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Crestwood Behavioral Health


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Health Crisis

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How many times do we have to see our clients, friends and coworkers receive a diagnosis of breast cancer, chronic obstructive pulmonary disease (COPD) or coronary disease at an early age? How many times do we see these same people pass away from “natural causes” in their 30s, 40s and 50s, while we see the average life span of people grow from 51 years in 1910 to 78 years in 2010?

The sad fact is that for those among us living with a mental health diagnosis, the average life expectancy is conservatively 10 years less than those who don’t have that challenge and it also accounts for 8 million deaths worldwide annually.  NAMI and other research suggest that the life expectancy gap is actually 14 to 31 years shorter for those with a mental health issue.  The mortality rate for people with schizophrenia is four times higher than those without this diagnosis and those with a bipolar disorder have a 13 year decreased life expectancy. This is a reflection of our broken system and communities in need of healing and compassion.

Much of this early mortality is attributed to “natural causes” such as heart disease, pulmonary diseases, cancer, cerebrovascular, respiratory, and lung diseases. Elizabeth Walker, a researcher at the Emory University Rollins School of Public Health in Atlanta, writes, “People with mental health disorders have a high prevalence of chronic medical conditions, with fewer resources to manage these conditions. People with mental health challenges are dying prematurely and at a rate far exceeding their peers without this diagnosis.”

How many people that we love and care for have to die before their time and how many times do we have to plan services and mourn their passing? This disturbing health crisis is often overlooked. According to the National Institutes of Health (NIH), life expectancy has increased dramatically, unfortunately, “reductions in mortality are not shared equally in this country across racial, ethnic, and socio-economic groups or health-related conditions.”

So what can be done to start to change this shocking reality?

The first change that is needed is how we deliver services as a society. We need to be honest about the disparities in our culture. Services may be accessible with wheelchair ramps and Braille signage, however, there is no tolerance for people who are disheveled, responding to voices, have ticks, look different or have unpredictable behavior.  This intolerance creates barriers so preventive healthcare, such as routine checkups, mammograms, and teeth cleaning, is out of reach.  These disparities have led to women with mental health issues dying from cancer at twice the rate as the general population, and these women are also three times more likely to die from breast cancer.   Researchers, Colton and Manderscheid, found that the secondary consequences of mental illness are poverty, unemployment, poor housing, stigma, and low self-esteem leading to challenges accessing healthcare, including health professionals’ misdiagnosis, less focus on physical health, low compliance with health screening and treatment, and poor communication.  This has to stop! We have to create pathways to accessibility, prevention and care.  We need to train more primary healthcare providers to work with people with mental health challenges, which is something Crestwood Behavioral Health has been providing to our county stakeholders.  We need to design clinics, waiting rooms and services that are more accepting and inclusive of all marginalized populations. We need to develop more welcoming and validating preventive health screenings and utilization of services.

The second thing we need to do in our communities is the creation of Federally Qualified Health Clinic Clubhouses that welcome those with mental health challenges, the homeless, the disenfranchised and their families.  A Clubhouse is first and foremost a local community center that offers people who have mental health challenges the hope and opportunities to achieve their full potential.  During the course of their participation in a Clubhouse, members gain access to opportunities to rejoin the world of friendships, family, employment and education, and to the services and support they may individually need to continue their recovery. A Clubhouse also provides important routine health screenings that are completed in a client-friendly space, rather than in a hospital or sterile clinic setting. Crestwood is currently looking to explore creating a Clubhouse program in San Diego.  Also, a mobile whole health services unit, a companion to the Clubhouse, is needed to bring health screenings and health services to the homeless where they are, whether it is under a bridge, in a shelter or at a wellness center.

The next action that needs to be taken is to launch a statewide Wellness and Resiliency Initiative similar to the one Crestwood has adopted in all of our programs that includes serving heart-healthy diets and creating client-oriented cookbooks with heart-heathy recipes and shopping guides. It includes planting organic gardens and using the farm to table approach in our meals. It is bringing Zumba and Yoga to every campus and community.  It is having exercise tracks in yards that used to be used for smoke breaks. At Crestwood we support smoking cessation, sobriety and meaningful roles to help replace addiction and isolation. Crestwood also teaches meditation and mindfulness to our clients which lowers heart rate, reduces risk of heart disease and increases pulmonary capacity.

