Our Work - Healthy Partnerships

Park and Trails Prescription Partnerships

Physically active opportunities exist throughout  the nation’s parks.  Here participants  paddle in the Washington, DC area.

Physically active opportunities exist throughout the nation’s parks. Here participants paddle in the Washington, DC area.

“Let’s go to the park today! ...Access to parks, trails, open spaces, and recreational facilities not only provides increased opportunities for children and adults to play and be physically active ...the use of parks and other recreation spaces as a healthful venue is important to consider in a comprehensive view of childhood and family obesity prevention.”

~Blanck HM. Et al in Childhood Obesity October 2012

America's Great Outdoors - Institute at the Golden Gate

Healthy Parks Healthy People - NPS and East Bay Parks

Partnership Examples

Sitka National Historical Park
Sitka National Historical Park has partnered with Sitka Public Health, Sitka Community Hospital, Southeast Alaska Regional Health Consortium and other local healthcare providers to implement a park prescriptions program for the community of Sitka, Alaska. The program is designed to help healthcare providers prescribe outdoor activity to their patients in order to improve the overall health and wellbeing of our local community. The program has quickly garnered public support. The Sitka Health Summit contributed financially to help offset the cost of printing the first batch of custom prescription pads. The community-based workgroup is continuing to make contacts with local physical and mental healthcare providers to prescribe outdoor activity via this custom Park Prescription pad.

Partnership Documents: This is an informal partnership and does not currently have formal partnership documents.

Sitka Park Prescription Bulletin

Contact Carin Farley, Chief Ranger at Carin_Farley@nps.gov

New Mexico Prescription Trails

The National Park Service Rivers, Trails & Conservation Assistance (RTCA) Program has been active as part of the New Mexico Prescription Trails Program. Initially RTCA facilitated a planning process and brought the parks and recreation disciplines into the project. RTCA continues to provide technical assistance to new communities within New Mexico and nationwide interested in developing Rx Trails programs.

The program encourages health care professionals to offer a walking prescription for patients who need to increase physical activity, with the ultimate goal of patients adopting regular walking as a lifelong activity. The tool provided to the patient will be a 'walking prescription' accompanied by a field guide to recommended walking routes. Providing information and guidance about how to access high quality walking environments is a unique feature of this physical activity project, since it directs people unfamiliar with walking in their community to walking sites throughout the City of Albuquerque and the South Valley in Bernalillo County.

Initial Partners included NM Health Plans, American Heart and Stroke Association, National Park Service - Rivers Trails and Conservation Assistance Program, NM Department of Health, Albuquerque Alliance for Active Living. The partnership is managed by the NM Health Care Takes On Diabetes Coalition.

Prescription Trails is an emerging program and we ask:

  • How can national, state, and local parks combine forces with business, healthcare professionals, scientists and advocacy organizations to promote wellness and reduce healthcare costs? 
  • How can we influence a cultural shift to value parks for health? What can community leaders, healthcare professionals, and managers learn from experts and visionaries in order to make this a sustainable idea that affects behavior at its core? 
  • How is human health dependent on the health of all species and the planet that we share, and in what ways can parks and open spaces strengthen these connections?
Some of the key objectives for the NM Prescription Trails program include:
  • Simple low-cost modifications to sidewalk or trails surfaces to accommodate universal accessibility.
  • Market local parks to new audiences and increase community use of the parks.
  • Develop new partnerships among health care and parks and recreation professions
  • Promote health and outdoor recreation.
Lessons Learned
  • Securing funding for trail publication is easy, linking the publication to a prescription has proved to be more complex.
  • Review park infrastructure first - does the community have sufficient facilities to develop a Rx Trails Program.
  • Need physician champion - prescribing physical activity is beyond the comfort zone of many health care practitioners.
  • Need to change perception of parks as only sports fields and think of them as health care resources.
  • Engage business to help support parks and increase community involvement.
  • Encourage community to advocate for parks and become stewards.
  • Work with ancillary health care professionals who spend more time with patients.
  • Not all communities will be able to support a Prescription Trails program because parks are not maintained
  • Engage other health care professions - mid-wives, podiatrists, veterinarians, social workers, ...
Partnership Documents: The National Park Service does not have an overarching formal agreement document for work in this partnership. Individual community projects are supported through the traditional Rivers, Trails, and Conservation Assistance application process and partnership agreement letters of acceptance.

Contact Attila Bality, Outdoor Recreation Planner, Attila_Bality@nps.gov
National Association of Community Health Centers

Working with the National Association for Community Health Centers (NACHC), Rivers, Trails, and Conservation Assistance Program (RTCA) is developing another model for integrating physical activity in green space and parks into conversations health providers have with patients.

