Outdoor Recreation and Nature-Based Programming for Veterans Study

Objective: Research and catalogue the hundreds of programs, initiatives and organizations currently providing outdoor recreation and nature-based programs to military veterans in order to document current practices within the field.

Documentation of current practices will allow researchers to standardize protocols, establish best practices, share results and improve the services of providers to the veteran community.

The establishment of best practices will furthermore have implications for service providers within the broader civilian populations who are either working within similar fields, such as police, first responders or Intensive Care Unit health care providers.

It is hypothesized that, in the midst of COVID-19, best practices will also be of value to providers who deliver the mental health benefits of outdoor recreation to the general public.

Background: Following wars in Iraq and Afghanistan, American troops returned to the United States suffering from PTSD and TBI in unprecedented numbers. The Department of Veterans Affairs (VA), charged with caring for military veterans, lacked effective interventions to address these conditions. Studies conducted as part of the Green Road Project and the Naval Medical Center’s Surf and Hike Therapy trial have indicated that nature-rich programs such as hiking, surfing, hunting and angling provide benefits that complement or exceed those provided by  traditional (pharmaceutical) interventions, but they failed to gain widespread adoption with the VA.

As a result, many veterans began taking matters into their own hands, founding nonprofit organizations that incorporated nature-rich activities into programming to benefit their peers. Problematically, little coordination between these nonprofit organizations exists, resulting in fragmentation, siloing and a lack of communication between principles. 

At the 2019 SHIFT Festival, a workshop on Military Readiness examined the therapeutic effects of nature on our wounded and non-wounded active duty service members, including how it could help reduce levels of stress, depression, burnout and concommittant economic costs to the military healthcare system.

The 2019 workshop catalyzed a project to develop a study on hiking as a mental- and emotional-health intervention for veterans with Posttraumatic Stress Disorder and Major Depressive Disorder.  Such a trial would provide the military with a novel mechanism for a prioritized issue that has broader implications for civilian populations that experience stress, including first responders, police officers and intensive care unit health care providers.

SHIFT coordinated a series of meetings throughout the year that resulted in the development of A Randomized Controlled Trial (RCT) of Nature Exposure for Veterans with Posttraumatic Stress Disorder and Major Depressive Disorder. The RCT’s objectives are to:

  • Develop a manualized nature exposure via hiking intervention (NEH)
  • Evaluate the safety and feasibility of utilizing a manualized NEH intervention for Veterans with PTSD & MDD
  • Evaluate the short-term impact of NEH on PTSD and depressive symptoms, psychological flexibility, quality of life and the use of inpatient and emergency services for these conditions

The project, which will be conducted at Whole Health Flagship site at the VA Salt Lake Health Care System in Salt Lake City, is currently awaiting IRB approval.


  • William R. Marchand, MD,  Clinical Director and Service Chief of the Whole Health Flagship site at the VA Salt Lake Health Care System; Clinical Professor of Psychiatry at the University of Utah School of Medicine
  • Nick Otis, Senior Research Associate / Project Coordinator, Leidos; Senior Research Associate, Naval Health Research Center

A webinar on the project may be found here.

The Nature Exposure RCT identified a lack of consistency in outdoor recreation-based interventions for military veterans. Accordingly, SHIFT led a project to document the current landscape of outdoor recreation programming and nature-based therapeutic interventions for military veterans; develop a baseline assessment of current practices within the field; and use it to establish best practices for such programming.

Beginning in July, SHIFT researched and catalogued more than 300 outdoor recreation and nature-based therapeutic programs for military veterans, then surveyed them to determine the state of their practices and programs.

SHIFT then coordinated a series of meetings with researchers from the University of New Hampshire, Clemson and the Leidos Research Center that discussed the development of standardized practices.

A September 22 webinar—part of the Health and Nature Webinar Series—was expanded into a half-day workshop that invited survey respondents and program providers to discuss the development of standardized practices with the research team.

The workshop laid the groundwork for a half-day workshop at the SHIFT Summit that further explored next steps in the implementation of the Sept. 22 workshop’s findings.


  • Semra Aytur, PhD, Associate Professor, Health Management and Policy, University of New Hampshire
  • Jessie Bennett, PhD, Assistant Professor, Recreation Management and Policy, University of New Hampshire
  • Nick Otis, Senior Research Associate, Leidos & Naval Health Research Center 
  • Colonel Sally Coulthard, Founder, Nature & Health Foundation
  • Jasmine Townsend, PhD, Associate Professor, Recreational Therapy, Clemson University
  • Deborah Tysor, PhD, Lecturer of Recreational Therapy, Clemson University

The development of a database to catalogue the myriad initiatives currently underway will assist with standardization of protocols, establishment of best practices, shared results and communications among principals. This in turn will provide value to veterans, the VA, and the Department of Defense, which is charged with providing continuity of care for active duty service members as they transition to civilian life.

How it Works: The study began with the creation of a database of programs currently providing outdoor recreation and nature-based interventions to military veterans.

This survey was then sent to direct service providers to collect information about organizations and programs that serve the veteran communities. 

We invite service providers of recreational therapy or outdoor recreation-based programming to complete the survey. 

If you provide such programming, please click on the following link to take the survey: https://www.surveymonkey.com/r/LN8GBHZ

The resulting information is being analyzed by project leaders, who are developing findings identified during the interactive workshop held at SHIFT on Oct. 15 into next steps.

Key Benefits: A database of programs, initiatives and organizations currently providing nature-rich programs to military veterans  will allow for a baseline assessment of practices within the space, the consolidation of insights and the establishment of best practices within the space.

This in turn will provide opportunities for researchers and providers alike to access the insights developed in aggregate for the benefits of their programs.

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