When a person has no hope, no sense of self, no meaning in life, and when they feel that their purpose on this earth feels nonexistent, their dreams have evaporated and thoughts of tomorrow are too heavy a burden to carry - that person can start to drown in emptiness.  It is at this time when they need that path to be opened – the path of connection, the path of light and a path that is uniquely theirs. It becomes the one place or thought that they can hold on to; this is their personal spiritual path. Spirituality is the connection to a greater power, others and self.  It is the way to find meaning, hope, comfort and inner peace in life.  Many people find spirituality through religion, music, art or a connection with nature, while others find it in their values and principles. At Crestwood Behavioral Health we hold spirituality as one of our core values for recovery. Each person’s spiritual path can be healing, centering, a moment of peace that is filled with acceptance and love. The path can be dark at times. It can be difficult to find without a companion, a guide or simply someone who believes in you, who sees you and who can by a look, a touch or a word begin to open the door to your spiritual path.  The door may be a prayer, a moment of tears, or even a moment of silence. It is a connection with a higher power, with nature, with something or someone greater than ourselves. The door to your spiritual path may be opened in the simplest and most humble of settings or it may be in a mosque, temple or church. It may be sitting near water or may be by spending time in the outdoors. At times it’s in silence or it can be brought on by a beautiful song. Each person’s spiritual path can be healing, centering, a moment of peace that is filled with acceptance and love. It is often what brings back hope, a sense of self, purpose and a meaning to life. It is and shall always be a core value to what we offer in our services for our clients at Crestwood.

As we age there are many emotional and physical transitions to cope with, and change is difficult, no matter how old you are. It’s natural to feel those losses. But if that sense of loss is balanced with positive ingredients, you have a recipe for staying healthy as you age. Healthy aging means finding new things you enjoy, learning to adapt to change, staying physically and socially active, and feeling connected to your community. An active lifestyle as you age can help reduce physical illness and emotional distress and increase longevity and quality of life. It is never too late to start to exercise. Regular physical activity helps you look and feel younger and stay independent longer. It also lowers your risk for a variety of conditions such as heart disease, diabetes, Alzheimer’s and dementia, high blood pressure, certain cancers, and obesity. The mood benefits of exercise can be just as great in the elderly as for the youth. And did you know that exercise and stretching that is appropriate for your ability, will reduce falls and increase balance. At Idylwood Care Center, their Medical Director, Dr. Silver, observed about their residents and exercise, “Regardless of underlying medical conditions the data is clear that the one thing that will increase the length and quality of life is exercise.”  “Zumba has shown to help create new neural pathways and new brain cell growth" Motivation to exercise as you age can be challenged by the loss of strength and stamina, medical conditions and lack of social support. Communities play an important role in promoting health and wellness. Recently Greg Parnell, Crestwood’s Health and Wellness Facilitator and Zumba Zen Master, visited Idylwood Care Center to work with their new Zumba instructor, Elsa DeIxta. Residents and staff alike had a great time moving their bodies to a playlist of music featuring oldies and Latin classics. “Zumba has shown to help create new neural pathways and new brain cell growth reversing signs of Alzheimer’s and Dementia and improving physical, psychological and emotional health,” said Greg. He adapted the class to be done in a chair or bed for those that are bed bound or physically disabled. “As I visit each of our unique campuses, the one thing I know for sure is when more staff are involved in participating in a Zumba class, it inspires more of our clients to participate. Zumba and exercise are a part of our Wellness Initiative and when we get moving together, it feels like one big community coming together, creating an organizational wellness landscape. Remember, there is no right or wrong way to do Zumba, as long as you are moving and smiling.” Contributed by Cindy Mataraso, Director of Operations

