CULTIVATE

FLORIDA HORTICULTURE FOR HEALTH NETWORK

Fall 2023 Volume 3 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 Horticultural Therapy with

Female Survivors of
Human Trafficking

7 Horticultural Therapy
Activity Plan – Sowing
Seeds in Winter

10 Horticulture for Health

Update

12 Purple Produce A wetland field filled with yellow pitcher plants on the edge of a pine
forest in the Florida Panhandle. Photo: J. Talbert

Horticultural Therapy with Female Survivors

of Human Trafficking
By Zuzana Poláčková
Photos by H. Rivera & J. Fleming

Female survivors of human trafficking face many health challenges

physically, emotionally, socially, spiritually, and behaviorally. Many
have experienced substance abuse and sexual abuse related to
human trafficking. Horticultural therapy (HT) is now being used to address these co-occurring health
challenges to begin a path to recovery and healing from trauma. It has been described as the bridge
from despair to hope and healing. HT is a recognized therapeutic modality using plant-based activity
in a therapeutic process to achieve specific and documented health outcomes.

Human trafficking and sexual abuse are growing issues in society. Physical or sexual violence is a public
health problem that affects more than one-third of all women globally (London School of Hygiene &
Topical Medicine, 2018; Coverdale et al., 2020; De Shalit et al., 2020). Over 50% of women have
experienced sexual violence involving physical contact during their lifetime, and one in four women
has experienced rape or attempted rape (CDC, 2022).
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Research in the Journal of Human Trafficking and other publications continue to tease out health
challenges faced by victims and survivors of human trafficking (Altun et al., 2017; Vellani & Kristof,
2021). A systematic review found that human trafficking is associated with high levels of physical and
sexual violence prior to and during trafficking (Hemmings et al., 2016; Stöckl et al., 2021; Ramaj, 2021).
Many survivors experience physical and sexual abuse from partners, family members and other
perpetrators even after escaping the exploitation (Ottisova et al., 2016). Over three-quarters reported
abuse in childhood, one-quarter of sexual abuse, and two-quarters of physical and emotional abuse
prior to trafficking (Coverdale et al., 2020). Research published in 2022 suggests that there is a link
between female victims of trafficking and intellectual disabilities, with this group more often involved
in commercial sexual exploitation (Jagoe et al., 2022). Human trafficking preys on vulnerabilities—
marginalization, employment instability and economic insecurity (Jagoe et al., 2022; ICAT, 2022; ATEST,
2021).

Health issues prevalent in

trafficking victims include
substance abuse, sexually
transmitted disease, pelvic pain,
rectal trauma and urinary
difficulties, as well as lack of
self-worth, depression, stress-
related disorders, confusion,
disorientation, denial, shame,
helplessness, disbelief, grief,
PTSD, suicidal ideations and
nervous system dysregulation
(Jagoe et al., 2022; Hemmings et
al., 2016; Coverdale et al., 2020;
DHHS, nd.; Vellani & Kristof,
2023; Altun et al., 2017). Trauma, both psychological and physical, is prevalent in this population, which
impacts their perception of the world. Feelings of intense fear, helplessness, horror, anger, and
uncontrollable mood swings are evident, exhibited by self-regulation dysfunction, impaired neural
response flexibility, distorted coping mechanisms and unhealthy behavioural patterns (SAMHSA, 2014;
Reid et al., 2020; Casassa et al., 2021; Van der Kolk, 2000; Okech et al., 2018).

Therapeutic interventions that incorporate trauma-informed and recovery care, along with survivor-
centred theory are being used with survivors of human trafficking (Gordon et al., 2018; Coverdale et
al., 2020). Horticultural therapy is one such intervention. It is able to integrate these approaches into
the horticulture-based modality.

