CULTIVATE

FLORIDA HORTICULTURE FOR HEALTH NETWORK

Fall 2022 Volume 2 Issue 4 FLHort4Health@outlook.com
The Florida Horticulture for Health Network’s vision: To promote activities and connect organizations to each
other and resources that use horticulture to improve health including: therapeutic horticulture and horticultural
therapy, landscapes for health, nature, emerging professional support, allied horticulture and health services,
community and school gardens, and food action initiatives.

CONTENTS

1 Feeding and Eating

Disorders and
Horticultural Therapy

6 Making Agua Fresca

9 Practitioner Tips:
Marketing People-Plant
Programs

11 Beekeeping Programs at
Correctional Facilities

13 Cultivating Social &

Therapeutic
Horticulture in Spain
Feeding and Eating Disorders
and Horticultural Therapy
By Lesley Fleming, HTR & Kate Sampson, CTRS
Photos by L. Fleming, K. Hamkhor, I. Yunmai,
N. Hamann & M. Spiske, Unsplash

Feeding and eating disorders are now understood to include a range

of disruptive behaviors including – anorexia nervosa (AN), bulimia
nervosa (BN), binge-eating disorder (BED), avoidant/restrictive food
intake disorder (ARFID), purging disorder and other specified
feeding or eating disorders. Research continues to tease out the
pathology, psychobiology and epidemiology of feeding and eating disorders (FEDs). Researcher Hay
suggests that “eating disorders [are] characterised by the internalisation of the thin ideal and extreme
weight‐control behaviours. In both, overvaluation of weight and shape – where such body image
concern is of major or paramount importance to self‐view – is a mandatory criterion.” (2020).
Pinpointing specific characteristics across this group of disorders is challenging given the varying
nature of each.

Hornberger and Lane’s systematic review of the literature (1994-2013) provides a good overview of
eating disorders (2021). Most often diagnosed in children and adolescents, with the mean age of onset
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

at 12 years old (Swanson et al., 2011), disordered eating also affects adults. Previous perceptions of
FEDs have been proven incorrect. Eating disorders in fact exist across all racial and ethnic groups, in
lower socioeconomic classes, with preadolescent children, males and females of all ages. Referencing
the DSM of Mental Disorders 5th edition, and the more current understanding of eating disorders, there
is a greater emphasis on behavioral rather than physical and cognitive criteria, along with inclusion of
children who do not express body or weight distortion. There are a range of characteristics across the
multiple disorders including: restricted caloric intake relative to energy requirements; intense fear of
gaining weight; altered perception of one’s body weight; repeated episodes of binge eating, self-
induced vomiting, self-value overly influenced by body shape; and disruptive eating pattern not
attributed to coexisting medical conditions. Hornberger and Lane noted that other factors may be
related to eating disorders like weight stigma, being sexual minority youth (LGBTQ), chronic health
conditions (diabetes, cystic fibrosis), dietary practices that may overlap or disguise as eating disorders
like restrictive food consumption or obsessive-compulsive disorder (for some, vegetarianism may be
obsessive compulsive disorder) (Robinson-O’Brien et al., 2009). Disordered eating attitudes and
behaviors in males, previously viewed as leanness, weigh control, muscularity with purging using
muscle-building supplements, substance abuse or comorbid depression, may have been undetected
or misdiagnosed (Calzo et al., 2016).

This very complex health issue

continues to be elusive.
Psychological symptoms can be
primary to eating disorders,
comorbid psychiatric disorder,
emotional regulation, and
deficits in executive cognitive
functioning though structural
brain imaging studies to date
have yielded inconsistent results
(Allen et al., 2013). Eating
disorders can be potentially life-
threatening, impactful on every
organ system with potentially
serious medical complications
due to malnutrition, weight changes, and purging. On a positive note, research has indicated that most
medical complications resolve with weight normalization (Golden et al., 2015).

Treatment principles across the eating disorder spectrum seek to attain healthy weight and growth
trajectories. This includes developing a healthy relationship with food, body image, weight and shape,
along with healthy nourishment and eating patterns. “Effective psychological therapies are the first‐
line in care and most people recover in the medium to longer term…. In children and adolescents, an
atheoretical family‐based treatment (FBT), and psycho-behavioral therapy, often provided through
outpatient sessions, are the leading modality of care” (Hay, 2020). Multi-disciplinary teams of
dieticians, pediatricians, psychologist, social worker, recreation therapists, and occupational/activity
therapist may provide treatment addressing physical, nutritional and mental health co-morbidities.
Interventions occur at day/outpatient clinics, residential facilities, and hospital-based stabilization

2
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

settings. Researchers and practitioners suggest that expanded prevention initiatives, better clinician
awareness and more health services will better serve people with eating disorders.

