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Crestwood Behavioral Health


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The Healing Power of Dogs

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When he first stepped inside Crestwood San Diego he was thin, weak, and frightened. He had patchy hair from malnourishment and poor hygiene. He had been abused and kept in a small space when he was younger, and he was later abandoned by his first family. He had been forced to live on the streets for some time before getting taken in by the “system.” He would sometimes get aggressive with others and he clearly was traumatized by his past in ways that gave him nightmares that made him toss and turn and cry at night. His legs were weakened and arthritic from being confined when he was young, and this caused him to struggle when walking. He was nervous when he first came to Crestwood San Diego, but he was quickly embraced by both the staff and clients. His name is Gifford and he is a six-year old Chow Chow/Golden Retriever mix dog.

Gifford was adopted with another rescued older Chow Chow/Golden Retriever mix, named Enzo, from a high-kill shelter in San Bernardino by two staff members, Meghan O’Barr, a Service Coordinator at Crestwood Chula Vista and Stephen O’Barr, Director of Nursing at Crestwood San Diego.  Enzo’s first owner was a man with mental illness who ended up hospitalized for a long period of time, which then left Enzo to fend for himself on the streets, until he was picked up by the shelter.

Gifford was so scared and traumatized that he didn’t make eye contact at first, but he was ever so grateful for any petting he received. He required a lot of care, rehabilitation, and exercise before he stepped inside the facility as a therapy dog. He was shy at first, but as staff and clients opened up to him and showed him love, he quickly grew to like spending time at Crestwood San Diego and Crestwood Chula Vista. Like Gifford, Enzo had many trust issues.  He would greet people, but also kept his distance for the first month. It took patience, consistency and compassion for Enzo to get past his trust issues, just like many of our Crestwood clients.  Enzo is now the quintessential “Velcro” dog, always staying close to his family, yet with reassurance, is eager to meet new people and give them kisses.

Michael Bargagliotti, the former Administrator of both Crestwood Chula Vista and Crestwood San Diego, who is now the Administrator of the Crestwood Center San Jose campus, was highly supportive of incorporating pets as part of the therapeutic milieu.  Since September 2015, Michael opened the door to allow several staff members to bring their dogs to both facilities, including Service Coordinator, Maida Ferraes, who brings her dog Rocco; Director of Nursing Services, Fabiola Evans, who brings her dog Riley; and Service Coordinator, Jana Cook, who brings her dog Sammy Thomas. All of these dogs were rescued from shelters, have experienced their own trauma and now love their new lives as the dogs of Crestwood.

The dogs add to the feeling of a warm and homelike atmosphere that Crestwood MHRCs strive to create with a living-room milieu. They don’t just bring cuteness, fur and fun to the two programs; they have made connections with some of the clients who suffer from the worst paranoia and anxiety and who often push most people away. Studies have shown that pet therapy helps clients by lessening depression, decreasing feelings of isolation, encouraging communication, providing comfort, increasing socialization, lowering anxiety, and reducing loneliness.  Gifford recently helped a client with suspected sexual abuse to feel safe and comfortable enough so that they could start opening up to the staff. Gifford was also the mascot at the first San Diego vs Chula Vista kickball tournament, and he even makes appearances at IDT meetings so that clients can feel more comfortable in discussions that may be sometimes stressful.

One client coping with manic episodes at Crestwood Chula Vista refers to Rocco as “my boy” and their shared exuberance and energy makes them the best of friends.  Rocco has been instrumental in reducing this client’s symptoms with simple, every day dog activities, such as walks and games of fetch. Like Gifford, Rocco struggled with his relationship with other animals and underwent training with a behavioral therapist, an experience that many clients can relate to. Sammy Thomas, who one of the clients calls, “Jana’s Lamb,” is a gentle boy, who like some of our clients, suffers from a severe medical condition.  Sammy experiences seizures and takes medication daily. Jana and Meghan both use their dogs’ medication needs to help normalize medication management and this helps many of their clients realize that Sammy and Enzo are just like them.

