NEW: How To Start a Nature-Based Pediatric Practice
Laura Park Figueroa: 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 100 percent real, you'll hear it all on this podcast, Dr. Laura Park. My name is 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 therapyinthegreatoutdoors. com to help you pursue your nature based therapy dreams too. Are you ready to take action on those dreams? Let's jump in.
Hello, everyone. I have to tell you right off the bat. I am so happy that I have decided to stop publishing the podcast to YouTube. Because I realized that it was really a weight on me and it made me not want to record the podcast because I am not someone who gets dressed up cute and puts on makeup every day.
And I felt like I always had to look presentable to record a podcast for you all, because we were starting to publish the episodes on YouTube with like video of myself. Y'all may look back at those videos and go, wow, Laura, it really doesn't look like you got ready for those videos either, but I assure you those were my more presentable days. Today, I just got back from the gym.
I am so excited to share this episode with you, but I did not want to take a shower and do my hair and get dressed and all of that before getting this done. So the lesson here for all of you is that. You can reflect on your business and do what works for you. Sometimes I think we feel like we need to do what everybody else is doing.
There are a lot of podcasts on YouTube. And I do think it's great if you have the capacity to be able to be in more places online when you're running an online business like therapy in the great outdoors is. But I feel so good about this decision, especially going into this year in 2024 and just feeling like I will have the energy to be able to produce weekly podcast episodes for you all because I won't have to worry about looking presentable to be on camera.
And I can record late at night when the lighting's bad, all of that. So I'm feeling a huge sense of relief. This is the first. Intro to an episode that I'm recording since I made that decision. So I thought I'd share with you all, because there's that little takeaway for your own life and practice as well. I hope you all are well. This episode is going to be a.
Replay of a video that I did way back in 2020, and somehow I came across it. I don't even remember how I came across it. I have so much content out there now. It's hard for me to even remember the things that I have done, especially when they're almost four years ago. But I came across this episode and I thought I would repurpose it for you all and share it again here, because. The things that I talk about in this episode about starting a nature-based pediatric practice are questions that I continue to see in the TGO community, as well as people asking me online. So this episode, I basically went through all of the frequently asked questions I get and describe how I started my own nature-based practice.
And I think it can be very helpful for all of you as well. So some of the things I will cover in the episode are how I started my practice. Like I said, how the Contigo approach was developed, Contigo stands for connection and transformation and the great outdoors. It is my nature-based therapy program that will help you become an expert in nature-based pediatric therapy.
So you'll hear. A little bit about the beginnings of that program. We are opening. I should mention this because I think this episode is coming out. The week before we're going to open enrollment again for Contigo. So if you're interested, you can go to Contigo approach.com and get on the wait list there.
And we will let you know when we open enrollment on the 15th. So this episode will come out on the 8th of January, 2024. And enrollment will be opening on the 15th in one week from today. So in this episode, you'll hear a little bit about the beginnings of the Contigo approach. You'll also hear startup logistics.
So finding a location, getting liability insurance, and then. One caveat I do want to say is my practice specializes in therapy groups. So I talk a little bit at the end about grouping children for services. How we go about doing that. And then you'll also hear the structure of our nature based OT groups in my practice.
What, how long we meet, like what we do in a session, things like that. And finally a little bit about the systems that you need for nature-based therapy. I go into a bit at the end about. What therapy is and how it's different from nature based learning. Next week's episode here on the podcast is going to be a deep dive into that topic.
The difference between nature-based enrichment programs or nature based outdoor play programs. And nature-based therapy programs. What sets therapy programs apart from enrichment and other nature-based programs that may be out there like forest schools or. Outdoor programs. So I will talk more about that next week, but that I mentioned that at the end. A few caveats before I play the. Episode that was previously recorded a few years ago.
I say some things in the episode.
So this was interesting for me to hear. The difference in my practice now versus what it was three or four years ago when this was recorded. So my team has grown to three times the size that it was in 2020. And I am also done with my PhD. So I mentioned I'm doing my PhD right now, and it's just funny for me to hear myself say that and go back and be able to. Just be proud that I actually finished.
