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Crestwood Behavioral Health


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First Impressions

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In life we only get one chance for a few things – one of them is a first impression, so it’s vital we prepare ourselves to give an authentic and genuine one. In doing so, we share ourselves with others in the way we wish to be understood.  First impressions can be our calling card and they can be the one element or the one interaction that connects two people deeply.

At Crestwood Behavioral Health, we believe in the value of the first impression so we strive to make it the most authentic and positive one possible.  We create the opportunity to meet the person, whether it’s a client, a coworker, a family member or visitor, exactly where they are at. We have drawn from a course created in the hospitality industry called First Impressions to teach the skills needed to make this welcoming and warm first impression.  We included it in the curriculum lessons from Dialectical Behavior Therapy (DBT), the 12-Step Program, Core Gifts, Trauma-Informed Care and Wellness Recovery Action Plan (WRAP). The course framework focuses on the principles of commitment, leadership, attitude, service and support.

The principle of commitment in the First Impressions course emphasizes how to do our very best each day, to make a difference in someone else’s life and by doing so, we then make a difference in our own lives. We commit ourselves to the Crestwood values of family, to holding ourselves with integrity, to compassionately doing our work, to being flexible and forthright, and to have a sense of humor and positive attitude about the serious and challenging moments that frequently occur in our day.

The leadership principle in the course focuses on leading by example. No matter what position you hold in life or at Crestwood, we are certain that we all have an opportunity and responsibility to lead. In life we are all leaders and we must demonstrate our values each day so that we create a sense of positive peer pressure, creating a culture of caring behavior by “paying it forward.”

Attitude is addressed in the course as being reflected in our actions. We promote healthy productive behavior through building skills to increase the self-esteem and sense of value of our clients and staff. We create an environment where skills are taught and practiced to enhance the lives of our clients, families and ourselves, whether it’s DBT, Trauma-Informed Care approaches or WRAP. This culture of learning creates a positive sense of self which turns into positive performance at Crestwood.

The service principle in the First Impressions course focuses on the work we do and so much more. It is being committed to come to work on time and making each moment count. It is having a smile. It is consistently meeting the needs of those around us with healthy boundaries, dignity and compassion.

And finally the principle of support is addressed on how it holds the first impression and the ongoing relationship together. Support of others starts with self-care. In Trauma-Informed Care approaches we say “put your mask on first, before you can help someone else”, so if you are not healthy and supported, then you cannot provide care and support to others.  Support includes anticipating the needs of co-workers, as well as clients. It is creating a healthy environment where we feel cared for and appreciated. This leads to our sense of pride in the work we do and the people we are.

The First Impressions class at Crestwood teaches each of these values and allows our staff to spend time together sharing their thoughts and developing the rapport to truly emanate team work. The opportunity is always there for a positive first impression and at Crestwood we seize the moment to do so.

Contributed by: Patty Blum, PhD, Crestwood Vice President


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Empowering Clients through Motivational Interviewing

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The Crestwood Wellness and Recovery Center in Redding has incorporated an additional and powerful therapeutic tool in their dynamic recovery program known as Motivational Interviewing.  Motivational Interviewing is a person-centered therapeutic approach using a process that is infused with collaboration and personal choices and honors the person’s autonomy and self-direction.

There are five principles to Motivational Interviewing, which includes developing empathy to elicit engagement; identifying discrepancy between where the person is not and where they want to be; avoiding conflict while passively rolling along with any perceived resistance; avoiding the development of counter positions between client and staff; and supporting the client’s belief in their own abilities to build self-worth.

John Dalton, the facility’s Wellness and Recovery Director, explained, “Almost instantly after beginning the use of Motivational Interviewing, I noticed the clients being less resistive and more communicative.  We were able to elicit new information from each of the clients and there was the development of enhanced therapeutic relationships as clients and staff worked together toward each client’s self-identified goal.”

