Ask-Laura-Anything About Nature-Based Practice: A Reverse Interview with Alexa Ambrosino, OTDS
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Laura: Welcome to Therapy in the Great Outdoors, the podcast where we explore the business and practice of nature based pediatric therapy of all kinds. If you're an outdoor loving pediatric practitioner in the fields of occupational, physical, or speech therapy, social work, or mental health, This podcast will help you start and grow a successful nature based practice or program.
I am the ever honest, always a hundred percent real, you'll hear it all on this podcast, Dr. Laura Park Figueroa. I'm a pediatric OT with over 20 years of experience and I run a thriving nature based practice with profitable locations in two different states and multi six figures in revenue. I also host the free online community at Therapy in the great outdoors.
com to help you pursue your nature based therapy dreams too. Are you ready to take action on those dreams? Let's jump in.
Welcome back everyone to Therapy in the Great Outdoors. Today we have a Very unique episode because Alexa Ambrosino is here. She is an OTD candidate. Oh, sorry. I should clarify occupational therapy doctorate candidate. I don't want to assume people know all the acronyms we use in our profession at Duquesne University.
And she reached out to me on Instagram and asked me if she could interview me for a project that she is doing for her capstone, like part of her capstone. And I said, Yes, if we can record it for the podcast. So we are going to talk about advocacy, but lots of things related to nature based practice as well.
So she spent time this summer completing her capstone project at a therapy clinic. on a farm in New Jersey called Special Strides. And she designed and implemented a nature based OT playgroup called Social Strides for children with disabilities to foster social skills and social participation. I love it.
So I don't really know what Alexa is going to ask me here, but... Welcome, and let's do a little reverse interviewing here on the podcast and ask me anything. Thank you for being
Alexa: here. Yes, thank you for having me. Yeah, as you mentioned, I go to Duquesne. It's actually in Pittsburgh, Pennsylvania, but I'm located in New Jersey.
As you mentioned, I'll be interviewing you for this project. And so to begin, can you tell me a little bit about your professional background so that can relate to jobs? advocacy or leadership?
Laura: Yeah. So I became an O. T. In 2000. 2000, that is 23 years ago, and I worked for the first 15 years of my career in pediatrics in various settings, most of it in schools, but I did some private practice on the side as well, some clinic based work and some hospital work and and I was really burned out.
I went to I went back to grad school cause that's the logical thing you do when you're totally burned out. Not really but it helped for me. And I, that is where I found out about nature based therapy. Essentially. I read Richard Louv's book, Last Child in the Woods. I was involved with Timber Nook for a little bit and really loved their programming.
And I started my nature based practice because I saw that a lot of the kids, when I ran those larger group camps, that weren't necessarily OT camps. They really needed more support than that. And so I started to think about, could I do smaller group kind of sessions with kids, but have group, like really have kids in the session because I thought that was so important.
And I started Outdoor Kids OT in 2015. So that is my business that I've had for eight years now. And we have grown it now Two locations. So I now live in Madison, Wisconsin. My practice is in California. And yeah, so I have two locations and I also have a business called therapy in the great outdoors.
This feels so stupid to be saying this on podcast because people probably know this, but I also have a business called therapy in the great outdoors, which is a membership community for therapists who are interested in nature based practice. And I forgot to say a couple of years ago, I, created the Contigo approach.
It stands for connection and transformation in the great outdoors. And we've trained. 106 people through the online program and another 20 something or so in an in person event that we did in 2019. So 120 or so people have trained in the approach and what else? Oh, I did my PhD. I just finished that in May and I did research on nature based therapy.
So that's it. Very cool. 23 year career. It's hard to say that in a minute.
Alexa: I actually read about Timber Nook a little bit in Balanced and Barefoot. Yeah, that's a great book. Free play and stuff. And that's how I centered my group a little bit with free play, always at the beginning and the end.
And what was really cool is week one. The kids had no idea how to do free play, they couldn't think of an idea, they were just there independently, but then by week six, they were creating their own play schemes, and they were playing together, so that was really cool to see that social growth over those six
Laura: weeks.
That's so great.
Alexa: So just moving into general information about nature based therapy, so how is it different than just playing or spending time outside?
Laura: Oh, you're going to get me on a soapbox here. I am so Your quickest little spiel about it. What'd you say? Your quickest little spiel about it.
Yeah I just say, when I teach the Contigo approach, one of the things I say is this is not just nature play. Okay, so if you are a therapist, you are a therapist first, whether you're a PT, an OT, a speech therapist, a mental health counselor, a social worker, you are your licensed profession first.
You are not a nature based therapist, right? That isn't a profession. And i, I think it's really important that we use the tools that we have within our individual professions. OT being the one that we're talking about right now, but I think it applies to any pediatric therapist really.
Certainly. You have to use your own assessment process and your own clinical reasoning and you have to write goals and you have to track. Progress and you have to do all those things that you would do in any other treatment setting, it's that you're partnering with nature in the process. And maybe there's some ways that nature augments that process for you or benefits the child in that process.
But I am really passionate about that. Even if we're doing. What I might call enrichment based services where we're not going through a formal assessment process, maybe for each kid, but we're offering a camp, but probably I don't know how yours was set up, but I could see a social skills group or camp kind of being set up that way where you're not doing assessment and goal writing.
But I still as a therapist can do the general like thinking of what is an evidence based way to address social skills when you are planning your programming right in accordance with your professions skill set. So that's
Alexa: yeah, 100 percent when I went into my group, we. I personally looked up all the research of group dynamics in general, how to run a social skills group effectively, and then also looking at how do the social, how do the social skills develop and then using play.
