In the past five to ten years, there has been increasing research of the healing, social, and therapeutic benefits that plants impart to human life. With all of the resultant new information, people have become confused by the many facets of people-plant interactions, including the meaning of horticultural therapy. Much of this mismatching and misunderstanding has occurred at the university level as horticulture faculty members, well-versed in crop production and basic science, have begun to try to understand and share with students the value of horticultural commodities to the consumer. Horticultural therapy frequently is used as the catch-all phrase applied to anytime anyone gardens and feels better, acts better, or gets better under any conditions. In some situations, it has been the term of choice to apply to children's gardening, home food production in developing countries, and hobby gardening practiced by individuals with a disability. The restorative value of views of plants and nature also have been lumped into horticultural therapy, as has the social value of community gardening. Although horticultural therapy is a very important aspect of human interaction with plants, and is a rapidly growing profession, there are many other areas of people-plant interaction of equal importance to understanding the role of horticulture in addressing special populations.
It is the purpose of this special issue of HortTechnology to explore some of the different elements of people-plant interaction, such as healing, social, and therapeutic aspects, that address individuals with special needs, as well as to discuss horticultural therapy in-depth, and to provide the reader with resources to develop teaching, research, and extension programs for these individuals.
It will be helpful to first define the term "individual with special needs." This term refers to
persons who might benefit from participation in horticultural activities or from viewing plants and landscapes, but who requires special adaptations or modifications for this to occur. These special adaptations may be required because of physical, mental, or social (including economic) limitations that prohibit the individual from acting on his/her own without assistance.
To understand the application of horticulture to individuals with special needs, the discussion is divided into the following topics:|
Enabling or Accessible Gardens - Both public and private gardens can be made significantly more useful to individuals with disabilities. This involves not only more appropriate designs, but also incorporation of tools, techniques, and plant material selected to enhance gardening for the more than 55 million Americans with disabilities. The Americans with Disabilities Act mandates that public gardens become accessible to those with disabilities.
Children's and School Gardening - Whether or not a child has a physical or mental disability, involvement with plants has become a very limited experience for most of America's youth. Many arboreta and botanic gardens, Cooperative Extension, and other agencies and non-profit groups are beginning to address this population with its unique needs. Children with special needs, including youth-at-risk, have been targeted to participate in gardening programs.
Healing Landscapes - In the design of landscapes for hospitals, nursing homes, and hospices, the presence of plants is considered to be the healing element rather than part of a treatment program in which active participation with plant culture is integral to the therapy. These landscapes may be designed cooperatively with a horticultural therapist to serve the dual purpose of a healing landscape for some clients and a horticultural therapy garden for others. This field is becoming an increasingly recognized element in landscape design.
Garden/Plant Therapy - Garden clubs, Cooperative Extension Master Gardeners, and other volunteer groups have long been involved in bringing gardening to individuals who otherwise would not have such an opportunity. As volunteer-based activities, garden therapy programs frequently are not part of the treatment processes per se, but are valuable additions when
conducted cooperatively with professional staff.
Horticultural Therapy (HT) - The profession of horticultural therapy is one of the treatment modalities (including art therapy, music therapy, and recreational therapy) that form the
adjunctive therapy treatment approach. Horticultural therapy programs are found in psychiatric hospitals, physical rehabilitation facilities, educational centers for individuals with intellectual impairments, and similar treatment facilities. Professional horticultural therapists also work in vocational training programs, sheltered workshops, and prisons. In addition, arboreta and botanic gardens are employing Registered Horticultural Therapists to conduct educational outreach programs for professionals and clients in treatment facilities in their communities.
Human Issues in Horticulture (HIH) - HIH looks at the influences of plants on people in all aspects of their lives, regardless of special needs of the individuals. Other terms used to refer to this broad concept include socio-horticulture, people-plant interaction (PPI), and human dimensions in horticulture. HIH includes all of the above areas of concern, plus economic and marketing issues; physical and environmental amelioration by plants; food and nutrition; ethnobotany considerations as they apply to horticulture; and the role of horticulture in art, music, drama, and philosophy, as well as other issues.
Enabling or Accessible Gardens
Millions of individuals with disabilities garden or would garden if given greater accessibility to
tools and techniques that would facilitate this hobby. The fact that a person has a disability and
participates in horticulture should not be taken to mean that they are involved in horticultural
therapy. Having a disability does not require that all future daily life activities be considered
therapy. Once persons have completed rehabilitation or therapy treatment, the term is no longer
applied to their activities. In recent years, numerous books (see side bar A; Cloet and Underhill, 1990; Please, 1990; Yeomans, 1992; Adil, 1994; Rothert, 1994) and articles (Beems, 1985; Neace,1985; Bubel, 1990; Relf, 1994) have been published, targeted to gardeners with disabilities. With our rapidly aging population, this will be a growing area of concern. The horticulture industry is beginning to recognize the potential of this market, thus a few relevant articles have appeared in trade publications (Fuller, 1993; Saunders, 1994).
