Crestwood’s Psychiatric Health Facilities Providing a Beacon of Light in the Darkest Moments There is no more significant moment than the moment when you feel the greatest despair, the moment when you cannot find any controls for your emotions and actions, the moment when you find yourself lost in the streets, homeless, hungry and frightened, the moment when you can no longer endure the life you are living. These times generally get you to the door of an ambulance, police car or crisis center. These are the crisis moments the clients who come to Crestwood’s Psychiatric Health Facilities (PHFs) find themselves in the midst of. This moment is pivotal and can be the beginning of a long and dark road of hospitalizations, or an opportunity to embark on a journey of recovery, serenity and peace. Crestwood has become one of largest provider of PHFs in the state with programs at our American River, Bakersfield, Solano, Sacramento and San Jose campuses.  The PHFs are designed by and for individuals who are in the middle of crisis moments and need a soft place to land. The PHF environments are cozy, with soft wall paint hues of welcoming color and are decorated with carpet and home furnishings to eliminate the sterile hospital environment feel.  When a client first arrives at one of Crestwood’s PHFs they are greeted in a comfortable welcoming room and are provided with snacks and drinks.  Each client’s initial assessment occurs in this welcoming room and is conducted as a soft inquiry interview, rather than a long list of yes and no questions, which helps to calm the client and put them at ease. Once a client has been welcomed, they are then provided with a tour of the rest of the environment. The PHFs are small programs, accommodating 10 to 16 individuals, yet each has a large, relaxing living room; dining room and kitchen; group rooms; sitting areas for just visiting; and a serenity room with chaise lounges, walls painted darker soft hues, art and music for contemplation, meditation and peace of mind. The bedrooms have homelike beds with comforters and enough space to allow freedom of movement and privacy. The support offered at Crestwood’s PHF programs is exceptional. The PHF programs are designed to be open, enabling clients to choose classes each day, as well as to take the time they need for individual healing rituals such as journaling, sharing stories and laughter. The evidence-based classes available to clients include Dialectical Behavior Therapy (DBT) skills, Wellness Recovery Action Plan (WRAP), and Cognitive Behavioral skills training in anger management, self- soothing, assertiveness training, medication awareness, and life-skills training. The creative arts are also provided as another recovery tool that each person can bring with them as they transition back to their home or community. The support offered at Crestwood’s PHF programs is exceptional.  The psychiatrists are well-versed in recovery methods and a variety of recovery tools, including medication. The licensed clinical staff and nursing staff are trained in WRAP and have extensive training to avoid coercive treatment. The relationship each staff member has with each client is viewed as one of the most healing recovery tools. Another significant support that is available for clients is peers helping peers. Clients are also provided with transition training to help prepare them to return home or to a new environment. Linkage to community-based providers is vital at this time, as well as family support and education. With the support of the PHFs’ service coordinators, each client is linked to services, understands their aftercare plan and has an idea of where to get help should another crisis arise. So it is only with love, compassion, hope and ongoing support that the darkest moments can be transformed into the beginning of a sacred healing journey of recovery and peace.  The Crestwood PHFs provide clients who are in this time of crisis with a safe environment that is warm and welcoming and surrounded by others who have been in their shoes and who can hold hope until they are ready to hold it for themselves.

