Collectively we can start to feel the shift. A few days before our August WRAP Seminar II in Eureka, I was working on finalizing some last-minute arrangements with the Jefferson Center, who hosted us. I experienced some nervous-stream-of-consciousness-type thoughts about the upcoming week such as, “It’s my first time mentoring as an Advanced Level WRAP Facilitator (ALWF) and BJ North and Jane Winterling from the Copeland Center will be watching me.” Of course, everything worked out well and the Jefferson Center was wonderful and the staff gracious and accommodating. Day One of the Seminar, Jane Winterling said something amazing in response to a question posed to each participant about their hope for the training, she said, “You know when a WRAP Seminar is successful because the participants come together and make the magic of WRAP happen.” What I’ve found with WRAP seminars is that it’s very difficult to hide from the demand that wellness makes. Being immersed in a setting where we’re all talking about how we will support ourselves each day really doesn’t allow us to ignore internal questions and long held beliefs about wellness. For me, these questions are, “How do I not judge myself for prioritizing my wellness? What do I do to keep myself well? Where in my life am I denying my wellness?” Answers to these questions involve holding up my “WRAP mirror” and realizing that wellness isn’t something I’ll kick back and do when I get the time, but something that I must continually take personal responsibility for. During that seminar, I watched some of my peers experiencing similar reflections about the foundations of their wellness, and I really saw some magic happen. Individuals opened up to their own vulnerabilities. Participants who had personal-life challenges arise, took hold of those challenges and prioritized their wellness in the midst of the difficulty, affording themselves a view of the problem from the perspective of their unique action plans. It was amazing and humbling to observe. Our Crestwood Eureka staff returned with an enthusiasm and commitment to working toward a campus culture of wellness. I hear the language of hope and recovery becoming more common on the campus every day. Wellness connections are becoming part of shift change. We had our first Organizational Wellness Landscape (OWL) gathering for wellness support for staff this past September. We also have two facilitators in the community coming to be a part of our WRAP meetings and groups. At Crestwood, our personal practice of wellness directly serves as the model of wellness and recovery to those we serve. We have been presented with the OWL Project as a challenge for us to take responsibility for wellness at the campus level, with a built-in platform of support. Part of this support is the ALWF training offered to each campus. As an ALWF, both the commitment to personal and campus wellness and the OWL Project grows. And as a result, change for the better does happen, with ourselves, our staff, those we serve, and our communities. It’s inspiring to watch, and it is an honor to be a part of the Crestwood family, as we hold hope and model recovery to those we serve every day. Contributed by: Theresa Sorensen, Director of Staff Development, ALWF Eureka Campus

“I am home” are rarely the words spoken by a client entering a behavioral health program, however, at Crestwood Behavioral Health, Inc., we hear this often. The environments we create are as important as the therapeutic tools we employ throughout the course of treatment, whether it’s several hours in our Crisis Stabilization Unit (CSU) or days in one of our Psychiatric Health Facilities (PHFs) or years in one of our Skilled Nursing Facilities (SNFs). Our mission at Crestwood is to provide the highest quality of recovery-based care and delivery of services to the people we serve, stakeholders, and the community. The strategy includes using the environment as a therapeutic tool and it is designed to maximize options and choices, as well as clients’ freedom of movement. The environment is intentionally designed to reduce the amount of client rooms and clinical space to allow for space design to be based on evidence-based practices, promising practices, best practices and Crestwood’s client-centered model. SAMHSA and CARF have recognized our utilization of space and environmental features at our campuses as a trauma-informed treatment approach. Space utilization, as well as Crestwood philosophies and trainings, encourages reduction of barriers for interaction between the clients and staff. Crestwood’s intention in creating our homelike environments is to allow for the greatest choice and ease of living, while providing a secured, safe and sustainable environment, which is not an easy task. Janet Vlavianos, our Director of Development and Corporate Initiatives, has been the creator of most of our Crestwood environments. Her sense of design and color is outstanding, but her greatest asset is looking at a space from the perspective of the person who will be receiving treatment. The space is allocated not just on the number of beds or clients served, but rather on how much movement will be needed in the interior and exterior space, particularly if it is secured. We believe people need to be able move around and to have windows that look out onto gardens, trees and ponds. We also believe there needs to be a quiet space and a social space for activities such as gaming, so our serenity rooms, which are quiet and contemplative in design, are not next to living rooms or gaming rooms, which are designed for louder, group activities. Our gaming rooms, which