Feeding and Eating Disorders using Horticultural Therapy

Where does horticultural therapy and therapeutic horticulture fit into strategies addressing FEDs?
A small number of feeding and eating disorder treatment programs integrate horticultural therapy or
therapeutic horticulture into eating disorder interventions. The breadth of health challenges across
eating disorders requires a thorough understanding of each type of FED, and comprehensive physical
and psychosocial assessment of each individual prior to delivering interventions.

General program goals for plant-

based strategies involve growing
and eating healthy food,
establishing an healthy
relationship with food, body
image and eating patterns,
adapting disruptive unhealthy
eating patterns (purging,
binging), emotional regulation,
and positive leisure activities.
Based on an individual’s type of
eating disorder and the severity of
it, horticultural and recreational
therapy will vary.

The treatment process, connecting health goals to therapeutic plant-based activities, might include:
planting food crops, preparing harvested foods, sharing communal meals, understanding food
security – addressing fears of contaminated food by experiencing seed to harvest cycle, nutrition
counseling, and sensory based mindfulness activities using a garden environment. Interventions may
be held in group sessions or one on one.

Examples of horticultural therapy/therapeutic horticulture programs shed light on how it can be used
in treatment for eating disorders.

The Eating for Life Program, Nova Scotia Health, Halifax, NS is delivered at its out-patient clinic in a
hospital setting, focused on developing interpersonal skills, self-esteem, routines and structures for
healthy eating, and recognizing hunger ques. Its Leisure Group integrates relaxation and grounding
techniques using mindfulness activities as sensory experiences to connect to the present moment
while promoting here and now understanding, and indoor/outdoor gardening activities such as
terrarium making, floral wreath making and outdoor activities like planting herbs and vegetables in
raised beds. Some patients are treated as Adult Acute Care inpatients, with both services provided by
psychologists, psychiatrists, therapeutic recreation professionals and nutritionists specializing in
mental health (Fleming, 2012; 2015). Patients under 18 are typically treated at Halifax’s IWK Pediatric
Hospital which has a multidisciplinary specialty team that services youth identified as having either
anorexia or bulimia nervosa. The team consults and collaborates closely with colleagues in pediatrics
at the IWK hospital providing direct consultation and ongoing care for youth requiring inpatient
medical care secondary to an eating disorder. Clinical care occurs not only with the youth (in inpatient
and outpatient settings) but also directly involves immediate family members in the form of
3
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

psychoeducation, support, psychotherapy and training in the integral components of evidenced based
behavioral and cognitive therapy used for treatment of this illness (IWK Psychiatry Services, 2022).

Homewood Health Centre in Guelph Ont. (Canada) offers specialized programs for mental health
challenges including eating disorders. “In planting fruits and vegetables, patients with eating disorders
learn about nutrition and also the importance of nurturing their bodies and soul.” Three registered
horticultural therapists deliver the Homewood programs. (Hospital News, n.d.).

Baltimore Maryland’s Sheppard Pratt Center for Eating Disorders uses planning, planting and tending
crops as therapeutic activity with its horticulture group in support of self-esteem, mood and social
skills. (Haldeman, 2020).

Rogers Behavioral Health, a multi-location health organization,

uses horticultural therapy in eating disorder recovery. Dr.
Brad Smith comments “horticultural therapy is a natural
exposure that can be used to reduce anxiety and fear. If
someone has challenges with contamination, they might
avoid getting dirty or exposing themselves to germs, bugs,
and plants. We use horticultural therapy as part of their
exposure hierarchy to have an activity that will continue to
challenge them, resulting in fewer obsessions and
compulsions” (2022).
Denver Colorado’s Eating Disorder Foundation offers a
therapeutic garden, an in-person garden circle support group,
and gardening series workshops, the latter open to people
anywhere on the mental health spectrum including those
with eating disorders. Activities like composting, companion
planting, native edible plants and food forests workshops
foster a number of themes relevant to eating disorder
challenges.

