An Innovative Neurobehavioral Rehabilitation Approach

National Award Recognizing Dr. Gordon Muir Giles’ Innovative Neurobehavioral Rehabilitation Approach at Crestwood.

Crestwood Behavioral Health’s own Dr. Gordon Muir Giles, Director of Neurobehavioral Services at Crestwood Treatment Center in Fremont and Idylwood Care Center, was awarded the most prestigious honor related to clinical practice in the occupational therapy profession, the Eleanor Clarke Slagle Lectureship Award. This award was made in recognition of his “innovating the clinical practice of cognitive neurorehabilitation” through his groundbreaking work with clients who have severe neurological impair- ments.

Dr. Giles was presented with the Eleanor Clarke Slagle Lectureship Award by the Ameri- can Occupational Therapy Association (AOTA) at its 2017 Annual Conference and Centennial Celebration on April 1st in Philadelphia. The Eleanor Clark Slagle Lecture- ship Award was named after a pioneer of the occupational therapy profession, and recog-nizes achievements in research, education, and clinical practice that make substantial and lasting contributions to the occupational therapy profession’s body of knowledge.

This award recognizes Dr. Giles’ efforts to improve the lives of Crestwood’s clients through innovative clinical practices, including his relational neurobehavioral approach to neurorehabilitation. This non-aversive method, which has been described as “relentless kindness,” assists clients with severe behavioral and emotional problems by empowering them through person-centered care and building positive relationships with them, rather than relying on confrontation, seclusion, or restraints. Dr. Giles uses this compassionate approach to treat clients whose neurological impairments have caused many of them to fail in other treatment settings due to difficult-to-manage behaviors. An example of this compassionate approach is being used with a client at Crestwood Treatment Center, Fremont who has had post-severe Trauma Brain Injury for 23 years. This client believes that he is a billionaire and that people are stealing his money. He would joke to the staff that they are stealing from him and if they would joke back, he would become very upset. To help deescalate this behavior, the staff now meet with him daily to review any areas of concern, assist him with solving any perceived problems, review his finances with him weekly and have him sign-off on any expenditures. Additionally, the staff responds to any of his questions about money by stating that taking money from him is unlawful and that if they did steal from him, they would go to jail. This increased focus on interpersonal factors and therapeutic relationships has made an amazing difference in this client’s life by helping to reduce his anxiety, stress, and negative attributional bias.

“This is the greatest honor of my professional life,” said Dr. Giles, who has written books and articles on the subject of neurorehabilitation. “It will absolutely raise the profile of our work at Crestwood and our innovative approaches to the practice of neurobehavioral rehabilitation.”

Karen Scott, Program Director at Crestwood Treatment Center, Fremont said, “The positive impact Dr. Giles has made with both his clients and colleagues is immeasurable. He is a tireless advocate for persons with neurobehavioral differences.”

As part of winning the Slagle Award, Dr. Giles will deliver an AOTA lecture in 2018 that will discuss how best to meet the needs of clients with neurobehavioral disability in a changing healthcare environment.

Contributed by:
Karen Scott, Program Director Crestwood Treatment Center, Fremont

The Lessons of Change

At Crestwood Center San Jose MHRC, they have been going through major changes, both physically and programmatically. The campus has undergone major reconstructive surgery, and now has a beautiful design similar to our other Crestwood programs. The design changes have brought about a more homelike environment and their clients are enjoying new areas, such as two living rooms, a comfort room, a serenity room, a group room, a library, and a den. Walls have been painted in soothing colors, lovely decor has been placed throughout the building, and new, stylish flooring has been installed.

Crestwood San Jose’s new design of their dining room also includes a living space that clients can also use for Xbox Connect games, karaoke, and entertainment when eating their meals.

On the program side, a mindful effort has been made to not only embrace the Crestwood Values (Family, Commitment, Compassion, Enthusiasm, Collaboration, Character, and Flexibility), but to also actively practice them in the staff’s daily activities. They have also incorporated a more comprehensive program schedule, opened up the patio area, and expanded their outing and pass policy. With these efforts, they continue to maintain the important focus on recovery, program success, and preparedness for community re-entry for their clients.