Another action we can take is to live healthier lives as healthcare providers. At Crestwood we use Wellness Recovery Action Plan (WRAP) to support our workforce, with staff being paid for time off the floor to attend WRAP groups. We provide mental health days, as well as sick days and expect our staff to do routine health screenings – modeling wellness. We employ meditation and mindfulness practices at all staff meetings and events to encourage our staff to practice mindfulness as a health and wellness practice.

At Crestwood we will continue to do our part by looking for and incorporating innovative health and wellness measures into our programs.  We can truly practice self-care each day, creating a compassionate community of people caring for themselves and others. This may not move the needle on the mortality rate very quickly; however, it is a promising start that we hope will begin to create healthier, longer lives for our clients, friends and coworkers.

Contributed by:
Patty Blum, PhD
Crestwood Vice President


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Transformation – One person, one program, one community at a time.

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The day Crestwood Behavioral Health opened the Kingsburg Healing Center was one of those beautiful moments of transformation. We spend much of our lives working with people and ourselves on transformation, it could be changing a small behavior or a big one, and it may mean adding an exercise routine, revising a Recovery Service Plan, or helping a person find a job.  Transformation may also be seen in the developing of a new program, which was the central theme in the opening our Kingsburg Healing Center.

Transformation for Kingsburg Healing Center began with rehabilitating an old building that had been vacant and lifeless for decades, into a beautiful, warm, welcoming facility. It involved designing a new program that incorporates all of our recovery services such as Homelike Environments, Mind, Body, and Spirit Wellness, Wellness Recovery Action Plan (WRAP), Dialectical Behavior Therapy (DBT), and Trauma-Informed Approaches.  The development of the Kingsburg Healing Center also gave us a chance to get to know the neighbors and community leaders and to start becoming part of such a wonderful community.

Opening week for our Kingsburg Healing Center was very exciting and included an Open House on January 27, where community leaders and neighbors were welcomed in to tour the newly transformed facility and meet the staff. The event began by a warm blessing from Father Gregory, from the Holy Family Parish.  Kingsburg Mayor, Bruce Blayney, then provided opening words and other local community leaders such as Kingsburg District Hospital Board Members Glenn Snyder, Robert Johnson and Arlie Rogers, as well as Kingsburg City Manager, Alex Henderson also added their own words of welcome. Dawan Utecht, Director of Fresno County Behavioral Health, shared her kind words with the group.  Many other community leaders were also in attendance such as City Council Members Staci Smith and Michelle Roman; Chief of Police Neil Dadian; and Steve Safarjian, local broker/owner of RPS Real Estate.

The Open House was a great success with more than 200 community members attending.  One Kingsburg citizen, Mrs. Johnson, commented, “Thank you so much for letting us tour the facility.  Crestwood has done an amazing job transforming the old Hospital.  My husband and I are excited to leave here and tell all our friends what the facility looks like and what we learned from the tour.”  And another Kingsburg citizen, Mr. Lopez, said, “Your staff was so nice and gave us a lot of great information about the facility during our tour.   Thank you for giving the community a chance to see for ourselves all the hard work that has gone into the building and understanding what your company stands for.”

So one week later on February 1st, after two years of planning, challenges, hearings and a lot of hard work, the Kingsburg Healing Center was ready to open for clients!  On that opening day it was a gift to have five clients who were warmly received in our welcome room; who sat watching our fish tank; who walked in our yard; who found a space for a quiet time in our serenity room; who shared in delicious homemade lasagna; and who  slept on new beautiful, comfortable beds. These five people were now on a journey to start their own recovery transformation.