Very limited research on horticultural therapy used as a modality for people with feeding and eating
disorders exists. Few plant-based programs also are available for this population. As the number of
individuals with eating disorders continues to rise for several factors including the pervasiveness of
social media influencing attitudes of body image, greater number of services will be required,
particularly those using plant-based interventions which have been well-received by clients.

Allen, K.L. Byrne, S.M., Hii, H., van Eekelen, A., Mattes, E. & Foster, J.K. (2013). Neurocognitive
functioning in adolescents with eating disorders: A population-based study. Cogn Neuropsychiatry
18(5):355-375. doi: 10.1080/13546805.2012.698592
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed.
American Psychiatric Association Publishing.
Calzo, J.P., Horton, N.J., Sonneville, K.R., Swanson, S., Crosby, R.D., Micali, N., Eddy, K.T. & Field, A.E. (2016).
Male eating disorder symptom patterns and health correlates from 13 to 26 years of age. J Am Acad
Child Adolesc Psychiatry 55(8):693-700. doi: 10.1016/j.jaac.2016.05.011
Fleming, L. (2015). Horticultural therapy programs that excite, excel and engage. Guelph Enabling Garden.
http://www.enablinggarden.org/wp-content/uploads/2015/08/Lesley-Flemming-Guelph-Enabling-Garden-
Article.pdf

4
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Fleming, L. (2012). Interview with Dr. Cheryl Aubie, Psychologist, Capital Health Eating Disorder Program.
Digging In 2(1): 1-3.
Golden, N.H., Katzman, D.K., Sawyer, S.M., Ornstein, R.M., Rome, E.S., Garber, A.K., Kohn, M. &
Kreipe, R.C. (2015). Position paper of the Society of Adolescent Health and Medicine: Medical
management of restrictive eating disorders in adolescents and young adults. J Adolesc Health 56(1):121-
125. doi: 10.1016/j.jadohealth.2014.10.259
Haldeman, E. (2020). Mental health movement – horticulture as therapy. Baltimoreoutloud.com.
https://baltimoreoutloud.com/wp/mental-health-moment-horticulture-as-therapy/
Hay, P. (2020). Current approach to eating disorders: A clinical update. Intern Med J. 50(1):24-29. doi:
10.1111/imj.14691 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003934/
Hornberger, L.L. & Lane, M.A.; Committee on Adolescence. (2021). Identification and management of
eating disorders in children and adolescents. Pediatrics 147(1):e2020040279. doi: 10.1542/peds.2020-
040279
Irish, J. (2019). Program example: Psychiatric, Rogers Memorial Hospital, Oconomowoc, Wisconsin. In Haller,
Kramer & Capra (Eds.) The Profession and Practice of Horticultural Therapy. CRC Press.
IWK Psychiatry Services. (2022). IWK psychiatry services. https://www.iwk.nshealth.ca/mental-health/iwk-
psychiatry-services
Robinson-O’Brien, R., Perry, C.L., Wall, M.M., Story, M. & Neumark-Sztainer, D. (2009). Adolescent
and young adult vegetarianism: Better dietary intake and weight outcomes but increased risk of
disordered eating behaviors. J Am Diet Assoc. 109(4):648-655. doi: 10.1016/j.jada.2008.12.014
Smith, B.E.R. (2022). Implementing horticultural therapy in eating disorder recovery. National Eating
Disorders Association. https://www.nationaleatingdisorders.org/blog/implementing-horticultural-
therapy-eating-disorder-recovery
Swanson, SA., Crow, SJ., Le Grange, D., Swendsen, J. & Merikangas, KR. (2011). Prevalence and correlates of
eating disorders in adolscents. Results from the national comorbidity survey replication adolescent
supplement. Arch Gen Psychiatry 68(7):712-723.

Lesley Fleming, HTR researched this population for the Florida Horticulture for Health Network’s Resource
Hub. Kate Samson is a Certified Therapeutic Recreation Specialist (CTRS) working as a recreation therapist
in Mental Health and Addictions specializing in treatment for patients with complex trauma and eating
disorders. Kate has a passion for helping others find motivation to live a healthy life by providing access
to leisure resources and strategy to navigate barriers to participating and pursuing opportunities for
meaningful engagement.

This article is being published concurrently in epublications Cultivate (Florida Horticulture for Health
Network) and Digging In (Nova Scotia Horticulture for Health Network).