During this remodel and program changes, the staff learned some important lessons, such as any major change starts with the Administrator and Department Heads, and then it needs to be embraced by the entire team. “The change process may be challenging for some, even if it is perceived as positive or good, because it means saying goodbye to what we are familiar and comfortable with,” said Angele Suarez, the MHRC’s Program Director. Campus Administrator, Michael Bargagliotti, added, “It is human nature to be drawn to comfort and security, regardless of the outcome, because it is something that is known and we know what to expect. The change process introduces an insecurity and emotional instability that can cause people to react with resistance, fear or anger.”

To help with managing the challenges of change, the staff at Crestwood Center San Jose found that implementing a few key measures such as maintaining an open mind, being optimistic, asking questions and helping others with the changes, made a huge difference in how everyone dealt with what was happening around them.

“By maintaining an open mind, even though we may not always agree with the changes being implemented, we can actively listen and analyze the information, and then we can form an honest and genuine opinion about the changes. We might even surprise ourselves on how much we like the ideas,” said Angele.

The staff found that by being optimistic, even though people might be currently unhappy with the changes, can be helpful since negativity usually comes from a fear of the unknown. By not being able to predict the future, a good strategy is to then focus on the present moment with a positive attitude, which can create an optimistic outlook towards the future.

The staff also encouraged everyone to ask a lot of questions because it is important for each person to not only be notified of the changes that are occurring, but to also understand the reason behind the changes. Asking questions provides everyone with the needed information to make informed choices.

“And we found that one of the best ways to help ourselves with change is to focus on helping others with change. Helping others takes the focus off ourselves, allowing us to connect with our peers, and we can then become a part of the change process through positive interactions,” said Angele.

“At Crestwood, we know that we will always be part of innovative recovery practices and leadership. The best part of innovative change is that you end up creating a culture that is not only open to the concept, but takes on that personality. At Crestwood Center San Jose, as we continually work towards providing the best recovery program for our clients, going through change will allow us to continue our evolution, and never stop searching for our better self,” said Michael.

Change is inevitable in life and usually out of our control; however, how we respond to the change is completely in our control. How will you choose to change and how will you choose to respond? It is all up to you.

Contributed by:
Angele Suarez, Crestwood Center San Jose MHRC, Program Director,
Michael Bargagliotti, Crestwood Center San Jose, Campus Administrator

Empowering Peer Support

Last November, Humboldt County Department of Human and Health Services, through a grant from California Office of Statewide Health, Planning and Development (OSHPD) hosted a 10-day Peer Support Specialist Certification training that was led by Recovery Innovations (RI) to train 10 mental health staff and volunteers in the Eureka area. A lucky member of our Crestwood Eureka campus, Rebecca, a Peer Support Specialist through Dreamcatchers Empowerment Network, was invited to attend. This training is designed to enhance the peer support skills of participants, while empowering them to be more self-directed and competent in providing recovery and resilience services to clients.

“The Peer Support Specialist Certification training turned out to be one of the most interesting classes I have ever taken. I was excited to be included in the two-week course, which opened new doors for me to learn how I could partner and relate to people seeking services,” said Rebecca.

It has been a year since Rebecca began working as a Peer Support Specialist at Crestwood Eureka, and she is grateful for the conceptual framework and the set of skills which this training gives to her job. “I felt empowered to learn these things in the company of other peer support and mental health workers, who have been working to combat stigma and provide support within the county mental health system,” said Rebecca. “I have learned to better understand my role in the comprehensive health facility that I work in. I have gained valuable resources to guide me, to set my own goals, and to provide meaningful direction for my work.

Rebecca (left) and Kelli Jack, Director of Hope Center in Eureka (right), proudly displaying their certificates from the Peer Support Specialist Certification Training.

This Peer Support Specialist Certification training provided a wealth of a wealth of information and skills to participants. Rebecca reported that the train- ing was relevant not only to her, but to anyone doing mental health work. She said, “The concept of helping people find their own strengths to make decisions leading to recovery is a powerful idea and is useful at any level of the mental health community.”

Contributed by:
Rebecca, Peer Support Specialist, Dreamcatchers Empowerment Network, Crestwood Eureka Campus

The Importance of Peer Providers in the Workforce

There was a time when a person receiving behavioral health services was simply looked on as a client. They were identified as the targeted person or the recipient of services. They generally looked to specialists to understand and treat their symptoms, their discomfort or disease. They were dependent on the system to take care of them. There was no reciprocity, no mutuality and no equality. Often there was no actual relationship, no trust, no compassion and sadly, there was no hope.

