Clinic among the trees: Occupational therapy master’s student blossoms during fieldwork in Washington rainforest

Three women smiling while standing in the forest
(Left) Emily Bryce, OTR/L, Fieldwork educator, (Middle) Emily Tull, MSOT, EP-C, (Right) Emily Grieb, MSOT

When most people imagine an outpatient pediatric clinic, they likely picture four walls, splashes of bright colors, a waiting room, and a zero percent chance of rain in the office. For Colorado State University occupational therapy master’s student Emily Tull, this could not be further from the truth.

Tull, a Virginia native and licensed exercise physiologist, is spending her summer in Washington state completing her required fieldwork working with Emily Bryce, an educator who practices outdoor occupational therapy for the Center for Therapeutic Intervention. The outdoor sensory clinic, nestled in Bryce’s acres of forest on the Kitsap Peninsula, provides patients aged 2 to 18 the same things a typical clinic would.

“Clients meet us at the outdoor clinic for their OT sessions. Our day-to-day practice is child-led, meaning children are able to engage in the environment in ways that interest them most,” Tull explained. “We do all the same things a typical outpatient peds clinic would do, except we do it outside and nature grants us natural affordances during therapy!”

Tull’s job as an occupational therapist in this role is to be there in order to ensure safety, provide just the right challenge activities for therapy, and to collaborate with clients to solve problems. Her day is always full of play, as that is most youths’ main occupation, but she and her team also work on social participation by having groups or camps of clients, and activities of daily living such as hygiene, dressing and feeding, emotional regulation, and more.

Path to the forest

Portrait of Emily Tull smiling while standing in the forest
Emily Tull

When Tull was young, her grandmother suffered a brain aneurism. This prompted Tull to gain an interest in therapy. “Since then, I knew I wanted to pursue some realm of a therapeutic profession,” Tull said. While earning her degree in exercise science from Virginia Commonwealth University, Tull happened upon a poster for an occupational therapy seminar. Unfamiliar with the field, she decided to attend and was immediately struck by the need to learn more.

“What intrigued me most about the profession was the ability to collaborate with the clients on what was meaningful to them in their day-to-day life,” remarked Tull.

In 2019, while working with the geriatric population as a licensed exercise physiologist in Virginia, Tull transferred to Denver with her company. Soon after moving to Colorado, she began as a student in the Occupational Therapy Program at CSU.

“The Occupational Therapy Program and the extensive research coming from the department is what initially drew me to CSU. Living right next to the mountains was pretty convincing as well,” added Tull. “My favorite part about occupational therapy is how broad it is! You can really find a passion area and find how that can be incorporated in your practice. Occupational therapy has the potential to impact the world beyond the healthcare system alone.”

While attending the 2021 CSU OT Knowledge Exchange, an event connecting students, faculty, alumni, researchers, and practitioners with one another, and with cutting-edge information about occupation-based practice, Tull noticed a discussion revolving around nature-based therapy. This piqued her interest.

“My thesis was on outdoor occupational therapy camps, and I have a background in adaptive recreation, so I was instantly interested and attended the talk,” said Tull. After the discussion, Tull was able to set-up a meeting with Bryce and another interested CSU student, Emily Grieb. “The rest is history,” she said. “Emily Bryce, Emily Grieb, and I are all here in the forest this summer providing therapy to clients beneath the trees!”

 Hands-on fieldwork

A large play structure used for therapy in the forest
Clinic’s largest play structure

It is one thing to attend lectures and write the notes, but it is an entirely different challenge taking that information and using it in a professional setting. Luckily for Tull, and countless other CSU OT students, the curriculum designed by the expert OT faculty has paved the way for success outside of the classroom.

“At CSU OT, our pediatric, adolescent, and young adult classes not only prepare us with the theory and anatomical/neurological underpinnings of the therapy we are providing, but also emphasize the importance of being an evidence and reflective-based practitioner,” she explained. “It has been eye-opening to see the things we learned in the classroom and lab connect to the hands-on therapy we are providing every day.”

As Tull notes, plenty of learning occurs while conducting hands-on fieldwork as well. Tull credits her fieldwork educator, Bryce, for lessons she will take home from her experience. Tull cites Bryce’s desire to continue education as one of the biggest lessons she has learned. When Bryce isn’t actively giving therapy, she is broadening her horizon and educating herself on how to uplift, advocate, and lessen the amount of harm in her clients’ lives. From Bryce’s modeling, Tull now feels confident encouraging autonomy for clients to explore their environment. She also feels comfortable validating their emotions and feels motivated to advocate for clients’ voices to be heard.

At the end of this experience, Tull will be moving back to Fort Collins to study for her NBCOT (National Board for Certification in Occupational Therapy) exam. Upon passing the exam, she hopes to find a pediatric occupational therapy position where she can practice outdoors, employ the use of adaptive recreation, or work in a community-based setting.

Currently, Tull is turning her thesis into a published manuscript. She was selected to present at the annual Occupational Therapy Association of Colorado Conference in October where she will be presenting her research entitled The Effect of an Intensive Outdoor Occupational Therapy Camp on Behavioral Regulation and Praxis in Children.

The Department of Occupational Therapy is a part of CSU’s College of Health and Human Sciences.