are a new addition to our Crestwood environments, are equipped with bean bag chairs, gaming screens and a variety of games. These environments allow clients a choice on what space that would like to be in that fits their needs and contributes to their wellness and recovery. We have also replaced nursing stations in many of our Crestwood’s programs with a casual gathering space that features overstuffed loveseats and a fish tank relaxation media screen. You often find people gathering there regularly to talk or to simply watch the fish or nature scene on the screen. Nursing stations historically have been the site of power struggles and arguments, but now this location has been transformed into an empowering, social, and welcoming place for our clients. Wellness is another focus of our Crestwood programs and today many of our campuses are now equipped with gyms and workout areas that provide an outlet for exercise, which is much needed when you are working on your wellness in a secured setting. The gyms are shared by staff and clients alike, which serves to minimize stigma and maximize empowerment. And if working out is not in our clients’ recovery toolbox, then we have created small, cozy libraries in each setting, which allows access to a variety of reading material, wellness tools and a quiet space to read and contemplate. One environment feature in our campuses, the use of tiles, has had some recent acclaim and was even referenced in a San Francisco Chronicle article (March 4, 2018) on the opening of our San Francisco Healing Center. Janet has placed tiles, in a variety of shapes, colors and textures, strategically on walls in common areas and some bedrooms. Her work in trauma-informed approaches has allowed Crestwood to be on the leading edge in using tiles as a trauma-informed tool, which provides clients support with grounding and release of energy. Crestwood is beginning to build a body of evidence supporting the use of tiles. The tiles support grounding when a client places their hand and touches a tile, which allows them to focus on the tile’s texture, temperature, size and smell. This focus brings attention inward and allows for mindful practices and settling their thoughts. The tiles are also used to release energy for clients when they place their hands on the tiles and push with as much pressure as possible, then gradually release the pressure and repeating until the ability to be at ease is achieved, this then allows the brain to reset the body and bring it into homeostasis. The exteriors of our campuses are also designed for choice and respect, as well as fun. Our grounds have organic gardens, fruit trees, volleyball courts, chicken coops, swings, basketball courts, gazebos, waterfalls, bird feeders, ponds and water features. It’s not uncommon to see staff, clients and their families sitting in the sun and picnicking on our grounds. Healing and recovery requires a great deal of work and love. There is science behind each tool that Crestwood applies, whether it’s Dialectical Behavior Therapy (DBT), Wellness Recovery Action Plan (WRAP) or our Trauma-Informed environments.  From originally using research from trauma experts including Raul Almazar, Elaine Miller-Karas and Peter A. Levine, Crestwood is now building our own body of research to support the growth of our homelike environments as healing tools. Home is where the heart heals and for many at Crestwood, it is healing their hearts through our homes. Contributed by: Patty Blum, PhD, Crestwood Executive Vice President

On a sunny day last March, staff members at Idylwood Care Center discovered that the resident feral cat had given birth to three tiny, adorable kittens. Two of those kittens were black and white, and one was grey and white with piercing blue eyes. The grey and white kitten was quickly named Henry and he soon became the campus’ very own resident kitten. The staff soon discovered that, while this chosen kitten was small in stature, he was big in heart and personality. Immediately after taking Henry in, their Business Office Manager, Deana Guzman, aka Idylwood Care Center’s Cat Mom, took him to a nearby veterinarian. The Cameron Veterinarian office went above and beyond their call of duty and provided Henry with a free examination, free formula, a free can of food, a flea comb, and a wealth of advice on how to best care for Henry. After Henry was bathed and the fleas were removed from his plump belly that was now full of food and treats, he looked like a new kitten. Staff members volunteered to take him home for the night, and lines to visit with Henry during breaks formed in the Business Office. Staff members rallied together to provide Henry with the necessities that included blankets, a comfortable carrier, kitty condo, litter box, and toys. To say that Henry is well-loved is an understatement. Our gracious and compassionate Administrator, Rashmi Rajadhyax, allowed us to bring Henry to visit our residents after he was vaccinated and acclimated to human interaction. Our residents love dogs and cats. They receive a monthly visit from a volunteer group, Furry Friends, and look forward to visiting with the dogs and benefit from the calming, loving interaction that these animals provide. Since we strive to give our residents the best quality of life possible, we truly believe having Henry is also emotionally and mentally beneficial to our residents. Staff members have benefited from Henry’s presence, too! Henry is truly part of our campus family. As for the other two kittens, they were adopted by staff members. We were also able to bring the other feral cats to a veterinarian office to have them spayed or neutered and released. Our Idylwood Care Center staff’s amazing compassion can be seen and felt every day for humans and animals alike. Keri Arnold, Social Worker Idylwood Care Center

