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July 19, 2017

The latest prescription for children: Go play outside

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In a new initiative, CHOP Primary Care is teaming up with several outdoor education and recreation organizations to take an innovative approach to boosting children's physical activity: "prescription-strength outdoor play," Samantha Melamed writes for the Philadelphia Inquirer.

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Prescribing the great outdoors

CHOP, the Schuylkill Center for Environmental Education, Philadelphia Parks & Recreation Department, and the National Forest Service are launching the new initiative, called NaturePHL, in August.

According to Melamed, the initiative will be piloted at CHOP's primary care offices in Cobbs Creek and Roxborough—both in Pennsylvania—where providers will begin including NaturePHL in all regular checkups for patients ages 5 to 12. As part of the program, the physician will screen each child, talk to the child and his or her caregivers about the importance of outdoor play, and refer them to a new website called

According to Chris Renjilian, a physician at CHOP, the website serves as a guide to parks in the area—a crucial aspect of the program because many doctors do not live in the same neighborhood as their patients, creating a knowledge gap when it comes to local areas for outdoor play. The website includes filters so users can search for sites such as playgrounds, swimming pools, bathrooms, and wheelchair-accessible areas, Melamed reports. Schuylkill Center also plans to add a safety feature to the website, conducting "park audits" and posting pictures and reviews to a given park's page on

If the patient has certain conditions, such as obesity or attention-deficit disorder, the physician will provide more counseling, order a "detailed park prescription" for outdoor movement—such as a hike or scavenger hunt—and refer the patient to a "nature navigator." The navigator, a community health worker, will collaborate with providers on the park prescriptions, help patients overcome obstacles to outdoor activity, and accompany the patient on a park visit.

Renjilian said, "As primary care pediatricians, one of our goals is to help children get more active. The American Academy of Pediatrics recommends 60 minutes a day of outside play." He added, "This is something we already spend a lot of time screening for and talking to families about."

The most comprehensive program yet

According to Melamed, providers and outdoor recreation groups in Washington D.C. and other cities around the country have launched similar programs, with the D.C. program reporting an average boost of 22 minutes in outdoor activity levels each week among participants, the National Park Service said.

But NaturePHL wants to go a step further. The organizers are launching what Melamed calls the "most comprehensive study yet of whether such programs work and how best to undertake them." Specifically, researchers want to determine whether the program encourages physicians to discuss outdoor play more often with pediatric patients, whether patients in the program spend more time outdoors, and how the program affects participants' health and wellness, if at all.

As Michelle Kondo, a scientist at the National Forest Service, put it, "There really isn't any research out on parks-prescription programs, their effectiveness and their impact on health. ... We're still figuring out what's important to measure and what you can quantify."

While Renjilian said it may be challenging to work these conversations into a visit, it's important. "We're the ones who are going to have to do this. This has to be practical," he said. "But for kids with obesity, other than telling them to go outside, there was nothing to give them. Now we have NaturePHL" (Melamed, Philadelphia Inquirer, 7/11).

Review the major trends in pediatric behavioral health

The CDC estimates that nearly $247 billion is spent annually on the treatment and management of childhood mental disorders. Further, pediatric patients and caregivers often struggle to access high-quality behavioral health expertise due to a limited number of specialists and fragmented approaches to behavioral health services.

Given the growing costs and increasing difficulty in obtaining care, coordinated models of behavioral health can address the dire need for distributed pediatric behavioral health expertise.

In this webconference, we'll review the case for improving coordination between behavioral health and pediatrics, and describe four successful models that increase access to behavioral health care.

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