Eight learnings from running nature-based therapy for children with anxiety  

A blog by Mark O’Connell, Ed Balls, Mairead Murphy 

The Apricot Centre, in the scenic village of Dartington, South Devon, is a combined organic farm and Ofsted registered Adoption Support Service, specialising in supporting young people with attachment issues and developmental trauma. 

Here Apricot Centre Director, Mark O’Connell, Apricot Centre Associate Trainee Clinical Psychologist and project Evaluation Lead, Ed Balls, and Health Innovation South West Evaluation Lead, Mairead Murphy, reflect on the eight things they learnt from delivering and evaluating therapy-based work in green spaces for children and young people attending non-mainstream school to improve their mental health. 

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There is a strong evidence base that both exposure to nature and positive sensory experiences can improve mental health. The Apricot Centre wellbeing service delivers therapeutic support using nature and food as a ‘second therapist’. The farm setting provides an opportunity for young people to interact with the natural world and to engage their senses in harvesting and preparing food from its source. 

In 2022, the innovative community-based organisation was funded by Health Innovation South West as part of its Children and Young People’s Mental Health Equity Programme to hold nature-based workshops for children from an Alternative Education Provision unit in Torquay, to help reduce their anxiety.  

This project involved four cohorts of up to five children, aged seven to thirteen, with five sessions in each programme. These took place at the Apricot Centre between January and the end of March 2023. Two programmes focused on Sensory Integration in Nature and the other two on Food and Mood.  

Here are eight things we learned from this project. 

1. A Nature-based approach can reduce anxiety 

“I liked best being able to go outside and be in the fresh air”. (Child) 

We tested the levels of anxiety in the children at the beginning and the end of the workshops and found that their anxiety reduced on average. Being in nature, a stimulating environment, was important in making this happen. The children loved being among birds, trees and wildlife and smelling and tasting new things. They also valued making friends and learning new skills. Teachers commented that the children were more resilient. 

2. Skilled practitioners are needed 

“What I found helpful was when the adults [practitioners] could help me when I got anxious, and I could tell them” (Child) 

80% of the children had high to very high levels of behavioural, emotional, hyperactivity and peer problems disorder (the highest 10% of the population). These children needed limits and boundaries as well as respect. This requires expert practitioners are who capable of working flexibly and with sensitivity. Practitioners also needed to be “streetwise” to respond to challenging behaviours without polarising or amplifying them. They needed to communicate effectively and develop a good connection early on with the children. 

3. Children need choice, agency and freedom 

“I liked being away from staff a bit, like I could hide from them and take space”. (Child) 

Children wanted sessions that felt different to school. One way of doing this was to involve the children in choosing activities. For example, some children did not want to engage with an early task of building a shelter. When the task was reframed into different choices of activity each child chose a task willingly. Children also wanted some free time “just wanting to go off and explore and not be watched all the time” (although they were supervised from a distance).  They loved balanced risk – playing with spears, fire, sticks and chopping firewood.  

4. Children also need some structure 

“He is desperate to get involved, just doesn’t quite know how”. (Parent) 

As well as freedom and agency, the children needed structure and support. One of the reasons the children did not want to build the shelter initially is that it felt too difficult, and it was raining. Their baseline anxiety made it difficult to cope with big tasks. It felt more manageable and fun when broken down into structured sub-tasks they could choose from (erecting a rain cover, taking a break with a hot drink, building a fire to keep warm, building elements of the shelter, chopping wood.)   

5. The relationship with the school is vital 

“It was really helpful learning about how some students may push and pull against things. We see this at school a lot. We learnt this may be a way of regulating emotions.” (Teacher) 

The relationship with the school was important. Firstly, the teachers needed to communicate in advance about children’s needs and triggers. Secondly, we needed their support on site to help de-escalate any difficult situations. Lastly, seeing their teachers on-site, also enjoying the sessions, helped the children have a more positive attitude to them. The sessions have provided a common thread between teachers and pupils and have helped the teacher/pupil relationship back in school. 