There were so many times I wanted to quit. So I'm done with my PhD now. I mentioned an article in this episode about the Contigo approach. So I will put the link in the show notes for that was published in 2020. And I have a link that you can download it. It is not available. It's not publicly available unless you're a. AOTA American occupational therapy association member. So even if you're not, I am allowed because I'm the author to give away free copies.
So I have a very simple website landing page where you can go and enter your email and it automatically emails to you. You are not added to my email list or anything. If you want to download that article for yourself. So that is available for you. The link will be in the show notes.
All right. Finally, before I play the prerecorded part of this episode. I answer some frequently asked questions in this episode, but I hope that, and if you've listened to me at all for any period of time, I believe that we should be willing as therapists and as practice owners. We should be willing to invest in ourselves in order to get the resources and support we need in order to deepen our understanding. Deepen our clinical reasoning. And deepen our business sense really. One podcast is not sufficient to help you start.
The title of this podcast is how to start a nature-based pediatric practice. But I just want to be very clear that you absolutely need ongoing support. I cannot emphasize this enough, do not wait to get support early on in your work as a nature based therapist. To really become an expert in nature-based therapy, it takes time and energy and you need ongoing mentoring and support, which is what we give you inside of the Contigo program.
Contigo is for you therapists out there that want to become experts in nature-based pediatric therapy.
It's not for people who are just dipping their toe in the water. It's not a 30 day limited access. You get lifetime access to all of the content and all of the mentoring that we provide an ongoing basis. It is definitely for those of you who want to really delve into expertise in your nature-based therapy work.
And if that's right for you again, you can join the [email protected]. So let's dive in to this episode and I'll do a little wrap-up at the end as well.
Laura Park Figueroa: If you've been listening to the podcast for a while, you may know that I am the owner of Outdoor Kids OT, which is a nature based pediatric practice.
And in this episode, I am going to share my top tips for starting and running a nature based practice because I get questions about this all the time.
So I am going to give you a little background about how I started my practice and then talk to you about the startup. And the structure and the systems you need for nature based pediatric practice in particular.
Okay, let's just jump right in. So I started Outdoor Kids OT with just me. I was a solopreneur. But from the start of the business, I was really thinking like an entrepreneur because I really wanted this, whatever I learned to be able to help other therapists to do the same work because I knew that there was something unique to working outdoors and I knew that this was something that made so much sense for pediatric OT, right?
Most of us as pediatric OTs can just look at nature and know the sensory and therapeutic benefits that it offers for children. So I won't go into that too much in this podcast, because there's a ton of literature. You can read about that out there. But I grew, I started just as me. And the second year in business, I hired a few part time OTs, and several of those people are still with the practice to this day.
And now we're a really small team, so right now I have three part time therapists that each run a group or two during the week, and then I'm running the business, and I have a practice manager who helps with the admin and the management stuff. We have someone that we contract with to do social media for the business.
So that's the team I'm managing right now. Now as I started this work, something that I did was I took notes like meticulously and was really consistent. I am. You may laugh to know this, but I'm not really a consistent person. I get bored really quickly, so I'm not good with routines, and I have to constantly revisit my routines and get back into them.
But one of the things that I did really consistently when I started Outdoor Kids OT was I took notes, reflective practice notes, and my documentation on kids goals. And I took notes about what really worked, and I was at the very beginning thinking a lot about developing a framework to help other therapists take their work outdoors with kids, in alignment with what research says is best practice when we work outdoors.
So what developed out of that was the CONTIGO approach. So it stands for, CONTIGO stands for Connection and Transformation in the Great Outdoors. CON T I G O. CONTIGO. I am actually pursuing my PhD right now in occupational therapy, and I am studying nature based occupational therapy. So it's not a program in nature based OT, it's an OT PhD, but my specific area of practice and my line of research will be specifically related to nature based pediatric practice.
tHe Contigo approach grew out of this, and the Contigo approach is actually, I forgot about this. I was in my notes to tell you guys I just wrote an article about it actually that just got published in the special interest section in the August issue of AOTA's special interest section quarterly.
