BLOOM: Boldly Living outdOOrs for Mental Health

Purpose

In 2019, the Office of the California Surgeon General launched the ACEs Aware Initiative in collaboration with the California Department of Health Care Services. This ambitious campaign aims to develop a network of care model of healthcare delivery that explicitly links health resources within communities to clinicians screening patients for ACEs. The ACEs Aware Initiative recognizes nature experiences as one of seven "stress busters." Indeed, California boasts many outdoor resources for clinicians to integrate into the network of care. Through a calming effect on the autonomic nervous system, providing a setting for supportive relationships to develop and physical activity to occur, time in nature may help California prevent, heal and treat ACEs and the clinical sequelae. As one of the most common psychiatric disorders in youth, anxiety remains one of the most important sequelae of ACEs. There is a gap in evidence evaluating nature-based programs for child mental health. This study will evaluate BLOOM [Boldly Living outdOOrs for Mental health], a new intervention which is a modified version of an existing nature-based curriculum called SHINE (Stay Healthy In Nature Everyday) curriculum currently in place at UCSF Benioff Children's Hospital Oakland, which takes youth and their families into nature once a month for stress relief. This new intervention mirrors SHINE except that it will be tailored to children ages 9-12 with a history of ACEs and current anxiety. This study will evaluate the benefits of a group intervention model, an independent nature-outing model, and a comparison to a wait-listed control group. Our goal is to provide a scalable model for low-cost mental health care to the California Department of Health Care Services.

Conditions

  • Anxiety
  • Stress Disorder, Posttraumatic
  • Loneliness
  • Adverse Childhood Experiences

Eligibility

Eligible Ages
Between 9 Years and 12 Years
Eligible Genders
All
Accepts Healthy Volunteers
Yes

Inclusion Criteria

  1. Age 9-12 years at enrollment 2. Has an ACE Score of 1 or higher 3. Has a SCARED-P score of 15 or higher 4. Is available to attend three group outings if assigned to group intervention arm. 5. Has a caregiver who is able to consent and attend outings with them. 6. Is able to read, write, and speak English, Spanish or Arabic. 7. Has no serious health conditions that affect their ability to be in nature. 8. Willing to wear a provided electronic sensor continuously for 6 weeks, including sleep, excluding bathing and device recharging time. 9. Have no major changes in their mental health treatment plan during the time of the study. Caregiver eligibility criteria 1. Able to read, write and speak English, Spanish or Arabic 2. Be at least 18 years old. 3. Have no serious health conditions that affect their ability to be in nature. 4. Is available to attend 6 weekly outings if assigned to group intervention arm. 5. Have a smart phone and be willing to download NatureDose app from NatureQuant.

Exclusion Criteria

Child: 1. Concomitant active treatment modification (eg medication changes) for the past month. 2. Unable to attend weekly nature outings if randomized to the group intervention. 3. Physical or health limitation to participating in outdoor activities. 4. Previous SHINE participant. 5. Caregiver unable to consent. 6. Unable to pass short quiz at the end of the assent. 7. Wards of the state who do not have a guardian other than the state who can consent on their behalf. 8. Non-English, Arabic or Spanish speaking participants. 9. Unwilling to use a FitBit. Exclusion criteria - caregiver 1. Unable to attend weekly nature outings if randomized to the group intervention. 2. Physical or health limitation to participating in outdoor activities. 3. Previous SHINE participant. 4. Unable to provide informed consent. 5. Non-English, Arabic or Spanish speaking participants. 6. Unwilling to use NatureDose app.

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Treatment
Masking
None (Open Label)

Arm Groups

ArmDescriptionAssigned Intervention
Experimental
BLOOM Group Outings
6 weeks of nature based anxiety intervention for families with children who have at least one ACE and higher than average anxiety. Three of the outings will be group outings; the family will conduct 3 of the outings on their own independently.
  • Behavioral: Group Nature Outings
    A 6 week nature-based intervention for pediatric anxiety. Every other week group outings for families in nature, alternating with every other week nature-based goals for families at home.
Experimental
BLOOM Independent Outings
This group receives text support in going outdoors as a family once a week for 6 weeks to gain skills in managing anxiety.
  • Behavioral: Family Outings
    6 weeks of weekly outings into nature. These will be supported by the research team through a weekly text message and written materials on skill building and activities to do outdoors.
No Intervention
Control
Wait listed control. Receives standard of care referral to mental health resources on enrollment. At the end of study receives information on health benefits of being outdoors in nature and an invitation to group outings through the SHINE program at UCSF Benioff Children's Hospital Oakland.

Recruiting Locations

More Details

Status
Recruiting
Sponsor
University of California, San Francisco

Study Contact

Nooshin Razani, MD MPH
4155147877
nooshin.razani@ucsf.edu