6. Trust is essential and takes time to build 

“I was worried because it was out of my comfort zones – coming to a new place. Coming for the first session was the most difficult bit – but it has got easier each week” (Child) 

Establishing trust is the foundation for being able to work with the children and move them forwards. It took time to build enough trust for the children to fully engage. Most students didn’t want to participate right away, and some were reluctant to come initially. They were anxious about trying new foods and reluctant to do different things. This changed when the children were allowed to come to the activities in their own time. 

7. Things will go wrong, and that’s all right 

“I realised that I need to step back a bit more and allow him to make his own mistakes”. (Parent) 

Even after trust had been built, there were often moments when the engagement would break down. One child became angry and threatened to throw something, another child became stressed and tried to leave the site, and one autistic child had a meltdown. Not only was this OK, but it was also a necessary part of the process. When the child with autism calmed down, he was anxious about lost friends, but the group worked together to restore the friendship.  This process helped to model healthy relationships and shows the children that things can go wrong and can be repaired. 

8. Need to focus on problems with the system, not the child 

“We need to reframe our thinking away from problems with a child and towards how to learn as a system together to best support a child.” (Mark O’Connell)  

Perhaps the most important thing we learned was that our workshops were not all about ‘fixing’ the children. Responding to each challenging moment as a ‘behavioural problem’ which needs to be stopped can often do the opposite and cause a situation to escalate. Practitioners need to ‘tune in’ to the child, to try to understand their position and respond to the changing situation. We must recognise that children operate within a wider system which includes the parent, peers and school, and any problems they face are not individual problems but systemic. For example, some parents can find it difficult to build positive relationships with the school. This affects the child too. 

What we are doing with this learning 

The Apricot Centre has reflected on these learnings to develop the vision for the programme in partnership with the alternative education provider. In line with what we have learnt, the partnership wants to develop the programme as a whole-school, whole-community approach, focusing on the parents and the school, as well as the child. It will aim to build relationships across the system and enable better interactions between staff, parents, school, to the benefit of all involved. Health Innovation South West will continue to support the Apricot Centre in this partnership. 

It is clear that a nature-based model of therapy, like that delivered by the Apricot Centre, shows potential for improving mental health for young people experiencing some of the biggest disadvantages and health inequities. It is also clear from our eight learnings that therapy-based work in green spaces for children and young people needs careful implementation. Services or systems implementing similar models might like to consider these eight learnings in their design to maximise the benefit for some our most vulnerable children and young people. 

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These learnings come from an evaluation of the Apricot Centre, coordinated as part of Health Innovation South West’s Children and Young People’s Mental Health Programme and Health Equity Challenge Fund 2022, which funded six South West-based innovators with solutions to closing equity gaps in children and young people’s mental health to gain real-world evaluation support to generate the evidence needed to bring their innovation to market. The project was delivered by the Apricot Centre and supported by the Health Innovation South West Evaluation and Learning Team. The blog is focused on children from a non-mainstream school, but adopted children in Devon were also part of the project, in collaboration with Devon County Council.  

Our Children and Young People’s Mental Health Programme has now closed but Health Innovation South West is committed to promoting and enabling quality care for mental health for people of all ages living across the South West. We are working with the three Integrated Care Systems for Devon, Somerset, Cornwall and the Isles of Scilly, our university and National Institute for Health & Care Research partners, in a new partnership to increase the impact of research and innovation in mental health, among other areas, in our region.  Learn more about our work via our website and in our latest Annual Review 2022-23. 

Health Innovation South West has specialist expertise in planning, supporting and delivering evaluations of healthcare innovations and innovative practice. If you have an evaluation project in mind that you are looking to progress or you are interested in arranging bespoke training for your organisation, please contact Health Innovation South West Evaluation Director, Lynnette Chapman. 

The Apricot Centre Wellness Centre offers a range of different therapeutic support and therapeutic mentoring for children, young people and families funded and referred to us by local authority adoption support services, children’s services and education teams. The Apricot Centre love working collaboratively with schools on children’s wellbeing. If you are an organisation seeking more information or would like to make a referral, contact [email protected].