Pilot Testing an Ecotherapy Program for Adolescence: Initial Findings and Methodological Reflections
Abstract
1. Introduction
2. Materials and Methods
2.1. Internal Pilot and Service Evaluation Before/During COVID-19
2.2. Ecotherapy Co-Design Events
3. Results
3.1. Relationships and Connection with Other People
3.2. Enjoyment and Fun
3.3. Improved Confidence and Independence
3.4. Being in the Outdoors
3.5. Wider Impacts
3.6. Revised Child Anxiety and Depression Scale (RCADS) Scores
3.7. Co-Design of the Ecotherapy Service and Evaluation Framework in 2024
4. Discussion
4.1. What to Measure?
4.2. Co-Production and Embedded Research
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Blanchflower, D.G.; Bryson, A.; Xu, X. The Declining Mental Health Of The Young And The Global Disappearance Of The Hump Shape In Age In Unhappiness. Natl. Bur. Econ. Res. Work. Pap. Ser. 2024, 32337. [Google Scholar] [CrossRef]
- Global Mind Project. The Mental State of the World in 2023: A Perspective on Internet-Enabled Populations; Sapien Labs. Available online: https://mentalstateoftheworld.report/ (accessed on 20 April 2025).
- UK Parliament. Child Poverty: Statistics, Causes and the UK’s Policy Response. Available online: https://lordslibrary.parliament.uk/child-poverty-statistics-causes-and-the-uks-policy-response/ (accessed on 20 April 2025).
- Hirsch, D. The Cost of Child Poverty in 2023. Available online: https://cpag.org.uk/sites/default/files/2023-08/The%20cost%20of%20child%20poverty%20in%202023.pdf (accessed on 20 April 2025).
- Kessler, R.C.; McLaughlin, K.A.; Green, J.G.; Gruber, M.J.; Sampson, N.A.; Zaslavsky, A.M.; Aguilar-Gaxiola, S.; Alhamzawi, A.O.; Alonso, J.; Angermeyer, M.; et al. Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. Br. J. Psychiatry 2010, 197, 378–385. [Google Scholar] [CrossRef] [PubMed]
- NHS England. Mental Health of Children and Young People in England, 2023-Wave 4 Follow Up to the 2017 Survey. Available online: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2023-wave-4-follow-up (accessed on 20 April 2025).
- NHS England. Mental Health Services Monthly Statistics, Performance April 2024; London: NHS England. Available online: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-services-monthly-statistics (accessed on 20 April 2025).
- Royal College of Psychiatrists “We Cannot Allow Childhood Mental Illness to Become the New Norm”-RCPsych. Available online: https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2024/02/07/we-cannot-allow-childhood-mental-illness-to-become-the-new-norm----rcpsych (accessed on 22 July 2024).
- National Youth Agency. Time’s Running Out: Youth Services Under Threat and Lost Opportunities for Young People. Available online: https://nya.org.uk/document/times-running-out/ (accessed on 20 April 2025).
- UNICEF. Discussion Paper: The Necessity of Urban Green Space for Children’s Optimal Development. Available online: https://www.unicef.org/media/102391/file/Necessity%20of%20Urban%20Green%20Space%20for%20Children%E2%80%99s%20Optimal%20Development.pdf (accessed on 20 April 2025).
