Recommendation 1:
Increase the amount of vegetation in and around residential settings

To examine whether vegetation near the residential environment might buffer or moderate the impact of stressful life events on children’s psychological well-being, data were collected from 337 rural children in the U.S. Results showed that the impact of life stress was lower among children with high levels of nearby nature than among those with little nearby nature.
Wells & Evans, 2003. Nearby nature: A buffer of life stress among rural children.
Access Study

Another study involving 172 urban children in Spain found that more access to natural areas, as well as more perceived nearby nature, can lower children’s stress levels and bolster their resilience in dealing with stress. This research indicates that nearby nature can moderate the negative effect produced by stressful events.
Corraliza, Collado & Bethelmy, 2012. Nature as a moderator of stress in urban children. 
Access Study

Recommendation 2: Increase greenness on school grounds

This study examined positive youth development outcomes of renovated, green schoolyards for K-8 students in low-income urban areas in Chicago, Illinois. Results suggest that greening school grounds may contribute to enhanced physical activity and prosocial behavior, maintained over time, among underserved children. Ensuring that more schoolyards incorporate green spaces may be particularly important in urbanizing settings, where the distribution of green space is not equitable.
Bates, Bohnert & Gerstein, 2018. Green schoolyards in low-income urban neighborhoods: Natural spaces for positive youth development outcomes. 
Access Study

Recommendation 3:
Expand the allowable places where children are permitted to play, such as ditches, vacant lots, water areas and woodlands

Children from India, Nepal, Japan and Thailand found ways to play after experiencing natural disasters and everyday crises. Their places for play often included elements of nature. This research – while suggesting that children tend to look to nature when faced with crisis in their lives – also “illustrates children’s adaptive capacity to manage risks in high-risk, unsafe environments… first as a coping mechanism and over time as a process of building resilience.”
Chatterjee, 2018. Children’s coping, adaptation and resilience through play in situations of crisis.
Access Study

Recommendation 4:
Add elements of nature to pediatric health care facilities

Child life specialists in the U.S. rated photographs of hospital playrooms in relation to the rooms’ ability to support child life goals, including the goal of helping children cope with the stressors of hospitalization. Rooms with biophilic elements (elements that appeal to humans’ inherent affinity for nature), appealing color and décor, and open space received the highest ratings.
Weinberger et al., 2017. Child life specialists’ evaluation of hospital playroom design: A mixed method inquiry.
Access Study

A review of studies from multiple countries focused on ways in which the built environment of pediatric health care settings could promote the healing and well-being of children. The feature most frequently mentioned as being “highly beneficial” in children’s healthcare was garden/green spaces. Overall results indicate that having direct or even indirect access to nature can reduce pain and stress, enhance social functioning and promote an increased sense of control.
Gaminiesfahani, Lozanovska & Tucker, 2020. A scoping review of the impact on children of the built environment design characteristics of healing spaces.
Access Study

Recommendation 1: Use nature-based interventions to improve outcomes for vulnerable youth

This review, based on studies from multiple countries, focused on both the therapeutic and protective potential of nature for young children with ACEs. Overall findings indicate that children experiencing the negative impact of adversity can benefit from therapeutic nature-based interventions. Intervening before the appearance of psychopathologies, however, could potentially counter the effects of ACEs altogether.
Touloumakos & Barrable, 2020. Adverse childhood experiences: The protective and therapeutic potential of nature. 
Access Study

This scoping review highlights the value of four nature-based interventions (wilderness therapy, animal-assisted therapy, care farming and horticultural-based interventions) for vulnerable youth. Across studies, there were a range of positive psychological, behavioral, and social outcomes for nature-based interventions that were maintained post-treatment.
Overbey, Diekmann & Lekies, 2023. Nature-based interventions for vulnerable youth: a scoping review.
Access Study

Thirty-six children with behavioral, emotional and social difficulties (BESD) in the U.K. participated in a study of the effectiveness of garden-based activities in promoting mental health and well-being. A “Five Ways to Wellbeing” approach framed both the intervention and the evaluation. Findings suggest that this approach may be effective in fostering the mental and emotional well-being of children with BESD.
Chiumento et al., 2018. A haven of green space: Learning from a pilot pre-post evaluation of a school-based social and therapeutic horticulture intervention with children.
Access Study