In 2011, RTCA and the NACHC developed a five year cooperative agreement and piloted the program, Healthy Communities in health clinics in Boston, NYC-Bronx, and Washington, D.C. The partnership placed Community HealthCorps Navigators (AmeriCorps youth) in community health clinics for 10 months. Two navigators per city connected clinic patients to nearby green space and led walks, fitness programs, and other outdoor activities with youth and senior citizens.

NACHC and RTCA developed an orientation and training for the Navigators, immediate supervisors, and NPS local partner/staff representatives to introduce them to national and local park resources and Community Health Center resources, respectively. Training participants were also introduced to the NPS Healthy Parks, Healthy People US initiative and the principles embodied in the Let's Move! campaign.

Community HealthCorps/AmeriCorps members designed, developed and implemented programs and engaged in activities that applied the principles of the Let’s Move Cities and Towns and Let's Move Outside initiatives, as appropriate, to encourage health and wellness, in part, by promoting the utilization of park resources, with an emphasis on National Parks.

RTCA hopes to expand this program nationally and continue efforts in the pilot locations.

Partnership Documents: Cooperative Agreement

Contact Anne O'Neill, Outdoor Recreation Planner, at Anne_O’Neill@nps.gov
Indiana Dunes National Lakeshore

Indiana Dunes National Lakeshore works with Porter Health System, a prominent regional health provider to promote the use of the park for health and fitness along the 15 miles of southern shoreline of Lake Michigan and 15,000 acres of beach, woods, marshes, and prairie. Porter Health System healthcare providers write prescriptions for use along the Lakeshore. The National Park Service works to reach out to local communities to share information regarding opportunities for physical recreation on park lands. The National Park Service is also working to foster safe and effective nonvehicle access to the Lakeshore's trails.

Indiana Dunes' brochure on the program, a description of the process of creating the partnership, and a flyer for new healthcare partners interested in joining the effort.

Contact Lynda Lancaster, civic engagement, Lynda_Lancaster@nps.gov
Nature Prescriptions
Chesapeake & Ohio Canal National Historical Park & Eastern Area Health Education Center

C & O Canal National Historical Park and Eastern Area Health Education Center have partnered to encourage outdoor recreation and healthy living as part of the daily practice of visitors and the general public through the Nature Prescriptions program. The Nature Prescriptions program will include educating local health care providers on outdoor recreation opportunities along the 184 mile long park for use in their subsequent visits with patients regarding healthy living and outdoor recreation and exercise.

This partnership is working to facilitate health care providers use of Nature Prescriptions through clinic visits, engage in research and assemble information concerning outdoor recreation, physical activity and the benefits of healthy exercise, develop a comprehensive trail map system with a searchable database of local trails, create print, video and web resources that feature train information, develop connections with community organizations to promote the use of trails and outdoor recreation opportunities among many other objectives.

Partnership Documents: Cooperative Agreement and Task Order

Contact Kevin Brandt, superintendent, at Kevin_Brandt@nps.gov
Park Prescription and Health Education Program
Jewel Cave National Monument & Custer Regional Hospital


For More Information
Regional Health
PR/Marketing Dept.
Melissa Tideman
(605) 719-5630

Custer Regional Hospital Partners with Jewel Cave National Monument in Park Prescription Program

CUSTER, SD - Are you ready for a prescription with little to no unpleasant side effects aimed at benefitting your overall health? Custer Regional Hospital (CRH) physicians are partnering with Jewel Cave National Monument of the National Park Service (NPS) in presenting a free Park Prescription Program for patients.

As part of the Park Prescription Program, which will take place at Jewel Cave, CRH patients will have free access to walk on the Scenic Tour route within the cave during scheduled tour times. Their walking exercise includes the status of a volunteer on a guided tour, serving as a “caboose” at the end of the tour groups. Another exercise opportunity includes hiking the one-quarter mile Roof Trail or three-mile Canyons Trail at the Monument. Volunteer hikers will serve as backcountry observers for off-season trail conditions and guided snowshoe hiking events.

Jewel Cave is located 13 miles west of Custer, and for the days when the weather is too cold, it provides an all-weather, year-round environment for exercise with a constant cave temperature of 49 degrees.“We are very excited to offer this service to our patients,” said Lisa Brown, M.D., Family Medicine, CRH. “This partnership allows us to use the natural resources the Southern Hills area has to offer to benefit the health of our community.” 