Yes. Intertwine all of that. So the kids didn't even really know that they were working on social skills. They were just playing outside. From our perspective, there was so much more
Laura: happening. Absolutely.
Alexa: I feel like something that isn't really known about that much. What's the process of becoming a licensed practice that uses nature based approaches?
Laura: I don't think there's, I don't know that there are licenses. Do you mean like for a business or?
Alexa: Pretty much that way, like any standards that you have to follow
Laura: or it would be the same as it would be the same as any business would have to follow and it's going to differ between where you live and what state you live in and what country you're in and all of that.
But, yeah, you have to follow the rules of your state. And Google is your friend. You can Google how to start a business in X state and find a literally a checklist of what you need to do. It's I do think a lot of the time people don't realize that if you are starting a nature based practice or program, you really do need to learn to think like a business owner.
That is something that I talk about a lot on this podcast because a lot of nature based therapists enter this work thinking that they just want to play in the woods with kids all day. And that's amazing. When you love that work, but there's also a large part of the work that is the logistical business kind of stuff that you have to do in order to run an effective practice or a program.
Even if you're just running a summer camp, it could be a program at another facility, but you still have to know how to market it, how to get systems in place to get people to enroll, have good customer service. All those things that we. We don't really think about when we're just practitioners, in our therapy brain, like there's business brain business hat on.
Yeah, absolutely. So yeah, it wouldn't be any different. There are some like, you have to think about like liability requirements. Like liability insurance can sometimes be tricky to find. And workers comp can be tricky to find once you have employees because they think we're risky because we're outdoors.
But yeah.
Alexa: Okay, so moving into the benefits of nature based approaches. So from your previous experience working in a clinic, what added benefits do you see using nature based approaches versus the typical clinical?
Laura: Gosh, this could also be a whole episode in and of itself, but I will share, I think what would make the most sense for me to share here is what my research found, because I interviewed 22 OTs who work outdoors with kids.
So this isn't, I guess I should say, I'm not, Answering this question, just thinking of my views, I'm answering this question, having synthesized a lot of data from that's even better. Yeah, a large issue of people. So therapists seem to say that nature. Allows the therapist and the child to be in it together for lack of a better term.
Yeah, when something challenging happens in nature, it is the therapist and the child both experiencing it. It's not like the therapist set it up for the child to be challenging. That's a really good way to put it. Yeah. Yeah. The other thing is that. Therapists seem to say kids kind of embrace challenges more willing in nature.
That was like one of the core constructs of my research was braving real life challenges. Things that happen in daily life are not predictable and they happen in, it's the same in nature. It mimics daily life was what a lot of them were saying. It mimics what we see happen in daily life.
Therapists also say that the weather can be really challenging. That's a good and a bad thing, right? Sometimes I just shared with you before we hit record that someone in the therapy and the great outdoors community this week or last week posted, I just held my first nature based session help.
Nobody, the kids hated it. Three out of four kids hated it or something. And it was such a good, it got the most engagement of almost any post. I think maybe in the whole lifetime of the community for the last year, because I think therapists can relate to that, that sometimes there are just like really hard things outdoors and the therapist has to be.
The therapist has to be very skilled at using their own clinical reasoning expertise in the moment because you do not have the ability to just whip out some toy from the cabinet that you have at the clinic or whatever, or your anchors are perfectly located. So you can move the swing to a different location or whatever.
So there's a lot of like flexibility needed and there's a lot of Advanced clinical reasoning I would say needed because you have to be able to use what you have on hand in that moment and really use your relationship with the child and the other kids maybe or other staff that are there in the group to make that group or that session be therapeutic no matter what.
Pops up and happens in the session. So those are some of the ways top of mind. I'm sure I forgot something and later I'll be like, I forgot to say that, but now we'll leave it there.
Alexa: Yeah. Kind of what you just said. I feel like in my group, in the first session, we created ground rules together.
Of things that we had to watch out for especially safety being on a farm with, there was a camp going on, racehorses are training there in the mornings, so we really just got to be careful for everything going on, and during the group, one of the kids actually noticed it before any of us did, and there was a racehorse loose, and we were like, okay, everyone stay right here, because they couldn't run after the horse, because that would make the horse even more. So we were like, okay, let's stay here. Let's be safe here. And they were just so aware of everything going on that it was just really great to see. You could never mimic something like that in the clinic and they knew the real potential dangers of being outside. And yeah, it was just great that they all like work together to always be on alert for things like that.
But we're able to still have fun and do everything.
Laura: That's cool. I love that story. Yeah. Yeah, it was really
Alexa: cool. Thank you. Thank you. In your practice, do you ever work individually with kids in the nature based setting, or is it primarily
Laura: small groups? My, the Contigo approach was developed around small group practice because I really believed that kids who a lot of reasons I really felt like kids needed other kids in the group to make it feel playful.
There's a sense that you're not different, quote unquote, if you're going to a group where other kids are going to yeah, if you're going to see a therapist, like an OT, As a nine year old really that you're going for some reason that you're different in some way, right?
And it's fine to be different. I know, like the neurodiversity movement. I love it. I love that. We're like celebrating differences and stuff. But I did think that like a model makes it feel more playful and more. Fun for kids. But we do offer individual because group is not appropriate for all children.