Research and evidence-based practice have validated the benefits of HT. Specific research on female
survivors of human trafficking and HT is limited. Research by Chen (2021), Silvia-Rodriguez Bonazzi &
Febles (2022), and Branco (2022) provide insights into trauma and trafficking. Some health challenges
and health outcomes experienced by other populations may be pertinent to survivors of human
trafficking and inform their HT treatment:

2
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

- reduced stress and psychiatric symptoms; stabilized mood and increased sense of
tranquillity, spirituality, and enjoyment (Shao et al., 2020; Olszewska-Guizzo et al., 2022;
Ulrich et al., 1991; Cipriani et al., 2022)
- increased self-efficacy and self-esteem, reduction in mental dysfunction (Park, 2021;
Wiesinger et al., 2006)
- development of group cohesiveness and a sense of belonging (Diamant et al., 2010)
- development of sustainable vocational skills for clients (Silvia-Rodriguez Bonazzi et al., 2022)
- strategies to cope with trauma (Wise, 2019; Silvia-Rodriguez Bonazzi et al., 2022)

Horticultural therapy programs led by trained

professionals have been able to alleviate anger,
aggression, depression, and other negative feelings
across populations. Health improvements related to
behavioural and social interactions—social
inclusion and social isolation—challenges for
human trafficking victims and other populations,
have been documented in HT services (Okech et al.,
2018; Bahamonde, 2019). Therapeutic activities like
pruning, smashing pots and putting them back
together, digging, mixing soil, raking, or seed
germination, along with therapeutic techniques
involving reflection, mindfulness, meditation and
connection with truth and nature, are used in HT,
the latter important for spiritual and emotional
health improvements for survivors of human
trafficking and other populations.

Physical health challenges, a hallmark of this (and

other) population(s), are being treated by a variety of interventions including HT. Horticultural therapy
activities can help clients improve physical coordination including proprioception, increase physical
exercise, increase exposure to sunlight and Vitamin D (essential for circadian rhythm related to
balanced sleeping patterns), the latter vital in recovery and healing processes per research on
addiction recovery (TRWH, 2023). Research has established that 20-minute gardening activities with
low to moderate intensity can help increase the production of two main brain proteins BDNF and
PDGF, critical for healthy brain functioning (Park et al., 2019; Tu & Chiu, 2020).

Horticultural Therapy with Female Survivors of Human Trafficking

Horticultural therapy programs at a facility in Kenya, Community Gardens in the UK, and a recovery
home in Canada were developed and delivered for vulnerable populations of individuals with
substance abuse, domestic violence, and sexual abuse problems. In each of the groups, unreported
female survivors of sex trafficking were identified. Of note—survivors did not or would not always
recognize their situation. Each of these programs focused on identifying needs and variabilities
specific to, and suitable for female survivors. One of the programs used a clinical HT treatment
modality. The other two were delivered as therapeutic horticulture, a less formalized health
intervention.
3
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

The HT programming used the therapeutic process -

identifying health challenges and goals, selecting hands-on
horticultural activities, and measuring outcomes, within the
context of creating new opportunities for trauma healing
(LaRocque, 2019). Mindfulness, guided visualization, and
metanarrative–storytelling techniques were incorporated
into HT sessions, informed by Kaplans’ attention
restoration theory (Kaplan & Kaplan, 1989).

The metanarrative technique was particularly effective with

female victims of human trafficking. Using storytelling
within HT sessions, discussing fictional figures, gardens and
situations, provided allegories for real-life experiences, re-
enforcing an overarching account or interpretation of
events. This provided a pattern or structure for
participants’ beliefs, giving meaning to their experiences.
The three HT programs mentioned used a framework of
four historical and anecdotical gardens. Metanarratives
helped to make the connection between the individual’s personal journey with others in the group
who had experienced similar violence. Sharing their stories supported the development of coping
tools where their own reality was interpreted in a new way. The HT modality provided a non-
threatening and plant-based medium in support of healing.