In Pleasant Hill, we have the great fortune of having a campus, Crestwood Healing Center, with two residential programs for our residents.   Crestwood Healing Center serves adults of all ages, needs and interests; employs staff in different departments who work various days and shifts; and has the normal difficulties of getting everyone on the same page.  In late 2017, in an attempt to bring our campus closer together, we set out on a process to create a community agreement that would set guidelines for how everyone on our campus is expected to treat one another. Like with most activities on our campus, this process was inclusive and open to any interested residents and employees.  As we began gathering ideas around our community, it became clear that the focus of our agreement would be centered on respect and inclusiveness.  As the process continued, it added elements of holding patience and an understanding for one another, as all of us are going through our own experiences.  The developing community agreement included input from individuals, groups and members from our monthly Community Meeting.  The team leading this process sought out as many voices as possible, and a few months later, the campus agreed on a final version. Our Community Agreement hangs on our walls throughout the campus and is read before the start of each monthly Community Meeting.  It is introduced to new residents and new employees and is the basis for how we all, staff and residents alike, conduct ourselves.  It informs decisions throughout the campus and works together with our campus’ mission statement.  It is not always a perfect solution to ensure respect is given because as human beings we all have tough moments and make mistakes, but it is a reminder for all of us of what it means to live and work together.   Our Community Agreement is about building more community on our campus and has hopefully made us a little more connected and brought us strength in our togetherness.  Our campus culture is increasingly one of respect and embracing differences and by making the agreement a living part of the campus ensures that we will keep moving forward in that direction.  While it took time to get to our final version of our Community Agreement, the process itself was meaningful, and certainly replicable across the rest of our Crestwood campuses.  We're happy to help anyone who is interested in getting started! Contributed by: Travis Curran, Campus Administrator, Crestwood Healing Center, Pleasant Hill

Over the years, Crestwood has developed a set of practices, protocols, and tools that we employ across our organization and they have become part of our service model, programs, and reputation. This service model is what you see when you come into any of our Crestwood programs and it includes Wellness Recovery Action Plan (WRAP), Trauma-Informed Approaches; homelike environments; employee and person-served wellness; peers in the workforce; Dialectical Behavior Therapy (DBT); employing people at all levels of care with disabilities through Dreamcatchers Empowerment Network; and mind, body, spirit wellness. This service model has become our Crestwood Praxis, which is a process by which a theory, lesson, or skill is enacted, practiced, embodied, or realized. Crestwood has seen the results of this Praxis in successful discharges, shorter lengths of stay, working with individuals who challenge the system at all levels, and building relationships with communities. So, for our next step, we wanted to start looking at how to measure and study the impact of the Praxis and the individuals we serve in a more scientific and quantifiable manner. After searching for the right University-sponsored research, we found Rutgers University, who had two researchers that could evaluate our Praxis as a whole, as well as individual elements across the levels of care we provide that includes our skilled nursing facility programs, acute crisis programs, long-term residential programs and community-based, peer-operated programs.  This past January, after several months of working with our team to determine how we might best collaborate in the researching and publishing of the efficacy of our initiatives, two leading researchers from Rutgers University, Nora Barrett, MSW, LCSW, CPRP and Associate Professor and Vice Chairperson of the Department of Psychiatric Rehabilitation & Counseling and Aaron Levitt, PhD, Director of the Integrated Employment Institute, visited eight Crestwood campuses and the Sacramento Home Office on a 5-day visit.  During the visit, the researchers analyzed each of our Crestwood initiatives such as WRAP; Dreamcatchers’ Peer Employment Program; Compassionate Care; Trauma-Informed Approaches; Wellness with our heart-healthy diets and Zumba; Peer Providers; and our therapeutic, homelike environments. Nora and Aaron also met with Elaine Miller-Karas from the Trauma Resource Institute; Raul Almazar on Trauma-Informed Approaches; Matthew Federici from the Copeland Center on WRAP and Organizational Wellness Landscape; and Lori Ashcraft from Resilience Inc. on peers, so that they could talk to the source of each training that we use for our programs and staff, as well as to gain a better understanding of each of the elements of that practice.   The visit was a great success, with the Rutgers researchers initiating a formal review to create a scientific platform for the analysis of our Crestwood initiatives and practices, which ultimately will then lead to publication of our Praxis.  We look forward to working with Nora, Aaron and Rutgers University during the next several years to study the specific elements of our service model Praxis and its impact in general on the people we serve, our employees, and communities. Contributed by Patty Blum PhD, CPRP, Crestwood Executive Vice President