And that is something that I'm really adamant about to that. We have really clear behavioral policies in place. You have to for safety. It's not an exclusionary thing. It's for safety. And so what happened was we had a few kids like over the first few years of the practice that, we had to like With the family make the decision to take them out of the group because it wasn't helping the child or the group and like
Alexa: the integrity of the group, you got to maintain to
Laura: make an effective group, right? And we have in our language says something like, in a group. Treatment format. The needs of the group are prioritized above the needs of the individual. And that is so hard for Americans to understand because it is not our culture, right?
Our culture is individualistic. I want to get mine. Not that's how families are, but it As Americans, that is how we think. It is just part of our, for better and for worse, it is part of our innate kind of brain, the way we are in our culture, that we value independence, and that can be really hard. That can be really hard to communicate to families, to say we, it is our responsibility as a practice to protect the integrity of the group over the needs of your one child. That can be really hard. So we started offering individual because of that. So we do have individual services now that we offer.
We require that a parent stay in those services because that's part of the connection. Piece of Contigo is that connection is foundational. And so if you don't have anyone in the group or anyone in the session, except for the therapist and child, yeah, you have a connection there, but you're not the person that you're most connected with is your parent.
And if they're not in the session and don't know what's going on, then you're missing opportunities for carry over into daily life. So Sounds like a
Alexa: great kind of approach that you have with that. What population or diagnoses do you find benefit the most from nature based
Laura: programming? I think any population could benefit.
I guess I haven't worked with all populations, so I don't really know. I can say what my practice has seen. We primarily see kids with ADHD and autism. That's like the diagnoses we see the most. We do see a lot of kids with anxiety, a lot of kids with mental health challenges kids with dyspraxia who have motor planning challenges.
I have not done. work with children who have like multiple disabilities who use motorized wheelchairs or anything like that in nature, mostly because of logistics and the model I developed wasn't geared towards that population. But we have a capstone student coming in the spring. Who's going to try to do a camp for kids with multiple disabilities.
Using the Contigo approach, she's going to modify it. I. I'll have to think about it because I do think it could be applied. I just, I think the logistics of managing the staffing support needed and the access to nature that is needed, like the space that you use is, has to be very carefully chosen if you're going to work with that population because there's a lot of logistical things that, that would need to be figured out.
So yeah, but I think, I think any, anybody, we're all humans, right? Anybody can benefit from being outdoors. So I don't even know if there's a, I wouldn't say I have an answer to anybody can benefit the most from it. It's anybody can get them all right.
Alexa: We're talking about that with anyone.
Do you ever see any adults at all, or would you be willing to open it up to adults?
Laura: Nope, not in my practice. I'm just not, I'm not willing to work with adults. Like we're not adult therapists. We're pediatric therapists. This is something too. And I think the reason I could so quickly be like, nope, we're not doing that is because I see this a lot when people start a business.
They do a bazillion different things and nobody flippin knows what they do, because they're offering 10 different services and I am really, I really believe that the success of my practice is because we focused on doing one thing and doing one thing really well for many years on end.
And we didn't try to, we didn't try to go down every rabbit hole and do this kind of group and that kind of group and then go into adults and then also do this. It's and that's fine. If people want to do it and it's growing, but my practice is pediatrics. I'm a pediatric therapist. I'm never, I don't have any desire to work with adults.
And so my practice will never work with adults because it's not something I'm interested in. And I think that's totally okay as a business owner to say no to things and to not do that.
Alexa: Yeah, cause you don't want to spread yourself too thin and you want to stay in the area that. And can be the best self, your best
Laura: self in right?
Although now that you say that, I'm like, gosh, maybe we could do like mom's hiking groups or, like a
Alexa: parent and me
Laura: kind of group. Yes. That I could see, but it would always be related to kids. It wouldn't. I don't think we would ever start seeing adults in nature for therapy, but right.
Alexa: So if parents ever report to you that their child isn't spending time outside versus someone who maybe is spending more time outside, do you see any difference in the children knowing who spends more time outside or anything like
Laura: that? I don't know if I have a good answer to that question, honestly, because I've never intentionally asked and taken data on it.
I
Alexa: was just curious if like your personal experience, which then ties into. In your past experiences, how has technology impacted? The amount of time that children spend outside and their overall well being like, have you seen over the past few years of shift
Laura: at all? Yeah, it's interesting because my my oldest two kids, I have three kids, my oldest to my own children.
My oldest two are 21 and 19. And my youngest just turned 13. So the older two are in town over the weekend for his birthday. And we were watching old like videos from our phones from 10 years ago when. The young, when the youngest was like, we were watching his like birthday, when he was two years old and when he was three years old and then like ridiculous home videos of them just like being silly and rough housing and being crazy people in our tiny little house in California.
And so we were just laughing at it and I was thinking how it's so strange that I have no footage like no. No video of my older two kids when they were that age I don't even remember what they sounded like I have no memory video wise of that made me realize how rapidly right just in my youngest child's lifetime, how rapidly technology has changed because now almost every person has a phone in their hand and can immediately take a video right.
And so I do think we're going to see. More and more we're going to see kids like you mentioned that just don't know how to play because they've just been on screens for their whole life, and of course I lament it and I think about it a lot and I also. feel interestingly, I feel a little bit of shame about it in some way because like my kids totally watch TV.
Like they totally are on YouTube. They totally probably have too much screen time. Me personally, my own children, as they were growing up. And so I think a lot of times I see these, authors or bloggers or people who are online talking about no screen time, limit screen time, get kids outside.