There was a time when a person receiving behavioral health services was simply looked on as a client. They were identified as the targeted person or the recipient of services. They generally looked to specialists to understand and treat their symptoms, their discomfort or disease. They were dependent on the system to take care of them. There was no reciprocity, no mutuality and no equality. Often there was no actual relationship, no trust, no compassion and sadly, there was no hope.

But today the good news is this view in behavioral health services is changing for the better. And at Crestwood, you can see the changes we have embraced in the behavioral health services we provide that are filled with hope, compassion, integrity and love. One important way we do this is to have services at Crestwood be directed by peer providers, who are people who have been clients or who choose to self-identify as a person with lived experience. Crestwood actively recruits staff with this type of lived experience and this perspective, and we refer to it as the peer experience. We also pride ourselves in employing peer providers at all levels of our organization, including at our corporate executive level, all leadership levels, as well as in the direct care areas of our organization.

The Human Resources practice of recruiting, hiring and employing people with lived experience is based on the mounting research that has led peer-provided services to be identified as an Evidence-Based Practice and one of the highest factors to eliminating coercive treatment. At Crestwood, we have found that by having peers in all levels of employment, the use of restraint and seclusion has dropped by more than 92% in the past 8 years.

Peers, whether an RN with lived experience, a Vice President who has family member dealing with mental health issues or a bookkeeper who has been hospitalized for depression, all bring the gift of empathy and understanding to our clients that other staff may not be able to provide. Our programs have become richer and more effective and most importantly, there is hope, meaningful engagement, empowerment and strong, well-defined career paths with opportunities for growth reaching to the highest levels of Crestwood leadership. This practice is the true essence of integration and meaningful roles.

Peer Providers enrich our programs for our clients on a daily basis that benefit everyone and provide a supportive and understanding resource that only they can offer. When our clients know that a staff member, who is there to help and support them, has also been through similar issues in their life, they know they are not alone and that they too can succeed in their recovery.

Contributed by:

Patricia Blum, PhD Executive Vice President

Lacing up their shoes for Health and Wellness

“A journey of a thousand miles begins with a single step.”- Confucius

At Crestwood Chula Vista, they offer several types of fitness and movement activities for their clients, from Yoga to Zumba, to strength training, to dodgeball and kickball. Unfortunately, they found that only a small percentage of their clients were participating in these activities and at the same time were also still struggling with their desire to be healthy and to maintain their weight. “I’m too overweight to exercise” and “I don’t have the energy to work out” were common explanations as to why they were not participating in activities. This presented the staff with a challenge. They asked themselves what activity can just about anyone do, what activity will they want to do and what would be something that would also benefit both their physical and emotional health? The answer was right in front of them. Every client was doing it every day – walking!

It was right about this time that the City of San Diego advertised the Parks Fit San Diego 2016 Challenge, which is to walk 30 miles in 60 days. Clients and staff were excited to become involved in the 30-mile challenge and it was a way for them to celebrate every step they would take. But as their clients thought about it, they decided that 30 miles in sixty days was not enough and they would instead do 30 miles in 30 days. So the staff purchased pedometers for everyone participating and off they went.

The challenge began on June 18^th with a 1-Mile Fun Run.  After that, they went on walks in the community, took nature hikes, and joined 5k events. Each and every day, clients could be seen walking the halls and the patio at the facility with pedometers in hand. They pounded the pavement in their neighborhood, trampled the grass at Balboa Park, explored the trails of the Living Coast Discovery Center, and even kicked up some sand at Imperial Beach. The results of the challenge were tremendous! One of their clients walked 215 miles! She reported her miles to the staff proudly every morning. One day she joked, “I didn’t do so well yesterday, I only went 20 miles.” Other clients were motivated to keep up and the race was on!  Four clients logged more than four hundred miles and together, as a group, they walked more than 500 miles!

“Beyond the miles they racked up, we were seeing firsthand what we have all read in the research studies, that walking and exercise promotes good health, reduces anxiety, increases self-esteem, and boosts mood,” said Shanel Stec, Recreation Assistant.  Clients also made healthier food choices. One client lost 20 pounds and another client lost three pounds.  They set goals for themselves and tracked their progress faithfully. They worked together as a team, challenging each other to keep up and they joined other groups. They were out in the community, they were out in nature, and best of all, they were having fun.