American River Residential Services Providing Meaningful Roles for Their Residents At American River Residential Services (ARRS), they provide residents with community housing and support services in a welcoming and motivating atmosphere, with the goal for each resident to be able to live independently when they graduate from the program. One important part of ARRS’ program in helping residents achieve their goal of independent living is Vocational Wellness.  Vocational Wellness acknowledges the need for creating meaningful roles through personal satisfaction and enrichment in one’s life, which is developed through learning job skills and building on positive activities. Vocational Wellness at ARRS begins with an assessment, followed by providing residents with assistance in applying for an identification card, obtaining a social security card, and completing paperwork. ARRS’ Program Director, Damela Barnes, initiates the next step in the Vocational Wellness program by encouraging residents to become a Dreamcatcher.  A Dreamcatcher is a resident who, after having gone through the initial process of participating in the Vocational Wellness program, agrees to go through vocational training by working in a part-time job.  Often times when residents are first approached about becoming a Dreamcatcher their responses range from, “I can’t work because I’m disabled,” to “I can’t do a job, it’s too hard,” and even “I receive an SSI check every month and I don’t need a job, I’m fine.”  But with positive encouragement from the staff, these same residents often agree to participate in the Dreamcatchers’ program and discover meaningful roles for themselves through the job experience.  Dreamcatcher residents are thriving, feel empowered, supported and understood at ARRS by being provided with meaningful roles. An example of this is Tamara who says, “I enjoy being a Dreamcatcher.  I work three times a week and it’s really fun. I have been working for a month now and would like to continue.” Dreamcatchers are assigned rewarding and positive work experiences in various job positions throughout the facility, such as kitchen assistants, housekeeping assistants, maintenance assistants, office assistants, recycling, and groundskeepers. Staff members, working in their respective departments, serve as mentors to the Dreamcatchers. The Dreamcatchers’ program is very popular at ARRS, with at least half of their residents participating.  ARRS’ ultimate goal, by providing the resident Dreamcatchers with a simulated working environment within the facility, is that it will eventually help them transition into working in the community prior to graduating from the program.  It is extremely rewarding for the staff mentors to see this whole transformation unfold before their eyes. “The experience of working with residents and seeing them succeed is simply amazing and enriching and it all begins with providing residents with meaningful roles,” said Vernon Frayna, Program Coordinator at American River Residential Services and the PHF. Many Dreamcatcher residents love the fact that they receive a paycheck with their name on it every two weeks.  “I work as an office assistant.  My job is very fulfilling and I like working with the staff,” said Traci, a Dreamcatcher.  “I am excited about my paycheck every two weeks. And I look forward to a rewarding career as a full-time receptionist after I graduate from the program.” Meaningful roles created through learning job skills and working at a job gives the Dreamcatchers a reason to get up in the morning, smile, and keep up with their hygiene and grooming, and associating with others.  Vernon observed, “Because they know that people believe in them, that makes them feel good about themselves.” The Dreamcatcher residents are thriving, feel empowered, supported and understood at ARRS by being provided with meaningful roles. Vernon reflected, “One of the best compliments I have ever received from a Dreamcatcher at ARRS was, ‘Thank you for letting me do a job and for giving me hope.’”

Crestwood is proud to announce that our newest Psychiatric Health Facility, Crestwood Sonoma County Healing Center (SCHC) in Santa Rosa, is scheduled to open early February! This 16-bed PHF will provide much-needed, mental health services with 14 beds dedicated to Sonoma County residents and 2 beds dedicated to Marin County residents. This program came together through a truly collaborative partnership that included Sonoma County General Services, Sonoma County Department of Health Services, Sonoma County Board of Supervisors, Kaiser Permanente, Sutter Health, St. Joseph Health and the County of Marin Department of Health and Human Services. Our SCHC campus offers a warm, welcoming and homelike therapeutic environment, from the soothing paint colors and comfy furniture to the beautiful artwork and provides a safe place for the people that we serve to receive the services and support they need to start their recovery journey.   We are also excited to announce that Mary Fiumara has joined Crestwood as the SCHC Administrator!  More Video: C lick here to check out the virtual Sonoma County Healing Center Open House event from January 20 In The News: Sonoma County Gazette Healthcare Design Magazine Marin Independent Journal