Many of the clients involved with the Motivational Interviewing therapy stated that they felt in greater control of their own recovery, and that the staff working with them truly heard what they had been trying to say to others for years.

The facility staff who have utilized the Motivational Interviewing technique also identified that it creates a collaborative conversation that leads to tremendous growth, empowerment, and healing.  By using the client’s own goals, beliefs, abilities, and reasoning, clients were less likely to resist the process of making positive changes in their lives.  The key to the therapy is the process of asking, listening, and informing the client in a reflective manner what was said during the conversation.  This interactive role between the clients and staff, which is grounded in the understanding of the importance of the clients’ perceptions and desires, has led to multiple success stories.

One of their clients said, “I never knew that I possessed the ability to change my life in such a profound way.  My Service Coordinator helped me to hear my own voice, and then cheered me on as I began to make the changes in my life that I wanted to change.”

Motivational Interviewing is just one of many tools that can be used in the recovery journey.  Yet, for many, it is that unique inner voice that once identified, heard, and acknowledged, can then be nourished, cultivated, and supported to help clients make self-empowered changes toward health and stability.


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Healing Trauma

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Most of us have suffered some degree of trauma during our lifetime.  A glimpse at human history shows us that we live in a traumatized world.   Since trauma is not fully acknowledged as a universal experience that requires continued attention, in many cases, it perpetuates.  It is crucial to recognize our unaddressed trauma because a high degree of stress does not merely cause discomfort, it disturbs us physiologically, mentally, emotionally, and spiritually.   We begin to operate from the part of the brain directing survival instincts rather than from an integrated, whole-brain perspective.

The question of how best to heal trauma is a complex issue.   The Strategies for Trauma Awareness and Resilience (STAR) program, led by Carolyn Yoder, helps to clearly outline the causes, types, effects, obstacles, needs of trauma, as well as breaking the cycle of trauma.  “Unaddressed traumas affect not only those directly traumatized, but their families and future generations,” says Carolyn Yoder.

These are all valuable concepts to consider and/or revisit for people who work in the mental health field.  It is also beneficial for our personal healing.  The more importance that is placed on self-awareness and growth, the greater amount of internal resources can be found to handle triggering events and unresolved pain.  Our capacities expand, building a repertoire of emotionally-intelligent responses to pain rather than dissociating or denying our trauma.  Conversely, if our society were to fully recognize its trauma, we would be less likely to place labels on the already wounded.  This would not only bring more awareness toward how trauma is treated, but would instill more compassion towards the traumatized.

Breaking the cycle of trauma requires fortitude and courage.   It begins with the acknowledgement of the traumatic incident(s). The process of self-inquiry, grieving and honestly identifying fears is deeply transformative.  As Yoder states, “it unfreezes the body, mind and spirit so that we can think creatively, feel fully, and move forward again.”

Trauma healing is about transformation.  Through personal reflection, we can break our own cycles.   By creating our own personal healing practice, we move a little closer to a society that endeavors to do the same.

At Crestwood, we take a trauma-informed approach to care that includes being aware that the majority of our clients experience trauma and that the trauma then becomes the lens through which they view and experience the world.  The initial trauma-informed care training Crestwood received came through a SAMHSA grant. It has impacted the design of our programs in the environmental planning with comfort rooms, a library area and a Serenity Room.  The training included an introduction to trauma-informed care services and an overview of creating a trauma-informed care service model for our programs. We are continuing to work with trauma consultants, such as Raul Almazar, from Almazar Consulting & Senior Consultant to the National Center for Trauma


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New Programs & Innovative Spaces

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Crestwood Behavioral Health Inc. started a big growth spurt in the spring of 2014 from Solano to San Diego. That year we opened two new distinct programs, with some exciting and significant outcomes and contributions. In April 2014, we opened our sixth Psychiatric Health Facility (PHF) at our Solano campus and in June, we opened our seventh Mental Health Rehabilitation Center (MHRC) on our first campus in San Diego. These programs are very different, but serve the same type of clients at different points in their recovery. The PHF is a soft place to land for clients who need to stabilize during a time of crisis. The MHRC is a gentle, homelike space conducive for clients to transition back into the community. The commonality between both programs is that they share the best of all of the research and practices that Crestwood has used in space conversion and intentional space utilization such as the welcoming room, comfort room, serenity room, living room, dining room and library