So if you're a member of AOTA, you can go to the website there and look at the SIS section and it is called nature based therapy. Occupational therapy for children with developmental disabilities, I think is the title. I don't have it right in front of me, but it just got published. And so it goes into the framework and gives a case study and kind of talks more about what is involved in the Contigo approach, but I'll go through those really briefly right here.
So the connection piece stands for the approach. Being focused on connecting children to one another, to other people, and connecting them to nature. So that's a foundation of the Contigo approach. The transformation word refers to using evidence based practice. So we take What research says works well with children and what we have evidence for, and we use that in partnership with Nature Outdoors to address children's goals.
And finally, the GO, the G O, Great Outdoors, stands for the setting of our services when we do nature based work with children using the Contigo approach. The setting is in an immersive nature setting. So there's a lot of theory behind this. I won't go into it here. But Basically, an immersive nature setting is somewhere where children and adults can feel away.
You can feel a sense of relief from daily life and can feel that, that sense of forgetting about your problems and just being present in nature. And for kids it's getting into the enjoyment of play, really, and not thinking about stressors in daily life. Immersive nature settings tend to be rather uncultivated.
They're not like near buildings or near roads and cars where those things remind you of the built world, right? But if you're in an immersive nature setting, you're away from those things and feel like you're away. Okay? And also, I want to say too that great outdoors piece in the Contigo approach refers to nature as a co facilitator.
So I think often we find ourselves saying we use nature as a setting or we use nature to facilitate children's goals. And I don't like to say the word use because I feel like it disrespects nature in some way, and really in this approach, nature is a co facilitator with the therapist of the session.
And as you do this work, you'll realize this, that nature offers therapeutic opportunities that cannot exist in an indoor setting. Just the things that happen when you're outdoors in treatment sessions that you can't control. That's the way nature facilitates, right? You see An animal or the environment changes because of the seasons.
There's ways that nature facilitates with us. So it refers to nature as a co facilitator. We're not using nature, but nature facilitates with us. We're in partnership with nature. So that's the language I like to use. Okay, so let's dive into the first topic of startup logistics. These are things I often get questions about, so I want to, in this episode, answer a lot of the frequently asked questions that I get so then I can refer people when they ask me these questions to say, oh, I covered that in the podcast episode and refer them here so you guys can have all the information in one place.
So startup logistics. So one of the things people often ask is how do you find a location? The honest answer is this takes time and work and energy. It you need to physically go to a lot of different locations and you need to be in those locations and experience and think about what it would be like to be with a small group of children in these locations.
And you want to consider things like the setting, feeling away, like what I just talked about. You want to consider drop off and pickup for families, is it going to be easy, is there a place that's easy for them to drop off and pick up? A lot of parks charge entry fees or things like that you don't want parents to have to pay five or ten dollars every time they drop their kid off for a group.
You want to think about drop off. Privacy. So if you're not using private land, now that is something I would encourage you to do if you live in a more rural area or an area where there might be private land you could use, I would encourage you to consider that. But if you have to use a public park system, I'm more thinking about people that are in urban or suburban areas where you may not have a ton of land, of private land at your disposal.
So you want to think about easy pick off and drop off, you want to think about location of bathroom and water facilities, especially, I'm recording this in July of 2020, and we're in the age of coronavirus. You have to have a way to make sure that we're being sanitary, especially right now. And then you also want to think about privacy.
I think I just mentioned this and now I'm circling back to it, but Privacy is really important because a lot of times if you're in a public space, people walking by or people with their dogs or other groups of hikers will distract children from their play and so when you're looking at a public park, I always look for areas that are like off the beaten path a little bit where you're still allowed to use them but a space behind trees near the trail or a space, a picnic site that might have a little alcove in the trees behind it or something where you could be a little bit away from where the main trail and the main traffic of the park is going to be.
