“Dedicated” System Changes in Portland Reduce Health Barriers

Portland, OR | January 2014 | By National Recreation and Park Association

OR Portland Reduce Health Barriers 410

Over the past six years, Portland, Oregon’s Rx Play park prescription program has served as a powerful tool for strengthening conversations about exercise between physicians and patients. To expand Rx Play in 2013, the Portland Parks and Recreation Department focused on making simple system changes to the program—leveraging key strengths and addressing key challenges—in order to build stronger relationships with disadvantaged families and eliminate access barriers to parks and recreation.

Launched in 2008 by Terry Bergerson of Oregon State Parks and Recreation and Jean Rystrom of Kaiser Permanente as part of Oregon’s Statewide Comprehensive Outdoor Recreation Plan (SCORP), Rx Play creates a bridge between medical advice and community-based recreation systems.

Through Kaiser Permanente, OHSU Doernbecher Children’s Hospital, and Multnomah County School Based Health Centers, approximately 200 prescriptions are made each year to youth by more than 50 clinicians. Written consent from parents is acquired so physicians can refer these patients to the Portland Parks and Recreation and Tualatin Hills Parks and Recreation departments via U.S. Mail, after which recreation staff follow up by phone and offer to enroll referred youth in fitness classes and programs. The activities are paid for through a scholarship fund.

Physicians have been very enthusiastic about the program concept. However, the city has noted varying and sometimes low conversion rates (average 12.5 percent per year), which they historically attribute to: the lack of a dedicated staff person to follow up with patients and physicians; and, language barriers with parents and guardians, as 40 percent of those involved with Rx Play speak English as a second language or not at all. To overcome these issues, Portland hired and trained a bi-lingual, part-time program coordinator with the following objectives:

• Provide rapid follow-up to referrals, and at appropriate times of day (e.g., evenings and weekends);
• Meet participants where they are physically, speak their language, and motivate them into action; and,
• Capture stories to build relationships with clinicians and supporters.

Prior to the program coordinator’s start in June 2013, follow-up calls could take one to three months. But after her arrival, and despite a backlog, she was able to quickly narrow the window to between 7 and 10 days. “Our goal was to close the gap,” states Sue Glenn, North/Northeast Zone services manager for Portland Parks and Recreation. “To be able to reach families in a week was a great gain, and we attribute that to having a focused professional just working on Rx Play.”

Of the 157 participants who received prescriptions during or after January 2013, 27 (17 percent) were registered in 1 or multiple programs.

The ability to communicate in Spanish created a layer of support for the 65 referrals made for bilingual and Spanish-speaking families. Additionally, the program coordinator made great strides in connecting with families in their own neighborhoods. By meeting them at close-to-home recreation centers, introducing them to staff (bilingual when necessary), giving tours, and assisting with onsite registration, she lessened the “fear” of unfamiliar ground.

As a point of emphasis, Rx Play partners note that they were not just successful in motivating youth referred to the program, but siblings and parents too. “One example is a family of six in which [everyone] was very interested in being involved,” states Glenn. “The parents registered all four of their children for classes and signed up for a family membership.”

Funds for Rx Play scholarships were drawn initially from Portland’s Nike Play Pass partnership, which targets youth. However, Portland was able to dedicate other city funds to support the unexpected but welcome family-wide interest. Portland is currently seeking additional donations for ongoing Rx Play scholarship support.

And for those families who did not register in programs, Portland points out the value of simply being able to follow up with them and have a conversation about physical activity.

Although staff turnover led to the acquisition of a new program coordinator in the fall, Portland continues to reduce referral follow-up times and strengthen relationships with healthcare providers. Portland also recently discussed expanding options for teens with School Based Health, and in the next couple years hopes to greatly broaden the reach of Rx Play in the metro area.