5
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Making Agua Fresca

By Mitchell Hewson, HTM, LT, RAHP
Photos by R. Kutsaev, B. Lark, K. Nguyen, Unsplash

Thirst quenching infused waters can stimulate a client’s palate and hydrate the body using fruit,
vegetables, and herb. Traced back to Spanish cuisine, fruit waters or aguas frescas, are gaining in
popularity as flavorful and healthy thirst quenchers. Infused waters can provide an alternative drink
offering flavor, color, texture, and creativity for HT programming. For populations that have a
tendency to become easily dehydrated; seniors, people on certain medications, or for anyone
outdoors in hot temperatures, infused water may be one approach to combining hydration, nutrition,
and horticultural therapy in a long, tall glass.

Proper hydration is important for maintaining a healthy body- boosting cellular energy production and
lessening daytime fatigue (Benton & Young, 2015). Hydration impacts many body parts including
reducing joint pain by providing synovial viscous fluid as a lubricant surrounding joints and making joint
surfaces spongier (Bezci et al., 2015). Brain function can be impaired by even mild dehydration (Miller,
2015); hydration loss of 1-2% of body weight decreases cognitive performance (Pross, 2017) and impairs
concentration and mood (Liska et al., 2019).

There are many therapeutic benefits of making and drinking infused water as a horticultural therapy
activity: an activity focused on healthy food choices, one that can be complementary to a program
growing edibles, and natural drinks without artificial ingredients using fresh ingredients loaded with
vitamins and antioxidants. The preparation of infused waters provides a range of movement, exercise,
manual dexterity, and hand-eye coordination as evidenced by (AEB) the ability to cut fruit, hold knives,
and use of pincer grip to place fruit into blender. Adaptable for all ages and abilities, Sophia Podrozny
RD, Clinical Dietitian, Homewood Health Centre states “preparing infused waters helps us re-connect
to healthy food and practice food preparation skills”.

Tips for Making Agua Frescas

• wash thoroughly before using any fruit, vegetable, herb or flower

• use organic, blemish free, firm edibles avoiding waxy vegetables

whose absorption is limited due to wax

• remove fruit stems, seeds, rough spots

• recommended fruits and vegetables include; apple, apricot, avocado,

blackberry, black currant blueberry, cherry, Clementine, cucumber,
elderberry, grape, grapefruit, kiwi fruit, lemon, lime, mango, melon,
honeydew melon, watermelon, rock melon, nectarine, orange, pear,
peach, plums, raspberry, strawberry

• herbs; anise, mint varieties, lavender, basil, cilantro, lemon balm, dill,
sweet woodruff, lemon grass, tarragon herbs

• flowers; pansy, nasturtium, roses, hibiscus, daylilies

6
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Benton, D. & Young, HA. (2015). Do small differences in hydration status affect mood and mental performance?
Nutr Rev. 73 Suppl 2: 83-96. doi: 10.1093/nutrit/nuv045
Bezci, SE., Nandy, A. & O'Connell, GD. (2015). Effect of hydration on healthy intervertebral disk mechanical
stiffness. J Biomech Eng. 137(10): 101007. doi: 10.1115/1.4031416
Liska, D., Mah, E., Brisbois, T., Barrios, PL., Baker, LB. & Spriet, LL. (2019). Narrative review of hydration and
selected health outcomes in the general population. Nutrients 11(1): 70. doi: 10.3390/nu11010070
Miller, HJ. (2015). Dehydration in the older adult. J Gerontol Nurs. 41(9): 8-13. doi: 10.3928/00989134-20150814-02
Pross, N. (2017). Effects of dehydration on brain functioning: A life-span perspective. Ann Nutr Metab.70 Suppl
1: 30-36. doi: 10.1159/000463060

Chocolate Fruit Delight

1 sliced apple 1 sliced lemon

1 sliced orange 1 sliced pear
Handful strawberries and chocolate mint

Place all fruits, berries and mint into a glass

container, add one half gallon of cold water.

Lemon and Lavender Water

3 lemons, thickly sliced

¼ cup fresh lavender
One gallon of water
Place all fruits and vegetables into a
glass pitcher.