What is the impact of forgiveness on ourselves or others? How do we forgive when there is no apology or amends? How do we open our hearts to forgive when we are still in pain?  Where does forgiveness come in when the harm is still being done? Does forgiveness change behaviors? Does forgiveness provide relief to pain? How does forgiveness impact our lives? These are the questions that provide a platform to study forgiveness.  The common definition of forgiveness is the intentional and voluntary process by which a person changes feelings and attitudes regarding an offense; letting go of negative emotions such as anger, resentment, vengefulness or desire to punish the offender, although it’s justified; and then replacing those emotions with compassion, love and positive regard. It does not equate to condoning or excusing behavior. Forgiveness requires gratitude and compassion.   The Stanford University Forgiveness Project’s study defines forgiveness as primarily of taking less personal offense, reducing anger and blaming of the offender, and developing an increased understanding of situations that lead to hurt and anger. This understanding may lead to greater empathy. Forgiveness is not granted because a person deserves to be forgiven, instead, it is an act of love, mercy, and grace.  According to the Greater Good Science at UC Berkeley, forgiveness provides a healthy physiological, emotional, psychological and spiritual impact contrasting with the harmful effects aligned with being unforgiving of others, which include depression, high blood pressure, muscle tension and an increased heart rate. Our ability to enjoy and be present in the moment is an outcome of forgiveness, while unforgiving practices can reduce confidence, comfort and lower self-esteem. Possessing the strength and willpower to embrace forgiveness will not only reduce these harmful traits, it can also create a renewed sense of hope, inner peace, gratitude and happiness.  There are three kinds of forgiveness that are all interrelated. There is self-forgiveness, which enables us to release our guilt and perfectionism. There is the forgiveness we extend to others and receive from them. And there is the forgiveness of God or our higher power or our universe that assures us of our worth and strengthens us for this practice. All the spiritual traditions raise up the value of forgiveness, but many people still find it to be a nearly impossible ideal. Just start somewhere. Look truthfully at one hurt you have not been able to forgive. Identify any associated feelings you might have, such as anger, denial, guilt, shame, or embarrassment. Imagine what it would be like to live without feeling this offense. Then let it go. According to Web MD your heart health and mental health may depend on your ability to reduce hurt and anger at yourself. The significant impact of the health benefits of forgiveness led Stanford University Forgiveness Project to look at how we can teach it as a practice, rather than a concept. The project is currently undertaking a study to learn how forgiveness can enhance health and relationships and even prevent disease. Part of that study has found that we forgive others with greater ease than we forgive ourselves. I speculate that until we master self-forgiveness, authentic and complete forgiveness of others cannot occur, thus anger still lingers underneath our conscious awareness. According to Juliana Breines, PhD, from Brandeis University, the lack of self-forgiveness is linked with suicide attempts, eating disorders, and alcohol abuse. Self-forgiveness and learning the practice of self-forgiveness may be the cornerstone to lasting personal wellness.  So how do we forgive ourselves or others? Dr. Frederic Luskin, Director of the Stanford University Forgiveness Project, has identified four stages to forgiveness.  Stage One: We recognize we feel self-justified anger. We may feel wounded or convinced that the offense is so great that it does not deserve a pardon. At this stage there usually is both active and submerged anger, as well as a great deal of pain. Stage Two: We realize that our hurt and anger does not feel good and may be causing health and life balance challenges You may wish to repair the damage to the relationship and take steps toward forgiveness. You no longer feel activated by anger. This process of forgiveness can be applied to anger at oneself or others.  Stage Three: As we start to experience the results of forgiveness – less stress, hurt and pain; we choose to let go of a new grievance more rapidly. In this stage, you choose to feel the hurt for a shorter period and then work to either repair the relationship or not see the situation as a problem. In either case, you are aware that you control the time and energy spent on the grievance and you decide to forgive because you have had more practice with it and see the clear benefit in your life. Stage Four: The fourth stage of forgiveness involves the choice to reframe the world and your experiences. You prepare to forgive in advance of a trigger such as anger or pain. You recognize that your time in anger may be wasted time or have a negative impact on your health and wellness. You recognize that you can forgive yourself, others, your circumstances and God.  Much like playing piano or baseball, forgiveness takes practice. It takes mindful awareness of identifying a grievance and chosing your response. It requires self-reflection, observation and gratitude. It is a practice, that like exercise or healthy eating, will have a positive effect on your health and wellness. It is worth the effort and self-forgiveness is where it starts.  Forgiveness does not require an apology or amends. It is ours to provide and practice.  Forgiveness changes our behavior and it has the potential to change a situation that harms, into a response that increases our self-esteem, improves our physical health and opens the door to overall wellness. Contributed by Patty Blum PhD, CPRP, Crestwood Executive Vice President