- Lee, K.O.; Mai, K.M.; Park, S. Green space accessibility helps buffer declined mental health during the COVID-19 pandemic: Evidence from big data in the United Kingdom. Nat. Ment. Health 2023, 1, 124–134. [Google Scholar] [CrossRef]
- Hubbard, G.; Daas, C.d.; Johnston, M.; Murchie, P.; Thompson, C.W.; Dixon, D. Are Rurality, Area Deprivation, Access to Outside Space, and Green Space Associated with Mental Health during the COVID-19 Pandemic? A Cross Sectional Study (CHARIS-E). Int. J. Environ. Res. Public Health 2021, 18, 3869. [Google Scholar] [CrossRef]
- Ulset, V.; Vitaro, F.; Brendgen, M.; Bekkhus, M.; Borge, A.I.H. Time spent outdoors during preschool: Links with children’s cognitive and behavioral development. J. Environ. Psychol. 2017, 52, 69–80. [Google Scholar] [CrossRef]
- Dadvand, P.; Nieuwenhuijsen, M.J.; Esnaola, M.; Forns, J.; Basagaña, X.; Alvarez-Pedrerol, M.; Rivas, I.; López-Vicente, M.; De Castro Pascual, M.; Su, J.; et al. Green spaces and cognitive development in primary schoolchildren. Proc. Natl. Acad. Sci. USA 2015, 112, 7937–7942. [Google Scholar] [CrossRef]
- Lanza, K.; Alcazar, M.; Chen, B.; Kohl, H.W. Connection to nature is associated with social-emotional learning of children. Curr. Res. Ecol. Soc. Psychol. 2023, 4, 100083. [Google Scholar] [CrossRef]
- Bijnens, E.M.; Derom, C.; Thiery, E.; Weyers, S.; Nawrot, T.S. Residential green space and child intelligence and behavior across urban, suburban, and rural areas in Belgium: A longitudinal birth cohort study of twins. PLoS Med. 2020, 17, e1003213. [Google Scholar] [CrossRef]
- Roslund, M.I.; Puhakka, R.; Grönroos, M.; Nurminen, N.; Oikarinen, S.; Gazali, A.M.; Cinek, O.; Kramná, L.; Siter, N.; Vari, H.K.; et al. Biodiversity intervention enhances immune regulation and health-associated commensal microbiota among daycare children. Sci. Adv. 2020, 6, eaba2578. [Google Scholar] [CrossRef]
- Sleurs, H.; Silva, A.I.; Bijnens, E.M.; Dockx, Y.; Peusens, M.; Rasking, L.; Plusquin, M.; Nawrot, T.S. Exposure to Residential Green Space and Bone Mineral Density in Young Children. JAMA Netw. Open 2024, 7, e2350214. [Google Scholar] [CrossRef]
- Gradinger, F.; Elston, J.; Asthana, S.; Martin, S.; Byng, R. Reflections on the Researcher-in-Residence model co-producing knowledge for action in an Integrated Care Organisation: A mixed methods case study using an impact survey and field notes. Evid. Policy 2019, 15, 197–215. [Google Scholar] [CrossRef]
- Morris, Z.S.; Wooding, S.; Grant, J. The answer is 17 years, what is the question: Understanding time lags in translational research. J. R. Soc. Med. 2011, 104, 510–520. [Google Scholar] [CrossRef] [PubMed]
- Glover, B. Liberated Public Services: A New Vision for Citizens, Professionals and Policy Makers. Available online: https://demos.co.uk/research/liberated-public-services-a-new-vision-for-citizens-professionals-and-policy-makers/ (accessed on 20 April 2025).
- Hayes, D.; Jarvis-Beesley, P.; Mitchell, D.; Polley, M.; Husk, K. [On behalf of the NASP Academic Partners Collaborative] The Impact of Social Prescribing on Children and Young People’s Mental Health and Wellbeing. Available online: https://socialprescribingacademy.org.uk/read-the-evidence/children-and-young-peoples-social-prescribing/ (accessed on 20 April 2025).
- Bradbury, A.H.D.; Burton, A.; Fancourt, D.; Wright, J.; Sticpewich, L.; Page, J.; Jarvis, L.; Empsom, L.M. Social Prescribing in Child and Adolescent Mental Health Services: A Guide for CAMHS Practitioners. Learnings from Phase I of the UCL ‘Wellbeing While Waiting’ Study. Available online: https://sbbresearch.org/projects/wellbeing-while-waiting-inspyre/ (accessed on 20 April 2025).
- European Centre for Environment & Human Health. Activities, Mechanisms, and Outcomes in Nature on Prescription [Handbook for Nature on Prescription to Promote Mental Health]. Available online: https://beccalovell.kumu.io/activities-mechanisms-and-outcomes-in-nature-on-prescription (accessed on 2 July 2024).