And I'm like, yes. And realistically It's just inundated our lives. Even adults are on our screens a lot. I'm on my laptop a lot for work. So it's I think there can be a balance. And I think sometimes the language around like limiting screen time or whatever. I hesitate to be super dogmatic about that in my practice and in what we share with families because I just know the reality is that like parenting is hard and screen use is so ubiquitous in our lives now.
It's just so inundated in our lives that it's really hard to limit it. So it's not, I don't really have an answer to that besides to say that I relate to parents and that. It's, it can be really hard to limit screen time, even when you love nature, value nature, want your kids outdoors. I should also say my kids did not show evidence of, they, they equally balanced very active outdoor time with any time that they were on screen.
So I think maybe that's a more a kind of logical or reasonable, approach in this day and age. But yeah, it's awful. It's horrible. Screen time is like incessant and horrible and it's damaging children. I totally believe that. But
Alexa: yeah, I feel like it's so hard, especially because like kids now in elementary school, everything that they do is on the computer.
Even in the classroom, they're on the computer, which is crazy, and then they go home and do homework on the computer, and then when they want to play, it's typically on the computer. Yeah, it's definitely, I don't know if COVID helped or hurt that, because I feel like a lot of us spent more time outside during COVID, but then it also became such a virtual world.
I guess in a few years when the research comes out with effects, we'll see everything. So shifting gears a little bit, talking a little bit about funding. So from my understanding, correct me if I'm wrong, insurance does not cover nature based therapy, right?
Laura: Insurance, it goes back to what I said when we started.
So you are your profession first. So insurance covers OT. And if you do OT outdoors and you bill for it appropriately with appropriate billing codes that are ethical based on the services you provided, then yeah, they'll reimburse for it. That's if you take insurance in your practice and if you're willing to get paid, whatever insurance is offering you through your contract with them you can't just go submit to insurance as an out of network person and expect that you're going to get reimbursed.
But but yeah, there's no difference between how you would bill for services and nature based versus how you would bill in a clinic or something. Do you personally take
Alexa: insurance? Nope. Do you find that's common for people amongst
Laura: this community? I do. I've coached a lot of nature based therapists in starting their practices and running them.
I'd say in my experience, it's about 80, 20, 80 percent of the nature based practices do not take insurance and 20%. Take insurance, Medicaid or other private insurances that they have contracts with. And when you think about funding, I think it's really important to think about local or regional or statewide funding sources that may be there.
The reason that we don't take insurance in my practice is because insurance typically, because we did most of our services and groups and still do, we have 14 groups going and probably, I don't even know how many individual kids right now, like less than 20, probably 10 or 15 maybe. My practice is really, it's really big for a nature based practice that I know.
I don't know many other nature based practices that are the size of mine, but it's very small as far as a therapy business goes. Like I don't have a hundred employees and, multiple locations and all of that, like clinics all over the world or something. So I guess I do have multiple locations now, but but yeah, so I don't take insurance because when we do mostly groups, the insurance tends to reimburse like 8 per kid per group, so I can't even pay a therapist for. I would get reimbursed. There's literally it's abysmal what insurance companies are reimbursing for groups in particular, but also sometimes even just for skilled OT services or I don't know about other professions.
So I probably shouldn't talk, but and if you're not, if you're not going to have the volume, if you're not going to have like hundreds of kids coming through to where you can pay someone to do the billing. And follow up when the insurance company doesn't pay and do all of that. That should be someone's role in your business.
If you're going to do like volume like that with insurance It's, if you think about my practice, like we really only need, we have 14 groups going, there's five or six spots per group. We really only need a little over 100, 150 people that can come to our services and we scholarship kids and there's other kind of smaller funding sources that we use in the different locations that are available.
But but yeah I think. You have to make a really intentional decision about that and decide if you want to go down the insurance route because it is a real headache. The people that take it, it is a real headache to do. So definitely
Alexa: sounds like it. Yeah. So I guess that's where I was also thinking of, too, in terms of advocacy.
Should we be advocating to insurance to cover more costs of it? Like more than 8 per kid per session.
Laura: Yeah, but here's the thing, like in some ways I'm like, it's almost like you're supporting, in my mind, this is, I'm gonna offend people, but that's okay, I've offended people before, but I almost feel if you're taking an abysmally low rate from an insurance company, you are supporting the system then.
You are supporting the system that devalues our profession. If you agree to take that amount for therapy. So it to me, that's part of my kind of like stick in the mud to about I don't really want to participate in the insurance system because it's broken. It's totally broken. Even me personally I just feel like I want to pay cash for services now because I think it's so broken when I go to the doctor and.
Just through my insurance versus through a service that I would pay cash for completely different experience. Right now. Yes, we have equity issues around. Are there people who cannot afford to pay cash for their services? Yes, absolutely. There are. And that's our job as business owners to figure out how to serve those people who can't afford our services.
If you run a, if you run a cash based practice, that doesn't mean that you're turning away people and saying no, you can't come here. If you can't pay, you don't know what goes on behind the scenes. Like we scholarship a lot of people. We lose a lot of money every year to not have people pay.
I have a rule that everybody has to pay something. That's my rule. Like I, I don't give away free services, but but some people are paying. A very low amount for their weekly OT services and that is on me as the business owner that I have to make sure that my business stays profitable like that.
I can pay my employees and then I can pay the expenses we have in the business because if you don't do that, you do not have a business and then you can serve no one. You're done. You close your doors and you serve no children. So I'm getting so passionate about it because I feel so strongly about this, that it's important that nature based business owners and therapists, again, if you're going to start this is a business, so you have to learn to look at your numbers and to keep your business profitable or you will not exist. And so part of doing that is like knowing that you have to say I can't afford to give away any more scholarships right now because then I won't be able to pay my employees or pay myself, whatever that may be.
