Park vis­its for city kids

Pae­di­a­tri­cians say it is an an­ti­dote to chil­dren with na­ture-de­fi­cient dis­or­der.

The Star Malaysia - Star2 - - Family - By SA­MAN­THA ME­LAMED

IN A dark­ened room in Chil­dren’s Hospi­tal of Phil­a­del­phia (CHOP), Cobbs Creek, United States, physi­cian Chris Ren­jil­ian set up a projector and de­briefed doc­tors, nurses, and other staff on a new in­ter­ven­tion that the of­fice will be­gin of­fer­ing to pa­tients in its care.

The med­i­cal break­through in ques­tion? Pre­scrip­tion-strength out­door play.

“As pri­mary-care pae­di­a­tri­cians, one of our goals is to help chil­dren get more ac­tive. The Amer­i­can Academy of Pae­di­atrics rec­om­mends 60 min­utes a day of out­side play,” he said. “This is some­thing we al­ready spend a lot of time screen­ing for and talk­ing to fam­i­lies about.”

Now, they’ll ac­tu­ally be able to pre­scribe it, in the form of cus­tomised, de­tailed ac­tion plans that are tai­lored to con­nect kids with Phil­a­del­phia’s park sys­tem at a time when chil­dren are spend­ing far less time in na­ture than doc­tors say is needed for healthy devel­op­ment of mo­tor skills, so­cial com­pe­tence, prob­lem-solv­ing abil­i­ties, and even eye­sight. It’s an an­ti­dote to the plague psy­chol­o­gist Richard Louv de­scribed as na­ture-deficit dis­or­der.

The ini­tia­tive, called Na­turePHL, is a col­lab­o­ra­tion be­tween CHOP, the Schuylkill Cen­tre for En­vi­ron­men­tal Ed­u­ca­tion, Phil­a­del­phia Parks & Re­cre­ation De­part­ment, and the Na­tional For­est Ser­vice.

The Na­turePHL will be a stan­dard part of all check-ups for kids age five to 12, in­te­grated right into their med­i­cal records.

Ev­ery pa­tient will be screened, given a brief mes­sage about the im­por­tance of out­door play, and re­ferred to a new web­site, Na­, that pro­vides a guide to lo­cal parks.

Some – per­haps those strug­gling with obe­sity or at­ten­tion-deficit dis­or­der – will get more com­pre­hen­sive coun­selling; a de­tailed park pre­scrip­tion for an out­door ac­tiv­ity such as a hike, a scav­enger hunt, or a visit to a play­ground; and a re­fer­ral to a “na­ture nav­i­ga­tor”.

That’s a com­mu­nity health worker who will help cre­ate a de­tailed plan, fig­ure out how to over­come bar­ri­ers to get­ting out­side, or even join the pa­tient on a park visit.

It’s not the first park-pre­scrip­tion pro­gramme: Sim­i­lar ones have launched around the coun­try, in­clud­ing one in Wash­ing­ton, DC, cre­ated by a net­work of com­mu­nity health cen­tres and the Na­tional Park Ser­vice that re­ported a 22-minute av­er­age boost in weekly ac­tiv­ity.

The Phil­a­del­phia or­gan­is­ers in­tend to un­der­take the most com­pre­hen­sive study yet of whether such pro­grammes work and how best to un­der­take them.

They hope to an­a­lyse whether the pro­gramme will lead doc­tors to talk about the im­por­tance of out­door play more, whether kids in the pro­gramme ac­tu­ally spend more time out­doors, and what ef­fect, if any, it has on their health and well-be­ing.

“There re­ally isn’t any re­search out on parks-pre­scrip­tion pro­grammes, their ef­fec­tive­ness and their im­pact on health,” said Michelle Kondo, a sci­en­tist with the Na­tional For­est Ser­vice. “We’re still fig­ur­ing out what’s im­por­tant to mea­sure and what you can quan­tify.”