Further research and use of HT with female survivors of human trafficking will provide evidence-based
practices which may be applicable to survivors of human trafficking from all genders, ages, and
geographic locations.
Altun, S., Abas, M., Zimmerman, C., Howard, L.M. & Oram, S., (2017) Mental health and human trafficking:
Responding to survivors’ needs. BJPsych Int., 14(1), 21–23. doi: 10.1192/s205647400000163x
Alliance To End Slavery & Trafficking (ATEST). (2021). Addressing Vulnerabilities to Labor and Sex Trafficking.
https://endslaveryandtrafficking.org/wp-content/uploads/2020/12/Addressing-Vulnerabilities-Brief.pdf
Bahamonde, A. (2019). Mental health through the art of gardening. Journal of Therapeutic Horticulture, 29(2).
Branco, P. (2018). How can therapeutic horticulture help meet the complex needs of domestic violence
survivors and their children? VAWnet – A project of the National Resource Centre on Domestic Violence.
https://vawnet.org/news/how-can-therapeutic-horticulture-help-meet-complex-needs-domestic-
violence-survivors-and-their
Casassa, K., Knight, L. & Mengo, C. (2021). Trauma bonding perspectives from service providers and survivors of
sex trafficking: A scoping review. SAGE Journals, Trauma, Violence, & Abuse, 23(3).
https://doi.org/10.1177/1524838020985542
Centers for Disease Control and Prevention (CDC). (2022). What is sexual violence?
https://www.cdc.gov/violenceprevention/sexualviolence/fastfact.html
Chen, E.Y., Robichaux, K., Gordon, M.R., Coverdale, J.H., Shah, A., Davis, M.P. & Nguyen, P.T. (2023) A pilot
program’s healthcare response to human trafficking in Houston, Texas. Journal of Human
Trafficking, 9(1), 119 129. doi: 10.1080/23322705.2020.1865095
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323517/#b9-mjm0902p111
Cipriani, J., Benz, A., Holmgren, A. et al. (2022). A systematic review of the effects of horticultural therapy on
persons with mental health conditions. Occupational Therapy Mental Health, 33(1), 47-69.
Coverdale, J.H., Gordon, M.R. & Nguyen, P.T. (2020). Human Trafficking - A Treatment Guide for Mental Health

4
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Professionals. American Psychiatric Association Publishing.

https://books.google.ca/books?hl=en&lr=&id=l-
fqDwAAQBAJ&oi=fnd&pg=PR9&ots=ioH2LP6O3S&sig=_50wvqO8sfyUPRB-
XOuJCNEJANI&redir_esc=y#v=onepage&q&f=false
De Shalit, A., Van der Meulen, E. & Guta, A. (2020). Social service responses to human trafficking: The making
of a public health problem. Culture, Health & Sexuality, 23(12), 1717-1732.
https://doi.org/10.1080/13691058.2020.1802670
Department of Health & Human Service USA (DHHS). (nd.). Resources: Common health issues seen in victims
of human trafficking.
https://www.acf.hhs.gov/sites/default/files/documents/orr/health_problems_seen_in_traffick_victims.
pdf
Diamant, E. & Waterhouse, A. (2010). Gardening and belonging: Reflections on how social and therapeutic
horticulture may facilitate health, wellbeing and inclusion. Br. J. Occup. Ther., 73, 84–88.
doi: 10.4276/030802210X12658062793924 http://www.greenfingersproject.com/wp-
content/uploads/2012/11/Gardening-and-belonging-reflections-on-how-social-and-therapeutic-
horticulture-may-facilitate-health-wellbeing-and-inclusion.pdf
Gordon, M., Salami, T., Coverdale, J. & Nguyen, P.T. (2018). Psychiatry’s role in the management of human
trafficking victims. Journal of Psychiatric Practice, 24(2), 79–86.
https://doi.org/10.1097/pra.0000000000000287
Hemmings, S., Jakobowitz, S., Abas, M., Bick, D., Howard, L.M., Stanley, N., Zimmerman, C. & Oram, S. (2016).
Responding to the health needs of survivors of human trafficking: A systematic review. BMC Health
Serv Res., 16, 320. https://doi.org/10.1186/s12913-016-1538-8
The Inter-Agency Coordination Group against Trafficking in Persons (ICAT). (2022). Addressing vulnerability to
trafficking in persons, Issue Brief 12.
https://www.icmpd.org/file/download/57956/file/icat_issue_brief_12_vulnerability_to_tip_published.p
df
Jagoe, C., Toh, PYN. & Wylie, G. (2022) Disability and the risk of vulnerability to human trafficking: An analysis of
case law. Journal of Human Trafficking. doi: 10.1080/23322705.2022.2111507
Kaplan R. & Kaplan, S. (1989). The Experience of Nature: A Psychological Perspective. Cambridge University
Press.
LaRocque, C. (2019). Program example: The interface between horticultural therapy trauma treatment and
somatic-oriented mental health therapy. In Haller, Kennedy & Capra (Eds.), The Profession and Practice
of Horticultural Therapy, 132-133. CRC Press.
London School of Hygiene & Tropical Medicine. (2018). Gender-based violence must be at the heart of global
health agenda – expert comment.https://www.lshtm.ac.uk/newsevents/news/2018/gender-based-
violence-must-be-heart-global-health-agenda-expert-comment
Olszewska-Guizzo, A., Fogel, A., Escoffier, N., Sia, A., Nakazawa, K., Kumagai, A., Dan, I. & Ho, R. (2022).
Therapeutic garden with contemplative features induces desirable changes in mood and brain activity
in depressed adults. Front Psychiatry., 13, 757056. doi: 10.3389/fpsyt.2022.757056
Okech, D., Hansen, N., Howard, W., Anarfi, J.K. & Burns, A.C. (2018). Social support, dysfunctional coping, and
community reintegration as predictors of PTSD among human trafficking survivors. Behavioral
Medicine (Washington, D.C.), 44(3), 209–218. https://doi.org/10.1080/08964289.2018.1432553
Ottisova, L., Hemmings, S., Howard, L. M., Zimmerman, C. & Oram, S. (2016) Prevalence and risk of violence and
the mental, physical, and sexual health problems associated with human trafficking: An updated
systematic review. Epidemiology and Psychiatric Sciences, 25, 317–341.
Park, SA. (2021). Theory and constructs of using horticulture for health and well-being. ISHS Acta Horticulturae
1330: XV International People Plant Symposium and II International Symposium on Horticultural
Therapies: The Role of Horticulture in Human Well-being and Social Development.
Park, SA., Lee, AY., Park, HG. & Lee, WL. (2019). Benefits of gardening activities for cognitive function according
to measurement of brain nerve growth factor levels. Int J Environ Res Public Health., 16(5), 760. doi:
10.3390/ijerph16050760
Ramaj, K., (2021). The aftermath of human trafficking: Exploring the Albanian victims’ return, rehabilitation, and
reintegration challenges. Journal of Human Trafficking. doi: 10.1080/23322705.2021.1920823
5
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Reid, J.A., Richards, T.N. & Kulig, T.C. (2020). Human