Yeah. Yeah.
Alexa: Special strides uses like a very similar model. They definitely take pride in making sure that no one is denied services because. of cost or finance. Yeah. They scholar, they provide scholarships to children. They fundraise annually. Yeah. Just so they can serve others and keep their doors open.
Yeah. But also, yeah, maintain the business and make sure that No child or adult is getting left behind because they
Laura: can't afford it. Yeah. That's, are they a non profit? I'm interested to know. Yes, they are. Yeah. So I'm not a non profit and that's something else. See, this gets into the business y stuff too, but my business is a for profit business.
Which doesn't mean that I'm just pocketing all the money, everyone, because I feel like when it says for profit, it's we're, we want money, that's not what it is at all. You can be a service organization and be a for profit business. It's just a structure. It's the business structure, right?
And I just set up a nonprofit for the purpose of fundraising to give scholarships to kids that need it to attend outdoor therapy. So basically, we're testing all the therapy projects. Systems and workflows in my own practice first and then we're going to like hopefully fundraise on a major level and expand it to any nature based practice.
But but super cool. The reason I did that is because we, I see this a lot that we have to like, there's lots of nature based practices that can't serve the number of kids they want to serve because they just, they have to stay financially viable. Yeah. Yeah, we'll see. It's slow going because a non profit is a whole beast of a structure.
Yeah.
Alexa: So on the topic of money, how much does a nature based session cost or the enrollment fee for the group?
Laura: Our, we do package pricing in our group, so it's hard to, Like the cost for California and Wisconsin are very different, but roughly in California, we do like a group of sessions and then they get like an assessment.
They get monthly calls with the therapist. They get a progress report at the end and there's something else. Assessment at the beginning. So there's all this stuff packaged together, right? So they're paying for all of that. They're paying for the consult call. They're paying for the assessment. So but in general, in California, our groups are 90 minutes long.
They cost 200. In Wisconsin, our groups are 90 minutes long. They cost like one. 33, I want to say, or something like that. I think we priced ourselves really low in Wisconsin. I'm actually probably going to raise rates next year, but but I don't have a problem with that. Like when you're first getting started to price like at, or slightly below what, the current market is, I think is fine because then you get like raving customers and you get people in the community that know you and love you.
And then it, it adds proof, that your business is helpful and can do something great for your family. And yeah. And I saw on the topic of pricing. I wanted to mention this really quick. I saw a local business here does does they, they call it like equity based pricing. So they have a really high price.
That's like the actual cost of the service. So they're charging, they do dance therapy and art therapy. And so it's not it's not like licensed professions like OT or PT or speech, but it's a mental health. Yeah. It's like a recreational, there's a recreational therapist who works there. Okay.
Okay. There's a, it's a mental health model essentially. So they have like counselors and art. They do art therapy, drama therapy, recreational therapy. And they have equity based pricing where they have an actual on their website, like a table that basically is like our full rate for art therapy is 180 for a session.
And the, I forget what they call the next level, but it's middle, their middle rate is one 50 and then their scholarship rate is 80 or something like that. So they have this, they have a structure in place. And I've thought about moving to this with my business. We haven't yet, but I like that they have it like really clear on their website.
Hey, we want to serve everyone. And here's what. Here's what we need to be able to run our business, like even an equity based pricing model, the lowest one is going to be 80 or whatever, 50. I don't know what it was. Yeah, it's an interesting way of pricing that, that people might want to consider.
Okay.
Alexa: And do you have anything else regarding money funding, anything like that, that you want to add?
Laura: I would just, I would say for sure that people should look into local and regional and state funding opportunities for their services because I think there are often programs like in Wisconsin we're trying to get, we're trying to get into a couple of like community funded programs that will like fund services for kids.
And in California, we've had some success. With the regional center, which is like birth to really they administer the early intervention program, but they also do services for kids all the way to 22, I think or maybe 18, I can't remember. But we've had some success lately with parents submitting our invoices because we.
My admin team managed it. I don't even really know, honestly, but so there's a couple of families now that have been able to access that kind of funding. So I would just say if you're a cash based practice, look into things locally, what might be out there in your state or your region.
Yeah.
Alexa: So either for you as the therapist or for parents potentially.
Laura: Yeah, the parents generally will know. That's a good thing to think about is to ask the parents what funding because in, in Wisconsin here, I kept getting the question, do you take the waiver? And I'm like, what's the waiver? I don't know what this thing is, but it's the Children's Long Term Support Program.
And it's a waiver through it's a Medicaid waiver. And basically, it's like people can get funding. I don't really understand it all, honestly, but they can get funding through the state to send their kid who Qualifies for the program. They have to have a certain qualification process, right?
But right. But if their kid qualifies for that program, they get funding through the state for them to attend like enrichment and different activities. So
Alexa: I wonder if we have something similar here in Jersey. Yeah,
Laura: I'll
Alexa: have to look into it. So going back to advocacy as a whole regarding nature based therapy.
What do you feel deserves the most funding or funding? I'm still on the topic of funding. Yeah. So what deserves the most advocacy? So I was thinking either potentially funding just children getting more time outside in general. I don't know. What are your kind
Laura: of thoughts on that? Gosh, that's such a hard one.
I feel like there is a general movement out there for kids to get more outdoor time, like a thousand hours outside. The book balanced and barefoot, the Timberdook programming, like there's a lot of, there's a lot of advocacy already going on, I think for the benefits of nature for children in general.
