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Crestwood Behavioral Health


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Lacing up their shoes for Health and Wellness

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“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 18th 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 13th 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


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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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Collaboration Changes Lives

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It’s unusual to observe collaboration as it is happening. It is far more common to celebrate the success of collaboration after its culminated.  Crestwood’s collaboration with San Diego Health Care Hospital system and San Diego County Behavioral Health Services has provided an incredible opportunity to observe it in real time with measurable milestones and outcomes.

This collaboration story began in 1992 when a case manager from San Diego County was seeking a placement for a very challenging client and a Crestwood facility in northern California was willing to take a chance. Later that case manager’s program manager got a chance to visit this client at the Crestwood Facility in northern California. What she saw there that day left a very positive impression that she remembered for many years to come. This was the first collaboration between Crestwood and San Diego County and set the stage for future events. Fast forward to 2013 when that very astute and dedicated program manager, Anna La Rocca Palid, LCSW, who is now a leader as a Behavioral Health Program Coordinator in San Diego County Behavioral Health Services, contacted Crestwood about the need in San Diego County for secured behavioral healthcare services. The county had grown tremendously and there were more challenging people to serve and insufficient programs to serve them. They needed a provider to work with the community and them to serve at least 40 clients requiring intensive, secured, recovery-based services. The county also wanted a provider who thinks outside the box, has creative individualized employment programs, recovery services and focuses on integrated alternative tools for clients and they chose Crestwood to be that provider.

Crestwood and San Diego County Behavioral Health Services began devising a plan to address the county’s needs. Crestwood found a beautiful site for a 42-bed Mental Health Rehabilitation Center (MHRC) on a hospital campus in San Diego and created the first of two programs – Crestwood San Diego. Crestwood San Diego opened in June 2014 and quickly filled up with 42 clients. Before long, there was a flow of individuals successfully reintegrating into the community and new admissions moving into the program. The hospitals in the area felt a sense of relief and the new services served their purpose with helping many clients with their recovery.

Soon Crestwood San Diego was full and the San Diego County behavioral healthcare system again felt the pressure of impacted Emergency Departments, long waiting lists at the psychiatric hospitals and a bottleneck in the mental health system. So they looked among themselves to find a possible location for a 40-bed MHRC. Paradise Valley Hospital found a location that would work. Crestwood and Paradise Valley Hospital started discussions about creating a 40-bed MHRC on this site. Dimitrios Alexiou, FACHE, President and CEO of The Hospital Association of San Diego and Imperial Counties and San Diego County Behavioral Health Services worked very closely together to successfully garner support from the San Diego County Board of Supervisors and the community to commit to the 40-bed MHRC in Chula Vista. Crestwood and Paradise Valley Hospital invested significantly in an extensive refurbishing project to create a beautiful, homelike, welcoming recovery-based MHRC known as Crestwood Chula Vista. Crestwood Chula Vista opened in July 2015 and is Crestwood’s ninth MHRC in California.

Collaboration is working with others to do a task and to achieve shared goals. The wonderful collaboration of these groups created an environment that enabled San Diego County Behavioral Health Services to provide beds to some of the clients in greatest need for these services, helping them with their recovery and easing stress in the community and local hospital emergency rooms. It is clear to see that through collaboration we can make a difference.

Contributed by: Patty Blum, PhD
Crestwood Vice President


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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


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Making a Difference & Giving Back

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Two Amazing Graduates who are Making a Difference and Giving Back

When Crestwood San Diego opened in June 2014, a client named J. was admitted to the program in its second week of services. It was then that J. and staff created and began working on her personal plan for recovery. In just a little over three months, J. became Crestwood San Diego’s first “graduate” meaning that she had successfully completed the program and was ready for discharge to the community.  J. felt that her experience at Crestwood was so valuable that she decided to return to the facility as a peer volunteer to assist others on their personal journeys of recovery.  After a couple of months of work as a peer volunteer, J. was offered a paid position as a Rehabilitation Assistant at Crestwood San Diego. She accepted that offer and has since completed a Peer Training course through NAMI.  J. continues to work in this capacity at the facility, providing inspiration and support to the clients, as well as staff.

Crestwood Chula Vista opened in June 2015, and one of the clients admitted there shortly after was A.  A. soon became a participant in the Crestwood Chula Vista’sDreamcatchers Empowerment Network Vocational Program, designed to provide support and education to those with the goal of finding employment. Following J.’s leadfrom Crestwood San DiegoA. became Crestwood Chula Vista’s second “graduate”. A. now returns twice a week to the facility in the role of peer volunteer, providing meaningful support to others. In addition to providing peer support, A. also leads a weekly bible study group at the facility.  He currently has the goal of becoming a Rehabilitation Assistant like J., and is well on his way to achieving that goal with thesupport of staff at Crestwood Chula Vista.