoming. We have a combination of short-term acute care, long-term SPMI (severe persistent mental illness) and forensic clients. Our campus is spread over 20 acres and includes group homes within the community. The needs and considerations vary considerably when providing programming for the clients.

Our HT program is a combination therapeutic/social program. The HT activities take place primarily in the greenhouse and in the attached activity room. We also have designated areas around the hospital grounds where we have developed garden areas near living units that provide accessible “outdoor classrooms” in the summer. We strive to create environments that promote and allow for growth. An assessment developed specifically for HT is given to each client prior to participating in the HT program. It assesses cognitive, social, physical and leisure needs/limitations and provides background information to help staff work more effectively with each individual. Activities are provided that focus on client’s needs/limitations and participation is documented towards client goals/objectives.

During the summer of 2006, I provide 8 contact hours a week for clients. Two hours of HT groups are part of the forensic day treatment program for the NGMI (not guilty due to a mental illness.) This group of clients is my main workers and they help take care of the needs of the plants at the greenhouse. The focus of the HT groups is leisure skill development and improved quality of life. Activities focus around watering, pruning, propagation, weeding, seeding, soil prep, planting, de-heading and all the tasks associated with the greenhouse. They also help prepare for our semi-annual plants sales. Two of the clients entered potted plants into the Uinta County Fair in the fall and took home the grand champion and reserve champion ribbons in floral/horticulture division. This was a highlight for all the hard work they did during the summer.

Two hours a week are dedicated to the short-term acute care clients. One group was held at the greenhouse for those clients who could leave the unit. The other group was on the unit for the clients who were less stable. The size of group for these clients is limited due to the need for more assistance during the activities. The unit staff accompanied and assisted the clients during the activities. The focus of the HT activities is more functional skills development such as focusing on tasks, following directions, positive interaction with others, self-expression and improved endurance/strength. Activities are completed within the time frame of the group. I utilize activities ideas from the year-round HT activities session I took from the HTI in 2004 and resources found in books, magazines and on various web sites.

The final and largest group of clients is from the outpatient programs. Four hours a week were dedicated to this program. Two hours spent in structured activities and two hours were “open” for any interested clients to drop in and assist in daily tasks being done. These clients are stable in their illness and require less overall supervision but still benefit from staff assistance during HT activities. The main focus for these clients is leisure skills development, improved quality of life and self-expression. Because the outpatient program has long term clients were are able to do activities that continue from week to week. Early in the spring we propagate and plant seeds. The clients tend to the needs of their plants and learn to thin and transplant. They plant the large containers that are placed in the common use areas and water and nurture them throughout the summer. Flower collecting and preserving are activities they enjoy and the material from these activities are used in craft activities during the winter months.

When I began as the Program Manager of the Greenhouse, I had experience as a therapist in developing recreational programs for the clients and was comfortable with assessing client needs, analyzing data and creating care plans related to leisure activities. The Horticultural Therapy Program was an avenue that had so much potential but lacked the structure needed to make it a viable therapy at our facility. I put together a proposal to attend the Horticultural Therapy Institute so I might become certified as a Horticultural Therapist and provide an alternative therapeutic modality. I began classes in January 2005 and was able to go straight through the five sessions and finished February 2006. Each class provided me with the knowledge needed to make the most of my program. The guest speakers who shared with us how they utilized HT with their populations inspired me. I learned characteristics of various populations and the benefits HT could be in improving their quality of life. We studied the history of HT with special populations and the human-plant relationship. We shared our ideas with our classmates and developed a wide variety of possible goals for participation in HT programs. We learned about HT treatment models and processes and explored our own personal journey with the benefits of HT. We developed programs and assessments for specific populations that we were interested in or were currently working with at the time. My favorite activity was developing indoor and outdoor sites for HT settings. I was able to take specific areas at the hospital and develop ideas for these areas. When I returned to WSH, I presented the plans to the Facilities Director and he and I are currently working together to put raised beds near the Visitors Center based on the assignment I did in class. It is an area that has high traffic use with the clients and visitors to the hospital. Besides providing a beautiful visual effect to those who visit the hospital, it will also provide another “outdoor classroom” for the HT clients. The final class was learning to manage an HT program and putting it all together. This covered needs, population, purpose, facilities and equipment, integrating with other services, personnel, and resources. I have the support of the hospital administration and a greenhouse/activity room. The professional disciplines are also supportive of the program and the benefits they see with individual clients.

The biggest challenge my program faces is the lack of a designated operating budget. When developing a budget during the HT Management class, I determined that I needed a minimum of $1000.00 a year to operate an HT program. This did not include any large expenses related to the greenhouse needs. I have a wish list for those. We are able to raise approximately $600.00 from our semi-annual plant sales. Recently, I was given an area in our hospital canteen and have set up a boutique to sell plants to the clients and employees. We have been able to generate about $60 a month from these sales. Once a year, I send a proposal to the Consumer Benefit Counsel for specific projects that will benefit clients. They have donated money to the program to purchase material for planting containers that are located in courtyards around the hospital grounds. The supervisor of the Therapeutic Services Department also has given the program money in the spring to help purchase supplies needed to begin the growing season. Just this past year, I have sought money from each of the specific program managers to help defray costs of material for the groups their clients attend. I have learned to utilized resources within the community both businesses and volunteers. A local nursery donated over $800.00 in plants. When the local grocery store remodeled their produce section, they donated all their old tables — perfect for raised work areas. The Master Gardener’s Club designed the landscape in front of our new 45-bed acute care facility and has provided volunteer hours to the HT

I am enjoying my experiences in horticultural therapy and give credit to the staff at the HTI as well as my classmates throughout the USA for helping me put it all together. Building a network of professionals is essential and has provided support and good friendships. Please feel free to contact me if you have questions, need ideas or want to share experiences.

Cynthia Conk, CTRS, HTR
Evanston, WY
[email protected]