One of the biggest challenges for both our clients and staff is finding the time and motivation to get adequate exercise. Greg Parnell, the Director of Education and Assistant Program Director at Crestwood Behavioral Health Center Eureka’s campus, has been a licensed Zumba instructor for five years now, and to say he is passionate about Zumba, would be an enormous understatement. He teaches Zumba classes not only for the clients in the Eureka facility, but also in the community at recreation centers and schools. Zumba was started in the 1990s blending aerobic exercise with infectious Latin dance music. It is now a worldwide phenomenon being done in 180 countries, with more than 15 million students taking classes. What Greg and many others that participate in Zumba have found is that it is an activity that sparks something deep inside your spirit. That spark energizes you, changes your mood, and changes your outlook on life. Not only does Zumba bring about physical changes in you, it brings about mental and spiritual changes as well. Zumba can be a spark that starts with a simple routine of fun exercise, which then progresses into wanting to eat better, feel better, present one's self better, and be more active in the world. Crestwood has added Zumba to our Mind, Body, and Spirit Initiative. To get Zumba started in our facilities, Greg, along with Margaret McDonald, Administrator at Crestwood Center at Napa Valley and Crestwood’s Director of Nutritional and Wellness Services, wrote a proposal for a Crestwood Zumba Program that has several components and was geared toward both clients and staff. Their first goal was to get one or two staff members at each facility to be trained as Zumba instructors. These staff members can then teach 3 to 5 classes a week for clients and staff at their facilities. The second component was the purchase of Zumba DVDs that could be used to do additional Zumba classes or while trained staff is away. And the third part was to reach out to local Zumba instructors and develop a mutually beneficial relationship with them, in which they would volunteer their time to do Zumba at our facilities, in exchange for directing staff toward their classes in the community. Greg, as Crestwood’s in-house Zumba resource, will also travel to the facilities quarterly to reinvigorate the programs and troubleshoot any problems. At the 2015 annual Zumba Convention that was held in Orlando, Florida, Greg shared Crestwood’s proposal for a Zumba program with Alberto Pearlman, the CEO of Zumba, who then shared it with conference Keynote speaker, actress and singer Ashley Judd, who lives her own recovery story of depression and wellness through Zumba. Ms. Judd and Mr. Pearlman were so fascinated by what Crestwood is doing with Zumba that they both decided they wanted to be involved. Mr. Pearlman graciously offered to train Crestwood staff to become licensed Zumba instructors. In November 2015, 11 Crestwood facilities, (Angwin, American River, Sacramento, Pleasant Hill, San Jose, Fresno, Bakersfield, Vallejo, Solano, San Diego, and Chula Vista) sent nineteen staff members to Cheryl Louie’s Studio Z in Newark, California, where they were trained by Joy Smith, a Zumba Education Specialist, to become licensed Zumba instructors. Since then, Greg and Margaret have been traveling to our facilities helping our licensed Zumba instructors plan their classes, help with choreography, and incorporate classes into program schedules. “The enthusiasm from staff and clients has been overwhelming, and the support from Administrators has been amazing. It is inspiring to see how many of our clients really get into the classes, the music, the movement, and just losing themselves into the rhythms,” said Greg. “There are also stories of amazing transformations of our very quiet and soft-spoken clients who suddenly come alive when the Zumba class starts. They see and feel the energy around them and then want to join in.” And then there are also staff members, who after just one of Greg’s Zumba visits, are then inspired to want to do more, learn more, and become Zumba instructors themselves. Greg and Margaret hope to measure the success of the program and the influence of Zumba on our clients and staff in several ways. They have developed a pre-survey to be used before Zumba is offered in the facility and a post-survey after Zumba has been added to the program schedule. These surveys will assess the number of days clients exercise, reported enjoyment of exercise, and reported barriers to exercise, such as feeling self-conscious or not enjoying exercise. When the Zumba program is fully up and running in our Mental Health Rehabilitation Centers, Psychiatric Health Facilities, Adult Residential Facilities, and Social Rehabilitation facilities, they intend to bring Zumba Gold to our Skilled Nursing Facilities. Zumba Gold is a specialized form of Zumba for older adults. “We believe all of our clients and staff, no matter what age or ability level, will benefit physically, emotionally, and spiritually from participating in such an accessible and inspiring form of exercise,” said Margaret. “We also would love to eventually have clients be trained to become Zumba instructors, giving them meaningful roles in the facilities and the potential for employment once they are back in their communities.” Zumba truly provides that amazing spark to energize the mind, body and spirit of those who experience and embrace it in their lives. Contributed by: Margaret M. McDonald, M.S. Director of Nutrition and Wellness Services and Robert Pitts, Campus Administrator Crestwood Behavioral Health Center Eureka

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. These amazing dogs have awakened empathy and affection in many of our clients through their unconditioned love and presence. 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.