The Park Prescription Program began November 2012. It provides the opportunity for physical activity to qualifying patients in need of a more active lifestyle. Each patient might be prescribed a different trail or volunteer activity depending on their individual needs and abilities as determined by their CRH physician. There is no cost to the patient other than their time commitment of participating in the program. Patients who participate serve as Volunteers in Parks (VIPs). VIPs help the NPS by doing trail patrol (checking for hazards along the path) and by being park guide assistants (ensuring cave resources and visitor safety).

“This program will be very beneficial to the patients who need or seek a more active lifestyle, but can’t be active because of the weather,” said Veronica Schmidt, CEO of Custer Regional Hospital. “I am very excited to offer this program to our patients, as it is a low cost solution to some of our patient health concerns. This could be the right ‘prescription’ for many of our patients, and the program exposes our local citizens to an amazing natural resource within their own backyard.”

The National Park Service is working toward several goals within its Call to Action Plan, unveiled in August 2011. One goal relates to Healthy Parks Healthy People and is entitled Take a Hike, Call Me in the Morning. All park sites within the Midwest Region are working toward at least two goals within the plan, and this partnership between Jewel Cave and Custer Regional Hospital complements a national direction.

If interested in the Park Prescription Program, talk to your Custer Regional Hospital primary care physician by calling (605) 673-2229. For information related to Jewel Cave National Monument, contact the visitor center at 605-673-8300 or visit the Monument online at www.nps.gov/jeca.


NEWS MEDIA - for more information or to arrange an interview, please call Melissa Tideman, of Regional Health’s PR/Marketing Dept., at (605) 719-5630. Thank you.

Jewel Cave brochure on the program.

Partnership Documents: Memorandum of Understanding

Larry Johnson, Jewel Cave National Monument superintendent, Larry_Johnson@nps.gov
Trailheads in Pediatrician's Offices

This pilot program of Kids in Parks offers a twist on the traditional Rx Trails and Rx Parks models to collaborate with medical providers to offer information and programmatic resources for families to take the initiative to recreate outdoors in our parks. Without a prescription component, it attempts to sidestep some of the legal concerns of medical practitioners. Instead it places an example trailhead in the lobby and medical practitioners wear buttons that ask questions such as, “Ask me how to get active an a park?”

These pediatrician office trailheads provide information about local TRACK Trails, a signature program of Kids in Parks, helping inform kids and parents about family friendly opportunities to get active outdoors near their home. This effort has been endorsed by the American Academy of Pediatrics and will become a focus of the program as the networks of trails expand into more regions.
Let's Get Healthy: An Initiative of the Southern Nevada Agency Partnership

Southern Nevada Agency Partnership (SNAP) is a partnership of stewardship professionals from the Bureau of Land Management (BLM), National Park Service (NPS), U.S. Fish and Wildlife Service (FWS) and the USDA Forest Service (USFS) who work together to coordinate the protection, conservation and use of the public lands of Southern Nevada. These four federal land management agencies work collaboratively on many initiatives, including educational projects and programs.

In September of 2010, the National Environmental Education Foundation hosted a Children and Nature Initiative: Nature Champion Train-the-Trainer Workshop at the FWS National Conservation Training Center. The workshop trained health care providers to become Nature Champions. National Environmental Education Foundation provided education about the health benefits of nature, as well as tools and resources for the Health care providers to use. The Health care providers were to "prescribe" nature and outdoor activity to their patients and train other providers in their communities.

A FWS employee, a SNAP educator and six health care providers from Las Vegas participated in this workshop. The providers came from the Southern Nevada Health District, the Children's Heart Center, Southwest Medical Associates, a school nurse from Clark County School District, and a pediatrician who owns a free health clinic. The workshop provided an opportunity for staff to collaborate and strategize with the local health care professionals. The health care providers recommended changes to the prescription slip created by National Environmental Education Foundation. Recognizing transportation as a major barrier, the team also designated a number of local parks as well as federal lands both in and outside of the city to highlight in the brochure. As a result, a graphic artist working for SNAP redesigned the initial prescription and the brochure with these recommendations and to reflect the desert/mountain look of the local area. She also created posters to promote the program and locations to 'get outside'. All these products have space for various sponsoring logos and websites for more information.

So far, over 150 health care providers have been trained to prescribe nature and refer families to a park or nature center, with an emphasis on economically, racially, ethnically, and culturally diverse populations.