trafficking and intimate partner violence. In Geffner,
White, Hamberger, Rosenbaum, Vaughan-Eden & Vieth
(Eds.), Handbook of Interpersonal Violence and Abuse Across
the Lifespan. Springer. https://doi.org/10.1007/978-3-319-
62122-7_159-1
Shao, Y., Elsadek, M. & Liu, B. (2020). Horticultural activity: Its
contribution to stress recovery and wellbeing for
children. International Journal Environ Res Public Health.,
17(4), 1229. doi: 10.3390/ijerph17041229
Silva-Rodriquez Bonnazzi, D. & Febles, A. (2022). Horticultural
therapy program for trauma survivors. Horticultural
Therapy Institute.
https://www.htinstitute.org/blog/horticultural-therapy-
program-for-trauma-survivors/
Stöckl, H., Fabbri, C., Cook, H., Galez-Davis, C., Grant, N., Lo, Y.,
Kiss, L. & Zimmerman, C., (2021). Human trafficking and
violence: Findings from the largest global dataset of
trafficking survivors. J Migr Health., 4,
100073. doi: 10.1016/j.jmh.2021.100073
Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). Trauma-Informed Care in
Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA)
13-4801., 63. https://store.samhsa.gov/product/TIP-57-Trauma-Informed-Care-in-Behavioral-Health-
Services/SMA14-4816
The Women’s The Royal Women’s Hospital, Victoria Australia (TRWH) (n.d.). Sleep, sunshine & vitamin D.
https://www.thewomens.org.au/health-information/periods/healthy-periods/sleep-sunshine-vitamin-d
Tu, H.M. & Chiu, P.Y. (2020). Meta-analysis of controlled trials testing horticultural therapy for the
improvement of cognitive function. Science Reports, 10(1), 14637. doi: 10.1038/s41598-020-71621-7
Ulrich, R.S., Simons, R.F., Losito, B.D., Fiorito, E., Miles, M.A. & Zelson M. (1991). Stress recovery during
exposure to natural and urban environments. J. Environ. Psychol., 11, 201–230, doi: 10.1016/S0272-
4944(05)80184-7
Van der Kolk, B. (2000). Posttraumatic stress disorder and the nature of trauma. Dialogues Clin Neurosci., 2(1), 7-
22. doi: 10.31887/DCNS.2000.2.1/bvdkolk https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181584/
Vellani, V. & Kristof, T.S. (2021). Identifying and responding to sex trafficking victims in healthcare
environments. CRIMRXIV. https://www.crimrxiv.com/pub/sextrafficking/release/2
Wise, J. (2019). Perspective: Using horticultural therapy to recover from trauma. In Haller, Kennedy & Capra
(Eds.), The Profession and Practice of Horticultural Therapy, 134-135. CRC Press.
Wiesinger, G., Neuhauser, F. & Putz, M., (2006). Farming for health in Austrian farms, horticultural therapy,
animal-assisted therapy. In Hassink & Dijk (Eds.), Farming for Health: Green-Care Farming Across Europe
and the United States of America. 233–248. Springer.

