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Crestwood Behavioral Health


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An Innovative Neurobehavioral Rehabilitation Approach

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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


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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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Building Resiliency in the Treatment of Trauma

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Resiliency is the ability to recover readily from illness, depression, adversity, or the like, and is one of the cornerstones to health and recovery for individuals and communities. Trauma is an emotional and psychological result of extraordinarily stressful events that shatter a person’s sense of security, making them feel helpless and vulnerable in a dangerous world. The necessity to treat and heal trauma has never been more evident than in today’s environment and culture. In recovery services, treating, mitigating and preventing trauma is a primary expectation for us at Crestwood. It is the starting point for most people as they embark on their recovery paths. The ability to restore and build resiliency through a variety of trauma-informed techniques, including engagement, resourcing, spirituality and somatic work is the basis for this integrated trauma-approach to services.

The research in neuroscience provides a foundation for the understanding that neuroplasticity and neurogenesis enables the brain to reprogram and develop new pathways for survival and growth. This has led to an understanding that we can expand the resiliency skills, thus enabling people to be less vulnerable to re-trauma, prevent trauma and heal existing trauma.  The premise is that if you teach a person to identify and access their resilient innate abilities, aptitudes or inner wellness tools, the individual can practice using these tools as a means to heal and prevent trauma. These tools are skill-based and use a wide-range of evidence-based practices, promising practices and spiritual practices as the building blocks. The practices are integrated and enable the staff at Crestwood to walk with our clients, support and stand behind our clients and guide our clients when needed.  The skills and practices are based on the premise that you meet the client exactly where they currently are.  This methodology creates a client- centered and culturally-sensitive service model.

Recovery services now have shifted from patterns that created ongoing dependency for clients, to interventions that support resiliency, self-reliance, and prevention. This trauma-informed model of building resiliency enables our clients to become more empowered, more independent of the mental health system, and more intimately connected to their communities. As Crestwood programs seek to build resiliency in our clients, communities benefit from mitigating the trauma from occurring in the first place, reducing the likelihood of diagnosed conditions recurring, and build resiliency through the community.

Trauma-informed care approaches have been the basis of the resiliency skills building. At Crestwood we utilize these trauma-informed care approaches along with culturally-sensitive multidisciplinary approaches and integrating spiritual practices by utilizing evidence-based practices including Wellness Recovery Action Plan (WRAP), Dialectical Behavior Therapy (DBT), and Peer Providers to provide a rich source for mitigating and healing the impact of trauma for our clients.  In our Crestwood programs we will continue to work with and support our clients with developing resiliency skills to create a strong foundation from which they can build from and use in their recovery.

Contributed by: Patty Blum, PhD
Crestwood Vice President


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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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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