And there's no short way to find these places. You really have to physically go to places in your area and find what would be best. The other thing you need to concern, consider with a location is permitting. So make sure that if you are. Using a public space that you ensure that you do not need a permit or that you have the necessary permits.
Not that I learned this through any mistakes I might have made. Okay, moving on now. Alright so that's it for location. Those are just some considerations. There's a lot of other things, but that's the basics. Another question I often get about startup is liability insurance. One of the things I would suggest to you if you are starting a nature based practice is to use the word community based practice, okay, rather than a nature based practice or an outdoor practice.
Because those words scream liability risk to insurance companies, if you use community based practice, you are a community based practice because you work out in the community. Because a public park or outdoor space is a community. a community space. So that is the language I would use. And I insure my practice.
They know my, they have my website, so they know I'm an outdoor practice. And I insure my practice as an occupational therapy practice. So I have general liability and professional liability insurance for myself, the practice, and for all of the therapists that work for us. And it is not any more expensive.
Like I, I think I pay 65 a month or something for my practice. And again, we're very small very small. We only offer 20 hours or so of therapy per week. So it's not for groups, for a few small groups of kids, and I'll get into that in a little bit. But you definitely, with liability insurance, that is my top tip is to use the word community based practice when you inquire with insurance companies.
Okay, so let's get into some of the structure of the group now. So those are some of the startup logistics, and I want to get into the structure of the group because this is another question I get a lot of the time, like, how many kids are in the groups? Who, how many, what types of kids do you serve? What's the structure?
How does it go? So I'm going to answer those now. So the structure of our groups we started with 90 minute groups, and that wasn't quite long enough. So now our groups are an hour and 45 minutes or two hours long. So you need more time when you're out in nature because you have to walk or hike to where you're going, you have to let the kids get into the flow of being outdoors, and you don't want to rush them.
That is the beautiful thing about nature based therapy is If you have more time, if you structure your groups in this way to have more time, you don't have to rush the way you often feel like you have to in a traditional half hour therapy session. I know when I worked in the schools, sometimes my sessions were only half an hour long.
It's crazy short. So we use a longer session. We group children in groups of four to six kids, and ideally we have three to four kids that are getting OT, and then we have two or three kids that are peer playmates where, who are just like neurotypical kids who are out there getting the experience of playing in nature with friends so it's, we use an inclusive model.
Now I will say, the challenge is, Marketing. So marketing is really hard to get those peer playmates. And sometimes we do have groups with more OT kids than peer playmates because we, it's hard to market to the peer playmate crowd and also market that we're an OT service. I would just say that I really encourage these inclusive models where it's a mix of different kinds of kids but just being really honest, sometimes it's hard marketing wise to market to two different crowds of people.
The types of kids that we see are typically so I'll share the tagline on our website is we help kids grow more coordinated, confident, calm, and caring. And those words stand for what we work on in the Contigo Approach treatment model. Coordinated refers to our children that have coordination issues, obviously, like fine motor, gross motor skill challenges.
And these are kids that might have dyspraxia or developmental coordination disorder or Maybe no diagnosis at all, but just really struggle with their motor skills and need to become more confident with their motor skills. So the outdoor setting is wonderful for that. All the uneven terrain and the climbing we do and the movement.
There's just so much movement in a nature based session. They're moving the whole time. And so good for kids that have coordination issues. tHe next one is confidence. So this is how we refer to work on mental health. So we want to, in the Contigo approach, we want to encourage children to have a positive mindset, to push through obstacles, to reframe negative thinking.
To see failure as opportunities for growth we actually call them fail learns. If we fail, we celebrate it as an opportunity for learning. So if someone falls down or if someone messes something up on an art project or something, we like, yay, oh, that's amazing. That got messed up and that means you're learning.
So it's like a real culture in the group to foster that growth mindset. Mental health is another area that we work on. Now, calm refers to, it's our parent friendly word to refer to sensory processing and self regulation. So this is another thing that is so beneficial in the outdoor space to work on sensory processing.