Several arboreta and botanic gardens (see side bar B) have demonstration gardens that assist individuals with disabilities in developing home gardens. In addition, many arboreta and botanic gardens, recognizing the need to include disabled, elderly, and disadvantaged individuals in their programs and addressing the requirements of the Americans with Disabilities Act, are making buildings, grounds, and display areas accessible, and expanding the scope of their existing educational programs to make them of interest and value to special populations.
The Friends of Horticultural Therapy, a support organization of the American Horticultural
Therapy Association (AHTA), has as one of its areas of concern making gardening more
accessible to everyone. They promote horticultural therapy by publicly advocating and providing
information about making the garden more accessible to disabled individuals.
The children's gardening movement has gained significant momentum in recent years (see
side bar C) through such efforts as the National Gardening Association's Grow Lab educational program. Their school gardening grants, consisting of tools, seeds, and garden products valued at an average of $500, are available to 300 programs nationwide. The American Horticultural Society has sponsored national conferences targeting school gardening. There are other outstanding national programs for integrating gardening into the elementary school curriculum, including Life Lab (sponsored by the National Science Foundation), and small businesses, such as Gardens for Growing People, dedicated to supplying children's gardening resources. A plant selection guide for children's environments (Moore, 1989) expands the concepts of how plants are used in the landscape. The People-Plant Council has an extensive list of books related to gardening and children available by sending a pre-addressed, stamped envelope to PPC, Office of Consumer Horticulture, 407 Saunders Hall, Virginia Tech, Blacksburg, VA 24061-0327.
A number of horticulture industry groups, businesses, and botanic gardens have been involved in
supporting children's gardening. In addition, Cooperative Extension has taken a leadership role in
this area, both in 4-H programs (Whittlesey, Curtis, and Laine, 1991) and through Master
Gardener efforts, such as the Virginia Beach 4-H Urban Gardening Project entitled Ready Set
Grow (Virginia Cooperative Extension, 1990).
Although the broad concept of children's gardening does not fall under the horticultural therapy
umbrella, there are horticultural therapy programs that specifically address children in hospitals
and other treatment settings (Kavanagh and Chambers, 1995). In addition, children's gardening
programs from arboreta and botanic gardens may include horticultural therapy in treatment
facilities or simply accessible gardening for disabled youth (Morgan, 1989; Moore, 1989).
Community Gardening and Urban Greening
Community gardens are particularly important to the elderly, disabled, and disadvantaged
individuals in urban areas. Most often, the community garden is developed under the leadership
of a group, such as the Pennsylvania Horticulture Society (Bonham, 1988, 1991), the Chicago
Botanic Garden (Brogden, 1991), or other not-for-profit associations (Carrier, 1985) interested in
horticulture and using it to improve the quality of life and the appearance of the community.
These gardens are located near the people who need them and are run by the people of the
community (Dotter, 1994; Keller, 1994; and Mattson et al, 1994). The Cooperative Extension
Service of the U.S.D.A. has been influential in establishing community gardens in order to
improve the nutrition of the people gardening, to develop leadership skills among these people,
and to help them improve their communities in many other ways (Patel, 1991). Other
organizations, such as the American Community Gardening Association, have resources available
for assistance in establishing community gardens.
The concept of designing landscapes at hospitals, hospices, and similar sites for their healing
qualities rather than merely to cover the grounds is gaining prominence as a result of the work of
Ulrich (1984) and the Kaplans (1989) which provide much of the theoretical basis for this
movement. Francis et al (1994, 1994) has drawn together proponents of this concept for an
exchange of ideas that has led to two sets of proceedings. The January 1995 issue of Landscape
Architecture Magazine (4401 Connecticut Avenue NW, 5th floor, Washington, DC 20008-2302;
tel: 800-787-LAMS) provides an overview of the current state of the art, as landscape architects
continue to explore both healing landscapes and therapeutic garden design for horticultural
therapy (Dannenmaier, 1995; McCormick, 1995; Stevens, 1995a, 1995b; Leccese, 1995; Sutro,
1995; Warner, 1995; Kavanagh and Musiak, 1993). The uniqueness of landscape design for
nursing homes and other housing facilities for elderly and disabled persons is becoming
internationally recognized (Stoneham and Thoday, 1994).