I do think that we Need more therapists specifically talking about children with disabilities and how we can access get kids to access nature and programming more outdoor programming more for kids with disabilities. I think there's probably an even greater need and this is not like there's a little bit maybe in, in some of the evidence that kids with disabilities don't get outdoors as much, but I don't know that's been like really definitively proven by research or like actually explicitly researched, but but it makes sense to me.
It makes sense to me that kids who have developmental challenges would maybe not get as much outdoor time and would definitely lack opportunities to participate in outdoor programming because there's just not maybe accessible to them or giving them the supports that they need to participate.
So I think just advocating for the rights of children who have Disabilities of any kind to get outdoors. And that's going to take all of us. I think because I'm not an expert in Children that have visual impairments, but there might be some therapist out there who is and who could advocate for that.
Or I'm not an expert in Children who have hearing impairments, even though I have a hearing impairment myself, but it's it's going to take all of us and all of our interest levels. I think that's something I would love people to embrace too, that we all as therapists have the things that are really interesting to us and the things that, that motivate us and just, we could, we're so curious about them and that's not going to be the same for every person, and you can build a nature based business around or a nature based practice around what you really love.
And. It's okay to not serve the other population that you don't have as much experience with or whatever. And it's okay to kind of niche and focus on the certain population or even outdoor activity that you love. Like I interviewed Naomi Matinik last week on the podcast and she, she developed a whole business around surfing.
She uses surfing as a therapeutic modality as an OT and she loved it and decided to do that. And so that's what she does. So it's I think your advocacy, what you're going to advocate for is going to depend on what you. Individually are like really interested and passionate about because just telling people they need to advocate is whatever.
No one's going to advocate, like you need to be passionate about it and find ways to speak up for it and to advocate in that area that you're passionate about. So sorry. It's a good
Alexa: lesson for
Laura: all
Alexa: have. What have you done specifically in terms of. Advocating would you say for nature based programming?
Laura: All my work. Yeah. All of my work. Literally 90 percent of what I do is unpaid. Like I'm not paid to do. In fact, I pay to manage the community, right? Yeah. The podcast, I do the podcast there's lots of things that I've done for free. And it's really hard to see that as advocacy, but that might actually help me to like persevere when I feel like quitting, if I looked at it that way, because I really see my role.
I am very good at the business stuff. Like I am. I'm it's I just love it. I'm really good at it. It's how my brain thinks. And so I feel like my sort of. Yeah. mission is I'm thinking out loud here. This is not actually a mission I have written down per se, but I feel like my work is advocacy and that I'm advocating for other therapists to start working with kids outdoors.
And then that expands the reach of more kids getting reached by outdoor therapy. So if I can help practices be profitable and actually exist for years to come, rather than just like being a hobby for a year, and then they. Closed down because they didn't have their systems in place or whatever. I'm trying to see that as beneficial because I think I do struggle with feeling like I'm not, I could, if I wanted to do more work with kids directly in the woods, like I could be doing the OT in the work in the woods with kids.
But I, and I'm good at it. I like doing it, but it's not what I am like uniquely. My brain is gifted to do it. I can talk about nature based therapy all day. I can tell you what works. I can talk about my experience and things like that. But really, I think encouraging and advocating for more therapists to do this type of work and to start programs and practices where they're doing outdoor work with kids is important Is almost more far reaching than I could be if I was working in the woods with kids, but it still feels embarrassing and shameful for me to say that because it feels like our profession values the direct work with kids, it feels like weird for me.
I don't know. It feels I'm still processing it. I've been processing it for a long time because I for a long time have known that yeah, Business is like how my brain works. Like I just love the entrepreneurship stuff. And so yeah, I think that is advocacy. A lot of what I do is advocacy.
Alexa: Based on what you're
saying, that totally makes sense. If you're helping others to be able to do the same intervention, you're reaching way more kids than if you were to just be directly intervening with the kids themselves. Yeah. So I would say that totally. Yeah. Makes sense.
Laura: Yeah, but it's hard to accept too, because it feels, I don't know.
I don't know. It's like weird. It's a weird thing. Because it's not an OT thing, right? It's not an OT thing to be like. a business owner, entrepreneur, business coach, or whatever. Like it's
Alexa: also something you're good at and you're passionate about, then use that. I personally, my only business experience is barely existing.
It was just my capstone where, yeah, I did the marketing and the logistics of the group and stuff, but that was not my favorite side of it at all. I'm glad I did it. But right. Yeah, the business side is not really for me.
Laura: That's legit experience, though. That is legit experience. I want you to hear that, Alexa, because to start a program and market it and have kids enroll and actually run it.
That is success. That is a successful program. A lot of people try to start programs and can't even find people to enroll and give money for the program. You did it. I just I think that's great.
Alexa: Yeah, and I loved running the program and working with the kids. It was so much fun.
So if you were to promote nature based therapy to parents or anyone with no therapeutic background, what would you say or do to convince them that this is an extremely beneficial modality of practice?
Laura: Oh, man, gosh, there's lots. I think it's really important. I think about what we try to convey in my practices, marketing.
I think it's really important to use the language that families would use, that parents would use. So no family is going to come to you and go like Johnny has trouble with bilateral coordination and I think it's proprioceptive system is off. Like nobody's going to say that. So I think it's really important to use language.