Last year the California drought led to state mandates for businesses and households to cut back on water usage.  While many California homes and workplaces made eco-friendly changes simply because of these mandates, Crestwood Healing Center Pleasant Hill had just launched a major environmental responsibility project, aimed at reducing water and energy usage, increasing sustainability and limiting general waste.  Creating a facility team later dubbed the Green Machine, the project has, in less than a year, achieved much more than they could have ever hoped. The environmental responsibility project developed out of recognition of the large amount of plastic cups that were being thrown away in the facility on a daily basis.  But the first and biggest priority for the Green Machine became water conservation, though the intention from the onset was not simply a response to the drought.  The team knew that to make real, sustainable change, it would be important to involve the entire facility community.  The project kicked off on Earth Day 2015, with the Green Machine providing educational presentations, giving out reusable water bottles to be used instead of disposable cups and with staff and clients making specific pledges on how they would be more environmentally conscious. For water conservation, part of the work to be done centered on general maintenance and repair around the building.  The team identified leaks throughout the facility, and proceeded to replace and repair toilets and sinks, while also installing faucet aerators and water-efficient showerheads that were provided for free by the local water company.  Other water conservation efforts included education and awareness on how to reduce water usage when showering, shaving and brushing teeth.  One resident, James, who has helped lead the charge on water consciousness, said, “I try to conserve water by turning off the shower when soaping up and shampooing my hair.”  Ultimately due to all these water conservation efforts, the facility cut its water usage by a whopping 45% in 2015, which is 20% more than the statewide mandate!  A year after launching the environmental responsibility project, the facility has saved more than a million gallons of water and counting. Additionally, the environmental responsibility project at the facility has focused on becoming more sustainable and reducing waste.  The facility has accomplished this through a composting project and by fixing a failing recycling system, as well as by creating Dreamcatchers Empowerment Network positions for clients to work in both composting and recycling.   The Green Machine also got clients involved in upcycling, a process in which materials that would otherwise be thrown out, such as plastic cups, are turned into new items, such as “flower” bouquets. To reduce waste, the Green Machine decided that it must start with a new mindset around awareness on how much trash was being routinely created.  Part of the fix was changing practices, such as cleaning with rags instead of paper towels, while also placing a huge emphasis on using reusable items, such as reusable water bottles and shopping bags instead of disposable ones.  Frances, a resident who is one of the biggest supporters of the project, said, “I hang clothes in the window to dry so I don’t use electricity and I turn off the lights in my room and other rooms when no one is in there.”  The early results have included a $1,200 reduction in energy costs and saving 25,500 plastic cups that were normally used one time for water when taking medications and then thrown away. Education has been one of the greatest tools the Green Machine has used to make change, and in addition to regular environmental events in the facility, they have begun making more of a difference outside the building as well.  One way is working alongside their partner organization, Putnam Clubhouse, a Contra Costa County community organization where adults with mental health issues go to build skills and make valuable connections.  The Green Machine and Putnam Clubhouse members are working together on a monthly cleanup of the Berkeley shoreline and so far have had 51 people involved making a positive impact on the community. As the environmental responsibility project at Crestwood Healing Center Pleasant Hill looks at next steps after a year of massive accomplishments, the Green Machine is aiming at expanding their environmental practices to continue reducing the facility’s impact on the Earth, while ultimately getting the facility certified as a green business.  As the team celebrated the first year of the project on this year’s Earth Day on April 22nd, the Contra Costa Water District joined them in the festivities to recognize the huge successes in conservation.  With a little education, effort and care for the planet, the Green Machine hopes its message can inspire others to make a similar impact in their community for the environment. Contributed by: Travis Curran, Campus Administrator Crestwood Healing Center Pleasant Hill and Chloe De Lancie, Project Coordinator Crestwood Healing Center Pleasant Hill