Communication is conveying a message to another person through language – both verbal and nonverbal. The basic steps of communication are thinking about the message, communicating that message and making sure it was heard and understood as intended by the recipients.  Communication in our Crestwood campuses is of paramount importance. It is the lynch pin in relationships, safety, effectiveness of services, satisfaction and sustainability of services in behavioral health. Communication can be as basic as breathing and as complicated as neurosurgery. Effective communication begins with these essential skills:  Listening- being a good listener is one of the best ways to be a good communicator and it requires paying attention.  Nonverbal Communication - y our body language, eye contact, hand gestures, and tone of voice all play into communication, so be aware of what you are communicating.  Clarity and Concision - good verbal communication means saying what you mean, just enough and not too much.  Friendliness - through a friendly tone and smile you will encourage others to engage in open and honest communication with you.  Confidence - it is important to be confident in your interactions with others. Confidence shows that you believe in what you’re saying and will follow through. Exuding confidence can be as simple as making eye contact or using a firm, but friendly tone . Be sure you are always listening to and empathizing with the other person.  Empathy - using phrases as simple as "I understand where you are coming from" demonstrate that you have been listening to the other person and respect their opinions. Open-Mindedness - in situations where you disagree with what someone else has to say, it is important to sympathize with their point of view, rather than simply try to get your message across. Respect the opinion of others and never resort to demeaning those who do not agree with you. Respect - respecting what others have to say and acknowledging them is an important aspect of communication. Being respectful can be as simple as paying attention to what they have to say, using that person’s name, and not being distracted. By respecting others, the other person will feel appreciated, which will lead to a more honest and productive conversation. www.thebalencecareers.com Effective communication is simple and exquisite, yet not easy. What makes communication work well is attention and intention. You need to pay attention to what and how you are communicating and focus on the intention, which should be honest, transparent, values-driven and beneficial so that it helps, not hurts the other person. By practicing and continuing to develop these essential communication skills, will help us to improve, foster and build stronger relationships with co-workers and clients throughout our Crestwood campuses. Communication is conveying a message to another person through language – both verbal and nonverbal. The basic steps of communication are thinking about the message, communicating that message and making sure it was heard and understood as intended by the recipients.

The family unit is one of the most important and influential social groups.  At some point in each of our lives, we are part of a family. Today we have expanded our definition of family beyond the “nuclear” reference and many people have created their own meaningful definition of family in their own lives. In serving people challenged by mental health issues, Crestwood recognizes how essential family can be to the process of recovery. One of Crestwood’s Core Values is Family, which means our company is committed to providing safe, secure and responsive mental health services to the entire family.  It is estimated that up to 70% of people living with mental health issues live with a family member. The needs of families for support, education, and information are evident.  At Crestwood American River, we seek out and actively engage with the family members of our clients, and have become acutely aware of the stress and conflict they are experiencing.  As a result, the American River campus offers a free-of-cost Family Support Group to help families navigate the systems designed to support their family member, provide an outlet for sharing, problem solving and processing of difficult feelings, and creating their own self-care plans. Our Family Support Group was started in January 2015, and is led by Denise Thompson, MFTI, who is one of the Recovery Service Coordinators at the American River PHF.   The group is a psycho-educational community support group and is open to all family members of past and present clients.  The group is held bi-weekly without fail and members set the topics.  It is a safe, confidential place to share their healing journeys.  They share stories, learn coping skills and Dialectical Behavior Therapy (DBT) techniques, while connecting with each other. One member of the group, Jamie, is a key advocate for the creation of the group and has been regularly attending since it first began. When his family member was a client at Crestwood American River he asked for support, he asked for resources, and he volunteered to be a part of helping others in any way possible. “It is difficult to find the right words to describe the excruciating emotional pain created by seeing a loved one secluded in a mental health facility.  It is difficult as well to describe the gratitude after finding the desperate relief through the sessions offered by Crestwood,” explained Jamie. “When my family member began in the rehabilitation program at American River, my family and I, at that time, did not have support or knowledge of where to go.  All of this was done in order to make things easier for me, and to point us in the direction of the light at the end of the tunnel. Thank you for opening this door of opportunity and healing, which is a great step for me, and for giving me the strength to persist and succeed.” At Crestwood American River we feel honored to support our clients and their families.  We believe by providing support and education to the families and the community, it leads to inclusion and reduces stigma.  This is what living our Crestwood Values is all about.

