HLOL Podcast Transcripts

Health Literacy

Accessible Recreation for All (HLOL #249)

Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z. I also produce and host this podcast series, Health Literacy Out Loud.

Today, I’m talking with Karen Foster, who is the Executive Director of All Out Adventures based in Massachusetts. Prior to being appointed as Executive Director, Karen worked for this organization as a program leader. She’s also been a 9th grade history teacher and school-based program administrator.

Karen is certified to teach coastal kayaking and stand-up paddle boarding. She also has experience leading many other outdoor recreation programs.

Beyond all these accomplishments, Karen is the former Vice President of the City Council and a current member of the School Committee in her hometown of Northampton, Massachusetts.

In a recent Health Literacy Out Loud podcast, Rear Admiral Paul Reed, who is the US Deputy Assistant Secretary for Health, talked about the importance of finding health in context of the environments in which people live, work, play, grow and age.

Karen, your program is a terrific example of doing just that. Welcome to Health Literacy Out Loud.

Karen Foster: Thank you so much for having me.

Helen Osborne: I am delighted. I saw your excellent work at a rail trail in my town of Natick, Massachusetts. It was last year, and I saw people of all abilities riding bikes of some variety up and down the rail trail.

I don’t think I’ve ever seen a group of people with bigger smiles on their faces. I had the impression that, for some people, this may have been their first time riding a bike on a rail trail thanks to you and your program.

Let’s take it from the beginning. Why is it important for people of all abilities to participate in active recreation?

Karen Foster: It’s something that complements and brings joy to all of our lives to participate in recreation programs.

In so many facets of our lives, people who have disabilities are not fully included. Offering outdoor recreation programs like we do, or sometimes it’s indoors at community facilities, people of all ages and all abilities are connected to each other, to their communities and to their own bodies.

Very often, people who are living with disabilities don’t necessarily know that these opportunities are open to them. Our program has really helped to bridge that gap.

As you saw that day in Natick when you saw us, absolutely everybody can participate in cycling on their local rail trail. We just really try to make that possible and make sure that anybody who wants to participate is able to do so.

Helen Osborne: Make it clear for others. I could see it myself and saw the bikes. I also saw people there who looked like they had a lot of challenges in their abilities. They each were on some version of a bicycle, with or without a guide.

Describe for all our listeners, please, some of those stories about what it took and what it was like to make that happen.

Karen Foster: I think so many of us, when we close our eyes and picture somebody out riding a bike, we have probably a relatively similar image. The first step for us is being willing to really change that image of what it looks like to be cycling.

To start at the beginning, we have a 16-foot box truck that we load up with a variety of different cycles. All of the different cycles that we have meet different abilities and disabilities to include everybody in riding.

We have cycles that have a wheelchair seat on the front. There is a cyclist behind doing the pedaling, while a person who uses a wheelchair can transfer into a wheelchair seat and be passive in their cycling.

We have recumbent trikes. They’re trikes that have two wheels in the front and one in the back, so balance is quite good. We can set up the shifting and braking on one side or the other, so people who have use of one arm, but not the other, can safely ride and independently control their cycle.

We have tandems of recumbent trikes, similarly, so that people, where balance is a concern, but maybe either don’t have the impulse control or the vision to be able to steer, brake and shift their cycle, can ride on a tandem with somebody who handles the steering, braking and shifting.

We have a wheelchair transport bike. Some people are far more comfortable in their custom wheelchairs, and with this cycle, we have a platform that we can roll the whole wheelchair onto and tie it down while somebody pedals.

We can really run the gamut from people who are completely independent to people who are participating passively.

Helen Osborne: The joy that I saw, I just felt the joy radiating there. I was walking along. I’m an everyday walker with a grin on my face, but their grins were even bigger. I felt like giving everybody a high-five. It was a wonderful experience to see and for you to be able to do that.

For all the adaptations that you had to do to make that work, is that something you have to figure out ahead of time, or can you do this in the moment with whoever shows up?