Clients at Crestwood San Diego and Crestwood Chula Vista have watched with delight as love and care have transformed Gifford from a nervous, half-lame dog with patchy fur, into a big, friendly bear with a beautiful, thick coat. The message our clients get is that if Gifford can grow and change, then so can they.  Just as the staff is deeply satisfied by their clients’ growth and successes, the clients have taken great joy in seeing the recovery and resiliency of our Crestwood dogs and know that they are capable of recovery too. Several clients have grown very attached to the dogs and look forward to each of their visits. These amazing dogs have awakened empathy and affection in many of our clients through their unconditioned love and presence. They both share a lot of trauma and suffering in their pasts.  They also share a simple need, which is to be loved and to know that they are not alone and they can give each other that powerful, simple love that makes them both stronger and happier.  That love, togetherness, and understanding are the mainstays of recovery, and are what makes Crestwood so special.

Contributed by: Meghan O’Barr, Service Coordinator
Crestwood Chula Vista
and
Stephen O’Barr, Director of Nursing, Crestwood San Diego


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Zumba’s Spark is Energizing Crestwood

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One of the biggest challenges for both our clients and staff is finding the time and motivation to get adequate exercise. Greg Parnell, the Director of Education and Assistant Program Director at Crestwood Behavioral Health Center Eureka’s campus, has been a licensed Zumba instructor for five years now, and to say he is passionate about Zumba, would be an enormous understatement. He teaches Zumba classes not only for the clients in the Eureka facility, but also in the community at recreation centers and schools.

Zumba was started in the 1990s blending aerobic exercise with infectious Latin dance music. It is now a worldwide phenomenon being done in 180 countries, with more than 15 million students taking classes. What Greg and many others that participate in Zumba have found is that it is an activity that sparks something deep inside your spirit. That spark energizes you, changes your mood, and changes your outlook on life. Not only does Zumba bring about physical changes in you, it brings about mental and spiritual changes as well. Zumba can be a spark that starts with a simple routine of fun exercise, which then progresses into wanting to eat better, feel better, present one’s self better, and be more active in the world.

Crestwood has added Zumba to our Mind, Body, and Spirit Initiative. To get Zumba started in our facilities, Greg, along with Margaret McDonald, Administrator at Crestwood Center at Napa Valley and Crestwood’s Director of Nutritional and Wellness Services, wrote a proposal for a Crestwood Zumba Program that has several components and was geared toward both clients and staff. Their first goal was to get one or two staff members at each facility to be trained as Zumba instructors. These staff members can then teach 3 to 5 classes a week for clients and staff at their facilities. The second component was the purchase of Zumba DVDs that could be used to do additional Zumba classes or while trained staff is away. And the third part was to reach out to local Zumba instructors and develop a mutually beneficial relationship with them, in which they would volunteer their time to do Zumba at our facilities, in exchange for directing staff toward their classes in the community. Greg, as Crestwood’s in-house Zumba resource, will also travel to the facilities quarterly to reinvigorate the programs and troubleshoot any problems.

At the 2015 annual Zumba Convention that was held in Orlando, Florida, Greg shared Crestwood’s proposal for a Zumba program with Alberto Pearlman, the CEO of Zumba, who then shared it with conference Keynote speaker, actress and singer Ashley Judd, who lives her own recovery story of depression and wellness through Zumba. Ms. Judd and Mr. Pearlman were so fascinated by what Crestwood is doing with Zumba that they both decided they wanted to be involved. Mr. Pearlman graciously offered to train Crestwood staff to become licensed Zumba instructors. In November 2015, 11 Crestwood facilities, (Angwin, American River, Sacramento, Pleasant Hill, San Jose, Fresno, Bakersfield, Vallejo, Solano, San Diego, and Chula Vista) sent nineteen staff members to Cheryl Louie’s Studio Z in Newark, California, where they were trained by Joy Smith, a Zumba Education Specialist, to become licensed Zumba instructors.

