Date Presented 04/05/19
Outdoor play has physical, cognitive, and social emotional benefits and has a direct positive influence on children’s development. It also provides a rich possibility for use in pediatric OT intervention. The results of this mixed-methods survey describe how OTs are using outdoor play in their practices and explore the barriers and affordances for using outdoor play in OT sessions.
Primary Author and Speaker: Kimberly Wilkinson
Additional Authors and Speakers: Julia Rossi, Louise Scott-Cole, Raleigh Silvia, Sarah King
Contributing Authors: Claire Allman, Alexis Kennedy, Jamie Langan, Stephanie Lasnicki, Alison Miller, Katarina Schutt, Hannah Wilcox
PURPOSE: Pediatric occupational therapists emphasize that play is a fundamental and important occupation for children (AOTA, 2008). Recent literature has noted a decrease in the amount of time children spend in outdoor and unstructured play (Tremblay et al., 2015). Outdoor play has physical, cognitive, and social emotional benefits and has a direct positive influence on children’s development (Hanscom, 2016; Louv 2005). As such, play outside provides a rich possibility for use in pediatric OT intervention yet the OT literature related to outdoor play is extremely limited. The purpose of this study is to establish a better understanding of whether and how pediatric OT practitioners think about and use outdoor play during therapy sessions.
METHOD: This study consisted of a mixed-methods descriptive survey. Questions were developed based on the available literature and expert opinion and a link for the survey was distributed through Facebook groups and email contacts targeting pediatric OT’s and OTA’s. Quantitative data was analyzed using descriptive statistics and correlations. Qualitative responses were analyzed for themes and used to add richness to the interpretation of the quantitative data. Participants: 180 people responded to the survey. Participants averaged 8.72 years of experience, with a range from 4 months to 38 years. 88% of participants worked in the US. The six most frequent responses for populations worked with were developmental disabilities, autism, sensory integration difficulties, behavioral problems, neurological impairments, and physical disabilities. Settings that participants worked in included outpatient, school based, early intervention, preschool, and community-based OT.
RESULTS: When asked if they had any continuing education related to play 48% of participants responded yes. The top four listed types of continuing education related to play included training in sensory integration, DIR/Floortime, Therapeutic Listening, and Neuro-Developmental Treatment. 43% of respondents indicated that they never or rarely utilize outdoor play in their practice compared to the 41% who reported sometimes using it, 13% using it very often and 3% who always used it. The top responses for why therapists were using outdoor play were: “To provide an opportunity for children to be outdoors,” “To meet strength based/motor goals,” “To work on sensory based goals,” and “To address the child's occupational performance in the natural environment.” Years of experience and likelihood to use outdoor play in practice were fairly correlated (r=.31) and significant differences were found in mean years of experience between those reporting that they rarely/never, sometimes, or often/always use outdoor play in their practice. Qualitative results found that the majority of pediatric OT’s in the sample perceived outdoor play as having a wide array of benefits for children but they felt limited by barriers to outdoor play such as weather, time restrictions, space restrictions, and a habit of remaining indoors.
CONCLUSION: Evidence for the benefits of outdoor play for all children’s development is strong and OT's value the potential for working on motor and sensory skills outdoors but many practitioners are not using this type of play in their practice. Discussion of the limiting factors and continuing education opportunities related to using outdoor play may be beneficial for therapists across practice settings.
IMPACT STATEMENT: This study provides data on current practice trends and describes barriers and affordances for using outdoor play in occupational therapy sessions. Better understanding of this can help practitioners to problem solve ways to get more children outdoors and take advantage of the powerful benefits of outdoor play.
References
American Occupational Therapy Association. (2008). Societal statement on play. American Journal of Occupational Therapy, 62(6), 707-708. doi: 10.5014/ajot.62.6.707.
Tremblay, M. S., Gray, C., Babcock, S., Barnes, J., Bradstreet, C. C., Carr, D., Chabot, G., ... Brussoni, M. (2015). Position statement on active outdoor play. International Journal of Environmental Research and Public Health, 12(6), 6475-6505. doi: 10.3390/ijerph120606475
Hanscom, A. (2016). Balanced and barefoot: How unrestricted outdoor play makes for strong, confident, and capable children. Oakland, CA: New Harbinger Publications
Louv, R. (2005). Last child in the woods: Saving our children from nature-deficit disorder. Chapel Hill, NC: Algonquin Books of Chapel Hill.