Karen Foster: We always book our cycles and get a sense ahead of time of what adaptations we may need. We’ll talk with people on the phone or by email and get a sense of how tall they are, if they can use one hand and not the other or will need a wheelchair bike. We do that over the phone.

But then in the moment, we’re pretty quick with a Velcro strap or with swapping out pedals if the pedals that are on the cycle aren’t going to be the best ones to meet somebody’s needs. You do this enough that you really get a sense of what adaptations may make the difference.

Very often, it’s a foam wedge to help somebody sit more upright and more comfortably, or a Velcro strap to make sure that if somebody’s leg is splaying out, we can keep it where it needs to be.

But it’s all about the principles, and that’s true of all of our programs. When you kayak, you want to be seated upright, balanced in the boat. On a cycle, you want to be upright and able to stretch out your pedals or access your steering, braking and shifting.

For us, it’s just about figuring out what tools and tricks we might need to get to the principle of being able to ride or participate safely and comfortably.

Helen Osborne: When you say “we,” it’s not just you and one other person. You work with a team. I saw a lot of people wearing signs saying “Guide,” too.

Karen Foster: There are three of us who work full-time at All Out Adventures, and then we have, depending on the season, up to 12 part-time staff who work to run programs. I’m out there running programs once or twice a week. We have other staff anywhere from two to five days a week that are out running programs.

That particular program in Natick was also very volunteer-heavy, which is wonderful. Our staff are generally looking at the big picture of our programs and making sure that we have our liability waivers, everybody’s helmet fits correctly and all of those things. Volunteers can help to provide one-to-one support for people. They really complement our programs.

Helen Osborne: Are programs like these unusual? Am I just super lucky to have met you and you are involved in my community as well as other ones across our state? Is this something that’s happening countrywide or worldwide?

Karen Foster: Adaptive recreation is definitely a growing field. I see many more organizations and many more opportunities out there than there used to be.

But that being said, there’s not enough to meet the demand. At All Out Adventures, we have waiting lists for many of our programs.

It’s not uncommon that somebody will have come across one of our programs, but they live in another state. They’ll call me and say, “Hey, where can I find something like this where I live?” I’ll look and maybe there’s a big service gap.

I wouldn’t call it unique. I would definitely say it’s growing. But it’s also not ubiquitous.

That’s one of the things that makes All Out Adventures unique. We are based in the western part of Massachusetts, but we work statewide.

We even run programs in Rhode Island because we are set up to offer these programs and we might be the closest organization to different locations to do that.

Helen Osborne: You talked about your huge truck that came with all your supplies and all your different cycling options. That sounds like a big deal, and it’s probably expensive for you to be able to have all that.

I’m interested for the listener who wants to be able to have something like this but doesn’t have the wherewithal like you have.

First of all, how do you overcome resistance to this? You talked about liability. Is there resistance at the organizational level? Is there also resistance from the individual who might be saying, “I’ve never ridden a bike. I have this limitation or that limitation. I couldn’t possibly do this”? Are you dealing with resistance in that way before you even get started?

Karen Foster: For sure. There are so many people who, when they discover our programs, feel like they’ve been set free. What they think is, “Oh my gosh, I had no idea that kayaking would ever be something I could do. This is amazing. Thank you.” We get that a lot.

But we also get people who either they or their family members are fearful, because this is not risk-free. There are opportunities out there that, yes, we could capsize in our kayak, or we could fall off our bike.

There definitely can be some fear. Just the idea of signing up for a program and coming and committing to a program can be a lot.

Very often, when family members ask how they can get their loved one involved and their loved one says, “I’m not doing that,” I’ll invite them just to stumble by the program and check it out. Just be out for a well-timed walk, or come have a cup of tea and check it out or meet us.

Then with individuals who really want to do something, but their family members or caretakers may be resistant, very often we can talk by phone and say, “You should see our risk management plans. They’re lengthy and detailed.”

I’ll share those plans and we’ll talk about all of the things that we do to help make it a comfortable experience for people.

Even then, we’ll invite family members and caregivers just to stop by and see what we’re doing, because it really can be a mental leap for folks.