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 1, 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

The staff at Idylwood Care Center is always looking for new ways to support the well-being of their residents.  Recently, Dietary and Occupational Therapy staff and interns came together to design and launch the Garden to Table program.  This program guides residents in the gardening of seasonal vegetables and herbs, provides education on plants, promotes physical activity, encourages healthful nutrition and supports emotional and mental well-being. The daily schedule for the program begins with staff sharing with residents a variety of information on nutrition, food basics and overall health and well-being strategies.  Next they demonstrate how-to gardening fundamentals such as weeding, watering, pruning and harvesting. In addition to working in the garden, residents are also encouraged to walk through the garden and get moderate sun exposure during sitting breaks. This give them an opportunity to enjoy the garden, while increasing their Vitamin D levels through sun exposure, which helps with calcium absorption to improve bone density and maintain muscle and nerve function. Residents are also involved from the beginning in the preparation of the garden by helping to choose what types of vegetables to plant such as peppers, basil and tomatoes.  When it is time to harvest the vegetables and herbs, residents are able to help choose a favorite recipe to use them in, so they can enjoy first-hand the delicious benefit of what they have grown. The Garden to Table program has been successful in helping residents to increase their group participation and peer interaction; improve their overall well-being and fitness by increasing strength and dexterity; increase their moderate sun exposure time and Vitamin D levels; and improve their weight management and lab levels. The facility plans to expand their Garden to Table program by having Dietary and Occupational Therapy interns and staff collaborate with residents to create new recipes for what they have grown and also donate a part of their garden produce to local community outreach programs. By sharing their garden bounty with the community, the hopes are that the residents will feel a sense of accomplishment and empowerment that they are making a difference in other people’s lives. With all of these amazing benefits, the Garden to Table program is having an overall positive effect on the mind, body and spirit of the residents at Idylwood Care Center. Contributed by: Sandy Narasimhan MS,RD,CSG and Rashmi Rajadhyax PD,OTR/L

When Sam Kim joined the Crestwood Manor Alameda team as Program Director, he brought to their community the gift of music.  Sam believes that music is an important part of daily life for many people and very quickly found out that the same is true for the residents of Crestwood Manor.  He decided to organize a music group at the facility called, the Sounds of Crestwood. The group meets every Friday in the facility’s community center and has grown from a few people, to a full orchestra of residents who play, sing, dance, listen and write music, or even simply come to turn music sheets for others and to just enjoy the festive atmosphere. Sam has managed to grow the facility’s inventory of instruments to now include percussion, guitars, ukulele, bass, electric piano, harmonica and even a violin. People have donated used instruments and they were also able to purchase some inexpensively. “Everyone can be an artist or musician once they step into the Sounds of Crestwood and express their creativity and talent,” said Sam. The staff has seen so many positive results, such as with residents who are reluctant to participate in other groups at the facility, now can’t wait for the Sounds of Crestwood on Fridays. It has also helped new residents to feel right at home and make peer connections more easily and accessible. One of their new residents said, “I can tell I am going to like this place already because music is my thing!” Other residents are reporting feeling joyful and proud that they can share their talent with others. Another resident stated, “I was a professional singer when I was young. The Sounds of Crestwood reminds me of the good old days.” “It’s a wonderful way for people to share in a safe and encouraging atmosphere. It’s really amazing the talent we have in our community and the memories shared by people who used to play or used to write music that are now so excited to have this wonderful venue to do it again.  It’s also an environment that helps people make friends with others who share a common interest in music,” said Sam. At Crestwood Manor Alameda, Sam and his musical group plan to continue to share, inspire and uplift both residents and staff alike with the beautiful Sounds of Crestwood. Contributed by: Samuel Kim, MA. Program Director Crestwood Manor Alameda

