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More doctors are encouraging their patients to take a dose of nature for their health. But for many, it isn’t so easy to follow that advice. To bridge the gap between receiving a nature prescription and filling it, a grassroots movement of nonprofit organizations is starting to develop urban nature programs.

One of the best such examples is the (AMC), one of the oldest outdoor clubs in the country, which launched in 2013. This Boston-area initiative works with physicians and other health care providers to help families get outside without leaving their neighborhoods. Programs are held in city parks and include hikes and activities like scavenger hunts, kite flying, and making bracelets from natural materials. Last year 2,200 people participated.

I spoke with Outdoors Rx director  and her colleague and program manager, Emily Grilli, about the challenges and opportunities of bringing the nature-prescription movement to the under-resourced neighborhoods of Boston.

���ϳԹ���: What are some of the barriers the families you serve face in trying to get a dose of nature?
Burres: We found that just the physical prescription from a doctor wasn’t enough of a catalyst to get people outside. We have a lot of working families, so there are constraints in terms of time and resources. Sometimes people have a perception that parks are unsafe. Sometimes they don’t even know where their parks are. This may sound weird depending on your own relationship with nature, but people don’t always understand that a park near them might be public. A great example is in Boston. It has huge wrought-iron gates around it, and the first thing you read when you get there is all the things you’re not allowed to do.

With those barriers and the AMC not being well-known in these neighborhoods, how do you get people interested in attending an Outdoors Rx event?
Burres: We’ve expanded beyond just working with pediatricians to work with a lot of community health workers, nutritionists, and different community providers who have more time with their patients than primary-care physicians. They’re often able to have longer conversations about why it’s so important to get outside. Where we can, we go to our partner locations to meet families, so they get to see who we are and make sure they are comfortable with us and know that their kid is going to have fun. We also work with a lot of other community-based organizations. These are folks who live in the neighborhoods that we work in. We can provide a resource to them that they don’t have, which is outdoor programming. And they offer a connection to their constituents.

There are lots of new studies about how time spent in nature improves aspects of our health, from blood pressure to stress resilience. Do you adjust the design of your programs based on new research?
Grilli: We have changed language in marketing materials, and we’ve incorporated more mindfulness activities into our programs, but the programs don’t shift when the research shifts. Typically, families don’t ask, “Oh, what was the health benefit I just gained from being outside?” But they go away feeling better and more connected with their kids and neighbors in a place where they can continue to return.

Burres: Our primary focus is to help families build healthy habits. When designing programs, we ask: What are the things that make people feel more connected to nature and to each other, and what are the things that help them keep coming back outside? There is science around that, in terms of the role of wonder and awe and joy and discovery. Those are the things we think about bringing into our programs. When you’re in a huge park that’s forested, the nature can really speak for itself, and kids are naturally curious. But when we work in places like Chelsea and Revere, there’s a lot less green space, unfortunately. That requires more creativity and a deeper reliance on our curriculum in order to keep it fresh and engaging.

The AMC has historically been a very white organization, while Outdoors Rx works primarily in neighborhoods of color. How are you sensitive to those power dynamics?
Grilli: The AMC has a code of conduct that explicitly states that we are open to all. Race is a huge dynamic in everything, including getting outdoors and who has had the privilege to be outside in the past and who has the tools to do it in the future. We are doing our best to try to break down those barriers and make sure everyone feels welcome. There are some really great green spaces in the region where you’d need to get into the car or bus to have a traditional nature experience, but the equity piece is we’re executing the programs in the zip codes where these families live. We’re saying, “There’s nature all around you, even in Washington Street in Dorchester.”

We also have bilingual program coordinators that offer programs in English and Spanish. We have some of our tools, whether it’s a scavenger hunt or bird-identification card, in both English and Spanish. We also partner with and to celebrate that heritage and that history and be mindful of who is coming outside with us.

Burres: One of the things that I’m really aware of is that this [project] could come off as overbearing and the whole “white savior” showing up—we would never want to conduct ourselves in that way. We know we are outsiders in the community and strive to approach everything with a community [lens] and to listen. I think one of the coolest things we have to offer is that nature is free. It’s open 24/7/365, and it’s one of these things that’s accessible for all of us. I just want to shout it from the rooftops. Being a parent is superhard. If you have constrained resources, it’s a whole lot harder. We want to make it as easy as possible for folks by doing things locally, so it’s easy to get to, it’s free, and it’s really fun.

How do you know if Outdoors Rx is succeeding?
Grilli: We’ve talked a lot about our retention. We’d rather see 20 families ten times than 200 families all at once. Creating a lifestyle change is really hard work, and that’s how you build that healthy habit. We can say we’ve seen the Lopez family 15 times in 2018 and 17 times in 2017. Our retention and testimonies about behavior change have helped us define our success.

Burres: Here’s one example. After a program in Callahan State Park, this woman who brought her three boys shared that she lived near that park for 20 years of her life and has always been afraid to go in it. She said she doesn’t consider herself knowledgeable about the outdoors and wasn’t sure how to figure out the trails and how to get them back out. But by coming out with us, having that introduction, and understanding how things connect within that park, she felt more confident and said that she intends to come back all the time. We don’t expect that you’re going to spend five years of your life with us. Your kids are going to grow, they’re going to change. But if we introduce you to local parks and give you the skills to find the local trailhead, if that keeps you going outside, then we’ve succeeded.