Children’s Heart Center Field Trips

With transportation as a primary concern, two of the health care providers from the Children's Heart Center worked with FWS and SNAP to organize bussed field trips for their patients. Funding for the buses came from internal sources and a FWS Connecting People with Nature grant. For two years, 20-40 patients from Children’s Heart Center participated in monthly trips, organized and led by SNAP educators, to the four national wildlife refuges in southern Nevada. The Children's Heart Center also created a bulletin board labeled “Kids in Nature” with pictures of the participants having fun on previous trips, a map to show the wildlife refuges, and a reference to our SNAP website for more information. An article in the USA Today contained photographs and interviews of patients from a field trip to Moapa Valley National Wildlife Refuge in February 2011. The Children's Heart Center placed a copy of this article in a big frame and hung it in their waiting room.

Workshops for the Health Care Providers in Las Vegas

Outside Las Vegas Foundation, a non-profit organization which assists SNAP with educational programs, wrote and was awarded a grant from REI to host two workshops so that the trained health care providers can network and share their best practices. The workshops, held in November 2011 and May of 2012, were enormously successful in finding ways to improve the program. Many of the success listed in this document were a result of the conversations from these workshops.

Southwest Medical Associates

Since doctors only have a precious 15 minutes with patients, Dr. Nancy Yu decided to train all staff at the seven Southwest Medical clinics in Las Vegas to help increase the opportunities to talk to the patients about this initiative. She trained a total of 80 doctors, nurses, nurse practitioners and front desk personnel. Southwest Medical also provides some health-related programs to a local YMCA. Outside Las Vegas Foundation worked with Southwest Medical to secure funding so that youth from the YMCA program could take field trips to public lands. In summer 2012, Outside Las Vegas Foundation received funding for buses from United Health Care and two trips were conducted to the Spring Mountains National Recreation Area,  which is a USFS site. Finally, with little assistance from SNAP, Southwest Medical organized three “Walks with a Doc” in local county parks. One of the walks became part of a Healthy Families Festival that Southwest Medical organized in partnership with the Nye County Community Coalition.

School Nurse Trainings

A Clark County school nurseand a SNAP Educator trained approximately 40 school nurses through two workshops in April and September of 2011. Utilizing monies from a Center for Disease Control grant acquired by the Southern Nevada Health District, 19 elementary schools were offered bus monies to provide one field trip per school to selected federal and local municipalities outdoor areas. Four field trips were conducted in the spring 2012 - one to Lake Mead National Recreation Area (an NPS site) and 3 to Red Rock Canyon National Recreation Area (a BLM site). An additional school nurse training occurred in June 2012, with a targeted nutrition brochure that also incorporated the ‘Let’s Get Healthy’ messaging. Finally, one of school nurse started an after-school program with activities focused on student health and the Nevada Children’s Outdoor Bill of Rights.

Family Fun Run/Walk on National Trails Day

The Southern Nevada National Trails Day Committee in Las Vegas, hosted by Henderson Parks and Recreation Department, organized a one mile Family Fun Run/Walk on behalf of this initiative as part of their festivities on the first Saturday in October in both 2011 and 2012. A bus was provided for patients from the Children's Heart Center to participate, however the vast majority of participants found their own transportation. Over 100 people participated in both walks and received t-shirts that contained graphics and messaging from this initiative. Additionally, four school nurses wrote prescriptions to the participants and others who attended the event. Another Family Fun Run/Walk is scheduled for October 2013.

Other Partners

In October 2011, Outside Las Vegas Foundation launched a website describing all the trails (www.outsidelasvegas.org) in southern Nevada. The Southern Nevada Health District, who encourages the public to use local trails to improve their health, also hosts a website that uses the same information. This is part of a Regional Open Space and Trails Initiative called 'Neon to Nature'. A page about this initiative is planned for the Children and Nature Initiative website and the Nevada Children's Outdoor Bill of Rights website. SNAP educators gave presentations about this initiative to the Nevada State Fitness and Wellness Advisory Council in September 2011, the Association of Partners for Public Lands National Conference in November 2011, the Nevada State Parks and Recreation Annual Conference in April 2012, and the Clark County School District Partners for a Healthy Nevada meeting in May 2012.

In conclusion, it is evident that there is much support and momentum for this initiative in Las Vegas from many different partners.


SNAP launched www.snap.gov - featuring Let’s Get Healthy section with downloads of products

OUTSIDE LAS VEGAS FOUNDATION launched www.outsidelasvegas.org and maintains www.nvoutdoorkids.org

SN Health District www.gethealthyclarkcounty.org to support Neon to Nature trail system

Partnership Documents: The Southern Nevada Agency Partnership does not have official partnership documents.

For information on the National Park Service's involvement in the Let's Get Healthy initiative contact Jennifer Haley, Chief of Interpretation Lake Mead National Recreation Area at Jennifer_Haley@nps.gov