7
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Mitchell Hewson, HTM, LT, RAHP is the Administrator- Horticultural Therapy in Practice, founding member
of the Canadian Horticultural Therapy Association, and recipient of five international awards. Author of
Horticulture As Therapy A Practical Guide to Using Horticulture as a Therapeutic Tool, Mitchell presently
provides the only Horticultural Therapy on line study on mental health issues in Canada
(horticulturerastherapy@gmail.com)

Mitchell was the first Registered Horticultural Therapist to practice in Canada. He has served a pioneering
role in the development of this important therapeutic modality, with a focus on psychiatric care. He has
focused on specialized populations including those who suffer from: post-traumatic stress disorder,
dementia, addictions and others.

"Mitchell has been at the forefront of the horticultural therapy profession for forty years. Influencing the
thinking and practice of horticultural therapy as it has developed in the U.S. and Canada, he has
contributed to the professional practice in many other countries including Japan, Taiwan, China, Russia,
Singapore, France, Belgium etc. His writing, his programs and his willingness to train others sets him
apart. It is his effectiveness as a therapist that is the foundation for all of his professional work and it is
his compassion with clients who have mental health issues that is often mentioned by his peers with
admiration and inspiration."

8
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Practitioner Tips: Marketing People-Plant Programs

By Lesley Fleming, HTR, Silvia Yoshimizu-Yee, MPA, Nancy Zola,
Catherine Crowder, HTR & Gerry Sherman
Photo by G. Sherman

Whether marketing your horticultural therapy skills and programs online or in-person, it is essential to
have a game plan. This includes a concise, descriptive, engaging three minute elevator speech that can
convey the essence of what horticultural therapy and people-plant programming can do, and the
talents and expertise you are offering. Horticultural therapy practitioners share tips for marketing
programs:

Understand what makes people-plant programming, horticultural therapy and therapeutic

horticulture exceptional. Horticultural therapy and therapeutic horticulture (HT/TH) is relatively
unknown to the general public and to health and human service administrators. Even less is known
about how it is unique from other gardening activities, particularly those led by gardener volunteers.
When attempting to distinguish it from other gardening activities, offer the following brief and clear
distinctions.
▪ HT/TH programs elevate the
typical gardening experience to
one that is more meaningful, with
therapeutic goals integrated into
sessions, ultimately bringing about
positive change to improve a
person's quality of life.
▪ HT/TH programs are led by trained
professionals who bring
multidisciplinary skillsets to the
program.
Silvia Yoshimizu-Yee, MPA, HT
Certificate, Private Contractor,
California

Make contact directly with the most senior administrator you can get to (face to face preferred) and
leave a live plant or sample plant activity (tussie mussie) to remind the contact about the potential
program. Physically knock on doors, use the telephone, mail a brochure and email..repeatedly.
Lesley Fleming, HTR, Salvia Sage Services, Florida

One approach is to break down any barriers to accelerate the awareness and adoption cycle. In
business, it’s expensive and time consuming to launch a new product category and establish a brand.
In people-plant programs and HT/TH, the costs include educating the public, potential clients, as well
as health care practitioners. And while HT/TH has been practiced for decades, it’s still a new idea to
most and therefore has low brand awareness. A related tip -

Align with existing, well respected organizations. This could be a local botanical garden or public park.
This partnership arrangement offers the plant-based program broad exposure by tapping into the
mature organization’s existing marketing and social media platforms. In addition to the reach and

9
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

range, this provides credibility that is conferred on the nascent HT/TH program, from the affiliation
with its seasoned partner.
Nancy Zola, HT Certificate, Grounded Horticultural Therapy, Colorado

The most persuasive program proposals are those that address an organizational need. For example,
are they trying to improve community access to fresh vegetables? Do they need a therapeutic modality
that can be taken outdoors? Is there a need for a wellness program that is unique and that can improve
their online/external marketing presence? Fortunately, people-plant programs including HT/TH
programs are very accessible and versatile. Understanding how an HT/TH program can address the
organization’s need(s) makes for a more compelling program offering. Therefore, it may be worth
investing a bit of time to know your audience.
Silvia Yoshimizu-Yee, MPA, HT Certificate, Private Contractor, California

Offer to do a sample session for free or for material costs, or a 3 session package with a set fee for
pre-determined number of participants, with feedback and commitment after this if the organization
is satisfied with results. Show your stuff!
Lesley Fleming, HTR, Salvia Sage Services, Florida