Since then, Greg and Margaret have been traveling to our facilities helping our licensed Zumba instructors plan their classes, help with choreography, and incorporate classes into program schedules. “The enthusiasm from staff and clients has been overwhelming, and the support from Administrators has been amazing. It is inspiring to see how many of our clients really get into the classes, the music, the movement, and just losing themselves into the rhythms,” said Greg. “There are also stories of amazing transformations of our very quiet and soft-spoken clients who suddenly come alive when the Zumba class starts. They see and feel the energy around them and then want to join in.” And then there are also staff members, who after just one of Greg’s Zumba visits, are then inspired to want to do more, learn more, and become Zumba instructors themselves.

Greg and Margaret hope to measure the success of the program and the influence of Zumba on our clients and staff in several ways. They have developed a pre-survey to be used before Zumba is offered in the facility and a post-survey after Zumba has been added to the program schedule. These surveys will assess the number of days clients exercise, reported enjoyment of exercise, and reported barriers to exercise, such as feeling self-conscious or not enjoying exercise.

When the Zumba program is fully up and running in our Mental Health Rehabilitation Centers, Psychiatric Health Facilities, Adult Residential Facilities, and Social Rehabilitation facilities, they intend to bring Zumba Gold to our Skilled Nursing Facilities. Zumba Gold is a specialized form of Zumba for older adults. “We believe all of our clients and staff, no matter what age or ability level, will benefit physically, emotionally, and spiritually from participating in such an accessible and inspiring form of exercise,” said Margaret. “We also would love to eventually have clients be trained to become Zumba instructors, giving them meaningful roles in the facilities and the potential for employment once they are back in their communities.”

Zumba truly provides that amazing spark to energize the mind, body and spirit of those who experience and embrace it in their lives.

Contributed by:
Margaret M. McDonald, M.S.
Director of Nutrition and Wellness Services
and
Robert Pitts, Campus Administrator
Crestwood Behavioral Health Center Eureka


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Our Spiritual Path

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When a person has no hope, no sense of self, no meaning in life, and when they feel that their purpose on this earth feels nonexistent, their dreams have evaporated and thoughts of tomorrow are too heavy a burden to carry – that person can start to drown in emptiness.  It is at this time when they need that path to be opened – the path of connection, the path of light and a path that is uniquely theirs. It becomes the one place or thought that they can hold on to; this is their personal spiritual path. Spirituality is the connection to a greater power, others and self.  It is the way to find meaning, hope, comfort and inner peace in life.  Many people find spirituality through religion, music, art or a connection with nature, while others find it in their values and principles. At Crestwood Behavioral Health we hold spirituality as one of our core values for recovery.

The path can be dark at times. It can be difficult to find without a companion, a guide or simply someone who believes in you, who sees you and who can by a look, a touch or a word begin to open the door to your spiritual path.  The door may be a prayer, a moment of tears, or even a moment of silence. It is a connection with a higher power, with nature, with something or someone greater than ourselves.

The door to your spiritual path may be opened in the simplest and most humble of settings or it may be in a mosque, temple or church. It may be sitting near water or may be by spending time in the outdoors. At times it’s in silence or it can be brought on by a beautiful song.

Each person’s spiritual path can be healing, centering, a moment of peace that is filled with acceptance and love. It is often what brings back hope, a sense of self, purpose and a meaning to life. It is and shall always be a core value to what we offer in our services for our clients at Crestwood.

Contributed by: Patty Blum, PhD
Crestwood Vice President


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Crestwood’s Core Values: Family

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The family unit is one of the most important and influential social groups.  At some point in each of our lives, we are part of a family. Today we have expanded our definition of family beyond the “nuclear” reference and many people have created their own meaningful definition of family in their own lives.

In serving people challenged by mental health issues, Crestwood recognizes how essential family can be to the process of recovery. One of Crestwood’s Core Values is Family, which means our company is committed to providing safe, secure and responsive mental health services to the entire family.  It is estimated that up to 70% of people living with mental health issues live with a family member.

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The needs of families for support, education, and information are evident.  At Crestwood American River, we seek out and actively engage with the family members of our clients, and have become acutely aware of the stress and conflict they are experiencing.  As a result, the American River campus offers a free-of-cost Family Support Group to help families navigate the systems designed to support their family member, provide an outlet for sharing, problem solving and processing of difficult feelings, and creating their own self-care plans.