The challenge ended on August 13^th with the Parks Fit San Diego 5k finale. However, this finale is not the end for them walking, even more clients and staff have signed up for a new challenge that begins soon.  Shanel said, “We are excited to lace up our shoes and walk together, not as clients and staff, but as companions on our journey toward health and wellness.”

Contributed by:
Shanel Stec
Recreation Assistant
Crestwood Chula Vista

Making Connections through Music

Music Therapy is playing an important role for clients in their recovery at Crestwood Center Sacramento. And it all starts with the drumming circle that was started by Linda Gerardy, a Registered Music Therapist and Director of Recreation, at the campus. “On our Psychiatric Health Facility (PHF) program, I use music with exercise and movement groups, guided imagery and art, and occasional lyric analysis, but my favorite is a weekly Creative Expression Drumming Group, utilizing various hand drums and hand percussion instruments,” said Linda.  “My mantra to clients is that no musical background is needed to have a successful and enjoyable experience in this group.  It is a rarity to have a client answer “No” to “Do you like music?” and the sound alone has a way of drawing in otherwise reticent clients to see what we’re up to.  The variety of instruments provided, learning their names, sounds and capabilities are intriguing, and in most cases, a source of instant success that is empowering and sustaining.”

The American Music Therapy Association defines Music Therapy as a clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional, and can help promote wellness, manage stress, alleviate pain, express feelings, enhance memory, improve communication, and promote physical rehabilitation for clients.

“The sound of a drum helps us to notice our own heartbeat, the part of us that keeps us alive and vital,” explained Linda.  Drumming in a drum circle with others can be meditative, but also energizing and invigorating depending on how it is structured.   Specific studies conducted by professionals in the fields of music therapy and mental health show us that drumming reduces anxiety, tension and stress, helps control chronic pain, boosts the immune system and releases negative feelings, blockages and emotional trauma.

“Community effects of drumming allow for an opportunity for participants to feel connected with others and gain a sense of interpersonal support.  This is especially important at our PHF program, where the tendency to isolate is evident with many clients, and the need to develop quick connections to others, who are in similar situations, is needed in order to make all of our program groups more meaningful and beneficial,” said Linda.

There are also both cultural and spiritual connections to drumming for several Native American clients who have come through the campus’ doors.  One client patiently informed Linda and her peers that in her tribe’s culture, the same people don’t both dance and drum, so her contribution to the group was to quietly dance her “shawl dance” in a circle around their drumming.  Another client thoroughly enjoyed the drumming, but felt the need to sing as well, teaching them a song in the Chippewa language, after which they were able to provide the rhythmic accompaniment for her singing.

Another positive aspect of a drumming group is the ability for clients to serve in a leadership position, a role which is often difficult to provide in an inpatient setting.  They have had clients with extensive musical backgrounds who easily and willingly take on this task, but even those without any formal music experience are usually quite successful in taking a leadership role once Linda has modeled it for them.

At Crestwood Center Sacramento, the drumming group will continue to be a wonderful outlet for clients to express themselves through music and helping them with their recovery and wellness goals.  Linda summed it up best by saying, “Music, with a drumming group as one small part, is a medium whereby we can more easily connect with ourselves and others.  It truly is a universal language where people can join together, at times free of the need for verbal communication, to be able to experience life more fully.”

Contributed by:
Linda Gerardy, RMT
Director of Recreation
Crestwood Center Sacramento

Health Crisis

How many times do we have to see our clients, friends and coworkers receive a diagnosis of breast cancer, chronic obstructive pulmonary disease (COPD) or coronary disease at an early age? How many times do we see these same people pass away from “natural causes” in their 30s, 40s and 50s, while we see the average life span of people grow from 51 years in 1910 to 78 years in 2010?

The sad fact is that for those among us living with a mental health diagnosis, the average life expectancy is conservatively 10 years less than those who don’t have that challenge and it also accounts for 8 million deaths worldwide annually.  NAMI and other research suggest that the life expectancy gap is actually 14 to 31 years shorter for those with a mental health issue.  The mortality rate for people with schizophrenia is four times higher than those without this diagnosis and those with a bipolar disorder have a 13 year decreased life expectancy. This is a reflection of our broken system and communities in need of healing and compassion.