Liberty Hyde Bailey, a renowned American horticulturist, botanist and cofounder of the American Society for Horticultural Science once said, “A garden requires patient labor and attention. Plants do not grow merely to satisfy ambitions or to fulfill good intentions. They thrive because someone expended effort on them.” At Crestwood Manor Modesto, their residents demonstrate exactly that philosophy with their Healing Harvest Project. The Healing Harvest Project is part of the facility’s vocational rehabilitation program, which consists of offering three types of jobs for residents - staff assistants, peer assistants, and caring for plants, animals, and the environment with the Healing Harvest Project. The Healing Harvest Project gives residents the opportunity to put their hands in the dirt and have the ability to enjoy outdoor time, while being simultaneously productive, industrious and a contributing member to the Crestwood community. “I like being outdoors, and having the freedom,” said one resident who is working in both the vegetable and flower gardens. The volunteer residents participate in the garden’s care and cultivate its growth, making it into a serene and beautiful place. It also gives the residents tools and skills, which they can use in the garden, as well as in their life. It has been shown that gardening is a genuine therapeutic tool for some and can help improve memory, cognitive abilities, language capabilities, socialization and problem solving skills. Furthermore, gardening can help strengthen muscles and improve coordination, balance, endurance and overall health. One resident who works in the flower garden commented, “I like to water, it’s calming and relaxing.” The gardens are often filled with beautiful flowers and nutritious vegetables and fruits that are used throughout the facility. The head of the vocational rehabilitation department, Judi Jimenez, makes great use of the flower garden, conducting a flower arranging group when they are in bloom. Dietary Supervisor, Rene Springfield, teaches nutrition groups, and Behavior Specialist, Michael Russ, who has a Culinary Arts degree, conducts a cooking group with geriatric residents using produce from the garden. Activity and program staff also teach independent living skills, focusing on food preparation with various cultural delights being created, always with delicious results. The benefits of the garden are not just for the residents, but for the staff as well. On occasion when things get tough and staff need a moment to relax, the garden offers a beautiful place to rejuvenate, smell the flowers and realize that this amazing garden is a product of the residents’ hard work and a reminder of the importance of what they do each day. Contributed by: Robert Leavy, Director of Program Education and Leslie Darouze, Program Director Crestwood Manor Modesto

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.

