Background: Social-emotional development and self-regulation are foundational skills in early childhood which impact long-term academic, behavioral, and mental health outcomes. Despite growing evidence supporting the benefits of exposure to nature, many children have limited access to natural environments and most existing OT interventions and programs targeting social-emotional skill development do not incorporate this valuable context. This capstone project addressed this gap by developing a nature-based occupational therapy (OT) group to support social-emotional and regulation skill development in preschool-aged children. Objective: The objective of this project was to develop and implement a nature-based occupational therapy group for preschool children at risk for social-emotional and self-regulation challenges and to evaluate the program’s perceived effectiveness through caregiver and teacher feedback. ACOTE Area: The primary ACOTE area of this project was Program Development and Evaluation. Secondary areas included Clinical and Education. Methods: The development of the group program was guided by a literature review, theoretical frameworks (ECO-Therapy Model, Attention Restoration Theory, Biophilia Hypothesis), and a needs assessment via key informant interviews. Two 9-week nature-based OT groups were implemented with eight children ages 3–5, divided by developmental needs. The group was primarily conducted outdoors and intentionally integrated natural elements to harness the benefits of engaging with nature. Sessions targeted emotional regulation and social skills through structured outdoor activities, social stories, a modified ALERT program, introduction of regulation techniques, modeling, and practicing of skills in a natural context with peers and adult guidance as needed. Evaluation of the group programming was conducted primarily via a thematic analysis of teacher and caregiver surveys. Informal assessments of group progress and goal tracking were also used as secondary methods of evaluation. Results: Survey responses were received from 7 out of 12 caregivers and teachers. The feedback indicated overall positive perceptions of the group program. The caregivers and teachers noted that the educational resources provided along with the group were helpful in developing a shared language around emotional regulation (e.g., “fast vs. steady engines”) and learning new methods to support their students or children. Respondents’ perceptions of behavioral changes in the group participants were mixed, with some noting improved confidence and self-awareness and generalization of skills to home and classroom environments and others noting no changes. The small group format was highlighted as a strength, and the natural setting was perceived to enhance engagement and attention. Suggestions included increased communication frequency and more individualized feedback. Additionally, the output of this project provides a set of adaptable, low-cost session plans and associated caregiver educational resources to support implementation of future programming. Conclusions and Relevance: This project supports the growing evidence that nature-based OT interventions can promote social-emotional and self-regulation skills in early childhood. The outdoor context was perceived to support emotional safety, engagement, and skill generalization, aligning with existing theories. While limitations included short program duration, influence of external factors such as weather, and a small sample size for surveys, findings suggest there is a meaningful potential for nature-based OT interventions in school and community settings. The program also provides a framework and offers practical tools for clinicians and educators to sustainably implement future nature-based OT groups.