In San Diego County, California’s unincorporated Lakeside community, engaging in physical activity is a challenge for many families due to a lack of resources and negative perceptions of nearby parks. In 2013, the County of San Diego Department of Parks and Recreation (County) launched a coordinated effort in Lakeside to: 1) assist local healthcare providers in connecting overweight youth to opportunities for exercise; and 2) address cost, information and perception barriers to park and recreation programs. Through the Rec Rx initiative, the County hoped to help more children attain their fitness goals and adopt lifelong healthy behaviors.

The County piloted Rec Rx in 2009 in the Spring Valley community, whereby free recreation programs, as well as fitness classes for a $5 copay fee, were made available to overweight and obese youth through clinical prescriptions. To assist pediatricians in making the prescriptions, the County created handouts with information about qualifying park programs along with maps detailing public transportation routes. The program helped educate many families about their neighborhood parks and created a sense of community connectedness in the area. 

Lakeside was an ideal location to expand Rec Rx. The community is home to Lindo Lake County Park, a recreational hub. A wide variety of amenities there support active recreation, including a community center, teen center, playgrounds, green space, sports fields and a 17-station fitness trail. Although residents have long considered Lindo Lake Park unsafe, the County has worked to improve perceptions over the last decade by increasing the park’s offering of community events and programs. The department hoped Rec Rx would further demonstrate the park’s value.

The park is also in extremely close proximity to the Neighborhood Healthcare (NHC) Lakeside clinic, a principle healthcare provider for Rec Rx. “The premise is, if the patients can get to the clinic, they can definitely get to the park,” notes District Manager Christine Lafontant of the County of San Diego Department of Parks and Recreation.

More than 30 recreation classes were made available to Lakeside patients through a $5 copay system. The County further reduced cost barriers by providing free programs, including ranger-led hikes, a “Fit Kids” program via the Healthy Adventures Foundation and a brochure-led TRACK Trails program developed by Kids in Parks.

Through detailed training sessions, the County successfully engaged eight healthcare providers for the expansion, including four doctors with NHC Lakeside, two “home visit” nurses employed by County of San Diego Health and Human Services, and two nurses providing weekly health services at the Lakeside Community Center via the American Red Cross Women, Infants and Children (WIC) program. 

According to Lafontant, the overwhelming excitement for Rec Rx expressed by health professionals was coupled with only one point of contention. While most felt that all children were at risk of being overweight and should receive prescriptions, the County wished to limit the program target to youth with high Body Mass Indices (BMIs) due to budget constraints. Ultimately, it was decided that any patients could receive prescriptions for free programs, but only patients with high BMIs would be eligible for copay classes. 

Of the 49 prescriptions handed out to date, the County notes that the overall filling of prescriptions has been low. However, the County has achieved enormous success with the WIC program, in particular, with 90 percent of the prescriptions being redeemed. The park and recreation department attributes this in part to the fact that prescriptions could be filled in the very facility in which they were handed out — reducing transportation barriers and eliminating the potential for loss of momentum following prescriptions.

Interestingly, the County observed that the copay programs were much more successful in appealing to parents, due to their perceptions of subsidized, fee-based classes having a higher value for participants than free activities.

In presurveys given to Rec Rx participants, patients indicated having negative perceptions of parks, and that their use of parks was low, prior to joining the program. The County is following up with respondents a second time to determine how Rec Rx has impacted their use and perception of local parks in the longer term. The County has officially mandated the official expansion of the program in the East Region through the Live Well San Diego initiative and anticipates that survey data will be useful in engaging new funding sources and partners.

This case study is part of a new NRPA publication, Prescribing Parks for Better Health: Success Stories. 

Success Through WIC

The Rec Rx prescriptions given out through the WIC program have resulted in a high follow-up rate of 90 percent. The County tentatively attributes this to the following:

• Patient visits take place inside the community center. This results in a high convenience factor for registration as well as constant exposure to classes.
• WIC nurses see many patients below preteen age who are easier to engage in new activities.
• WIC nurses see patients on a semi-regular basis, which makes it possible to build trust and form closer relationships.

Program Challenges

The County has noted two specific challenges in the implementation of Rec Rx: 

• Turnover among dedicated program staff
• The lack of a person in each clinic who serves as a physician champion for the program and helps streamline coordination with the County

Amy Kapp is a freelance writer in northern Virginia.