Mechanisms of Change in Nature-Based Pediatric Occupational Therapy: The Ecology of Change in Outdoor Therapy Model

Abstract

The purpose of this qualitative constructivist grounded theory study was to develop a model to explain potential mechanisms of change in the nature-based pediatric occupational therapy process, based on analysis of the perspectives of occupational therapy practitioners currently engaging in nature-based practice with children. Using 27 photos and interview data from 22 participants the Ecology of Change in Outdoor Therapy (ECO-Therapy) Model was developed. The model suggests mechanisms of change in nature-based pediatric occupational therapy may involve six iterative phases: Longing for Freedom, Embarking on Adventure, Dancing with Nature, Claiming Self-Agency, Braving Real-Life Challenges, and Growing Adaptive Capacity. The practitioner and child experiencing these phases throughout the nature-based occupational therapy process may lead to improved participation and performance in the child’s daily life.

Keywords:

• Children
• grounded theory
• nature-based therapy
• outdoors

Acknowledgments

The primary investigator would like to thank Hannah K. Burke for her assistance with peer coding, Corry Wagner and Elisabeth Meikle for their valuable feedback as expert reviewers of the preliminary model, Chloe Muntefering for her assistance with revisions, and all of the practitioners who shared their experiences and insights for this study.

Declaration of Interest

The primary author runs a business that offers a multi-disciplinary nature-based pediatric therapy course and a membership site for nature-based pediatric practitioners. Coauthors have no conflicts of interest to report. This research was not funded or sponsored by any company.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Gail A. Poskey

Laura Park Figueroa, PhD, OTR/L completed this work in partial fulfillment of the requirements for her PhD in occupational therapy at Texas Woman’s University. She is a nature-based private practice owner and founder of the Therapy in the Great Outdoors community for nature-based pediatric practitioners. She can be reached via email at [email protected]

Gail A. Poskey, PhD, OTR is an Associate Professor in the School of Occupational Therapy at Texas Woman’s University.

Katherine K. Rose, PhD is a Professor in the College of Professional Education in Child Development/Child Life Human Development, Family Studies, and Counseling at Texas Woman’s University.

Noralyn Davel Pickens, PhD, OT, FAOTA, is the Associate Dean of Interprofessional Education and Strategic Initiatives in the College of Health Sciences and the College of Nursing, and a Professor in the School of Occupational Therapy at Texas Woman’s University.

Katherine K. Rose

Laura Park Figueroa, PhD, OTR/L completed this work in partial fulfillment of the requirements for her PhD in occupational therapy at Texas Woman’s University. She is a nature-based private practice owner and founder of the Therapy in the Great Outdoors community for nature-based pediatric practitioners. She can be reached via email at [email protected]

Gail A. Poskey, PhD, OTR is an Associate Professor in the School of Occupational Therapy at Texas Woman’s University.

Katherine K. Rose, PhD is a Professor in the College of Professional Education in Child Development/Child Life Human Development, Family Studies, and Counseling at Texas Woman’s University.

Noralyn Davel Pickens, PhD, OT, FAOTA, is the Associate Dean of Interprofessional Education and Strategic Initiatives in the College of Health Sciences and the College of Nursing, and a Professor in the School of Occupational Therapy at Texas Woman’s University.

Noralyn Davel Pickens

Laura Park Figueroa, PhD, OTR/L completed this work in partial fulfillment of the requirements for her PhD in occupational therapy at Texas Woman’s University. She is a nature-based private practice owner and founder of the Therapy in the Great Outdoors community for nature-based pediatric practitioners. She can be reached via email at [email protected]

Gail A. Poskey, PhD, OTR is an Associate Professor in the School of Occupational Therapy at Texas Woman’s University.

Katherine K. Rose, PhD is a Professor in the College of Professional Education in Child Development/Child Life Human Development, Family Studies, and Counseling at Texas Woman’s University.

Noralyn Davel Pickens, PhD, OT, FAOTA, is the Associate Dean of Interprofessional Education and Strategic Initiatives in the College of Health Sciences and the College of Nursing, and a Professor in the School of Occupational Therapy at Texas Woman’s University.