Two schools in England participated in a study investigating the impact of a Forest School intervention for children with extreme anxiety and/or social, emotional and behavioral difficulties. Results showed that the forest school approach – which included a learner-led pedagogy – allowed individual children to take what they needed from the experience.
Tiplady & Menter, 2020. Forest School for wellbeing: An environment in which young people can ‘take what they need.’
Access Study

Recommendation 2:
Integrate nature into physical and mental health care programming

This longitudinal study of a park prescription program for low-income families in the U.S. found that for every increase in weekly park visits by the family there was a significant increase in children’s resilience. As resilience scores increased, child stress scores decreased, providing some indication that childhood stress partially mediates the relationship between park visits and resilience.
Razani et al., 2019. Clinic and park partnerships for childhood resilience: A prospective study of park prescriptions.
Access Study

This paper discusses the integration of natural items in the playroom during play-based counseling with young children. An evidence-based rationale for such integration is offered, along with a presentation of a case illustration from the U.S. and some recommendations for practice and research. Results of the case study indicate that nature-based play therapy can promote children’s social and emotional development.
Swank, Walker & Shin, 2020. Indoor nature-based play therapy: Taking the natural world inside the playroom.
Access Study

An experimental study in the U.S. compared school-based behaviors of children participating in a nature-based therapy program with children on a waitlist. Assessments conducted before, during and after the program provide initial support for using nature-based therapy with early elementary school children exhibiting behavioral problems. Counseling sessions for this study were conducted outdoors. Results indicate that nature-based play therapy may increase on-task behaviors and decrease behavior problems.
Swank et al., 2017. Initial investigation of nature-based, child-centered play therapy: A single-case design.
Access Study

This study gathered perspectives from 87 staff at a residential treatment facility to better understand how nature-based interventions are used and applied, and how they felt that youth with developmental disorders were impacted by such interventions. Overall, the nature-based interventions were beneficial and provided opportunities to learn self-regulation, delayed gratification and appropriate emotional responses. However, more research is recommended to understand the qualities of nature-based intervention and how they might be used by health professionals.
Gandenberger et al., 2022. Staff perspectives on the targeted incorporation of nature-based interventions for children and youth at a residential treatment facility.
Access Study

Recommendation 3: Provide increased opportunities for children to engage with animals and plants

Feedback from teachers and students involved in the care of hens at a Dublin (Ireland) elementary school indicated that the animal-care experience helped children (who were from an area of high socio-economic marginalization and who experienced a range of socio-emotional and educational needs) make gains in responsibility, empathy, respect for the natural world, cooperation, relaxation, improvement in motivation and peer-assisted learning processes.
Gilligan & Downes, 2021. Reconfiguring relational space: A qualitative study of the benefits of caring for hens for the socio-emotional development of 5 – 9-year-old children in an urban junior school context of high socioeconomic exclusion.
Access Study

Recommendation 4:
Combine nature and art to promote mental health and well-being

Artist pedagogues in the U.K. shared information about how the nature-based art activities they conducted with children from low socioeconomic homes might be used to promote children’s agency and confidence, while providing inspiration to support creativity. This study suggests that nature-based art activities might play an important role in the prevention and treatment of mental health concerns such as depression and anxiety, which tend to be more prevalent in children living in poverty.
Walshe, Lee & Smith, 2020. Supporting children’s well-being with art in nature: Artist pedagogue perceptions.
Access Study

Recommendation 5:
Increase the cultural relevance of nature-based programming

An investigation into the perspectives of Canadian Yellowknives Dene First Nation youth on health and health issues within their community revealed that activities promoting a connection to the land were a priority. The youth also identified community gatherings, gardens, the involvement of Elders, and other culturally-related activities as health-promoting elements for their community.
Lines, Yellowknives Dene First Nation Wellness Division & Jardine, 2019. Connection to the land as a youth-identified social determinant of Indigenous Peoples’ health.
Access Study