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Sunday, January 18, 2009

HT methods at the Medical Center

The application of horticulture therapy at the Medical Center where I work is primarily part of a large compensated work therapy program and is the avenue that I operate from. There are also other providers (Recreation Therapists, Social Workers) throughout the Medical Center that also provide more traditional types of horticulture therapy to their patients via individual growing pots of flowers and plants for the satisfaction of seeing a plant grow under their care. In the past (50 years ago, maybe?) veterans also participated in farming at the facility but since that was not truly a voluntary activity, it was discontinued with the initiation of more patient right focused programs.

As mentioned previously, the primary administration of Horticulture Therapy Program is through a work-for-pay program called CWT (Compensated Work Therapy). Our program is funded through a Hospital contract through the overall rehabilitation organization (Veteran Industries) for landscaping services. This translates into a work crew of 4-6 veteran patients and a full time VRS (Vocational Rehabilitation Specialist aka Horticulture Therapist...that would be moi) and a therapy assistant weeding, planting, mulching and watering approximately 30 semi-formal or formal gardens of various sizes. The pictures are from 4 of the gardens that we take care of... this is not inclusive. This outside classroom is where the work and the therapy are conducted. You may, or may not, be surprised at the types of discussions that occur when you are trying to get a flower bed weeded before the sun breaks out with 90 -100 degrees in full sun and humidity. When September rolls around, the Flower Shop is re-opened to provide additional work activity as the growing season is slowing down. Simultaneous to all of this, the Greenhouse stays a therapeutic activity center. In the spring, the greenhouse becomes point central for production of annuals and perennials grown to be sold in the flowershop in May. And the cycle continues...

Due to the nature of landscaping, this program is a work based program with a medical clearance required. Therefore, the models of work adjustment are used as means of providing guidance. This writer meets with veterans referred to the HT program first individually to ascertain interest, and assess abilities. Vocational treatment plans and ongoing progress notes are completed to begin the vocational rehabilitation process and document progress. After that initial meeting, both individual and group counseling occurs with this writer and assistant on the principles of the program.

The first principle discussed is how work relates to the individual and how meaningful and purposeful work is a viable and important part of life. In this HT program, patients will work as a team to complete several tasks. In exchange for work performed at the Medical Center, the individual is compensated monetarily for work performance. Secondly, the principles of appropriate work behaviors are constantly reinforced through performance, role play, and discussion. Examples of work behaviors are: Attendance, ability to accept constructive criticism, punctuality, ability to stay on task, ability to work at different tasks. Finally, patients are taught a leisure skill of gardening and or landscaping depending on the season that they are working in Horticulture Therapy.

Many of the traditional values of Horticulture Therapy are addressed via this unique avenue. It is a type of therapy that is spontaneous and ever changing. Many times if one way of demonstrating a way of completing something doesn't work, other methods of explanation are used. Sometimes, veterans who have been in the program longer than the new vets take pride in explaining tools, methods, and general practises. Traditional values of Horticulture Therapy are found in all three work areas: Outside, Flowershop, and Greenhouse. The value of work for work's sake is number one. Patients are involved in work activities that they can see immediate results to which increases a sense of belonging and satisfaction. In the summer, they can see different gardens that they have weeded and watered. Many of the visitors and outpatients to the Medical Center compliment the patients for the beautiful landscaping at the facility which increases a sense of pride. At this time of year, veterans can see their greenhouse skills and plant care come to fruition in the sales of the shop. They also are taught to make simple arrangements including flower care and flower preparation. In the Flower Shop, this writer has started the mosaic program to provide opportunities for artistic expression, anger management (smashing recycled ceramics is an appropriate outlet for smashing), and working on attention to details. Unlike flowers and plants, the mosaics will stand fixed for years to come which is something that can be discussed amongst the veterans as showing permanence. So in summary, horticulture therapy at the Medical Center is very task oriented but provides opportunities for therapeutic healing at many different levels.

I have been told that I rely on "Gestalt" principles. It is true that I focus on personal responsibility-after all, my patients are grown adults with substance abuse and/or mental health issues that no one can "fix" except for themselves. Helping the individual be aware and be accountable of his or her environment is Gestalt in nature. I also believe that substance abuse rehabilitation is a process that requires modification of previous behaviors in order to be successful. Since most people can not see their own persona very well, I will also reflect back to the patients what are their strengths that they could use to further their road to recovery.

I hope this has been insightful and helpful. Please feel free to contact me for further information or questions. Happy Growing!

1 comment:

  1. Thank You! I really enjoyed reading the details about what you do! I'll look forward to following your adventures here! (Thanks for the tips about the mealy bugs. May your green house be blessed with a scarcity of them this year!)