You can go to my website and see the language. It's not the greatest because I wrote it a long time ago and it has not been revisited. But But it's fine. It is what it is. It's working. Outdoorkidsot. com. And you can see the language on there. It's does your child struggle to pay attention?
Does your child struggle to make friends? Like the language parents would use, right? That's the kind of language you need to use to talk to them about nature based therapy. So in our nature based therapy groups, we help kids feel a part of a group. We help them make friends. You need to use language like that helps them see the benefits of it.
I also, this is a good question because it's making me think to like the age old question of how is what we do as therapists any different than what a nature based educator does or right for a school, like an outdoor school. I think we have to be really clear about the.
intentionality of our planning of what we plan in our groups and how we plan the groups in accordance with what the individual child's goals are. So if you're in a, if you're in a group, you have to consider all the individual kids goals. And talking with the families about that, about, we chose to do this because we were working on these goals.
Just making it explicit, like why we chose to do what we did. Yeah, I don't know if that was my greatest answer to that question but I do feel like it's a, it's a long game to communicate to families, the value, I think it's not just one post on Instagram, it's like sharing the pictures of what you're doing, sharing examples of what you're doing, talking to them about stories that happened during the group, right?
And kind of processing those with families and helping them see that the goal, in the Contigo approach, the goal is really to help children be the owners of their goals and of their own adaptation and their own change, right? They have self agency in the process. And so talking with families about when you see glimmers of that, when you see those moments when the kids are actually starting to problem solve on their own, or when they.
Bounce back from failure when they would normally have melted down and not been able to rejoin the group. Those are the things to share with families. Like when you see as a therapist those moments happening, like sharing with them so that they can see that the change happening
Alexa: yeah.
And then it carries over into all aspects of occupation and not just in the group setting outside itself. Yeah, it really does foster change.
Laura: That's what we're hoping for. At least I do think it's so hard. I think about this a lot to how what we're quote unquote selling as therapists, right?
Is this transformation? That's a word inside of the approach contigo, right? The T is transformation, right? But transformation is so it's so like this ephemeral thing, is that the right word? Like it's like a ambiguous it's not okay, you made a hundred dollars in your business this month and next month you made $500.
Like it's not, yeah, it's not like there's like really clear data. I do think it's important to track data Yeah. On goal and all of that. But like the process of change, it's not as black and white. It's not as black and white. Yeah, it's not like maybe there are some goals like that. Like you could say maybe I think about PT goals needing to be more like he, he could, the strength was this level or the distance was this, was this amount.
Yeah. But a lot of what we work on, I think of mental health, maybe with speech, there could be a little more of the, tracking how many times the child could do a certain sound or use a certain language concept, but with OT, Yeah. And maybe mental health too. I think so much of it is this like vibe that we get, like where you can see the progress happening.
You can see the child start to problem solve on their own. You can see them start to own the process. And that's really hard to articulate in, a quick way. Yeah. Soundbite to a family to try to convince them that nature based therapy is great. It's like a process of kind of over time kind of showing them rather than explaining it.
Maybe I don't know. And that's
Alexa: Too, what I mentioned with the group or the first group session versus the last group session, the kids not being able to play together, like engaging in free play. So then at the end they are the parents. Can we have a play date? Can we do stuff outside of this?
Yes. And then what was also cool was parents. sharing their phone numbers with each other because the kids are asking and it's yeah, not as clear cut as Did they improve? Did they not? This or that? Clearly there was some sense of growth from week one to
Laura: week six. Cause you can't write a goal that's by end of summer camp week three, parents will share phone numbers with one another to arrange play dates outside of group.
It's like those things happen like just organically. And that's what's amazing. Yeah, that's cool.
Alexa: But so with any topic, there's always people who are rooting for the opposite side. So what are the most common drawbacks of nature
Laura: based therapy? Okay I mentioned the post already that the one I wish I could remember her name.
I should look it up, but I feel like I should say so and so's post. I already mentioned that post in the community about I just held my first session. Three out of four kids had the worst time. They hated it. They complained the whole time. So I do think One thing is that we have to really consider if kids are ready and want to be in the outdoor environment.
In my experience, parents typically enroll their kids if they are a kid who really loves the outdoors. So they might already have an interest in being outdoors. So the drawbacks I would say would be that for some kids it may not be the best fit. There might be some kids who need like really, maybe the unpredictability of the outdoor environment is very dysregulating for them.
And they're just not that's not going to be a therapeutic setting for them. I think we always have to think about like access. To nature. So if you think about children who maybe have never been around woods they've never been around the beach. Those environments can be very scary to them if they're not familiar.
So I think there's definitely a process we need to go through as therapists to think about who is appropriate or not even appropriate. That's not the right word, but who can almost
Alexa: like Sensory their sensory systems are able to control whatever the environment kind of throws
Laura: at them.
I'd also say there are challenges. I think about Naomi's surf therapy business, like sometimes she just can't offer services because the ocean is too rough or there's something, there's often stuff like that in nature where in California we have to cancel groups when there's fire, when there's wildfires and the smoky air and Wisconsin, we're going to aim to do, this is our first year doing groups here in the winter.
We, we just started like a few weeks ago, we started our groups here. So our weather policy is going to be below 20 with wind chill, we will cancel group. So if it's 21 degrees, we will be out there. It can be, I think it, it can, weather can be a challenge and you have to have the gear and be ready, make sure all the kids have the right gear in order to be comfortable enough during their outdoor time in the session so that they can actually.