- Lord, E. Green space for public mental health: An ethnographic study of ecotherapy in Wales. Perspect Public Health 2023, 143, 173–178. [Google Scholar] [CrossRef] [PubMed]
- Foley, H.; Leach, M.; Feng, X.; Astell-Burt, T.; Brymer, E. Towards Key Principles for the Design and Implementation of Nature Prescription Programs. Sustainability 2023, 15, 9530. [Google Scholar] [CrossRef]
- Hunt, D.F.; Morgan, M.; Connors, M.; Mellor, C. Bringing nature into CAMHS inpatient services: Reflections for the implementation and integration of training into practice. Int. Rev. Psychiatry 2022, 34, 546–552. [Google Scholar] [CrossRef]
- Tiscareno-Osorno, X.; Demetriou, Y.; Marques, A.; Peralta, M.; Jorge, R.; MacIntyre, T.E.; MacIntyre, D.; Smith, S.; Sheffield, D.; Jones, M.V.; et al. Systematic Review of Explicit Instruments Measuring Nature Connectedness: What Do We Know and What is Next? Environ. Behav. 2023, 55, 551–608. [Google Scholar] [CrossRef]
- Beery, T.; Stahl Olafsson, A.; Gentin, S.; Maurer, M.; Stålhammar, S.; Albert, C.; Bieling, C.; Buijs, A.; Fagerholm, N.; Garcia-Martin, M.; et al. Disconnection from nature: Expanding our understanding of human–nature relations. People Nat. 2023, 5, 470–488. [Google Scholar] [CrossRef]
- Cole, S.; Goodenough, J.; Haniff, M.; Hussain, N.; Ibrahim, S.; Jani, A.; Jiggens, E.; Khan, A.; Langford, P.; Montgomery, L.; et al. Greenspace & Us: Exploring co-design approaches to increase engagement with nature by girls and young women. Int. J. Community Res. Engagem. 2024, 17, 1–17. [Google Scholar] [CrossRef]
- Agarwal, S.; Rahman, S.; Page, S.J.; Jakes, S. Economic performance amongst English seaside towns. Curr. Issues Tour. 2024, 27, 2631–2648. [Google Scholar] [CrossRef]
- Asthana, S.; Gibson, A. Averting a public health crisis in England’s coastal communities: A call for public health research and policy. J. Public Health 2022, 44, 642–650. [Google Scholar] [CrossRef]
- El-Hoss, T.; Thomas, F.; Gradinger, F.; Hughes, M.S. Child protection and family support: Experiences in a seaside resort. Geoforum 2024, 148, 103943. [Google Scholar] [CrossRef]
- Dorr, C.; Asthana, S.; Elston, J.; Gradinger, F.; Preece, D.; Schwartz, D.; Scott, G.; Wallace, G.; Harrell, R. Appreciating Dissonance: Using Open Appreciative Inquiry as a Tool to Generate Cultural Change. Teach. Public Adm. 2024. in print. [Google Scholar]
- Chorpita, B.F.; Yim, L.; Moffitt, C.; Umemoto, L.A.; Francis, S.E. Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behav. Res. Ther. 2000, 38, 835–855. [Google Scholar] [CrossRef]
- Borek, A.J.; Abraham, C.; Greaves, C.J.; Gillison, F.; Tarrant, M.; Morgan-Trimmer, S.; McCabe, R.; Smith, J.R. Identifying change processes in group-based health behaviour-change interventions: Development of the mechanisms of action in group-based interventions (MAGI) framework. Health Psychol. Rev. 2019, 13, 227–247. [Google Scholar] [CrossRef]
- Polley, M.J.; Barker, R.E.; Collaco, N.B.; Cam, C.; Appleton, J.; Seers, H.E. Developing a framework of concerns from people living with frailty, for the Measure Yourself Concerns and Wellbeing (MYCaW) person-centred outcome measure. BMJ Open Qual. 2024, 13, e002689. [Google Scholar] [CrossRef]
- Gaekwad, J.S.; Sal Moslehian, A.; Roös, P.B. A meta-analysis of physiological stress responses to natural environments: Biophilia and Stress Recovery Theory perspectives. J. Environ. Psychol. 2023, 90, 102085. [Google Scholar] [CrossRef]
- Gibbons, N.; Harrison, E.; Stallard, P. Assessing recovery in treatment as usual provided by community child and adolescent mental health services. BJPsych Open 2021, 7, e87. [Google Scholar] [CrossRef]
