The Nature Navigator: NaturePHL’s Innovative Use of a Traditional Health Care Role

Did you know there is significant research showing that increased time in nature benefits human health and well-being? Living in greener environments is often associated with higher levels of physical activity and lower levels of instances of chronic disease. In addition to research that demonstrates the physical health benefits of nature exposure, there is emerging evidence that green recreational spaces also have a positive influence on the mental, emotional and behavioral health of children.

Despite the number of potential health benefits of exposure to nature and green spaces, many children spend little to no time outside. One reason in cities like Philadelphia is that parks in urban areas are not always accessible, leaving many underutilized. Additionally, most pediatricians in our city don’t live in the same neighborhoods as their patients and are not equipped with the resources to give specific, local and personal counseling to patient families. That is, not until the launch of NaturePHL.

NaturePHL Provides Rx for Nature

NaturePHL is a cross-sector program that aims to improve the health and well-being of Philadelphia’s children and families through increased outdoor activity in local parks and green spaces. We bring together Children’s Hospital of Philadelphia (CHOP) primary care physicians, environmental educators, public health advocates, parks and recreation leaders, and other Philadelphian community leaders in order to connect families with healthy outdoor play in their neighborhoods through education about health benefits, incentives and resources. NaturePHL’s goal aligns with that of CHOP’s: achieving the best possible health outcome for every child.

The idea of having doctors provide counseling and prescriptions for being outdoors is not new—there are more than 80 programs across the U.S. that engage health care professionals and social workers in talking with individuals about the health benefits associated with time outdoors. In fact, just a few months ago, the President of the American Academy of Pediatrics , Dr. Kyle Yusado, wrote into his priorities for 2019 the need to connect children and families with nature.

The need is there and the providers are making it a priority, but the question all of these nature prescription programs are trying to answer is: How do we motivate providers to deliver counseling messages as well as ensure that the patients receiving the prescription are effectively changing their behavior?

Nature Navigators: Bridging Physicians, Families and Time Outdoors

NaturePHL is recognized by its peers as one of the most successful clinical outdoor activity prescription programs because of how our program is answering this question. In order to motivate providers to counsel patients and to fulfill our aim of changing health behaviors by getting patient families outside, we created the position of the Nature Navigator.

The Nature Navigator is a research-driven position based on the Managed Problem Solving (MAPS) tool that research has shown to be an effective intervention for HIV medication adherence. Dr. Robert Gross, an associate professor in the University of Pennsylvania’s School of Medicine, developed and tested this tool, which involves five basic steps: 1) defining the problem; 2) generating alternative solutions to each problem via brainstorming; 3) decision making regarding a plan of action; 4) implementation of the plan; and 5) assessing the implementation and effectiveness of the original plan and modifying it based on accumulated data. The Nature Navigator uses the MAPS tool when working with patients to identify their own barriers to spending more time outside and constructing a series of individualized solutions.

To fill this specialized role, we seek individuals with experience mediating between referred families and the health care system: community health workers (CHWs) and social/behavioral health workers. CHWs are unique in their ability to act as culturally competent mediators between providers and members of diverse communities. They can take the time, that physicians often cannot, to ensure that health communication is understood, efficient and sustainable for patient families. CHOP’s CAPP+ program is a great example of the power of CHWs—they are successfully helping families remediate their homes in West Philadelphia to reduce asthma triggers that send children to the hospital.

Employers typically hire CHWs for a variety of reasons, but most pertinent to the park prescription model is that they can help families navigate the healthcare system while also tailoring programs to meet the needs of the individual or community. Additionally, they have been shown to reduce the cost of care, making the role beneficial for both the patient and provider.

NaturePHL Nature Navigators have been making a strong impact on CHOP’s patient population who receive intensive counseling on the benefits of outdoor activity. According to our qualitative evaluation, all of the patients our navigators have worked with for the past two years have reported increases in the amount of time they spend outdoors, their understanding of health benefits associated with outdoor time, and their knowledge of places to go and upcoming outdoor events. In order to make a direct correlation between this increase in knowledge/behavior change and the Nature Navigators, our self-reported surveys ask specifically if the navigators helped with these changes.

This summer, we plan to begin a case-control study with PolicyLab to better understand the impact that Nature Navigators are having on patient families. We hope this study will also continue to show how NaturePHL is succeeding in creating behavior change that improves health outcomes through not only its program and clinical counseling message, but through our unique Nature Navigator role.

Elisa Sarantschin is the program director for NaturePHL.