Drumming has been a tool used in many cultures for many things, from communication, holistic rituals, community gatherings, and healing.   People have had an intimate connection with the drum since discovering that the beat of the drum is analogous to the beat of the human heart.  As a universal, vibrational language, the drumbeat communes with the Earth and all of her creatures. There have been numerous research studies conducted about the power of drumming and the significant effects it can have on the human spirit and body.  Drumming is now being used to help people with Alzheimer’s, children with autism, and teens with emotional dysregulation.  Large corporations have also used drumming to help employees focus attention and improve spirits. Research further suggests that drumming can serve as a distraction from pain and grief by enabling communication between the cerebral hemispheres, using the physical transmission of rhythmic energy.  This allows one to connect with their own spirit at a deeper, more intimate level, making it easier to access feelings of insight, understanding, certainty, conviction and truth. Drum circles provide an opportunity to connect with groups of like-minded people, including those struggling to find their own personal resonance.  Individuals may make this connection by listening and feeling the pulse of the drum, and working out their own personal rhythm in contribution. Sound vibrations have been known to resonate through every cell in the body, freeing energy blockages that can form as a result of unexpressed feelings and emotions.  Drumming helps emphasize self-expression, which can aid in an individual’s ability to address emotional health and issues with conflict and even violence.  Participants are given the opportunity to present and receive positive feedback.  It can help us find our center and become more mindful of the present.  Playing in a drum circle can create a magical paradox of moving from the awareness of being out of one’s body to being firmly grounded in the moment.  Group drumming can complement traditional talk therapy, providing a vehicle for personal transformation, as well as community building. Pam Akins, LMFT, a Clinical Consultant at Crestwood American River Psychiatric Health Facility, said, “Witnessing the responses of our clients to participation in a drum circle has been a personal growth experience for me.  As a clinician, I have had to give up control of the circle and allow the drummers to take what was needed and give as they were able to.  The main attraction is the drum, center of the circle and the heart of healing.  The circle creates unity and a sense of community among the participants. In the PHF setting, some clients are active participants, while others may be observers, but it is evident that some type of shift occurs with everyone involved, even if only momentarily.” “The most common initial response is that the client does not know how to play a drum or keep a rhythm, but, once an attempt is made, I can see the client respond to the beat that they create, and start to become increasingly more confident.  Instruments are eagerly shared and exchanged.  The circle creates unity and a sense of community among the participants. Playing along and sharing their hearts, helps the group become centered and calm,” explained Pam. The experience of conducting a drum circle at a PHF, with clients who are struggling with finding wholeness, has shown Pam and the staff the powerful, amazing and positive effect that beating on a hollowed wooden circle, covered by a tightly stretched membrane, can have. Contributed by: Pam Akins, LMFT, Clinical Consultant, Crestwood American River PHF and Nancy Soncrant, Campus Administrator, Crestwood American River