Helen Osborne: I can see that for the individual, for their expanded circle, families, caregivers and what it takes to make this happen.

As you’re talking about people who are concerned saying, “I could never do this,” I am thinking of my own experience. I don’t have any particular limitations in my abilities except that I am not all that agile. I am not all that comfortable in adventure situations.

I went somewhere with my family and there was white water rafting. I remember saying to them, “You go off and do that. I’ll see you on the other side.” They kept saying, “Come on. Give it a try.”

Someone who was leading the white-water rafting talked me through this, by saying, “What are you so concerned about?” I said, “I’m afraid I’m going to fall out. I don’t know what I’m doing.” They said, “We’ll work with you on that.”

They did, and it turned out to be the most amazing experience. As we were finishing our white-water rafting, I didn’t want it to end. They helped me overcome my personal reluctance, a fear at some level.

I assume that experience is what people feel like when they go out on a bike, a raft or whatever you do with them.

Karen Foster: It can. One of the activities we did at a recent staff training was for us all in small groups to think about a time where we were fearful, felt like we didn’t belong or weren’t sure how an experience was going to go, and to reflect on that and share that with other staff.

It was very powerful, because very much it can be about getting in that mindset and really understanding that something that maybe we do daily is actually something that’s very difficult for somebody else. Our staff are just tremendous at meeting people where they’re at and helping them to be comfortable.

Helen Osborne: That’s great. That’s a wonderful transition to where I want to go with this conversation. As you know, my focus for this podcast and in all the work I do is communicating health information in ways people can understand. On a recent podcast, Rear Admiral Paul Reed talked about health happening in the environments in which we live and work.

Can you tell us more about the health aspect of all of this. What you see as the benefits of this and how this might relate to health literacy and just being healthy.

Karen Foster: For sure. The impacts of time spent in nature on our mental and physical health and community connectedness are profound. For people to hike or kayak in a beautiful place has been shown to reduce anxiety, depression and feelings of loneliness. Our activities are group experiences and people make very deep connections. We see that happen and we facilitate that.

The other thing that the programs do is connect people to spaces that they can access on their own outside of our programs.

Thinking about health literacy, one of my most favorite experiences was several years ago. We were leading a hiking series for people who were blind. We had guided them through a fairly rugged hike and described everything about the hike, the logs and the rocks we were going to watch our footing on.

When we were done, we sat down at a picnic table and fired up the stove to make tea. Somebody said, “Oh, there are picnic tables here.” I thought, “Wow, I hadn’t thought to describe that.” I said, “Yes, there are picnic tables here. You can come any time you want, as this is your park, and have a picnic.”

When we saw her the next week, she said to me, “Karen, I came back over the weekend with my brother and his family.” That can sound so minor, but it’s not, because that was her first experience that the state park is her park and she belongs there. Yes, she can go hiking and she can gather with her family and be an integral part of the community.

There’s nothing more health-promoting than for people to make those kinds of community connections. It’s not just the physical health.

Helen Osborne: It’s not illness-based or limitations-based. It’s health-based, and that’s what you’re talking about, that’s what I saw and that’s what I perceived. It’s wonderful working toward this.

Our podcast listeners all care about helping people be as healthy as they can and helping people make reasoned choices and making health happen.

Without the luxury of having access to a group like yours, what are some suggestions for an organization, for an individual, for a family member or a caregiver? How can we each help make health happen where we live, work and play?

Karen Foster: I used to work with a volunteer coordinator whose favorite phrase was “imagine the possibilities.” I just loved that of her because I think that’s where we can start. Instead of seeing what people can’t do, if we look at what people can do, we can get to removing the barriers to people being active.

I’d mentioned cycling as an example. If I look at someone and say, “They can’t use their right hand,” that’s one mindset. But if I look at them and say, “Hey, look, they can use their left hand,” that’s a whole different mindset and we can start to think about that.

We also are very conscious about helping people use everyday objects to make recreation possible. We have this internal joke, but we travel with an Igloo cooler wherever we go.