Networking! Someone knows someone who could benefit from your work. Work with your contact
and host a sharing day with their peers in other organizations. This worked well with activity directors
in long-term care facilities and led to introductions to other activity directors, an introduction to non-
profit care-giver groups, and to a network of executives working in the aging arena.
Catherine Crowder, HTR, Seeds of Serenity HT, North Carolina

The initial contact or delivery of a one-off program raises the question - how do you stay top of mind
with the organization without “pestering” them to see if they have made a decision. While constant
communication is important, make sure your messages have meaningful content and potentially a
response mechanism. All push communications should have a relevant message and continue to
educate on the value and benefits of HT.
Catherine Crowder, HTR, Seeds of Serenity HT, North Carolina

Make it personal! Show that you are not only competent but compassionate and capable of creating
meaningful programming. Share why horticultural therapy is important to you. Share a short anecdote
of an interaction with a client you will always cherish. Showing that you are human and understand
how important the use of self is in horticultural therapy is sure to stick with whomever you are
approaching, and will make them think of you as more than a new line item on their budget.
Gerry Sherman, HT Certificate, NYU Langone Health & Hello Dahlia Horticulture, New York

Author/practitioner/contributors are members of a forum for regional horticultural therapy groups

where a recurring topic focuses on expanding job opportunities. Tips from practitioners across the
country come from: Silvia Yoshimizu-Yee - California Horticultural Therapy Network, Lesley Fleming -
Florida Horticulture for Health Network & Nova Scotia Horticulture for Health Network, Nancy Zola -
Rocky Mountain Horticultural Therapy Network, Catherine Crowder - Carolinas Horticultural Therapy
Network, and Gerry Sherman - Mid-Atlantic Horticultural Therapy Network.

10
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Beekeeping Programs at Correctional Facilities

By Weishunhua Zhang & Lesley Fleming, HTR

Beekeeping programs in correctional facilities can serve as

natural and symbolic models reflecting communities that
function cooperatively with eusocial behavior, and which
also involve challenges, adversity, and rehabilitation.
Mitigation and rehabilitation programs for bee colonies
have been considered viable small-scale remedies for
environmental distress addressing a challenging period
affecting the planet’s biodiversity. These can be provided
Photo: A. Mora Angulo
by beekeeping programs in correctional settings.

Beekeeping programs for incarcerated populations are able

to integrate the concept of rehabilitation. Inmates
participating in these programs can reap the benefits of
increased sense of purpose and belonging, increased
opportunities for physical activity, increased contact with
nature, and reduced stress levels. Participating in
vocational training can help inmates gain valuable skills that
Photo: B. Jaglicic
can be used for job and business prospects upon release
(McCray, 2015).

Beekeeping programs exist within the Canadian correctional system (Corrections Services Canada,
2019). A more significant number of programs are operational in the United States. The Sustainability
in Prisons Project in Washington state is perhaps the best known of the programs, and its participation
in research, and creation of a beekeeping program guide for correctional facilities highlight the success
this type of programming can achieve (Sustainability in Prisons Project, 2022; 2017). It is also an
example of a bee mitigation project where human effort and use of agricultural best practices can
make a difference, where valuing the environment can positively impact people, bees, and the earth.

The sustainability of beekeeping programs in correctional facilities are typically supported through
collaborations, with post-secondary schools delivering training and certification programs in support
of the goals, and local beekeeping associations providing bee expertise. Commitment by senior
correctional officials is also crucial for such programs.

The Important Role Bees Play

Beyond the people-plant benefits of beekeeping programs, bees play an important role in the health
of the planet and its inhabitants. Pollination is essential for maintaining life on the planet (DiDonato,
2022). Pollination enables plants to proliferate and is the process by which bees transfer pollen from
one plant to another, either between plants of different sexes for fertilization, or between various
portions of the same plant. Bees are among the most effective and efficient pollinators due to their
rapidity in moving from one plant to another in a single day. Bee and other insect pollinators have
contributed to the biodiversity and thriving ecosystems for plants and humans for millions of years.
The ability of bees to prevent inbreeding also contributes to the survival of plants. These have been
significant for increased food security and improved nutrition.
11
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

The importance of bees to agriculture cannot be overstated. They are responsible for the pollination
of crops, the growth in yields, and the establishment of prosperous honey businesses. Because of
bees' critical role in agriculture, millions of dollars are spent each year in leasing of hives. Pollination
by bees is directly or indirectly responsible for producing more than one-third of the food consumed
worldwide (Lawrence, 2015). For many types of fruits, nuts, and vegetables, pollination by bees and
other insects is required. Pollinator extinction would have drastic impact on crops and related
products resulting in food scarcities.