- Rueff, M.; Reese, G. Depression and anxiety: A systematic review on comparing ecotherapy with cognitive behavioral therapy. J. Environ. Psychol. 2023, 90, 102097. [Google Scholar] [CrossRef]
- Hinde, S.; Bojke, L.; Coventry, P. The Cost Effectiveness of Ecotherapy as a Healthcare Intervention, Separating the Wood from the Trees. Int. J. Environ. Res. Public Health 2021, 18, 11599. [Google Scholar] [CrossRef]
- Pretty, J.; Barton, J. Nature-Based Interventions and Mind–Body Interventions: Saving Public Health Costs Whilst Increasing Life Satisfaction and Happiness. Int. J. Environ. Res. Public Health 2020, 17, 7769. [Google Scholar] [CrossRef]
- Overbey, T.A.; Diekmann, F.; Lekies, K.S. Nature-based interventions for vulnerable youth: A scoping review. Int. J. Environ. Health Res. 2023, 33, 15–53. [Google Scholar] [CrossRef]
- Wang, E.; Jones, H.; Carus, A.; James, C.; Whelan, M. Ecotherapy for Adolescents Experiencing Mental Health Challenges: Qualitative Exploration of Perspectives of Adolescents and Parents. J. Creat. Ment. Health 2024, 1–17. [Google Scholar] [CrossRef]
- Smith, M.; Hannah, H.; Ron, C.; Wilson, R. New development: The ‘liberated method’—A transcendent public service innovation in polycrisis. Public Money Manag. 2025, 1–9. [Google Scholar] [CrossRef]
- Franco-Santos, M.; Otley, D. Reviewing and Theorizing the Unintended Consequences of Performance Management Systems. Int. J. Manag. Rev. 2018, 20, 696–730. [Google Scholar] [CrossRef]
- Axford, N.; Berry, V.; Lloyd, J.; Hobbs, T.; Wyatt, K. Promoting learning from null or negative results in prevention science trials. Prev. Sci. 2022, 23, 751–763. [Google Scholar] [CrossRef]
- Montgomery, C.; Hipólito, I. Resurrecting Gaia: Harnessing the Free Energy Principle to preserve life as we know it. Front. Psychol. 2023, 14, 1206963. [Google Scholar] [CrossRef]
- Arbuthnott, K.D. Nature exposure and social health: Prosocial behavior, social cohesion, and effect pathways. J. Environ. Psychol. 2023, 90, 102109. [Google Scholar] [CrossRef]
- Logan, A.C.; Berman, B.M.; Prescott, S.L. Vitality Revisited: The Evolving Concept of Flourishing and Its Relevance to Personal and Public Health. Int. J. Environ. Res. Public Health 2023, 20, 5065. [Google Scholar] [CrossRef]
- Clube, R.K.M.; Tennant, M. What would a human-centred ‘social’ Circular Economy look like? Drawing from Max-Neef’s Human-Scale Development proposal. J. Clean. Prod. 2023, 383, 135455. [Google Scholar] [CrossRef]
- Stein, B.E.; Stanford, T.R.; Rowland, B.A. Multisensory Integration and the Society for Neuroscience: Then and Now. J. Neurosci. 2020, 40, 3–11. [Google Scholar] [CrossRef]
- Jenkins, M.; Esemezie, O.; Lee, V.; Mensingh, M.; Nagales, K.; Obhi, S.S. An investigation of “We” agency in co-operative joint actions. Psychol. Res. 2021, 85, 3167–3181. [Google Scholar] [CrossRef] [PubMed]
- Shaffer, C.; Westlin, C.; Quigley, K.S.; Whitfield-Gabrieli, S.; Barrett, L.F. Allostasis, Action, and Affect in Depression: Insights from the Theory of Constructed Emotion. Annu. Rev. Clin. Psychol. 2022, 18, 553–580. [Google Scholar] [CrossRef] [PubMed]
- Djenontin, I.N.S.; Meadow, A.M. The art of co-production of knowledge in environmental sciences and management: Lessons from international practice. Environ. Manag. 2018, 61, 885–903. [Google Scholar] [CrossRef] [PubMed]
- Mitchell, S.B.; Chapman, B.; Hayes, R.; Bonnici, H.; Banks, H.; Mareva, S.; Hardwick, R. Nature-based approaches: A mixed methods study of facilitators and barriers to implementation in CAMHS. BMC Health Serv. Res. 2024, 24, 1369. [Google Scholar] [CrossRef]
- TLAP. What Is Co-Production? Available online: https://www.thinklocalactpersonal.org.uk/co-production-in-commissioning-tool/co-production/In-more-detail/what-is-co-production/ (accessed on 16 June 2020).