Zuzana Poláčková M.S., M.Ed is a horticultural therapy practitioner and accredited facilitator for trauma
healing through the Trauma Healing Institute (USA & Canada). She has worked with vulnerable
populations for more than a decade including substance users, victims of sex abuse & home violence.
She developed and delivered the programs mentioned in this article. Currently, she is working for Medical
Ambassadors International and Medical Ambassadors Canada Association as a Resource Facilitator for
Anti-Human Trafficking and Technical Advisor for Horticultural Therapy. Lesley Fleming registered
horticultural therapist contributed to this article.

The article is being published concurrently in Nova Scotia Horticulture for Health Network’s Digging In.

6
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Horticultural Therapy Activity Plan – Sowing Seeds in Winter

Text by Zuzana Poláčková & Lesley Fleming, HTR
Photos by Z. Poláčková & Z. Schaeffer.Unsplash

This activity was developed and delivered for programs with survivors of trauma, including female
survivors of human trafficking. It has been delivered as clinical horticultural therapy (HT) and as
therapeutic horticulture (TH), the latter with therapeutic goals that were not clinically charted as they
were in HT. The activity is appropriate across populations and can be adapted to focus on specific
therapeutic goals of renewal, personal growth, passage of time, practicing patience, coping with life’s
unpredictability and unexpected outcomes. Its versatility as a winter-time plant activity for all types of
climates including those with snow, underscores the theme of renewal, with the passage of plant
dormancy being transformed and regenerated as a new season emerges. Plant and season metaphors
and themes relating to human challenges including renewal and transformation are both abstract and
literal, understandable by all ages and cognitive/intellectual abilities.

ACTIVITY DESCRIPTION: Sowing seeds in winter months for renewal and emergence in upcoming
season.
THERAPEUTIC GOALS:
Emotional: exploring sense of renewal & growth, focus on self-identity, self-care, well-being, life
skills and needs, learning healthy ways of coping with emotions, practicing patience
Physical: eye-hand motor skills, maintaining hand dexterity, strength, & pincer grip
Intellectual: learning about vegetables, matching labels to seeds, cognitive practice of following
sequential steps, discussing life’s unpredictability, adversity, resiliency & unexpected
outcomes
Social: group cooperative activity, teamwork, collaboration, socializing

STEP-BY-STEP PROCESS:
1. Prep: pre-wash & dry all recycled milk containers before session begins.
2. Create a suitable growing medium for planting or have potting mix ready for session.
3. Participants, where appropriate, prepare the milk container by
7
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

cutting it almost in half, opening it so that the two parts (top

Materials
& bottom) are not completely detached.
4. Participants can fill containers with soil halfway up the bottom Recycled milk containers
part of container & gently press the soil. Soil, potting mix
5. Leader gives directions regarding planting the seeds, referring Seeds
to planting depth (on seed packet). Seed types – rye grass, Marker, nail, knife
radish, cabbage, kale, onion, leek, broccoli, beetroot, kohlrabi.
Cover with a thin layer of soil, gently compacting it.
6. Gently water the containers so as not to disturb seeds. Use masking or duct tape to seal the
two parts together at the cut line.
7. Pierce 5 holes in the top half of container to create airflow and provide optimal moisture (pierce
with nail, awl, or scissors).
8. Label containers with participant’s name, planting date & plant name. Read seed packet to
determine days to germination.
9. Place container outside including winter season, and plan schedule for observing plant
germination, growth, with possible activity extension of transplanting seeds when mature.
10. Discuss elements required for seed survival (winter temperatures, sun, water), care of seeds,
passage of time & patience during germination stage, expectations for plant emergence,
seasons - life cycles of planting, germination, renewal, growth & harvest. Relate these to
human growth.