And we do a lot of work with kids in our groups on self regulation and the outdoors. I don't think I need to convince any OT listening to this. Now, maybe if you're from another profession listening, you can read up on this, but the outdoor world in nature is so beautifully balanced with being a stimulating and exciting environment while also at the same time being very calming.
And so the sensory input that kids get when they are outdoors in nature is so different than an indoor clinic based setting, right? It's just complete, you can't even really compare the two because they're so different. We love the outdoor space for that reason because it's a great place to work on sensory processing needs in kids.
Okay, and then the final one is caring. This refers to our work on social skills. We work a lot on perspective taking. We work a lot on how to be a friend, turn taking Being a good sport when you play a game, things like that. The typical and the typical kids who come to our groups needing to work on these things are kids that have autism or kids that have, ADHD because a lot of times the impulsivity of ADHD gets in the way of them having good peer relationships.
So we work on friendships, making friends. so That's it. So the general, that's the kind of the types of kids and the things we work on in our groups. I talked about grouping kids. I talked about how long the groups are. And then the structure of the group, like the actual sequence of events that happens in the group.
Every therapist has their own way of weaving these elements together, but generally the groups all include a main therapy activity of the day and a healthy snack time and time for supported free play. So I'll talk a little bit about what each of those things involve. For a therapy activity, this is the therapy activity that is planned that day to address the children's goals, so I'm going to get into the therapy process in a little bit, but if you need ideas, if you're just getting into nature based practice and you need ideas for some activities to do outdoors with kids I have a book.
It's available on Amazon. It's called Therapy in the Great Outdoors. You can look it up. There's 44 activities based on all that Writing that I did my first few years of practice to write down what actually worked for kids. So only things that actually worked made it into the book. The failures are not in there.
So plenty, plenty of things I tried that did not work. So so yeah, if you need ideas for therapy activities, you can just grab that and use it and it'll give you, more than a whole school year's worth of activities you could try. But the point is that the therapy activities or the main therapy activity of the day is chosen based on the needs of the kids in the group.
So you're really thinking about, as a therapist, if you're practicing nature based therapy and I'm going to talk a little bit about what that means in a minute. You should be thinking about the goals that you are trying to work on and planning the activities in accordance with those goals. So we plan a main Therapy activity, and then we also have a snack time because we really believe that it is very important for kids to, it's part of nature connection for kids to understand that the earth provides healthy foods for us.
So we have a healthy snack time where we have maybe a fruit and a vegetable or things that are natural foods that come from the earth. And so that's another way that we integrate that nature connection into our groups when we use the contigo approach as we have that healthy snack time.
And then finally, we have during each. Two hour long session. We have at least 45 minutes of supported free play time. And when I say supported free play, the supported part is important. It is not just a time for the therapist to stand back and relax and let the kids play, right? I guess I'll I'll get into the systems now as I'm talking about this.
So this idea of supported free play is really important because a lot of times we hear in, the media how important nature play is for children and how important outdoor play is for children. And I think there are some children who need more than just nature play. We are seeing those kids in therapy when we do outdoor nature based therapy.
When kids need more than just nature play, we need to be supporting them to develop the skills they need. as they play in nature. So what I mean by supported free play is that we do stand back and we do let the kids play during this time, but the therapist and the other staff in the group are oh, I didn't mention that.
We never have just one person out with kids. We always have a couple of volunteer staff or OT students or an OT assistant or someone who's with them. the therapist with a small group of kids. So we always have at least two adults with four to six kids. Okay, that being said, sorry, that should have gone back and start up logistics and set up stuff.
so During that supported free play time, they're standing back, but they are looking for opportunities to help expand the children's play, to help them practice inquiry based learning, to help them expand their thinking, to help them be a good playmate to their friends in the group. To help them join in play, to help them try new things so we're not like, we're not like hovering over them necessarily, but it is a time to support children's free play.
So they have a choice of what to play, but we will hop in and give support where needed so that they can really get the most out of that free play experience in nature. I could go on and on about this so those are the three main elements of the session We also write down a schedule for the kids and things like that But basically that's the structure. Now let's talk about systems. So this is going to get a little more into that not just nature play idea when you are offering nature based therapy, you need a therapy process, okay? You need to be doing a therapy process behind the scenes, all right?