Helen Osborne: A cooler?

Karen Foster: It’s a cooler. We call it our transfer cooler. We set our transfer cooler on the ground next to a kayak, and it’s a mid-step for somebody to get from standing to seated to then swinging their legs in and transferring into a kayak. Or we might use a Velcro strap to get somebody’s hand safely attached to something.

There are a lot of times that there’s a lot of innovation people can do without necessarily having access to the fancier equipment.

Also, in Massachusetts, many of the state parks have equipment that people can use. A number of our ice rinks have ice-skating sleds that people can access on their own.

Helen Osborne: Ice-skating sleds?

Karen Foster: Yes, so that people can skate in a seated position.

Depending on resources, a lot of times some of that equipment is available for people to use. Or it may be finding the accessible walking trail that a wheelchair can go on. They’re popping up in more and more communities. Sometimes it’s time well spent with Google to see what resources are out there.

Helen Osborne: As you’re telling this, I’m thinking of the time we took a brother-in-law birding down some accessible path, even though he was in a wheelchair, and the joy that he felt. This is joy we all can bring, which is what we want to be doing. That’s how we want to live and we want others to live.

What do you think it’ll take to make this happen more universally?

Karen Foster: I think the growing awareness of its importance is one of the most significant things. It’s going to come from demand.

Many people who are living with disabilities themselves already have financial barriers, time barriers and things like that. A lot of it, as well, will come from family, friends and community members who say, “I can access this incredible park. Why isn’t there a ramp? Why isn’t there an accessible hiking trail in my park?” and to start to look for opportunities to create accessibility where we can.

A lot of times, it’s just paying attention to what those barriers are and then looking to see, “How can I contribute to removing some of them?”

Helen Osborne: You used a word right at the beginning, the word “opportunity.” It sounds as though you’re an opportunity seeker. You’re finding those opportunities. You’re not looking at what might not be able to happen, but instead looking for ways to make it happen.

Karen Foster: Yes, absolutely. That’s the mindset that works, and it’s the people who come and work with us to make something happen that they didn’t think was possible. It’s its own reward. Once you start to have those experiences, you start to see that opportunity everywhere.

Helen Osborne: I hope this opportunity of talking with you on this podcast will go forth and spread so people will hear the enthusiasm in your voice, will hear these stories and will find ways to make this happen where they live, work, play and grow.

Are there ways people can be learning more? Also, your company is All Out Adventures. Can they learn more about that group. Are there other ways that they can feel a little more confident moving forward?

Karen Foster: Certainly. Our website is www.AllOutAdventures.org. There, we have quite a bit of information.

There are also a number of other organizations though I hate to start mentioning them because I’m afraid I’ll leave somebody out. Maine has Maine Adaptive, and Vermont has Vermont Adaptive.

There are a number of different organizations, as well as certain companies, that are making equipment that work for a wide variety of people.

For kayaking and stand-up paddle boarding, we often get our supplies from a company called Creating Ability. Then for recumbent trikes, there are a number of manufacturers of recumbent trikes and Van Raam cycles that have a wide variety of adaptive cycling opportunities for people.

Helen Osborne: It sounds like, as you said, this is growing.

Karen Foster: It’s growing.

Helen Osborne: It’s growing, and probably a really good search will help people to find what may be available in their community or in their state. There might be networks out there.

Karen, I thank you for all you do, all that you make possible and for sharing that with us on Health Literacy Out Loud.

Karen Foster: Thank you for having me.

Helen Osborne: As we just heard from Karen Foster, it’s important to find ways to make recreation happen and accessible to everyone. That’s part of good health. But doing something like this is not always easy.

For help clearly communicating your health message, take a look at my book, Health Literacy from A to Z. Feel free to also explore my website, www.HealthLiteracy.com, or contact me directly at helen@healthliteracy.com.

New Health Literacy Out Loud interviews come out the first of every month. You can get them all for free by subscribing at www.HealthLiteracyOutLoud.com, or wherever you get your podcasts.

Please help spread the word about Health Literacy Out Loud. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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