Our Family Support Group was started in January 2015, and is led by Denise Thompson, MFTI, who is one of the Recovery Service Coordinators at the American River PHF.   The group is a psycho-educational community support group and is open to all family members of past and present clients.  The group is held bi-weekly without fail and members set the topics.  It is a safe, confidential place to share their healing journeys.  They share stories, learn coping skills and Dialectical Behavior Therapy (DBT) techniques, while connecting with each other. One member of the group, Jamie, is a key advocate for the creation of the group and has been regularly attending since it first began. When his family member was a client at Crestwood American River he asked for support, he asked for resources, and he volunteered to be a part of helping others in any way possible. “It is difficult to find the right words to describe the excruciating emotional pain created by seeing a loved one secluded in a mental health facility.  It is difficult as well to describe the gratitude after finding the desperate relief through the sessions offered by Crestwood,” explained Jamie. “When my family member began in the rehabilitation program at American River, my family and I, at that time, did not have support or knowledge of where to go.  All of this was done in order to make things easier for me, and to point us in the direction of the light at the end of the tunnel. Thank you for opening this door of opportunity and healing, which is a great step for me, and for giving me the strength to persist and succeed.”

At Crestwood American River we feel honored to support our clients and their families.  We believe by providing support and education to the families and the community, it leads to inclusion and reduces stigma.  This is what living our Crestwood Values is all about.

Contributed by:
Stacy Small, Clinical Director


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Choosing Recovery

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Recovery is a choice; a person has to choose to be willing to work on their own recovery and actively participate in determining what recovery means to them. Not only is recovery a choice, it is an ongoing choice that is deeply personal and one that a person has to keep choosing every day, even though it may be difficult at times.

At Crestwood Center at Napa Valley when a client is not ready to begin their journey of recovery, we let them know that we are here to help them when they decide they are ready. We are able to offer compassion, support and empathy in a non-judgmental manner. We offer a variety of opportunities they can participate in that will hopefully make their choice for recovery easier such as WRAP, DBT, working for Dreamcatchers Empowerment Network, art therapy, and various addiction-based recovery groups. Independent studies are also available for those not comfortable in groups.

Once one of our clients makes the decision to begin their journey of recovery, it then becomes an ongoing choice, a new habit and a new way of life for them. Eventually, choosing recovery for them becomes easier. Recovery may be difficult for so many reasons such as facing uncomfortable thoughts, doing things they may not want to do, and even things they may believe are unnecessary. Sometimes the process of recovery includes not having much power or control over one’s own life for a time. So we try to provide our clients with tools, skills and plans they can use to gain empowerment and independence. Sometimes the realization of having to make the choice of recovery for the rest of their lives can be overwhelming, but we always remind them to take it one day at a time.  We encourage them by letting them know that when recovery does become a habit, it stops being so daunting.

The work we do at Crestwood Center at Napa Valley can be frustrating at times because we cannot force a client to work on their recovery, as much as we want it for them. But more often than not, our work is very rewarding when we can help a client with their recovery. We can never give up hope and instead we can hold the hope for the hopeless and support their decisions. We can continue to help others discover their own path on the road to recovery by offering counseling, encouragement, our life experiences and our strengths. Our goal is to let our clients know that recovery is a choice that is worth making, so that they can maximize their life and achieve a sense of balance and fulfillment.

Contributed by:
Cheri Tugmon
Service Coordinator
Crestwood Center at Napa Valley


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Supporting Recovery with WRAP

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At Crestwood Bakersfield, Wellness Recovery Action Plan (WRAP) is an important part of the healing and recovery process for their clients. Their motto and goal is to stay well by playing and focusing on their key recovery concepts, which include hope, personal responsibility, education, self-advocacy and support.  WRAP is used to learn to uncover each person’s own wellness tools and put them into action on a daily basis. Many of the WRAP activities they have incorporated into their classes are team building activities, which help others learn how to work as a team, increase problem solving skills and improve communication.

“Our goal is to incorporate more fun, interactive and competitive activities into our WRAP trainings.  Just recently I developed a WRAP Trivia/Crestwood Family Feud game which has been helpful in understanding why WRAP is such a vital part of our lives,” said Linda Johnson, Director of Recreation Therapy.

