Prescribe Outside: Progress moves at the speed of trust in Philadelphia

Philadelphia, Pennsylvania, is one of several U.S. cities that’s joined the growing nature prescription movement. Nature prescriptions are formal recommendations from healthcare professionals that encourage patients to spend more time in nature to improve their physical and mental health. Around the world, doctors have been prescribing time in nature to help families and children lead healthier, happier lives. 

In Philadelphia, nature prescriptions provided a solution to address growing physical and mental health crises. At a recent Prescribe Outside event, Dr. Barbara Rolnick of Children’s Hospital of Philadelphia explained, “There’s a tsunami of mental health needs in our community and a limited number of practitioners. People are in crises, and we are trying to get ahead of this.”

Philadelphia’s pediatric nature prescription program is called Prescribe Outside. Prescribe Outside is a coalition including Awbury Arboretum, Children’s Hospital of Philadelphia (CHOP), Let’s Go Outdoors, the USDA Forest Service, Temple University Center for Sustainable Communities and the Sierra Club Pennsylvania Chapter. These partners have worked to increase the number of nature prescriptions and to create multiple ways for physicians and patients to learn about nature-based opportunities through trusted providers, such as Children’s Hospital of Philadelphia and local outdoor programs like Let’s Go Outdoors.

At a time when many young people struggle with mental health and excessive screen time, prescribing nature is a preventative strategy to help the residents of the City of Brotherly Love unplug — literally and figuratively — and realize the benefits of time spent in nature.

Nature Everywhere Communities

Early on, most community members and healthcare professionals did not know about Prescribe Outside. In 2023, however, Prescribe Outside joined Nature Everywhere Communities — a joint initiative of the Children & Nature Network, National League of Cities and KABOOM!. Nature Everywhere provided technical assistance and seed funding for Prescribe Outside to expand nature prescription programs through Children’s Hospital of Philadelphia.

Over the past two years, Prescribe Outside has seen families shift from initially hesitant to fully engaged in prescribed nature activities. From January 2024 to December 2025, approximately 1,000 people participated in its nature prescription programs.

Based on community data generated through Ripple Effects Mapping, participation in the Nature Everywhere Communities initiative spurred much of this growth, as it:

•   Strengthened partnerships and cross-organization relationships
•   Supported new engagement structures and community needs assessments

Growing the movement

The growing popularity of nature prescriptions in Philadelphia stems in part from Prescribe Outside’s intentional cultivation of strong partnerships across diverse organizations. Doctors, nurses, educators, students and researchers working side by side have built trust, personal connections and a belief in the power of working together to increase equitable access to nature. In the words of one participant,

In the last two years, Prescribe Outside went from a group who all brought individual goals to a community that has friendships beyond professional capacity. Our lesson learned is that “progress moves at the speed of trust.”

As participants reflected on Prescribe Outside’s expanding impact, they also credited the coalition’s governance structure with maintaining momentum. Virtual meetings and working groups have kept partner organizations interacting and in sync. The program director has not only managed projects and collected data but also brokered deeper connections between organizations.

This case is also a strong example of a local network listening to and learning from families, youth and community partners. Prescribe Outside initiated comprehensive environmental, community engagement and communication needs assessments through a collaborative partnership involving Nature Everywhere Communities, Temple University and the USDA Forest Service. This included listening sessions facilitated by a Community Connector across all ten Philadelphia Council districts.

This informational video about Prescribe Outside explains the how and why behind nature prescriptions for physical and mental health.

This community engagement grew citywide awareness of Prescribe Outside while strengthening community trust and family engagement. A participant in the Ripple Effects Mapping session reflected, “Through the listening sessions and tabling, we learned that families didn’t know Prescribe Outside existed. They were very excited to learn more and eager to participate. This highlighted the importance of community outreach.”

The community outreach and needs assessments also enabled community voices to shape decisions that have made nature programs more accessible, responsive and effective in Philadelphia:

•   Prescribe Outside made all events free and allowed walk-ins to extend participation to low-income residents and to families who didn’t know about events in advance.
•   Children’s Hospital of Philadelphia hosted a Prescribe Outside event at a park the community considered “unsafe” to help them overcome unfounded fears and safety concerns.
•   Survey data showed sending direct text reminders reduced barriers to participation and built trust by allowing direct communication between partner organizations and the community.
•   Prescribe Outside learned that stressing the fun of activities was more effective messaging than emphasizing scientific guidance like, “Exercise 3 times a week.”
•   The listening sessions also revealed that the community trusted a physician’s nature prescriptions more than nature recommendations from educators.

Some of these findings and strategies may be relevant to other cities — especially since they resonate with some research the Children & Nature Network recently highlighted in our Research Digest on nature and parks prescriptions.

Systems change

Prescribe Outside hasn’t only reached more families and successfully overcome barriers to nature access in Philadelphia. In two short years, it’s begun to effect systems change.

Prescribe Outside has begun to institutionalize nature prescriptions throughout Children’s Hospital of Philadelphia. The hospital has embedded nature-based health programs into its grants and research projects while promoting and supporting Prescribe Outside through its Center for Health Equity. The organization also plans to hire a Nature Prescription Coordinator to support both providers in their messaging around nature prescriptions, as well as helping families to follow through on filling those scripts by creating personalized access plans. 

Equally impressive, Prescribe Outside played a key role in Pennsylvania adopting the Children’s Outdoor Bill of Rights in 2025. After learning about the Children’s Outdoor Bill of Rights concept, Prescribe Outside partnered with the Pennsylvania American Academy of Pediatrics Climate and Environmental Health Committee to provide medical and political backing for this bill. Thanks to this collaboration, Governor Shapiro endorsed this statewide framework, which establishes nature as a right for ALL Pennsylvania children.

Transformation is most powerful when people’s perceptions and long-held beliefs change.

In this case, Prescribe Outside has transformed the culture of clinical practice at Children’s Hospital of Philadelphia to the extent that many practitioners now see nature as a medicine. One Prescribe Outside Ripple Effects Mapping participant said, “Thinking about nature as medicine… is more and more common.” 

More broadly, the Pennsylvania Children’s Outdoor Bill of Rights has made a powerful statement that “being outside is a right — not just a ‘nice to have’.”

Curbing the tsunami  

Philadelphia’s mental health crisis inspired pediatricians to prescribe nature to counteract a “tsunami” of mental health needs. Over the past two years, medical practitioners have gotten better at prescribing nature, and community partners have become more adept at adapting programs and reducing barriers to increase families’ and children’s participation in nature-based activities.

Prescribe Outdoors faces several challenges to nature prescriptions and nature-based programs — many of which lie beyond its control. Still, buoyed by the belief that “progress moves at the speed of trust,” this coalition continues to lean into strong partnerships and community outreach to make access to nature a medical priority and an essential right for every child. 

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