Written by Koh Kah Yong and Jewel Yi

What is the Natural Environment and Why is it so important?

Imagine yourself learning to drive a car in a car racing arcade machine. After you earn a high score, you are immediately given a driver’s license and put on the road and in a real car. How do you think you will do? Fortunately, you and I know that that’s not how we are going to get our driver’s license. But are you aware that that’s how therapy in a clinical setting can sometimes feel like? Our children are often put through simulated situations in a controlled environment, usually in a therapy gym or clinic. When they attain a “satisfactory score” or “perform well”, they are then deemed ready to cope with all of life’s challenges. But... are they really ready?

Let’s go back to the example of learning how to drive. Say, you hired a really considerate

instructor, who comes to your place to teach you how to drive in your own car, and how to

park in your neighbourhood’s car park. This instructor also guides you in driving to places

you frequent, navigating impossible multi-storey car parks, and refilling the petrol. They

even invite your family and friends into the car to put on their worst behaviour, so that you

can practice under added pressure and distractions. Sounds like a better and more realistic l

earning experience? What I have just described is essentially therapy in a natural environment.

A child’s natural environment consists of settings where routines and daily activities are carried out; at the home, school, community spaces, and even public transportation (Hanft & Kristine, 2000). These are places where the child and their family members perform everyday tasks, and where natural social interactions and events occur.

In contrast, a controlled environment is one where children are made to learn skills through carefully planned experiences. Sure, in many cases our children do need to start off in such an environment, just as how beginner drivers can build confidence through practising behind the wheel at the arcade. However, in this article, we would like to highlight the importance of conducting therapy in the natural environment.

Places In The Natural Environment

Participation in naturally occurring activities in their rightful environment serves as good learning opportunities that promote children’s learning and development (Dunst et al., 2001). However, research has consistently shown that children with developmental delays engage and interact less frequently with objects and people in shared spaces as compared to their typically developing peers (Odom et al., 2006; Vig, 2007). This may mean that our children might miss out on everyday opportunities to learn and develop in their community.

Let's talk about places. Your playground is actually pretty awesome; it is a source of many different kinds of activity settings (swings, slides, monkey bars) and thus provides many different kinds of learning opportunities (maintaining balance on swings and playing and socialising with peers in a game of hide-and-seek etc).

If our children are able to greet, engage in conversation and play calmly in a clinic once a week for 45 minutes, does that necessarily mean that they will be able to do the same with others in their family or in the community? Perhaps.

But if therapy:

Occurs in the specific places that they struggle in (eg. not greeting others at the neighbourhood playground or having meltdowns when things don’t go their way ) and
Is practised frequently during the week through coaching

Children might reach those skills more quickly and be able to thrive in everyday places!

People In the Natural Environment

Now let's talk about people. If the therapist only worked with the child, studies show that the family is NOT provided with adequate support on how to maximise the child’s development (Baker et al., 2012; Simpson, 2015). That’s because the people who spend the most time in the child’s natural environment are their families. Children learn best by watching how their families interact with each other and how they do things. They want to grow up to be just like you. The best thing your therapist can do is to promote child participation in family and community life family-centred practice.

Family-centred practise in the natural environment is also less disruptive because it is built into daily routines, and is meant to support the child and the whole family as they participate in these everyday activities (‌Moore, 2016). This ensures that family priorities are addressed through collaboration and shared decision making between the therapist and family members. In turn, it leads to greater relevance of therapy, more opportunities where children can practise the skills in their routines, and additional positive outcomes (Delany & Galvin, 2013).

Purpose of Therapy in the Natural Environment: Conclusion

To Summarise Why Little Marvels Therapy Believes in Practising in the Natural Environment:

Easy Transference of Skills in Everyday Places

Most life skills are best learnt in the natural environment, as many situations are hard to replicate in a clinical setting, e.g. tolerating noises in a clinic is different from tolerating noises produced by others at the playground. Even when children have mastered the skills in a controlled setting, they have to overcome an additional step of generalising these skills for real-life places and situations which can be challenging (Skubik-Peplaski, 2012).

We want to practice on the real road and not just in the arcade.

Family-Centred Practice

Therapy in the natural environment allows for therapists to observe and understand a family’s lifestyle habits and provide coaching opportunities to the caregiver where appropriate (‌Moore, 2016). Therefore, it allows for all parties to apply new strategies directly in real-life family routines.

We want to work with everyone who is going to be in the car.

As such, occupational therapists may (1) conduct a Routines-Based Interview, (2) work very closely with you to prioritise your goals and concerns, and (3) see your child at home, school, community playground, or even ask to accompany the family on special outings, especially for situations where your child struggles with repeated issues.

If you have any questions about therapy in the natural environment or just want to get started practising on the real road, do feel free to contact us!

In-person therapy services are based in sunny Singapore but we are happy to consult you wherever you are!

Click here to read more articles!

References

Baker, T., Haines, S., Yost, J., DiClaudio, S., Braun, C., & Holt, S. (2012). The role of family-centred therapy when used with physical or occupational therapy in children with congenital or acquired disorders. Physical Therapy Reviews, 17(1), 29–36. doi:10.1179/1743288x11y.0000000049

Delany, C., & Galvin, J. (2013). Ethics and shared decision-making in paediatric occupational therapy practice. Developmental Neurorehabilitation, 17(5), 347–354. doi:10.3109/17518423.2013.784816

Dunst, C. J., Bruder, M. B., Trivette, C. M., Hamby, D., Raab, M., & McLean, M. (2001). Characteristics and Consequences of Everyday Natural Learning Opportunities. Topics in Early Childhood Special Education, 21(2), 68–92. https://doi.org/10.1177/027112140102100202

Hanft, B. E., & Kristine, O. P. (2000). Therapy in Natural Environments: The Means or End Goal for Early Intervention? ResearchGate; Lippincott, Williams & Wilkins. https://www.researchgate.net/publication/232241129_Therapy_in_Natural_Environments_The_Means_or_End_Goal_for_Early_Intervention

‌Moore, J. (2016, April 13). 10 Awesome Advantages for Therapy in Your Child’s Natural Environment by Jeanne Moore - All About Therapy, PLLC. All about Therapy. https://allabouttherapyforkids.com/10-awesome-advantages-to-natural-environment-therapy-by-jeanne-moore/

Odom, S. L., Zercher, C., Li, S., Marquart, J. M., Sandall, S., & Brown, W. H. (2006). Social acceptance and rejection of preschool children with disabilities: A mixed-method analysis. Journal of Educational Psychology, 98(4), 807–823. doi:10.1037/0022-0663.98.4.807

Simpson, D. (2015). Coaching as a Family-centred, Occupational Therapy Intervention for Autism: A Literature Review. Journal of Occupational Therapy, Schools, & Early Intervention, 8(2), 109–125. doi:10.1080/19411243.2015.1040941

‌Skubik-Peplaski, C. (2012). Environmental Influences on Occupational Therapy Environmental Influences on Occupational Therapy Practice Practice. https://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1006&context=rehabsci_etds

Vig, S. (2007). Young Children’s Object Play: A Window on Development. Journal of Developmental and Physical Disabilities, 19(3), 201–215. doi:10.1007/s10882-007-9048-6