Another creative way Crestwood Bakersfield is presenting WRAP in their programs is by having individuals team up into pairs, with the assignment to create and design a WRAP community in which people would enjoy living.  This exercise is not only a lot of fun for the clients, but it also brings communication, group understanding and decision making skills in to play.

“Since so many of us enjoy being in a peaceful setting, we have also incorporated a beach theme into our WRAP classes this summer, with ocean sounds, beach sand, sea shells, candles, lounge chairs and many other soothing items which seem to help ease the pressure of daily life,” explained Linda.

Crestwood Bakersfield continues to find wonderful ways to support clients in their recovery through innovative WRAP activities and they love to say, “We are playing. What are you doing to stay well?”

Contributed by:
Linda Johnson
Director of Recreation Therapy
Crestwood Bakersfield


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Crestwood’s Journey

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I first learned about Crestwood four years ago in Boston, where I met Mertice “Gitane” Williams, Crestwood’s Vocational Wellness Educator, at a Trauma Summit hosted by the National Center for Trauma-Informed Care. My introduction to Crestwood and subsequent work with Crestwood has had a profound effect in my personal and professional life.

I train and consult on creating trauma-informed systems all over the country and in some other parts of the world. As many of you know, trauma-informed care (TIC) is about operating from a set of values consistent with trauma-informed principles. First and foremost, Crestwood values are very much aligned with the values of TIC. But more importantly, Crestwood lives and practices its values, which makes it a trauma-informed organization.

Creating trauma-informed organizations is a journey. This journey can be difficult and challenging, but rewarding. Crestwood understands this and has made a commitment to this journey for the long haul. This is what makes my journey with Crestwood unique. I have assisted many organizations in this journey and some organizations introduce TIC as a “flavor of the month”, and then later that energy fades away. But this is not the case at Crestwood. Two years after my big training for Crestwood on TIC, the DVD of that training remains mandatory viewing for their new staff orientation. Of course, I still blush when I walk into a program and get recognized from that DVD!

Trauma-informed care is about healing. There are experiences in all our lives and our clients’ lives that leave an emotional wound, and some of those are deeper than others. A very wise Native American psychologist once said that trauma is the “wound that does not bleed.” Therefore, our job is to create a system of care that ultimately helps heal these wounds. We can call it many names, but ultimately most everything we do boils down to promoting healing. Crestwood understands this concept and that is why the many initiatives that Crestwood embarks on helps people heal. For example, the development of welcoming rooms to replace intake/admission rooms is a significant move towards healing. When clients walk into a Crestwood building, their first encounter is to walk into a room that says, “We are here to make you feel safe and wanted” versus “We are here to fix you.” Practices that empower clients to manage their treatment honors clients’ self-determination. Also the preponderance of rocking and sliding chairs in the programs provides rhythmic and repetitive movements for self-soothing and building new self-regulatory pathways, which are important in a client’s healing journey.  All the environmental improvements and enhancements convey the message to your clients and staff that you provide them with a place to live and work that reflects their importance in this world. The Dreamcatchers Empowerment Network program is not just a vocational program, it is a program that helps clients rediscover and reinforce their worth in this world and that they can make a difference.

There are many big and small things that are being implemented throughout Crestwood. I urge you to view all of these as steps in the healing journey and that there is no deed too small to make an impact on healing. There is no job or function that does not contribute to this journey.  The Crestwood motto, “It’s About Growth” is founded on the understanding that it is hard to grow without healing from the past. Practicing trauma-informed approaches is akin to preparing and tilling the land to ensure growth is possible. A good gardener knows that it is important to know the nutrients that already exist in the soil in order to supplement and enhance what is already there.  This is why it is also crucial that you recognize and honor the many years you have been conducting healing practices with your clients. Your journey is in discovering and implementing healing practices that will augment the wonderful things you all are already doing.

Lastly, I thank you all for the privilege in making me a part of the Crestwood journey!

Contributed by:
Raul Almazar
Almazar Consulting & Senior Consultant to the National Center for Trauma Informed Care.