Rashmi Rajadhyax, Program Director at Idylwood Care Center, got up one morning and thought, “Life is worth living.”  As that thought passed through her mind she decided to wonder out of curiosity what do other people think about life in general and what kind of message are people saying to themselves on a regular basis. Are those messages positive or negative? So to find out more, she surveyed 228 people at Idylwood Care Center which included residents, staff, doctors, families and visitors and asked them what life means to them. She then comprised the list of all answers which included: Life is Worth Living • Life is Joy • Life is Beautiful • Life is Awesome • Life is Good • Life is Struggle, through struggles of life you find yourself • Life is Amazing • Life is Interesting • Life is Full of Meaning • Life is Happiness • Life is Wonderful • Life is Difficult • Life is Cavalcade of parade • Life is Crazy • Life is Challenging • Life is Great • Life is Full of surprises • Life is Family • Life is Enjoyable • Life is Fun • Life is Living • Life is Special • Life is Exciting • Life is Better than Death • Life is Short • Life is Precious • Life is Blessing • Life is Just a Bowl of Cherries • Life is Simple • Life is Rough • Life is Rewarding • Life is Everything • Life is Splendid • Life is Important • Life is Happy • Life is a Ball • Life is Prison • Life is to be Human • Life is What you make out of it • Life is Journey • Life is a Bowl of Honey, the More you Touch it, the Sweeter it Gets • Life is Everlasting • Life is Gold • Life is Full of Stress • Life is Blessing from God • Life is a Bowl of Roses • Life is Nice  • Life is Hard • Life is Complicated • Life is an Escalator with Ups and Downs • Life is Full of Choices • Life is On • Life is Full of Miseries  • Life is Bright • Life is 10% What you Make it and 90% How you Take it Rashmi said that it was a fun and satisfying experience to create something so simple that would inspire so much excitement and curiosity in people.  The final list was compiled and copies were handed out at the facility so everyone could share with their friends and families, and to clip on a bulletin board at work or home if they wanted to. “What it ultimately comes down to is that life is a field of unlimited possibilities. We have choices.  Life is all these quotes at one given time and life is inclusive of all,” said Rashmi.   “Use them, share them, and get inspired by them. It doesn’t matter how you use them, if they make your day happy and bright.” (download and share the image below to inspire others)

A values-driven organization identifies its values through a process of self-examination.  This involves identifying the organizational purpose, the needs of the customer, assessing all strengths, deficits, and opportunities, as well as threats to the organization’s mission. It also entails taking an extensive and comprehensive 360 degree look at the entire organization, in other words, a non-compromising organizational soul-searching. At Crestwood Behavioral Health, Inc. this self-examination involves a view of our organization, our communities, and our purpose which stems from four different perspectives. The first view we examine is from the perspective of the organizational leadership which consists of our Board of Directors, Chief Executive Officer, Chief Financial Officer, executive leadership, program administrators and campus leadership.  Next we include our front line staff, mid-management staff and program supervisory staff.  This provides perspectives from all viewpoints in Crestwood. The next vantage point that is vital to gaining the company’s full perspective is the client and family support system stakeholder group. This involves creating a safe space for our clients and their family voices to be heard.  The client and family are the primary voices to be listened to and it may take time, support and compassion to enable this perspective to be fully shared. At Crestwood we see this as the responsibility of the organizational leadership. One way we do this is to employ people with lived experience and have family members at the executive, management and front-line staff level job positions. The next perspective that we include is from our county partners, customers, and the communities we provide services to. This perspective enables us to understand the needs of the community and provides the opportunity to develop and enhance meaningful relationships with our partners so we can better understand and anticipate the needs of the communities we work with. Crestwood has developed its mission and values from gathering all of these different perspectives. Crestwood’s mission is to create a partnership with clients, employees, families, business associates and the community in caring for individuals of all ages affected by mental health issues. Together, we invest our energy to enhance the quality of life, social integration, community support and empowerment of mental health clients.  Crestwood promotes wellness and recovery by providing quality and cost-effective programs in a socially responsible manner, and works with families and communities to reduce the stigma associated with mental illness. The values that were developed from this framework are simple and come from the heart. Crestwood’s values are family, compassion, enthusiasm, flexibility, character and commitment. It is through these values that Crestwood views all aspects of our operations. These values reflect the strength and vulnerability of Crestwood, with a focus on trauma-informed approaches with love and gratitude for the people and communities we serve and the staff and partners we work with. Crestwood views all decisions, strategies, goals and objectives, and benchmarks for success based on these values.  Our organization is driven to achieve objectives and goals relying on the courage and strength to maintain the highest level of integrity, while honoring these shared values. Having this values-driven perspective has allowed us to grow as partners in services with other community-based organizations such as Recovery Innovations, Turning Point and Dreamcatchers Empowerment Network. The understanding and recognition that our county and community partners provide the foundation for our services, enables Crestwood to develop community specific services, with the values of the community intertwined with Crestwood’s values. The opening of our MHRC programs in San Diego and Chula Vista are an excellent example of involving all of these perspectives.  Crestwood worked very closely with the county and community leaders to identify the needs.  The community-based providers and hospitals helped Crestwood to find the right locations for the programs. The recruitment of employees was focused on hiring people with lived experience and allowing them to provide a strong client voice, as well having family members involved at all levels of service. We worked to include the voices of Crestwood San Diego’s and Crestwood Chula Vista’s leadership teams so that they could participate in all elements of program development, making it strong and reflecting all of Crestwood’s mission and values. By being a values-driven organization and continuing to take a full 360 degree look at ourselves and our services, Crestwood will continue to grow and provide the best care possible for our clients and the communities we serve.

