Funded Projects

Improving Equitable Greenspace Access for Children

Project Year

2025

City & State

Wilmington, Delaware

Program Name

CATCH Resident

Topic

Environmental Justice/Climate Change

Program Description

The problem:  It is well studied that spending time in nature has positive impacts on a child’s health. In 2022 the American Academy of Pediatrics convened the Nature and Child Health Planning Group, a cross-disciplinary group of pediatricians to create a roadmap for safe and equitable access to nature for children. Studies have demonstrated that being in nature can reduce stress, improve mental health, improve prosocial behavior, reduce aggression, and lead to better outcomes for asthma, allergies, obesity, diabetes, and ADHD(1,2). However, access to safe greenspaces vary by neighborhood, and often in less resourced neighborhoods, parks that are easily accessible tend to have fewer amenities, lower maintenance, and higher crime rates. These neighborhoods often have less access to private vehicles, making traveling to different greenspaces challenging(3). Such disparities in greenspace access means that children living in underserved neighborhoods have limitations to experiencing the positive benefits of nature contact. As pediatricians working in the inpatient setting, we have the unique ability to address these disparities and their impact on health outcomes, as evidenced by studies showing the positive effect of screening for social determinants of health within the hospital(4). We also understand that caregiver stress and burnout can uniquely and significantly affect the caregiver and the pediatric patient(5). The majority of the medical literature focused on greenspace access initiatives have traditionally been focused on the outpatient setting, with limited evaluation of interventions within the inpatient setting.   Number of children affected: It is not absolutely known how many children are affected, however a recent report estimated that about 28 million children do not have access to close-to-home parks, and that there is about 43% less park acreage in  in communities of black race compared to white neighborhoods(6). Nemours Children’s Health Delaware campus cares for approximately 500,000 children per year. Many of our patients come from Wilmington, Delaware with about 71,000 inhabitants, of whom 21% (or around 15,000) are under 18 years old.   Primary setting: Our project will take place at Nemours Children’s Hospital in Wilmington, Delaware, and at the Nemours Estate, located directly behind our hospital with 200-acres of natural greenspace accessible to patients and families for free. Families will be equipped with education and resources to continue this connection with nature at various other urban greenspaces within Wilmington.  Project Goal: Our project aims to increase equitable access to urban greenspace for Nemours patients and families in Wilmington.  Proposed intervention: We will achieve our project goal through three aims. First, using quality improvement methods, we will increase visitation to the Nemours Estate by caregivers of hospitalized children using the Estate Rx program. Associates throughout the hospital can hand out “Estate Prescriptions” so caregivers of hospitalized children may access the estate and its grounds for free. This is an existing program but is not currently widely used. Second, we will conduct pre/post surveys of caregivers visiting the Estate to identify community level barriers to greenspace access and measure the impact of greenspace visitation on acute distress levels. Third, we will partner with community nature organizations to create an action roadmap that addresses barriers identified in surveys. This will culminate in a nature resource fair at the hospital around Earth Day 2026.   Anticipated Outcomes: We will increase use of Nemours Estate by Nemours patients and families. We anticipate that through survey results we will show the impact of nature visitation on acute distress for caregivers of hospitalized children. By identifying community level barriers to greenspace access, we will create a roadmap to address such barriers in partnership with nature organizations. We hope such work leads to future roadmap implementation through sustainable hospital-nature community partnerships.

Project Goal

Increase equitable access to urban greenspace for Nemours patients and families in Wilmington, Delaware.

Project Objective 1

To increase use of Estate Rx passes by caregivers of hospitalized children by 30% in 6 months using quality improvement framework. 

Project Objective 2

By November 30, 2025, to identify barriers to greenspace access and the impact of Estate visitation on acute distress by administering 100 surveys to caregivers of hospitalized children visiting the Estate.

Project Objective 3

By April 1, 2026, to gather community partners and host two community organization meetings at the hospital, creating a roadmap for equitable community greenspace access in Wilmington and planning of Nature Resource Fair at the hospital.

AAP District

District III

Institutional Name

Nemours Children's Health

Contact 1

Samantha Neumann, DO