It might in­volve us­ing GPS track­ers to check whether kids are com­ply­ing with the pre­scrip­tions, or mon­i­tor­ing changes in a pa­tient’s heart rate, blood pres­sure, cor­ti­sol lev­els (which in­di­cate stress), core strength, and at­ten­tion.”

Ren­jil­ian was a pae­di­atric res­i­dent at CHOP when he be­gan talk­ing about the idea with staff at the Schuylkill Cen­tre.

“The story of Na­turePHL is re­ally a story of shared goals. Phil­a­del­phia parks ad­vo­cates want to en­cour­age use of green space,” he said. “And I think a lot of pae­di­a­tri­cians strug­gle be­cause they know they have a re­spon­si­bil­ity to talk to their pa­tients and fam­i­lies about phys­i­cal ac­tiv­ity and phys­i­cally ac­tive play, but that’s re­ally hard to do. We fall short in giv­ing ad­vice that is ef­fi­cient, but also suf­fi­ciently per­sonal, lo­cal, and spe­cific. There’s a knowl­edge gap there. Most pae­di­a­tri­cians don’t live in the same neigh­bour­hoods as their pa­tients, and we’re very aware of that.”

Na­turePHL aims to fill that gap with a web­site that maps Phil­a­del­phia parks and lists such fea­tures as play­grounds, bath­rooms, swim­ming pools, and wheel­chair ac­ces­si­bil­ity. Mary-Grace Gor­man of the Parks & Re­cre­ation De­part­ment said the hope was that a new de­mo­graphic would also get con­nected to ac­tiv­i­ties and pro­grammes the de­part­ment was al­ready run­ning in city parks.

The Na­turePHL in­ter­face starts with a map through which vis­i­tors can click into pages ded­i­cated to each park.

As Ren­jil­ian pre­sented the ini­tia­tive to CHOP staff, physi­cian Ni­cole Jaffe asked what or­gan­is­ers ex­pected, based on fo­cus groups, to be the most com­mon ques­tion.

“Are the parks on here screened for safety? That’s the big­gest con­cern I get from my pa­tients, and if I’m en­dors­ing it,” Jaffe said, “I want to know that there is a low prob­a­bil­ity of some­thing go­ing down there.”

There’s no sim­ple an­swer, though. “What is safe?” Ren­jil­ian asked.

The hope is that the web­site will help fam­i­lies eval­u­ate that. A team from the Schuylkill Cen­tre has been con­duct­ing “park au­dits” to list the fea­tures of each park, and the cen­tre plans to add pho­tos and a fo­rum for user re­views and user-sub­mit­ted pho­tos.

“The idea is, maybe if you can see what the park looks like, you might think it’s safer,” said Elisa Sarantschin, the Na­turePHL pro­gramme co­or­di­na­tor for the Schuylkill Cen­tre.

Al­though the web­site was de­signed in col­lab­o­ra­tion with CHOP, Sarantschin hopes that the gen­eral pub­lic will look to it as a re­source and that pae­di­a­tri­cians in other health sys­tems around the city can be­gin in­tro­duc­ing the pro­gramme to pa­tients.

Wedg­ing these con­ver­sa­tions into a 15-minute pae­di­a­tri­cian visit may be chal­leng­ing, but the hope is, if there’s a pa­tient whose body-mass in­dex has been creep­ing up over sev­eral vis­its, the doc­tor might set aside a cou­ple of min­utes to talk about op­tions.

“We’re the ones who are go­ing to have to do this. This has to be prac­ti­cal,” Ren­jil­ian told the group at CHOP. “But for kids with obe­sity, other than telling them to go out­side, there was noth­ing to give them. Now we have Na­turePHL.” – The Phil­a­del­phia In­quirer/ Tri­bune News Ser­vice

Doc­tors are col­lab­o­rat­ing with park au­thor­i­ties to en­cour­age their pa­tients to en­gage in out­door ac­tiv­i­ties. — TNS

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