It is different than a Nature based learning experience, or nature based education, or nature based enrichment, or nature based camp. Therapy is different than these things. When you are offering a therapy service outdoors, you need to have a therapy process going on behind the scenes to actually call it therapy.
So we should not be calling this is a big beef of mine, can you tell? We should not be calling things Therapy, , if they are educational experiences for children outdoors,
most therapists are allowed to provide health and wellness services underneath their practice act or their licensure or whatever you want to call it the laws that dictate how we practice. But we should not be providing a general outdoor experience for kids and calling it therapy if we are not going through a therapy process behind the scenes.
So what do I mean by a therapy process? Individualized assessment. I mean Writing the goals based on that assessment, in collaboration with the families. Documenting on the goals, progress reporting to families. Oh, and I forgot, planning intervention, right? Documenting and progress reporting to families.
That process that we all know that goes along with good therapy indoors applies outdoors as well. Now, there's a few extra things you may want to look at when you work outdoors, and I won't get into all of those right here. I mean it a little bit provocatively when I say nature-based therapy is quote, not just nature play
I, I actually put this on the slide when I did a training on the Contigo approach last fall. I put this on the slide, not just nature play, to be a little bit provocative because we all know that play is the most important, right?
It's the most, it's the work of the child. It's the most important thing that kids do is they learn through play. But I use the term, not just nature play, because I want therapists to know that if you are doing therapy in nature, there's still a therapy process behind it. You should be doing something different than a forest school teacher if you are calling something therapy and marketing it as therapy.
Okay. So that's just, that being said, I just want to be clear about that. The benefit to your business, if you are offering a nature based therapy service, is that in my opinion, It is less work and more financially lucrative, and when less work, I mean you can generally work with a smaller group of kids, focus on individualized needs, rather than if you're offering an enrichment experience, you're focusing on a larger group of kids, right?
And having to do staffing for a larger group and all of that. But with nature based therapy, if you're focusing on a small group of children, And they're individualized needs and you only need one other person, but you're charging more because you're doing that individualized service. It's a more sustainable business model.
In my opinion, it's a more sustainable business model than offering like large group enrichment type nature based programs. So that's just my experience. And again, other people will have other opinions, but I'm sharing here what I have experienced in my opinion. So there you have it. I think. I think you have to be aware that you're doing a lot of work behind the scenes when you offer nature based therapy.
So the time in the woods or in your outdoor setting is really important. That's your intervention time. But you're doing a lot of work behind the scenes to plan effectively and to really think about the needs of the children in the group to plan the experience for them. I Talk a lot more, if you guys are interested in this topic, I talk a lot more about the differences between nature based learning or enrichment or education and nature based therapy in a recent Facebook Live video... it was about I think I talked for about 20 minutes or 25 and then people ask questions too. So that is there as a resource for you if you want to hear more about the differences between nature based learning and nature based therapy. , I went into the Principles, purpose, and process, and then precautions for marketing of nature based learning and nature based therapy in that Facebook live video. So if you're interested, head over there.
Except you're not going to head over there because the Facebook group that I did that video in three or four years ago when this was originally published is no longer active because that is what I took and created the TGO community out of. So I closed down the Facebook group I had on Facebook. It was large like over 2000 people.
And then I moved all of my services over to the therapy in the great outdoors community. So I am going to make that next week's podcast episode we're going to delve into that topic of what actually sets nature-based therapy apart from nature based learning or enrichment or education services.
I think this is something that we as pediatric therapists have to really embrace and really understand in order to be successful in our nature-based practices. So I hope that you got some good learning and some good value out of this episode. And I will see you next week to talk about nature-based therapy versus nature-based learning. Bye.
Laura Park Figueroa: 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. 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 therapyinthegreatoutdoors. com roadmap. So until next time, get outside, connect, reflect, and enjoy therapy in the great outdoors.