- Norton, M.J. Co-Production within Child and Adolescent Mental Health: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 11897. [Google Scholar] [CrossRef]
- Heinsch, M.; Gray, M.; Sharland, E. Re-conceptualising the link between research and practice in social work: A literature review on knowledge utilisation. Int. J. Soc. Welf. 2016, 25, 98–104. [Google Scholar] [CrossRef]
- Scurlock-Evans, L.; Upton, D. The Role and Nature of Evidence: A Systematic Review of Social Workers’ Evidence-Based Practice Orientation, Attitudes, and Implementation. J. Evid.-Inf. Soc. Work. 2015, 12, 369–399. [Google Scholar] [CrossRef]
- de Beer, C.R.M.; Nooteboom, L.A.; van Domburgh, L.; de Vreugd, M.; Schoones, J.W.; Vermeiren, R.R.J.M. A systematic review exploring youth peer support for young people with mental health problems. Eur. Child Adolesc. Psychiatry 2024, 33, 2471–2484. [Google Scholar] [CrossRef]
- Edwards, R.C.; Kneale, D.; Stansfield, C.; Lester, S. “They don’t have the luxury of time”: Interviews exploring the determinants of public health research activity that contextualise embedded researcher roles in local government. Health Res. Policy Syst. 2024, 22, 88. [Google Scholar] [CrossRef]
- Ward, V.; Tooman, T.; Reid, B.; Davies, H.; Marshall, M. Embedding researchers into organisations: A study of the features of embedded research initiatives. Evid. Policy 2021, 17, 593–614. [Google Scholar] [CrossRef]
- Cheetham, M.; Wiseman, A.; Khazaeli, B.; Gibson, E.; Gray, P.; Van der Graaf, P.; Rushmer, R. Embedded research: A promising way to create evidence-informed impact in public health? J. Public Health 2018, 40, i64–i70. [Google Scholar] [CrossRef] [PubMed]
- Shaw, I.F.; Lunt, N.; Mitchell, F. Practitioner Research in Social Care: A Review and Recommendations. Available online: https://www.sscr.nihr.ac.uk/wp-content/uploads/SSCR-methods-review_MR018.pdf (accessed on 14 May 2020).
- Pinto, R.M.; Spector, A.Y.; Rahman, R. Nurturing Practitioner-Researcher Partnerships to Improve Adoption and Delivery of Research-Based Social and Public Health Services Worldwide. Int. J. Environ. Res. Public Health 2019, 16, 862. [Google Scholar] [CrossRef] [PubMed]
- Mitchell, F.; Lunt, N.; Shaw, I. Practitioner research in social work: A knowledge review. Evid. Policy 2010, 6, 7–31. [Google Scholar] [CrossRef]
- Ripple, W.J.; Wolf, C.; Gregg, J.W.; Rockström, J.; Mann, M.E.; Oreskes, N.; Lenton, T.M.; Rahmstorf, S.; Newsome, T.M.; Xu, C.; et al. The 2024 state of the climate report: Perilous times on planet Earth. BioScience 2024, 74, 812–824. [Google Scholar] [CrossRef]
Sample | T Score Before | T Score After | Percentage Change |
---|---|---|---|
Male/Age 12 | 68 | 50 | 26% |
Male/Age 11 | 71 | 54 | 24% |
Male/Age 11 | 61 | 51 | 16% |
Male/Age 10 | 37 | 31 | 16% |
Male/Age 13 | 64 | 57 | 11% |
Male/Age 11 | 77 | 70 | 9% |
Male/Age 11 | 64 | 64 | 0% |
Male/Age 13 | 54 | >80 | −48% |
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Westwood, S.; Edmunds-Jones, G.; Maguire, T.; Hawley, S.; Avent, H.; Griffiths, J.; Bates, R.; Marley, J.; Wallace, G.; Harrell, R.; et al. Pilot Testing an Ecotherapy Program for Adolescence: Initial Findings and Methodological Reflections. Int. J. Environ. Res. Public Health 2025, 22, 720. https://doi.org/10.3390/ijerph22050720
Westwood S, Edmunds-Jones G, Maguire T, Hawley S, Avent H, Griffiths J, Bates R, Marley J, Wallace G, Harrell R, et al. Pilot Testing an Ecotherapy Program for Adolescence: Initial Findings and Methodological Reflections. International Journal of Environmental Research and Public Health. 2025; 22(5):720. https://doi.org/10.3390/ijerph22050720
Chicago/Turabian StyleWestwood, Sophie, Grace Edmunds-Jones, Thomas Maguire, Sue Hawley, Hannah Avent, Jerry Griffiths, Rishi Bates, Jane Marley, Gary Wallace, Ruth Harrell, and et al. 2025. "Pilot Testing an Ecotherapy Program for Adolescence: Initial Findings and Methodological Reflections" International Journal of Environmental Research and Public Health 22, no. 5: 720. https://doi.org/10.3390/ijerph22050720
APA StyleWestwood, S., Edmunds-Jones, G., Maguire, T., Hawley, S., Avent, H., Griffiths, J., Bates, R., Marley, J., Wallace, G., Harrell, R., Asthana, S., & Gradinger, F. (2025). Pilot Testing an Ecotherapy Program for Adolescence: Initial Findings and Methodological Reflections. International Journal of Environmental Research and Public Health, 22(5), 720. https://doi.org/10.3390/ijerph22050720