“I am home” are rarely the words spoken by a client entering a behavioral health program, however, at Crestwood Behavioral Health, Inc., we hear this often.
The environments we create are as important as the therapeutic tools we employ throughout the course of treatment, whether it’s several hours in our Crisis Stabilization Unit (CSU) or days in one of our Psychiatric Health Facilities (PHFs) or years in one of our Skilled Nursing Facilities (SNFs).
Our mission at Crestwood is to provide the highest quality of recovery-based care and delivery of services to the people we serve, stakeholders, and the community. The strategy includes using the environment as a therapeutic tool and it is designed to maximize options and choices, as well as clients’ freedom of movement. The environment is intentionally designed to reduce the amount of client rooms and clinical space to allow for space design to be based on evidence-based practices, promising practices, best practices and Crestwood’s client-centered model. SAMHSA and CARF have recognized our utilization of space and environmental features at our campuses as a trauma-informed treatment approach. Space utilization, as well as Crestwood philosophies and trainings, encourages reduction of barriers for interaction between the clients and staff.
Crestwood’s intention in creating our homelike environments is to allow for the greatest choice and ease of living, while providing a secured, safe and sustainable environment, which is not an easy task. Janet Vlavianos, our Director of Development and Corporate Initiatives, has been the creator of most of our Crestwood environments. Her sense of design and color is outstanding, but her greatest asset is looking at a space from the perspective of the person who will be receiving treatment.
The space is allocated not just on the number of beds or clients served, but rather on how much movement will be needed in the interior and exterior space, particularly if it is secured. We believe people need to be able move around and to have windows that look out onto gardens, trees and ponds. We also believe there needs to be a quiet space and a social space for activities such as gaming, so our serenity rooms, which are quiet and contemplative in design, are not next to living rooms or gaming rooms, which are designed for louder, group activities. Our gaming rooms, which are a new addition to our Crestwood environments, are equipped with bean bag chairs, gaming screens and a variety of games. These environments allow clients a choice on what space that would like to be in that fits their needs and contributes to their wellness and recovery.
We have also replaced nursing stations in many of our Crestwood’s programs with a casual gathering space that features overstuffed loveseats and a fish tank relaxation media screen. You often find people gathering there regularly to talk or to simply watch the fish or nature scene on the screen. Nursing stations historically have been the site of power struggles and arguments, but now this location has been transformed into an empowering, social, and welcoming place for our clients.
Wellness is another focus of our Crestwood programs and today many of our campuses are now equipped with gyms and workout areas that provide an outlet for exercise, which is much needed when you are working on your wellness in a secured setting. The gyms are shared by staff and clients alike, which serves to minimize stigma and maximize empowerment. And if working out is not in our clients’ recovery toolbox, then we have created small, cozy libraries in each setting, which allows access to a variety of reading material, wellness tools and a quiet space to read and contemplate.
One environment feature in our campuses, the use of tiles, has had some recent acclaim and was even referenced in a San Francisco Chronicle article (March 4, 2018) on the opening of our San Francisco Healing Center. Janet has placed tiles, in a variety of shapes, colors and textures, strategically on walls in common areas and some bedrooms. Her work in trauma-informed approaches has allowed Crestwood to be on the leading edge in using tiles as a trauma-informed tool, which provides clients support with grounding and release of energy. Crestwood is beginning to build a body of evidence supporting the use of tiles. The tiles support grounding when a client places their hand and touches a tile, which allows them to focus on the tile’s texture, temperature, size and smell. This focus brings attention inward and allows for mindful practices and settling their thoughts. The tiles are also used to release energy for clients when they place their hands on the tiles and push with as much pressure as possible, then gradually release the pressure and repeating until the ability to be at ease is achieved, this then allows the brain to reset the body and bring it into homeostasis.
The exteriors of our campuses are also designed for choice and respect, as well as fun. Our grounds have organic gardens, fruit trees, volleyball courts, chicken coops, swings, basketball courts, gazebos, waterfalls, bird feeders, ponds and water features. It’s not uncommon to see staff, clients and their families sitting in the sun and picnicking on our grounds.
Healing and recovery requires a great deal of work and love. There is science behind each tool that Crestwood applies, whether it’s Dialectical Behavior Therapy (DBT), Wellness Recovery Action Plan (WRAP) or our Trauma-Informed environments. From originally using research from trauma experts including Raul Almazar, Elaine Miller-Karas and Peter A. Levine, Crestwood is now building our own body of research to support the growth of our homelike environments as healing tools. Home is where the heart heals and for many at Crestwood, it is healing their hearts through our homes.
Contributed by: Patty Blum, PhD, Crestwood Executive Vice President