The welcoming rooms are dedicated to the ritual of welcoming which is based on the research and information shared by Bruce Anderson of Community Activators. It also reflects the principles of Crestwood’s First Impression program. The welcoming ritual is our way of greeting the new client when they come through our doors. This initial engagement in our welcoming room is frequently one of the most important moments in treatment. The welcoming room has comfortable furniture, fruit and snacks and a quiet, peaceful environment for the client to be welcomed into our facility. The assessment process is also part of our welcoming ritual. We use a conversation approach for the assessment and we utilize the CARF-accredited Primary Assessment that is designed to be a narrative discussion with the client. This has been an effective tool in initiating the relationship with the client, setting them at ease and garnering the most accurate and authentic information.

Crestwood’s comfort rooms provide clients with a calming place to be. We designed our comfort rooms based on extensive literature review, visits to calming and comfort rooms in New York State, attendance at conferences and interviews with experts in the field.  Our comfort rooms are used as a tool to teach individuals calming techniques in order to decrease agitation and aggressive behavior. The goal for clients in using the comfort room is to develop practical skills that can be used in inpatient settings and after being discharged from care.

Our serenity rooms are based on research from a New York State grant on Positive Alternatives to Restraint and Seclusion (PARS) and serve a dual purpose. The first is to provide a space that is calming and self-regulating for clients to be in that then reduces the likelihood of coercive treatment. The secondary purpose is to honor the spiritual growth of each client by creating a sacred space designed to support them on enriching their spiritual journey. Our serenity rooms are dedicated to support the internal growth and opportunity for contemplation, meditation and introspection.

The living rooms in our programs are designed to be an environment that is specifically for the community to congregate and visit. It is based on the promising practice in the Living Room model from Recovery Innovations. The space is less clinical and is as homelike as possible. The colors are comforting and the furnishings are aesthetically pleasing.  This room can be used for community meetings and occasionally for groups and staff interactions. It is a place where people are treated with respect, have choices and feel safe.  The other elements of the Living Room model that are in place include peer providers, Wellness Recovery Action Plan (WRAP), inclusion and comfort. This model is closely aligned with the full-array of trauma-informed care approaches that we employ.

Our library space is designed to provide another indoor space to be used by and for the clients.  This space has resources including self-help books, meditation books and books for leisure. The space is light and open at all times for clients to use.

Crestwood’s dining rooms support our wellness initiative which includes healthy heart diets and exercise. This room is also used for recreation activities, movies, arts and crafts, games and therapeutic groups.

One room that we don’t have in the programs are the restraint and seclusion rooms.  Crestwood has an initiative to eliminate the use of restraint and seclusion so we have created a trend of decreased restraints and a greater understanding and awareness of the issues surrounding their use.  In 2011, Crestwood received a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to attend the Effective Use of Peer Programs to Prevent the Use of Seclusion and Restraints Conference in Boston.  Crestwood was recognized at that training as one of the leaders nationally on reducing seclusion and restraint throughout our organization. Our level of seclusion and restraint for similar programs was one-fifth the national average according to SAMHSA consultants. Crestwood incorporates trauma-informed approaches into each program, as well as using WRAP principles and Dialectical Behavior Therapy (DBT) assumptions to create antecedent plans for clients and staff.

As a result of creating these types of innovative spaces in our programs, Crestwood has been recognized by SAMHSA for the effective use of space and the positive effect it has on each client’s outcomes. All of these spaces are designed to provide our clients with the best environment possible to support their recovery.

Contributed by: Patty Blum, PhD, Crestwood Vice President