Play together and have a good experience. So
Alexa: I would say special strides definitely operates in a similar manner. They do. Okay. Horses. And if it's 94 degrees or above in the summer, they typically cancel for the day or will treat inside where it's. Air condition and everything. And one of our groups, it, our group was from nine to 10 30 in the morning.
So not when it was super, super hot out, but we had like a heat wave for a couple of weeks and it was getting close to a hundred, but it was like probably 92 or something that the group happened. And we actually had What's the word? A bucket of ice, basically. Oh, sure. Yeah. Put ice on their necks.
Use like a washcloth to like wet. We had one of the like Kubota farm vehicles. Okay. We had one of those actually come out and get us from the woods because it was just so hot to walk back. And with the wind on that the kids loved it because they probably were like, Oh my goodness, I get to ride on this.
Yeah. Is it
Laura: like a tractor? What is it? Almost like a
Alexa: farm version of a golf
Laura: cart. Okay. Okay. Yeah.
Alexa: But so they loved being able to ride that and yeah, so I would say. I agree with you totally that yeah, I mean itself just
Laura: heat you can't get you can't get naked in a group, right? At least in winter, you can put clothing on and move your body warm, but man, heat is like on.
It's like relentless to be in heat that. That is oh, wow. Good for you for persevering. You're glad it's over now, I bet.
Alexa: Yeah, we're actually going to continue the group. And so it'll be in the fall and then the winter. So I'm curious to see how the kids will do in terms of. The different seasons and everything.
That's great. Do parents or anyone ever worry about safety being out in nature? Oh, they might trip scrape their knee do you ever hear about that as a
Laura: con? Maybe, but we have a we communicate pretty well that our philosophy is that it's okay if kids get a scraped knee. That's we believe in risk, not danger, but risk, like risk taking is fine in play.
And so we, we have a whole parent welcome packet that we give to families to explain to them our philosophy. And so they have a little bit of that before they come in. And I'd say too, that like occasionally we've maybe had like an anxious parent who is maybe what I would consider to be overprotective of their child, but generally they're enrolling their child because they.
They believe it can be beneficial for them, even if they have some hesitancy about their kid doing some of the things like they know, really intuitively they know that it would be good for them. So yeah, and I think that's our job right as therapists to make sure that we stay as safe we keep safety in mind but we allow risk.
Yeah,
Alexa: I totally agree with that. Yeah. Yeah. One of the things we would preface to parents of Hey, we were in the woods, just check for ticks afterward. It was bad this season, but stuff like that. But so to wrap up everything, what is the biggest piece of advice that you have for someone who's using nature as their modality, like a new therapist?
Laura: This is so hard because like I feel pressure to make it like the best piece of advice ever like
Alexa: Any advice that you have. It doesn't have to be the best. It could be just anything that you think would be beneficial to hear.
Laura: Yeah. I think the thing that comes to mind is just to get started.
Don't worry about Is everything perfect and just get started like even if you're not running your own practice right now, you can do things to notice nature and tune into nature wherever you are. And I think that is a big piece. It's one of the things I teach in all the online.
Kind of free stuff I've done. I've said it a lot. It's just like tuning into nature can be done anywhere. It's just a matter of noticing the things around you and sharing those with the children that you're with. And that can be done anywhere that can be done on a school playground that can be done in the kids backyard.
If you're doing home health that can be done in a hospital setting by looking out the window like it does not have to be like you're deep in the woods with a group of Children and everything's all idyllic and you're, it's a perfect day and the weather's beautiful and, no, it doesn't, it's rarely like that anyway, but but just tuning in and noticing nature.
And I think developing your own appreciation for nature, I think is a huge thing that therapists can do because then naturally when you are in tune with nature and when you notice nature and you're interested in nature and curious about nature, You naturally are just going to infuse that into the kids that you work with.
You're going to notice it when you're working with any child and you can look outdoors through a window. You can move your session near a window. If you have to work indoors, you can bring nature materials into a session if you need to. And then when you're ready, like actually take it outdoors and play around with what that looks like.
So I would say just get started. It's not like. There's a million things I could say, but honestly, it's just play with it and have fun with it. That's what I would. Yeah, go for it. Exactly. Yeah,
Alexa: that's really a great piece of advice. I feel like within nature based therapy or just within anything in general too.
Yeah. That being said, is there anything else? You want to add or any questions you have for me?
Laura: No, I thought this was really interesting. The directions, the whole, it was fun, like not knowing what you're going to ask.
Alexa: Yeah. I like knowing what I was going to ask. So I'm glad that you're going to roll with everything and give some great advice and answers throughout.
Laura: Yay. Thank you so much for agreeing to do this. Kudos to you for being brave enough to have this recorded, shared with our community. And I do think we covered a lot and it was so cool too, to hear for everybody to hear about what you did in your capstone project and I'm just happy to be connected with you.
So yeah, we'll have to stay in
Alexa: touch.
It was really cool to share what I've done this past year and where I hope to go in the future. So thank you so much for your time and giving some great advice and answers. Yeah,
Laura: Thanks so much, Alexa. Thank you.
Thanks for joining me today for therapy in the great outdoors. If you want valuable advice, as you start or grow your nature based pediatric practice, get my free ebook, the nature based practice roadmap. It is a guide to help you focus and avoid. Mistakes as you start or grow your outdoor work with children in it.
I share the four stages of nature-based practice, what you need to focus on and common mistakes to avoid in each stage. Plus a checklist of specific action steps for you to take at each stage in the process. Get it at Therapy in the great outdoors.com/. roadmap. So until next time, get outside, connect, reflect, and enjoy therapy in the great outdoors.