Bees play a big part in providing food in the form of honey. Honey, not usually consumed in sufficient
quantities by most people for it to be considered a significant source of minerals and vitamins in the
diet, does contain trace amounts of several nutrients. Nevertheless, it is important to note that honey
contains many polyphenols, plant components beneficial to human health. It is an excellent source of
antioxidants, providing raw honey nutrition, with antibacterial and antifungal characteristics
supporting digestive health and positive effects on the brain. Honey can be used for throat lozenges
or to suppress coughs, and for some, a substitute for prescription cough syrup medications (Sultana,
2016). Additional health benefits - honey has been proven to lower mucus production, possess
antioxidant qualities, and can boost the release and production of anti- inflammatory cytokines, which
are involved in the immune system's response to infections (Masad et al., 2021). Honey has
antibacterial qualities generating hydrogen peroxide and reducing the production of biofilm, which
help limit the growth of bacteria. Since the time of the ancient Egyptians, honey has also been used
for treating wounds and it continues to be used for a variety of health-related purposes.
Corrections Services Canada. (2019). From offenders to beekeepers: A first bee keeping initiative in Ontario.
https://www.lte-ene.ca/en/offenders-beekeepers-first-bee-keeping-initiative-ontario
DiDonato, S. & Gareau, B. J. (2022). Be(e)coming pollinators: Beekeeping and perceptions of
environmentalism in Massachusetts. PloS One 17(3): e0263281.
https://doi.org/10.1371/journal.pone.0263281
Lawrence, T. (2015). Pollination and protecting bees and other pollinators. Washington State University
Extension.
https://www.researchgate.net/publication/280884049_Pollination_and_Protecting_Bees_and_Other_
Pollinators
Masad, RJ., Haneefa, SM., Mohamed, YA., Al-Sbiei, A., Bashir, G., Fernandez-Cabezudo, MJ. & al-Ramadi, BK.
(2021). The immunomodulatory effects of honey and associated flavonoids in cancer. Nutrients 13:1269.
https://www.mdpi.com/2072-6643/13/4/1269/pdf https://doi.org/10.3390/nu13041269
McCray, R. (2015). Beekeeping gives prisoners a sweeter future. Takepart.
Sultana, S., Khan, A., Safhi, M.M., & Alhazmi, H.A. (2016). Cough suppressant herbal drugs: A review. Int. J.
Pharm. Sci. Invent. 5(5): 15-28.
Sustainability in Prisons Project (2017). Beekeeping in Prisons Program Guide.
http://sustainabilityinprisons.org/wp-content/uploads/2017/02/SPP-Beekeeping-Program-Guide-2-3-
17.pdf
Sustainability in Prisons Project. (2022). Beekeeping & pollinator programs in prisons. The Evergreen State
College and Washington State Department of Corrections. http://sustainabilityinprisons.org/spp-
programs-in-wa/conservation/beekeeping-programs/

Weishunhua Zhang is a second year MLA student at University of Florida with an interest in landscape
architecture and therapeutic landscapes, their connection to nature and their role in the healing process.
Lesley has delivered therapeutic horticulture programs at a county jail in Florida.

12
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Cultivating Social and Therapeutic Horticulture in Spain

By Leila Alcalde & Eva Creus
Photo by Asociación de personas con discapacidad Virgel del Pilar

Leila Alcalde and Eva Creus, cofounders of the Spanish Association in Social and Therapeutic Horticulture
(La Asociación Española de Horticultura y Jardinería Social y Terapéutica, AEHJST), describe how social
and therapeutic horticulture is gaining recognition in Spain and other Spanish speaking countries.

Social and therapeutic horticulture (STH) is relatively new in Spain, although healing gardens in Spain
date back to the 19th century (Cambra-Aliaga, 2017). Founded in 2018 by several STH professionals, La
Asociación Española de Horticultura y Jardinería Social y Terapéutica (AEHJST) is a volunteer-run non-
profit organization driven by the commitment to raise awareness and to collaborate to develop this
field. The association provides training in social and therapeutic horticulture, consulting services and
support for various projects across the country.