The Crestwood Nutrition and Wellness Initiative was started in May of 2013 under the direction of Margaret McDonald, Crestwood’s Director of Nutritional and Wellness Services.  One of the initiative’s first goals was to provide Crestwood facilities with new menus and recipes based on government guidelines and the latest nutrition research, using whole foods, rather than processed foods. In many of our Mental Health Recovery Centers (MHRCs), we have been able to greatly reduce or eliminate therapeutic diet orders because this diet is appropriate for the vast majority of our clients, including those with diabetes, high blood pressure, and high cholesterol.  The diet is appropriate for diabetics because we keep each meal within a certain range of carbohydrates, and we offer very few concentrated sweets.  We do most of our baking with whole wheat flour and serve real sugar in small portions. The diet is appropriate for those with high blood pressure and high cholesterol because we limit saturated fat by serving red meat only once a week and serving low-fat dairy products.  We also use very little added salt, and few processed or canned goods. Dietary Directors have reported that the costs have been about the same or a bit lower than the old diet. We offer two fish meals per week, three vegetarian meals per week, and limit red meat to one meal a week. Other meals provide lean proteins such as turkey and chicken.  The diet is high in fiber with lots of whole grains, beans, lentils, and fresh fruits and vegetables.  We include many plant sources of healthy fats such as oils, trans fat free margarines, nuts, and seeds.  Whenever possible, we avoid products with trans fats, high fructose corn syrup, and artificial colorings and sweeteners, and we make as much as possible from scratch.  We also offer meals from a variety of cultural backgrounds in order to appeal to our diverse client population. We have been monitoring client weights, lipid profiles, and HGBA1Cs (a measure of blood sugar levels over time).  In the facilities that have implemented our menus, we have seen a gradual weight loss in some of our overweight and obese clients, and an improvement in lipid profiles and a lowering of HGBA1Cs in some clients.  Dr. Zhongshu Yang, M.D., PhD from the University of California, Davis was so impressed with the change in weights and lab results at Crestwood Sacramento Center, that she applied for a grant to do a research project on our diet. She and a graduate student, Jennifer Papac B.S., recently presented a poster on our diet at UC Davis Medical School, titled “Crestwood Nutrition and Wellness Initiative in Long-Term Psychiatric Patients.”  They concluded that after implementing the diet, there was a reduction in the percentage of obese patients and an increase in the percentage of patients in the overweight and normal weight ranges. They also concluded that patients lost a significant amount of weight over the time period looked at, and that they showed a significant decrease in Body Mass Index (BMI) over that time period. Lastly, we have received positive feedback from Dietary Directors, kitchen staff, and the clients themselves.  Dietary Directors’ comments include, “There was some resistance at first from clients and staff, but they gradually accepted the changes and are getting excited about eating healthy”, “We are starting to see healthy weight loss and an overall change in clients’ attitudes toward making healthier choices”,  and “Clients are enjoying the meals and we are getting positive feedback.”  Clients also have their opinions about the new diet changes and made comments such as, “It’s like restaurant food”, “I feel better and it’s only been a week”, “I feel good, not so heavy”, and “I feel like I have more energy.” Going forward, Margaret plans to develop more nutrition and exercise-related groups, for clients, as well as health related in-services for staff.  Overall, Crestwood’s ultimate goal is to continue to improve the health and wellness of both our clients and staff through educating and serving them nutritious and delicious food that will make a difference in their recovery and lives.  In the words of Hippocrates, “Our food should be our medicine and our medicine should be our food.”

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.