Kingsburg Healing Center is not only a transformation of an old building into a beautiful new program; it also is the beginning transformation in the lives of our clients and their families.  “I want you to know that I think the Kingsburg Healing Center is such a loving and warm place.  It is a wonderful place for my daughter.  She is doing so much better now that she is here,” said one client’s mother. No longer will clients in Fresno County have to travel hundreds of miles for mental health services and no longer will their families have to make long trips to visit them. “I wish this place had been here sooner, it would have been nice to have our son here sooner.  Now that he is back in Fresno County we can see him anytime we want and we know it will help him get better,” said one client’s parents.  The transformations at Kingsburg Healing Center are just beginning.

Contributed by:
Patty Blum, PhD
Crestwood Vice President

 


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Choosing Recovery

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Recovery is a choice; a person has to choose to be willing to work on their own recovery and actively participate in determining what recovery means to them. Not only is recovery a choice, it is an ongoing choice that is deeply personal and one that a person has to keep choosing every day, even though it may be difficult at times.

At Crestwood Center at Napa Valley when a client is not ready to begin their journey of recovery, we let them know that we are here to help them when they decide they are ready. We are able to offer compassion, support and empathy in a non-judgmental manner. We offer a variety of opportunities they can participate in that will hopefully make their choice for recovery easier such as WRAP, DBT, working for Dreamcatchers Empowerment Network, art therapy, and various addiction-based recovery groups. Independent studies are also available for those not comfortable in groups.

Once one of our clients makes the decision to begin their journey of recovery, it then becomes an ongoing choice, a new habit and a new way of life for them. Eventually, choosing recovery for them becomes easier. Recovery may be difficult for so many reasons such as facing uncomfortable thoughts, doing things they may not want to do, and even things they may believe are unnecessary. Sometimes the process of recovery includes not having much power or control over one’s own life for a time. So we try to provide our clients with tools, skills and plans they can use to gain empowerment and independence. Sometimes the realization of having to make the choice of recovery for the rest of their lives can be overwhelming, but we always remind them to take it one day at a time.  We encourage them by letting them know that when recovery does become a habit, it stops being so daunting.

The work we do at Crestwood Center at Napa Valley can be frustrating at times because we cannot force a client to work on their recovery, as much as we want it for them. But more often than not, our work is very rewarding when we can help a client with their recovery. We can never give up hope and instead we can hold the hope for the hopeless and support their decisions. We can continue to help others discover their own path on the road to recovery by offering counseling, encouragement, our life experiences and our strengths. Our goal is to let our clients know that recovery is a choice that is worth making, so that they can maximize their life and achieve a sense of balance and fulfillment.

Contributed by:
Cheri Tugmon
Service Coordinator
Crestwood Center at Napa Valley


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Supporting Recovery with WRAP

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At Crestwood Bakersfield, Wellness Recovery Action Plan (WRAP) is an important part of the healing and recovery process for their clients. Their motto and goal is to stay well by playing and focusing on their key recovery concepts, which include hope, personal responsibility, education, self-advocacy and support.  WRAP is used to learn to uncover each person’s own wellness tools and put them into action on a daily basis. Many of the WRAP activities they have incorporated into their classes are team building activities, which help others learn how to work as a team, increase problem solving skills and improve communication.

“Our goal is to incorporate more fun, interactive and competitive activities into our WRAP trainings.  Just recently I developed a WRAP Trivia/Crestwood Family Feud game which has been helpful in understanding why WRAP is such a vital part of our lives,” said Linda Johnson, Director of Recreation Therapy.

Another creative way Crestwood Bakersfield is presenting WRAP in their programs is by having individuals team up into pairs, with the assignment to create and design a WRAP community in which people would enjoy living.  This exercise is not only a lot of fun for the clients, but it also brings communication, group understanding and decision making skills in to play.

“Since so many of us enjoy being in a peaceful setting, we have also incorporated a beach theme into our WRAP classes this summer, with ocean sounds, beach sand, sea shells, candles, lounge chairs and many other soothing items which seem to help ease the pressure of daily life,” explained Linda.

Crestwood Bakersfield continues to find wonderful ways to support clients in their recovery through innovative WRAP activities and they love to say, “We are playing. What are you doing to stay well?”

Contributed by:
Linda Johnson
Director of Recreation Therapy
Crestwood Bakersfield


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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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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