Clinical Research

Winner

OrganizationUCSF Benioff Children’s Hospital Oakland 
InitiativeCenter for Nature and Health
LocationOakland, CA
Founded2016
LeadershipNooshin Razani, MD MPH, Director, Center for Nature and Health
Morgan Green, MD
Jennifer Matthews, MD
ContactDr. Nooshin Razani, nooshin.razani@gmail.com

Initiative Overview

Home to one of the first park prescription programs in the nation, and the first to receive insurance reimbursements for their park prescription program, UCSF Benioff Children’s Hospitals have spearheaded a therapeutic revolution in pediatric health care. We conduct original research relating to nature and health, provide clinical care in nature, and train health care providers as thought leaders in the field. We improve health equity through access to nature for health and well-being by creating opportunities for Bay Area children to spend time outdoors. We also advance the science of nature and health, disseminate best practices, and advocate for nature as a human right. 

Impact

CNH conducted and published the first ever randomized trial of a park prescription program; created the first billable nature clinic in the country; and are the first medical residency program to integrate nature into doctors’ training. 

Impact by the numbers

  • Four peer-reviewed publications, seven abstracts
  • 64 nature outings conducted to date
  • ca. 2,000 park visits for patients and families
  • Improved stress in parents, resilience in children
  • Billable clinic following health outcomes in patients
  • CNH team of five MDs
  • 81 doctors in training

Innovation

Through numerous national and international events, we have advocated for the importance of gathering an evidence-base for nature as important to clinical medicine. With one trial completed, we now have 2 more trial results in process for publication, and will be starting a systematic review and qualitative study this fall. Measuring the health impacts of a nature prescription program required interdisciplinary and imaginative collaborations in order to know what to measure. We worked with UC Berkeley Master’s students to identify that stress relief in parents and resilience in children were the outcomes that were of importance to the famlies we serve. While the national dialogue focused on physical activity for park prescriptions, we knew that for the families we serve, physical activity would be a piece of the prescription, but not necessarily the motivator in getting outside. We also created the first clinical scripts on how to talk to patients about nature and health, and evaluated them in our clinical trial; and we are the first program to create tools for what to measure and how to follow patients in an actual billable clinic. 

Replicability

Through our peer reviewed publications, others can build on our work of establishing an evidence-base for the role of nature in clinical care. Our emphasis on research is to ensure that an evidence trail is collected as this nature and health movement gains traction. The randomized trial is the language of the medical world and quality research is what will help move medical professional societies (such as the American Medical Association) as well as insurance agencies to reproducing nature and health programs.

Biggest Challenge to Advancing This Work

Articulating the difference between our public health and clinical missions. Being focused and effective in the clinical message. What are we treating, how are we treating it, how are we measuring that, and how are we billing for that service.

Official Selection

OrganizationNaval Health Research Center & Naval Medical Center San Diego
InitiativeSurf and Hike Therapy for Active Duty Service Members with Major
Depressive Disorder
LocationSan Diego, CA
Founded2008, study began in 2015
LeadershipDr. Kristen Walter, Primary Investigator / Clinical Psychologist
Betty Michalewicz-Kragh, Co-Investigator / Surf Therapy Program Manager
Nick Otis, Associate Investigator / Project Manager
ContactDr. Kristin Walter, kristen.h.walter.ctr@mail.mil

Initiative Overview

Many service members suffer from psychological disorders, such as posttraumatic stress disorder and major depressive disorder. Previous research indicates that various forms of physical activity, especially those that occur in the natural environment, can have positive effects on mental health outcomes. This two-part study evaluates the effects of Naval Medical Center San Diego’s Surf Therapy and Hike Therapy Programs on psychological symptoms among active duty service members. Phase I was recently completed, and examined outcomes of the Surf Therapy Program; Phase II is currently comparing the efficacy of Surf and Hike Therapy for service members with major depressive disorder.

Impact

Results from Phase I show that surf therapy—provided alongside other traditional treatments over the course of 6 weeks—was associated with reductions in symptoms of: depression, anxiety, posttraumatic stress disorder, and negative emotions; as well as improvements in positive emotions. Immediate effects of surf therapy include decreased depression/anxiety, and an improvement in positive emotions over the course of each session.

Impact by the numbers

74 participants completed Phase I (Surf Therapy Study)
43 new participants are currently enrolled in Phase II (Surf & Hike Therapy Randomized Controlled Trial), which is ahead of recruitment schedule!

Innovation

Research on the psychological effects of outdoor activity is in its infancy. The Surf and Hike Therapy study is the first randomized controlled trial to examine the effects of surfing and hiking on mental health, and to determine if there are comparable benefits—both immediately and in the longer term.

Replicability

Surfing is a common sport in areas with access to coastal areas, and hiking is an activity that can be done on nearly any terrain. Mental health improvements following surf therapy may extend to a wide range of individuals, although more research is warranted.

Biggest Challenge to Advancing This Work

The implementation of outdoor activity into medical and behavioral health care (i.e., its prescription) presents a multi-faceted challenge in the field’s advancement, with unique considerations for both military and civilian sectors.

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