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

At Crestwood Chula Vista, they offer several types of fitness and movement activities for their clients, from Yoga to Zumba, to strength training, to dodgeball and kickball. “A journey of a thousand miles begins with a single step.” - Confucius Unfortunately, they found that only a small percentage of their clients were participating in these activities and at the same time were also still struggling with their desire to be healthy and to maintain their weight. “I’m too overweight to exercise” and “I don’t have the energy to work out” were common explanations as to why they were not participating in activities. This presented the staff with a challenge. They asked themselves what activity can just about anyone do, what activity will they want to do and what would be something that would also benefit both their physical and emotional health? The answer was right in front of them. Every client was doing it every day – walking! It was right about this time that the City of San Diego advertised the Parks Fit San Diego 2016 Challenge, which is to walk 30 miles in 60 days. Clients and staff were excited to become involved in the 30-mile challenge and it was a way for them to celebrate every step they would take. But as their clients thought about it, they decided that 30 miles in sixty days was not enough and they would instead do 30 miles in 30 days. So the staff purchased pedometers for everyone participating and off they went. The challenge began on June 18 with a 1-Mile Fun Run.  After that, they went on walks in the community, took nature hikes, and joined 5k events. Each and every day, clients could be seen walking the halls and the patio at the facility with pedometers in hand. They pounded the pavement in their neighborhood, trampled the grass at Balboa Park, explored the trails of the Living Coast Discovery Center, and even kicked up some sand at Imperial Beach. The results of the challenge were tremendous! One of their clients walked 215 miles! She reported her miles to the staff proudly every morning. One day she joked, “I didn’t do so well yesterday, I only went 20 miles.” Other clients were motivated to keep up and the race was on!  Four clients logged more than four hundred miles and together, as a group, they walked more than 500 miles! “Beyond the miles they racked up, we were seeing firsthand what we have all read in the research studies, that walking and exercise promotes good health, reduces anxiety, increases self-esteem, and boosts mood,” said Shanel Stec, Recreation Assistant.  Clients also made healthier food choices. One client lost 20 pounds and another client lost three pounds.  They set goals for themselves and tracked their progress faithfully. They worked together as a team, challenging each other to keep up and they joined other groups. They were out in the community, they were out in nature, and best of all, they were having fun. The challenge ended on August 13 with the Parks Fit San Diego 5k finale. However, this finale is not the end for them walking, even more clients and staff have signed up for a new challenge that begins soon.  Shanel said, “We are excited to lace up our shoes and walk together, not as clients and staff, but as companions on our journey toward health and wellness.” Contributed by: Shanel Stec Recreation Assistant Crestwood Chula Vista

There was a time when a person receiving behavioral health services was simply looked on as a client.  They were identified as the targeted person or the recipient of services. They generally looked to specialists to understand and treat their symptoms, their discomfort or disease. They were dependent on the system to take care of them. There was no reciprocity, no mutuality and no equality. Often there was no actual relationship, no trust, no compassion and sadly, there was no hope. There was a time when a person receiving behavioral health services was simply looked on as a client. They were identified as the targeted person or the recipient of services. They generally looked to specialists to understand and treat their symptoms, their discomfort or disease. They were dependent on the system to take care of them. There was no reciprocity, no mutuality and no equality. Often there was no actual relationship, no trust, no compassion and sadly, there was no hope. But today the good news is this view in behavioral health services is changing for the better. And at Crestwood, you can see the changes we have embraced in the behavioral health services we provide that are filled with hope, compassion, integrity and love. One important way we do this is to have services at Crestwood be directed by peer providers, who are people who have been clients or who choose to self-identify as a person with lived experience. Crestwood actively recruits staff with this type of lived experience and this perspective, and we refer to it as the peer experience. We also pride ourselves in employing peer providers at all levels of our organization, including at our corporate executive level, all leadership levels, as well as in the direct care areas of our organization. The Human Resources practice of recruiting, hiring and employing people with lived experience is based on the mounting research that has led peer-provided services to be identified as an Evidence-Based Practice and one of the highest factors to eliminating coercive treatment. At Crestwood, we have found that by having peers in all levels of employment, the use of restraint and seclusion has dropped by more than 92% in the past 8 years. Our programs have become richer and more effective and most importantly, there is hope. Peers, whether an RN with lived experience, a Vice President who has family member dealing with mental health issues or a bookkeeper who has been hospitalized for depression, all bring the gift of empathy and understanding to our clients that other staff may not be able to provide. Our programs have become richer and more effective and most importantly, there is hope, meaningful engagement, empowerment and strong, well-defined career paths with opportunities for growth reaching to the highest levels of Crestwood leadership. This practice is the true essence of integration and meaningful roles. Peer Providers enrich our programs for our clients on a daily basis that benefit everyone and provide a supportive and understanding resource that only they can offer. When our clients know that a staff member, who is there to help and support them, has also been through similar issues in their life, they know they are not alone and that they too can succeed in their recovery. Contributed by: Patricia Blum, PhD Executive Vice President