How a pediatric clinic courtyard splash pad supports therapy, waiting families, and clinical engagement
A composite pediatric-clinic case study of a community pediatric clinic in a midsize Pacific Northwest city whose courtyard splash pad operates simultaneously as occupational-and-physical-therapy support infrastructure, family-decompression space during long appointment windows, and a clinical-engagement amenity reducing visit-anxiety across a predominantly Medicaid-and-CHIP-covered patient population.
Summary
A community pediatric clinic in Tacoma serving roughly 9,200 active patients across well-child, sick-visit, behavioral-health, and integrated occupational-and-physical-therapy programming added a $295,000 courtyard splash pad explicitly scoped as multi-purpose clinical support infrastructure. The pad operates simultaneously as OT/PT therapy support infrastructure with structured weekday-morning therapy programming windows, as family-decompression space during the long appointment windows characteristic of behavioral-health and complex-care visits, and as a clinical-engagement amenity reducing visit-anxiety across the clinic's predominantly Medicaid-and-CHIP-covered patient population. First-year operations served roughly 7,800 in-clinic-visit family uses plus roughly 4,400 community-open-hours uses, with documented clinical engagement and visit-anxiety improvements that the clinic medical director has cited at regional pediatric-care conferences.
Key metrics
Background: a community pediatric clinic, a long-underused courtyard, and a multi-purpose scoping framework
The clinic operates as a community pediatric practice serving a predominantly Medicaid-and-CHIP-covered patient panel of roughly 9,200 active patients, with integrated programming across well-child, sick-visit, behavioral-health, and occupational-and-physical-therapy dimensions. The clinic's main building, sited on a corner lot in a residential neighborhood, includes a roughly 3,200-square-foot rear courtyard that had operated as a partial parking-overflow area and underutilized landscape space across the prior decade. The clinical leadership team — including the medical director, the OT/PT program director, and the behavioral-health program lead — convened a multi-year courtyard-redesign engagement process beginning in 2022, scoping the project from the outset as multi-purpose clinical support infrastructure rather than as a generic outdoor-amenity addition. A splash pad emerged as the anchor scoping recommendation through extensive consultation with the OT/PT program (sensory-integration therapy support, gross-motor therapy support), the behavioral-health program (visit-anxiety reduction, family-decompression space), and the broader clinical leadership team (clinical-engagement amenity).
Therapy integration: structured OT/PT programming windows and sensory-integration design
Weekday-morning operating windows from 8am through noon are reserved for structured OT/PT therapy programming, with the pad operating as integrated therapy infrastructure during scheduled therapy sessions. Sensory-integration therapy programming uses the pad's quiet ground sprays, low-volume bubblers, and shaded decompression bench infrastructure for sensory-regulation support across patients with autism-spectrum, sensory-processing, and anxiety-disorder diagnoses. Gross-motor therapy programming uses the pad's broader feature distribution and perimeter-pathway infrastructure for gross-motor coordination support across patients in OT/PT programming for developmental-delay, post-injury rehabilitation, and chronic-condition management contexts. The pad's design palette was developed in extensive consultation with the OT/PT program leadership across the design phase, with sensory-integration considerations driving the inclusion of a low-stimulation feature cluster on the pad's eastern half (no bucket dump, no high-volume cannons, restrained color palette) distinct from the higher-stimulation feature cluster on the western half (one 30-gallon tipping bucket, two interactive cannons, broader feature distribution).
Family-decompression programming: long appointment windows and waiting-family infrastructure
The clinic's behavioral-health and complex-care programming generates a substantial volume of long appointment windows — initial behavioral-health intakes routinely run two-and-a-half hours, post-diagnostic family meetings routinely run three-and-a-half hours, and complex-care multi-specialty visits can run four hours or longer. Across these visit types, accompanying siblings and waiting-family members face substantive decompression-and-engagement infrastructure gaps that the clinic's standard waiting room cannot reasonably accommodate. The courtyard pad operates as integrated waiting-family decompression space during these long-appointment-window contexts, with clinical staff coordinating with families at intake to communicate courtyard-pad access alongside standard waiting-room availability. First-year tracking documented roughly 7,800 in-clinic-visit family uses across the operating season, concentrated heavily in the long-appointment-window visit categories. Parent-survey data collected at visit checkout documented substantive family-experience improvements, with 79% of parents in long-appointment-window visit categories citing courtyard access as 'very valuable' or 'extremely valuable' to their visit experience.
Visit-anxiety reduction: clinical-engagement amenity outcomes
The third programming dimension — clinical-engagement amenity, supporting visit-anxiety reduction across the broader patient panel — has produced the most substantive measurable outcomes. The clinic implemented a structured pre-visit-and-post-visit parent-survey instrument capturing visit-anxiety scores across the broader patient panel during the 2025 calendar year, generating both pre-pad-construction baseline data and first-season-of-pad-operation comparison data. The comparison documented a 23% reduction in mean visit-anxiety score across the patient panel during the operating season, with the strongest improvements concentrated in patient-age cohorts under age eight and in visit types historically associated with higher visit-anxiety (immunization visits, behavioral-health intakes, post-injury follow-up visits). The clinic's medical director has cited the visit-anxiety reduction outcome at regional pediatric-care conferences and in a peer-reviewed practice-improvement publication submitted to a regional pediatric-medicine journal, framing the splash-pad amenity as substantively connected to clinical-engagement and pediatric-visit-experience improvement rather than as a peripheral amenity addition.
