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Hens Bring Love & Joy

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Last Fall we welcomed two new family members into our community at Crestwood Treatment Center in Fremont. These individuals became instant local celebrities with their inquisitive demeanors, gentle dispositions, and feathered feet. Our new family members are two hens that have provided our residents and staff with the opportunity to deliver nurturing care, revisit childhood memories, and stimulate cognition, as well as being a source of therapeutic amusement.

Our residents consist of men and women who have had brain injuries, as well as a combination of psychiatric and dementia-related behaviors. Many have resided here for many years, supported by the structure, consistency and kindness of our environment. Our staff’s primary goal in developing the Hen Program was to promote a sense of well-being and self-worth for our residents, that by caring for an animal, offers an opportunity for companionship and a calming and emotionally regulating experience. By promoting participation in our Hen Program, we hoped to educate our residents and minimize a sense of boredom and isolation.

Our Hen Program officially started months before the arrival of the hens themselves as a truly interdisciplinary collaboration between our Administrator, Lilian Fong, our Rehab Staff/Occupational Therapists, Maintenance staff, and Program staff. A large enclosure was constructed in our Zen Garden, with a smaller henhouse inside; both are able to be locked to protect the hens. Food, wood shavings, and hay, along with storage containers, were purchased from a local feed store.

When our hens arrived, residents submitted ideas for names, which were then voted on by everyone and the winning names were Buddy and Gismo. Residents then got to know each hen’s distinct personality traits, favorite foods, and daily routines. Residents are an integral part of each hen’s care and wellbeing.

“We make sure the chickens know they’re loved, safe, and welcome here,” said Patti, one of the residents. The chicken coop has now become a favorite destination for socializing, restorative ambulation programs, 1:1 meetings, gardening groups, and the official Chicken Welfare Committee. Another resident, Gloria, observed, “Buddy and Gismo have potential. They help us feel good when we go outside by playing together and taking care of each other.”

 

Our Chicken Welfare Committee (CWC) consists of a group of 6-10 residents who meet weekly to discuss and make decisions about Buddy’s and Gismo’s health, as well as to ask questions and research answers to better understand these animals’ behavior and preferences. Each meeting begins with an egg count, overview of each hen’s health, and any significant changes in their routines/behaviors during the past week. The group then delves into activities such as cage beautification projects, scientific articles about the anatomy/cognition/evolution of chickens, or group discussion and personal anecdotes about chickens. The CWC has also led to improving our hens’ wellbeing by adding a dust bath to their enclosure, discovering a favorite treat (freeze-dried mealworms), and providing companionship.

Perhaps the most notable accomplishment of the CWC was the celebration of Gismo’s and Buddy’s 1st birthday party in February. The residents spent time making a celebratory banner and birdseed birthday cakes, then converged in the Zen Garden to prepare a fruit salad and enjoy the party. This experience was immensely meaningful for the residents, who continue to talk about it.

Residents are not the only ones who benefit from our chickens. Our staff, many of whom grew up in rural areas, have expressed delight, concern, and nostalgia regarding our hens. Staff is invited to take home the eggs and often compete playfully to get to the eggs first. One CNA reported that she made a quiche with our eggs and brought it to share with her co-workers. Rehab staff often elect to have their meetings outside in the garden to enjoy the calming effects of nature on their overall wellness. The hens have provided a warm and fun meeting place for residents and staff to relate to each other and share experiences. Cortney, another resident, remarked, “The chickens are role models for us; they teach us about companionship and how to interact with each other.”

Buddy’s and Gismo’s presence here at Crestwood Treatment Center has benefitted our entire community immeasurably. The hens are thriving under the dedication and care provided by our residents and staff, and the humans are thriving through the provision of that care. Our Hen Program embodies our Crestwood values and will continue to do so in the years ahead.

Contributed by:
Amanda Lord
Occupational Therapist Crestwood Treatment Center, Fremont


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The Lessons of Change

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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.

San Jose Dining Room

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


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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