Volunteers have been essential in conducting horticultural therapy programs and historically
volunteers have started many programs that went on to become part of the professional
adjunctive therapies. Alice Burlingame (1974; Watson and Burlingame, 1960), a leader in the field
of volunteering in HT, helped volunteers work with occupational therapists, physical therapists,
and other professionals who were not familiar with plants but could see the potential benefits to
their clients and wanted to add this tool to their therapeutic activities. Garden clubs traditionally
have held garden therapy as one of their major areas of interest, such as Gardening from the
Heart, a program of the Gardeners of America, Inc. (formerly the Men's Garden Clubs of
America, Inc.). It is their "mission to extend, as well as advise, current and additional clubs in the
formation of a horticulture therapy partnership, extending gardening to youth or adults who are
disadvantaged, handicapped, retarded or mentally ill, as well as to residential elderly, including
veterans" (Gardeners of America/Men's Garden Clubs of America, Inc., c.1990).
One of the most important new contributors to volunteering in HT is the Cooperative Extension
Master Gardeners (Flagler, 1992; Patel, 1991) The contribution of volunteers is so important that
AHTA has a national award for outstanding volunteer efforts.
Horticultural Therapy as a Profession
In order to conduct research, teach courses, or design and implement HT programs, it is
important to understand the basic framework and definition of HT, thus sharing a common term
for communication. This is made difficult by the fact that the term is used to mean a range of
topics, as discussed above. At one end of the range, HT is used to mean any gardening activity
that helps anyone in any way. Some people like to use the expression, "If it's horticulture, it's
therapy." However, this approach implies that to receive horticultural therapy, all you need to
do is plant a seed; and that to be a horticultural therapist, all you need to do is tell someone to
plant a seed. This is far from the truth. Although horticulture is good preventative medicine to
help overcome the stress and frustrations of daily life, it is an oversimplification to call any use
of horticulture, horticultural therapy; just as going for a walk is not the same as physical therapy.
The term also is used to talk about community gardening, flower planting and beautification, or
vegetables raised by a school child who also happens to have a disability. All of these are
oversimplifications and make it difficult to truly understand the nature of HT, why it works, and
how to implement it. The remainder of this article is intended to provide the reader with a
framework for thinking about HT and developing an understanding of it.
Who Conducts HT Programs
Three groups of individuals are involved in implementing horticultural therapy programs:
Professional horticultural therapists who are employed to conduct programs that focus exclusively on horticulture as the treatment method. Horticultural therapists can receive training at several universities and can be registered with AHTA (see article in this issue by Stephen Davis).
Allied professionals, including occupational therapists, physical therapists, recreation therapists, etc., who use horticulture as one of the many tools or techniques for treatment of a patient.
Volunteers, including members of garden clubs and Cooperative Extension Master Gardeners, who are knowledgeable about horticulture and wish to help others. Volunteers generally are limited in the amount of time that they contribute to a program (two to four
hours per week) and the degree of responsibility that they have (usually assisting a
professional). However, there are volunteers who work 20 or more hours a week and take
most of the responsibility for the program. There is no set system for this, and it depends
on the facility, the program, and the volunteer.
Defining Horticultural Therapy
In defining HT as a profession, it is useful to look at the definitions of allied professions, such as
physical therapy (PT) and occupational therapy (OT), that use a medical model in their approaches
to treatment and receive their salaries based primarily on payments for services from insurance
companies, employee health programs, and Medicare/Medicaid. It is to be acknowledged that these
professional areas used as models for the development of horticultural therapy are well-established
fields recognized by the medical community as integral to treatment, having been in existence for
close to 100 years. As HT is approximately 20 years old as a profession recognized by university
training, a professional association, and certification, it is still very new and not readily
acknowledged among the medical community, particularly insurance companies that must pay for
professional services. Often, the horticultural therapist at a facility will be hired under the auspices
of the OT department to ensure the payment for services. Horticultural therapists occasionally are
employed as activity directors or as recreation therapists when facility budgets do not have the
flexibility to include this newer, more specialized treatment area.
Based on material supplied by the American Physical Therapy Association, PT services include
identification, prevention, remediation, and rehabilitation of acute or prolonged physical
dysfunction or pain, with emphasis on movement dysfunction. PT services staff monitor the extent
to which services have met the therapeutic goals relative to initial and all subsequent examinations,
as well as the degree to which improvement occurs relative to the identified physical dysfunction or
the degree to which pain associated with movement is reduced.
As defined by the American Occupational Therapy Association, registered occupational therapists
and certified OT assistants provide services to people whose lives have been disrupted by physical
injury or illness, developmental problems, the aging process, or social or psychological
difficulties. OT focuses on the active involvement of the patient in specially designed therapeutic
tasks and activities to improve function, performance capacity, and the ability to cope with the
demands of daily living.
Each of these professions, as well as other allied professions, has three elements in common to
their definitions of the professional. They all have clients, goals, and treatment activities. An
examination of each of these elements and how they interact for the profession of HT follows:
CLIENTS are individuals who have been diagnosed as having a specific disability or disabilities that can be ameliorated if treated. Clients in HT programs are very diverse and represent all categories of disabilities, including, but not limited to:
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Psychiatric - Historically the first recorded area to utilize treatment through gardening,
this remains one of the major areas in which horticultural therapists work in private and
public hospitals and out-patient treatment facilities (Palamuso, 1985; Neuberger, 1991;
Kobren, 1991; Liberman, 1992; Schwebel, 1993; Strauss, 1994; Diethelm, 1994).