Much of this early mortality is attributed to “natural causes” such as heart disease, pulmonary diseases, cancer, cerebrovascular, respiratory, and lung diseases. Elizabeth Walker, a researcher at the Emory University Rollins School of Public Health in Atlanta, writes, “People with mental health disorders have a high prevalence of chronic medical conditions, with fewer resources to manage these conditions. People with mental health challenges are dying prematurely and at a rate far exceeding their peers without this diagnosis.”

How many people that we love and care for have to die before their time and how many times do we have to plan services and mourn their passing? This disturbing health crisis is often overlooked. According to the National Institutes of Health (NIH), life expectancy has increased dramatically, unfortunately, “reductions in mortality are not shared equally in this country across racial, ethnic, and socio-economic groups or health-related conditions.”

So what can be done to start to change this shocking reality?

The first change that is needed is how we deliver services as a society. We need to be honest about the disparities in our culture. Services may be accessible with wheelchair ramps and Braille signage, however, there is no tolerance for people who are disheveled, responding to voices, have ticks, look different or have unpredictable behavior.  This intolerance creates barriers so preventive healthcare, such as routine checkups, mammograms, and teeth cleaning, is out of reach.  These disparities have led to women with mental health issues dying from cancer at twice the rate as the general population, and these women are also three times more likely to die from breast cancer.   Researchers, Colton and Manderscheid, found that the secondary consequences of mental illness are poverty, unemployment, poor housing, stigma, and low self-esteem leading to challenges accessing healthcare, including health professionals’ misdiagnosis, less focus on physical health, low compliance with health screening and treatment, and poor communication.  This has to stop! We have to create pathways to accessibility, prevention and care.  We need to train more primary healthcare providers to work with people with mental health challenges, which is something Crestwood Behavioral Health has been providing to our county stakeholders.  We need to design clinics, waiting rooms and services that are more accepting and inclusive of all marginalized populations. We need to develop more welcoming and validating preventive health screenings and utilization of services.

The second thing we need to do in our communities is the creation of Federally Qualified Health Clinic Clubhouses that welcome those with mental health challenges, the homeless, the disenfranchised and their families.  A Clubhouse is first and foremost a local community center that offers people who have mental health challenges the hope and opportunities to achieve their full potential.  During the course of their participation in a Clubhouse, members gain access to opportunities to rejoin the world of friendships, family, employment and education, and to the services and support they may individually need to continue their recovery. A Clubhouse also provides important routine health screenings that are completed in a client-friendly space, rather than in a hospital or sterile clinic setting. Crestwood is currently looking to explore creating a Clubhouse program in San Diego.  Also, a mobile whole health services unit, a companion to the Clubhouse, is needed to bring health screenings and health services to the homeless where they are, whether it is under a bridge, in a shelter or at a wellness center.

The next action that needs to be taken is to launch a statewide Wellness and Resiliency Initiative similar to the one Crestwood has adopted in all of our programs that includes serving heart-healthy diets and creating client-oriented cookbooks with heart-heathy recipes and shopping guides. It includes planting organic gardens and using the farm to table approach in our meals. It is bringing Zumba and Yoga to every campus and community.  It is having exercise tracks in yards that used to be used for smoke breaks. At Crestwood we support smoking cessation, sobriety and meaningful roles to help replace addiction and isolation. Crestwood also teaches meditation and mindfulness to our clients which lowers heart rate, reduces risk of heart disease and increases pulmonary capacity.

Another action we can take is to live healthier lives as healthcare providers. At Crestwood we use Wellness Recovery Action Plan (WRAP) to support our workforce, with staff being paid for time off the floor to attend WRAP groups. We provide mental health days, as well as sick days and expect our staff to do routine health screenings – modeling wellness. We employ meditation and mindfulness practices at all staff meetings and events to encourage our staff to practice mindfulness as a health and wellness practice.

At Crestwood we will continue to do our part by looking for and incorporating innovative health and wellness measures into our programs.  We can truly practice self-care each day, creating a compassionate community of people caring for themselves and others. This may not move the needle on the mortality rate very quickly; however, it is a promising start that we hope will begin to create healthier, longer lives for our clients, friends and coworkers.

Contributed by:
Patty Blum, PhD
Crestwood Vice President