Replicability across other community pediatric clinic contexts
The Tacoma model is replicable across analogous community pediatric clinic contexts where substantive integrated OT/PT programming converges with substantive long-appointment-window visit volume and available courtyard or analogous outdoor-space capacity. Several conditions affect replication success. First, integrated OT/PT programming infrastructure supporting structured therapy programming windows is essential — clinics without integrated OT/PT programming face a substantively different scoping framework. Second, substantive long-appointment-window visit volume supporting family-decompression programming demand is essential — clinics with predominantly short-appointment-window visit volume face thinner family-decompression-programming demand. Third, available courtyard or analogous outdoor-space capacity is uneven — clinics in dense urban contexts without outdoor-space capacity face site-constraint barriers. Fourth, capital pathways supporting clinic-amenity capital — including HRSA capital grant pathways for federally-qualified-health-center clinics, community foundation pediatric-health pathways, and clinic-reserve capital — are uneven. Where these conditions converge, the pediatric-clinic courtyard splash-pad pattern produces uniquely strong clinical-engagement, therapy-programming, and family-decompression outcomes.
Voices from the project
“The OT/PT therapy programming windows in the morning are the part of this project that has changed how we deliver sensory-integration therapy. Working with patients in a real outdoor sensory environment beats anything we can do with clinic-room equipment alone.”
“Long behavioral-health intakes used to mean siblings sitting in the waiting room for two and a half hours. The courtyard pad means siblings have somewhere to actually be a kid while we do the clinical work with the patient and the parent. The family-experience difference is substantive.”
“A 23% reduction in mean visit-anxiety score across the patient panel is the kind of outcome that pediatric-care leadership across the region has been asking us about. The amenity is connected to clinical engagement, not peripheral to it.”
Lessons learned
- Scope the project from the outset as multi-purpose clinical support infrastructure rather than as a generic outdoor-amenity addition; framing shapes capital-pathway and programming outcomes.
- Reserve weekday-morning operating windows for structured OT/PT therapy programming; programming integration produces substantively stronger therapy-program outcomes than reactive clinical-amenity access.
- Design with sensory-integration considerations driving feature distribution; bifurcated low-stimulation and higher-stimulation feature clusters serve substantively broader patient-population needs.
- Communicate courtyard-pad access at intake for long-appointment-window visit types; passive availability undersells the family-decompression programming dimension.
- Implement structured pre-visit-and-post-visit parent-survey instruments capturing visit-anxiety scores; clinical-engagement-outcome data substantively strengthens the project's institutional legitimacy.
- Pursue HRSA capital grant pathways for federally-qualified-health-center clinics and community foundation pediatric-health grant pathways for non-FQHC community clinics; clinic-reserve capital alone rarely justifies the full project budget.
- Engage OT/PT program leadership across the design phase rather than retrofitting therapy programming after construction; therapy-integration outcomes are substantively stronger when programming considerations drive design.
FAQ
How does the clinic manage liability and supervision considerations for in-visit family use of the courtyard pad?
Family use of the courtyard pad during in-clinic visits operates under a structured parent-supervision protocol, with the accompanying parent or guardian responsible for direct supervision of children using the pad during the visit window. The clinic's intake protocol communicates the supervision expectation explicitly, and the courtyard pad's design — fenced perimeter, single entry-and-exit point, age-appropriate feature distribution — was scoped from the outset to support parent-supervised family use. Liability infrastructure was developed in coordination with the clinic's malpractice carrier during the design phase rather than retrofitted after construction.
Does the pad operate as part of billable OT/PT therapy sessions, or as an unbilled clinical-amenity adjunct?
The pad operates as integrated therapy infrastructure during scheduled OT/PT therapy sessions, with therapy programming delivered at the pad billable through the standard OT/PT therapy billing pathways under the supervising therapist's licensure scope. The OT/PT program director worked closely with the clinic's billing-and-compliance team across the project design phase to confirm that integrated outdoor-therapy programming falls within standard OT/PT billing scope when delivered under the supervising therapist's session protocol. Outside scheduled therapy sessions, the pad operates as an unbilled clinical-amenity adjunct accessible to in-clinic-visit families.
How does the pad operate during community-open-hours windows outside clinic operating hours?
Community-open-hours windows operate Saturday afternoons and Sunday mid-day during the operating season, with the courtyard accessible through a separate side-yard entrance during open-hours windows. The community-open-hours dimension was developed in consultation with the surrounding neighborhood block club and adjacent family-services organizations, with the broader clinical mission emphasizing community-engagement programming as a substantive dimension of the clinic's identity in the neighborhood. The community-open-hours model has not produced substantive clinical-operations friction across first-season operations, with the side-yard entrance routing keeping community-open-hours visits separate from the clinic's main entry-and-exit flows.
Related reports & data
Pair this case study with our original-data reports for citation and benchmarking.