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Geriatric - Among the ill elderly, such as those in adult day-care centers, nursing homes,
Alzheimer's programs, and others, horticulture is proving to have a calming and
therapeutic effect, resulting in a significant increase in its utilization in recent years
(Mattson and Hilbert, 1976; Hill and Relf, 1982; Ebel, 1991; Mooney and Nicell, 1992;
Roemer, 1994; Mooney and Milstein, 1994; Hoover, 1994; Kaplan, 1994).
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Mental disabilities - This including developmental disabilities, mental retardation, and brain injury - This is one of the principle areas of involvement for horticultural therapists. With
programs in public and private schools, vocational rehabilitation centers, sheltered
workshops, and residential facilities, much of the work is directed toward employment of
the clients (Airhart et al, 1987; DeHart-Bennett and Relf, 1990; Dobbs and Relf, 1990;
Schleien et al, 1991; Cecchettini and Goldman, 1994).
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Physical disabilities - Patients with strokes, paralyzing injuries, and a multitude of similar diagnoses are being treated in HT programs in many locations around the United States (Bales, 1995).
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Sensory impairments - Vocational and recreational programs for visually and hearing
impaired persons utilize horticultural activities as part of their rehabilitation. However,
"gardens for the blind" are recognized as stereotypical and undesirable. Emphasis is
placed on gaining skills for daily living (Perkins School for the Blind, 1993; Craig,
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Substance abuse - Individuals who abuse alcohol, drugs, and even food have responded
to horticultural therapy at certain stages in their treatment (Cornille et al, 1987; Hewson,
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Social deviation - Both adults and children who are mal-adapted to society norms and
commit crimes that place them in prisons or detention centers have been shown to benefit
from horticultural therapy (McGinnis, 1989; Pruyne, 1994; Flagler, 1993; McCombe-
Spafford, 1994; Rice and Remy, 1994; Whittlesey, 1994).
By establishing treatment goals and objectives, it is possible to determine the progress that the
client is making in treatment and determine when the patient has derived all the benefit anticipated
from a treatment program. This type of documentation increasingly is being required as
justification for payment of treatment procedures by insurance companies or government
In reality, due to limited staff, it is impossible to individualize the treatment goals and objectives to
the desirable degree discussed. Standardized client treatment goals are used to apply to all the
patients in the program with individual progress records being kept.
In addition to facility treatment goals and individualized treatment goals, many HT programs have
unwritten goals they are expected to achieve. These generally have less to do with client treatment
than with funding or prestige; for example, the HT program is often the most aesthetically pleasing
portion of a facility and, therefore, expected to host all visitors despite any impact it may have on
the treatment program. Or the products or services that are a by-product of the treatment of a client
(i.e., pot plants, vegetables, grounds maintenance services) have economic value and are expected
to contribute significantly to the budget of the program. These goals must be integrated into the
overall program goals if success is to be achieved.
TREATMENT ACTIVITIES must focus on the cultivation of living plants if the program is truly to be horticultural therapy. Occasional activities may include arts and crafts, field trips, reading, etc., but ultimately, a major therapeutic aspect of HT is the benefit to be derived from nurturing plants; therefore, living plants are essential. Beyond that, the type of horticultural activity should be adjusted to meet the abilities and needs of the client. Specific considerations include:
Examples of horticulture treatment activities vary from greenhouse crop production to learning to
make terrariums and bonsai, from harvesting flowers to dried flower arranging, and from pulling
weeds to transplanting trees. Because of the diverse clientele, any horticultural activity could
potentially be part of a successful HT program, if appropriately modified to meet the abilities and
needs of the client. However, high among the horticultural activities that have long been seen as
very motivational are potting plants, plant propagation, and flower arranging (Relf (Hefley), 1973;
HT is part of an overall treatment plan, and the people conducting HT programs work closely with
all other members of the treatment facility to reach the goals. For other professionals (such as
occupational, physical, or recreational therapists) using horticulture as one of their treatment
activities, the goals of horticulture will be integrated into the individualized treatment goals of the
patient in a similar manner.
For volunteers working with patients in HT, the goals are much more generalized, and they are not
requested to maintain records in the same way as professionals. The generalized goals of
volunteers in horticultural therapy include helping clients learn to have fun and laugh again, helping
clients understand that they are still valuable and people from their community still care about them,
helping clients improve physically by getting the exercise of gardening, or helping elderly persons
improve mentally by talking about childhood memories of gardening to someone who truly wants
to listen. It is essential that professionals in the field of HT develop the skills to work with