THERAPEUTIC APPLICATION: This activity lends itself to therapeutic goals in all health domains. In
particular, themes & metaphors related to renewal, hope, growth, care & self-care. Using different
types of seeds, identifying their specific needs, and recognizing the powerlessness of seeds relative to
weather conditions & other inputs can lead to discussions/metaphors for human growth, overcoming
adversity & trauma, cycles of darkness followed by blossoms/growth (plant & human), sense of self &
coping strategies for dealing with situations and emotions participants may have experienced.

APPLICATIONS FOR POPULATIONS: This activity can be delivered as a one-time or multi-session

activity, the latter including observations of plant cycles, perhaps most effective when seed growth is
apparent as mature, viable plants. It is appropriate for most populations, and for both individuals and
groups. Tasks can be supervised so that all levels of intellectual abilities can participate.

SAFETY CONSIDERATIONS: Essential to check with staff and individuals before the activity to identify
allergies, physical abilities, or emotional (in)stability. The use of sharp knives may not be appropriate
for some populations. The option of leader doing this step during or prior to session will minimize
safety challenges. Sharp objects may need to secured and out of reach of participants.

NOTES OR OTHER CONSIDERATIONS: Knowledge of trauma or human trafficking survivor populations

would be helpful, or sessions delivered in conjunction with “expert” in these fields (social worker,
mental health professional). Other containers may be used where recycled plastic milk containers are
not available. Creating the sealed “greenhouse” effect for condensation/watering of seeds is
essential.

This activity provides for the integration of garden elements which are often missing during long
winter months, with opportunities for participants to plan gardens, think about dreams, experience
hope & joy related to plant growth as a path to healing & recovery. Activity can integrate elements of

8
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

food production, ethnobotany, and connections to reality through natural cycles (seasons, growth,
rest).

REFERENCES/ RESOURCES:
Center for Health Care Strategies. (2021). What is trauma-informed care?
https://www.traumainformedcare.chcs.org/what-is-trauma-informed-care/
Poláčková, Z. (2023). Horticultural therapy with female survivors of human trafficking. Digging In 9(4),
4-9.
Voll-Wallace, L. (n.d.). Starting seeds in winter. Penn State Extension.
https://extension.psu.edu/starting-seeds-in-winter

Zuzana Poláčková M.S., M.Ed has developed and delivered therapeutic horticulture activities working
with vulnerable populations as a horticultural therapy practitioner and accredited facilitator for trauma
healing through the Trauma Healing Institute (USA & Canada). Lesley Fleming, HTR has developed and
delivered therapeutic horticulture activities with a wide range of populations.

The article is being published concurrently in Nova Scotia Horticulture for Health Network’s Digging In.

9
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Horticulture for Health Update

By Kathy Carroll, BS, MS, HTR & Lesley Fleming, HTR
Photos by J. Fleming

The term horticulture for health was coined by Lesley Fleming in 2018 and is a framework that identifies
areas where horticulture has a positive impact on health. It is the interdisciplinary approach across
disciplines that makes the horticulture for health (H4H) framework compelling, linking different health
interventions, disciplines, landscapes, and horticultural practices together in a wide-ranging mix of
programs, services, and landscapes. With developments in horticulture and health services and Covid
19 spurring greater interest in gardens, registered horticultural therapist Kathy Carroll interviewed
Lesley Fleming, lead for the Florida Horticulture for Health Network discussing updates on the concept
and practice of H4H.

What prompted you to conceive of the horticulture for health framework?

Practicing horticultural therapy (HT), and in discussions with other practitioners, we found that there
were crossover of ideas and practices that involved gardens, nutrition, and things like aromatherapy,
nature therapies. These were not technically part of HT but for practicing professionals, important to
understand and ultimately incorporate if appropriate. In response to a narrower view of HT, the H4H
framework evolved. It seemed to reflect the growing interest and breadth of alternative and related
areas within health and horticulture communities.

What is the short definition of horticulture for health?

Horticulture and health have many common connectors where services and activities have proven to
have positive impact: health services that use horticulture plays an integral role; horticulture as a
catalyst for social interactions; landscapes for health including gardens, parks, and schoolyards;
food/nutrition/food security; and horticultural practices.