AEHJST offers two levels of training for those interested in starting a new professional career in STH
or in improving their knowledge services they offer. First, is a 20-hour introductory course supported
by the Occupational Therapy Department of the Autonomous University of Barcelona. The second,
more advanced training offered by the Association itself, is 45 hours long. The instructors are trained
in different disciplines, to respond to the varying needs of the STH projects. Professionals like
psychologists, occupational therapists, healing garden designers, social workers or educators are the
typical students in the courses. Approximately 100 students have been trained to date. There has also
been an increase in research and publication in the field, including a book titled Conéctate con la
Naturaleza by Jabier Herreros.

Most of the garden projects in Spain utilize horticulture to promote social inclusion and to tackle
isolation. Clients with mental health issues, learning difficulties or elderly people are the predominant
13
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

participants. Social and therapeutic horticulture is also growing in hospitals and care homes. Among
these projects, some have been running for more than 10 years, such as Associació La Muralla, a social
club for individuals with mental health issues, and their families. Data is collected by AEHJST through
the project Mapeo, an initiative that seeks to create a network of professionals and projects in Spain
that use horticulture to improve the life of others. STH is gradually gaining recognition in Spain, with
STH practitioners being invited to participate in various national and international talks. In 2020,
AEHJST got in contact with other practitioners and STH associations in other Spanish speaking
countries. The first online event called Savias Conexiones has been popularly followed on Instagram
from people in Peru, Puerto Rico, Ecuador, Chile, Argentina, Mexico, Costa Rica, Colombia, or
Guatemala. As social and therapeutic horticulture is not well known in these countries, the event had
a positive impact and helped to lay the foundations for future collaborations. It has also led to building
a network among professionals and projects in these countries. Universities in Argentina, Puerto Rico
and Colombia have organized four congresses on this topic since then, showing their interest in this
career path, as well as supporting pioneering STH practitioners as therapeutic professionals.

This active communication with other associations and professionals has involved the European
network as well. In September 2022, the first meeting will take place in Germany organized by
Internationalen Gesellschaft Gartentherapie e.V. STH professionals from countries like France, Italy,
Belgium, UK and Czech Republic will explore how to collaborate in different areas. AEHJST has also
been in contact with colleagues in Asia and Australia.

Along with their efforts to promote training, books and other educational resources in Spanish,
AEHJST has made the commitment to advance research in this area. Most of the scientific studies are
published in English, this being a barrier for many Spanish speaking practitioners. AEHJST’s role in
promoting social and therapeutic horticulture includes being a reference for education and research
in the Spanish language, in Spain and beyond.

Cambra-Aliaga, A. (2017). El proceso de profesionalización de la Terapia Ocupacional en España (1961-2007)

[The professionalization process of occupational therapy in Spain (1961-2007)]. [Doctoral thesis,
University of Zaragoza].

This article is fifth in a series on Horticultural Therapy Worldwide.

Leila Alcalde is a HT practitioner (Coventry University, 2016) based in London. She works for Share
Community supporting adults with learning disabilities, on the spectrum and/or with mental health
issues. She has also worked in Spain and Germany.

Eva Creus is a veterinarian educator who is currently taking her Undergraduate Certificate in
Horticultural Therapy at the University of Florida. She is a private contractor practitioner who delivers
STH programs in Spain, mainly for older adults and people living with dementia.

14
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Florida Horticulture for Health Network

To receive Cultivate contact FLHort4Health@outlook.com

www.facebook.com/FloridaHort4Health

Upcoming Issue of Cultivate Winter 2023:

Gardening’s Social Side

Editor in Chief Lesley Fleming, HTR

Editor Siang Yu Tham
Contributors
Kate Sampson, Mitchell Hewson, Silvia Yoshimizu-Yee, Nancy Zola,
Catherine Crowder, Gerry Sherman, Weishunhua Zhang, Leila Alcalde, Eva Creus,
K. Hamkhor, I. Yunmai, & N. Hamann, M. Spiske, A. Mora Angulo, B. Jaglicic,
R. Kutsaev, B. Lark, K. Nguyen, Unsplash,
Asociación de personas con discapacidad Virgel del Pilar

Products, services, references, and medical research contained herein are intended for informational
purposes only and do not imply endorsement or practice by FLHHN. Website URLs may be changed
without notice. Original and creative material is considered the intellectual property of FLHHN. We
respectively request credit for reprinted articles.

15