What examples can you give that demonstrates this interplay between disciplines?
In a recently published Journal of Therapeutic Horticulture (JTH) article, Horticulture for Health in U.S.
Hospitals: Horticultural Therapy, Gardens in Hospitals, Nutrition-led Programs & Affiliated Community
Gardens (2022), my co-authors W. Zhang and K. Nelson and I examined how horticulture was being
used in hospital settings in these various capacities. New developments like hospital funds used for
“community benefit”, food is medicine movement, and stronger community connections to hospitals
through community gardens suggest ways that horticulture is integrated into health. Health
10
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

professionals - nutritionists, doctors, social workers, horticultural therapists, community organizers

and food security activitists have identified multiple mechanisms to use H4H improvements. And this
is just one setting – hospitals.

Are there areas or disciplines where horticulture for health is better known or more often used?
The framework began within HT circles, so it is probably best known in this field. With several
published articles on horticulture for health in the JTH, and several presentations at HT conferences, I
do think HT practitioners have expanded their knowledge with the broader H4H perspective. The H4H
networks that exist—Florida H4H network (FLHHN) and the Nova Scotia H4H network (NSHHN) —
have many HTs but also recreation professionals, horticulturists, Extension staff and master gardeners
from many countries. There is a growing number of mental health service providers who are
embracing HT and H4H and integrating best practices, programs and gardens with this particular mix
of disciplines in Dartmouth, NS, Lakeland, FL, and sites in California among others.

What developments have you observed in horticulture for health?

I will be giving a presentation on this topic at the 2023
American Horticultural Therapy Association’s annual
conference and a live/recorded-YouTube webinar hosted by
the Florida and Nova Scotia H4H Networks with the title
“Need to Know Developments in Horticultural Therapy and
Horticulture for Health” (October & November respectively).
The growing interest from mental health professionals; their
training and knowledge of self-regulation and polyvagal
theory is beginning to be integrated into the HT field. An
article by Fleming, Bethel & Roberts, “Self-Regulation, Its
Neuroscience Foundations and Horticultural Therapy:
Growing the Connections” is pending publication in JTH in
2023. More expansive and informed information on nutrition
is being integrated into other H4H areas like therapeutic
services, community and school gardens, with for example,
research supporting nutrition literacy in afterschool
programs, interesting models of “pay as you can” farm
stands, University of Alabama Birmingham’s Harvest for Health program + research where cancer
survivors are paired with master gardeners to grow food in home gardens for improved physical
exercise, nutrition, food sovereignty, self-confidence and sense of control.

What excites you?

The amount of research that is occurring now is fabulous, and at times overwhelming when looking at
the scope of H4H areas. The FLHHN’s Resource Hub has attempted to identify these, and program
models, by H4H topic areas - quite a huge undertaking but this a unique repository that brings all the
H4H elements together under one “roof/website”. I am excited by unusual & wild plants – hyacinth
bean being promoted as solutions for food insecurity, sweet potato ice cream developed to provide
nutrient-dense food, emerging professionals wanting to integrate food security efforts into HT and
community garden programming, and HT programs for female survivors of human trafficking. I am
excited to share the 15 YouTube videos from FLHHN on interesting H4H topics.

11
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Purple Produce
Text & photos by Lesley Fleming, HTR

Purple fruits and vegetables are nutritionally dense, rich in anthocyanins, vitamins, minerals and fiber.
Their natural plant pigment makes them appealing to choose and taste. These superfoods include
beetroot, purple corn, purple sweet potato, figs and acai berries.

12
 Florida Horticulture for Health Network
FLHort4Health@outlook.com

Editor in Chief Lesley Fleming, HTR

Editors Siang Yu Tham & Bree Stark

Contributors
Zuzana Poláčková, Nova Scotia Horticulture for Health Network, Kathy Carroll,
N. Jovanovic, H. Rivera, J. Fleming & Z. Schaeffer.Unsplash

Florida Horticulture for Health Network

To receive Cultivate contact FLHort4Health@outlook.com

www.facebook.com/FloridaHort4Health

Upcoming Issue of Cultivate Winter 2024:

Active and Passive Engagement with Plants: Incorporating Interoception, Proprioception &
Vestibular Senses for Therapeutic Outcomes

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.

13