What do you think when you hear “music therapy?” Many times, the first idea that comes to mind is using music to help people relax, but what if I told you that it is that and so much more? Music therapy is a profession that formally began after World War I and World War II with community musicians (both amateur and professional) going to veterans’ hospitals around the country to play for veterans suffering both physical and emotional trauma from the wars. Since then, the profession has grown into a clinical and evidence-based service that uses music, music therapy techniques, and the therapeutic relationship to address physical, emotional, cognitive, and social needs. Music Therapists work in different settings and with different populations, such as hospice care, general hospitals, correctional facilities, mental health services, and special education. On July 31, 2019 Governor Gavin Newson approved AB1540.  This bill provides a statutory definition of music therapy and prevents individuals from using the title “Board- Certified Music Therapist” if the individual has not completed specified education and clinical training requirements. This bill also enables consumers and state and local agencies to more easily identify qualified Board-Certified Music Therapists.   The music therapy program at Crestwood Manor in Stockton was started in July 2018. Since then, some of the great work being done at Crestwood Manor through music therapy includes music therapy groups for residents, one to one music therapy services, and music therapy for staff to reduce burnout and increase staff camaraderie as part of our Organizational Wellness Landscape (O.W.L.) project. A few examples of music therapy interventions include singing, music improvisation, music performance, receptive music listening, songwriting, lyric/song discussion, music-assisted relaxation, music and imagery, and movement to music. What can one expect from a Music Therapist that works in a behavioral health setting? A few examples include exploration of personal feelings and therapeutic issues such as self-esteem or personal insight; positive changes in mood and emotional states; a sense of control over life through successful experiences; enhanced awareness of self and environment; opportunities to express oneself both verbally and non-verbally; and development of coping and relaxation skills.  Music therapy is a powerful recovery tool that we can use in all of our Crestwood programs to help provide soothing healing and wellness to our clients and staff.  - Contributed by: Jesus Garcia, MT-BC (Board-Certified Music Therapist), Crestwood Manor, Stockton.

When I was a child, I got to know the local utility company very well in our little hometown.  Because my stepfather spent more time in the local tavern than managing the family budget, getting our electricity turned off was a common occurrence. Whenever this happened, my mom would somehow scrape and borrow enough money to pay the past due bill. She and I would then make the two-mile trek to the utility office to get our power restored. Inside the small lobby of the utility office were two glass windows-one had a sign saying “Payments” and the other one was labeled “Delinquent Payments.”  Our window never had a line in front of it, so I figured it was mostly reserved for us. The woman who sat behind this window looked like she hated her job or perhaps she just didn’t like interruptions. Whenever we came to her window, she never had to ask for our last name or address; instead, she would just pull out her clipboard, glance at it, and tell us what we owed.  After my mom paid her, the woman would usually lecture us on how future late charges and turn-on fees could be avoided if payments were made on time. Mom would then apologetically thank the woman who often responded with a sigh and replied with something like, “Let’s hope this gets you back on track this time.” I never remember her saying “You’re welcome” or “Thank you for bringing this up to date; we appreciate your business, etc.” This experience reminds me of how our recovery campuses are like power stations, and we are the utility workers. The people we serve are our customers who are doing the hard work of recovery. Their work requires lots of energy because they often reside at the intersection of shame, guilt, grief, and sadness. They come to us to get their power restored. And our primary business purpose is to empower them. Unlike the “delinquent payment” lady who sat behind the glass window clutching her clipboard and authorizing who got power, we do our best empowering work when we operate from a utility of humility. When we can step back from needing to be the expert or person in charge and when we can be a little vulnerable (human) ourselves, then we can empower the people we serve to remember who they are; discover their answers; and contribute their gifts. So, in order to gauge the recovery level in our empowering grid, here are a few questions to consider.  Are we finding ways to mitigate the power imbalances between us and the people we serve? Are we doing more mentoring than monitoring? Are we inspiring people to recover and honoring them as the experts in their lives? Are we validating their strengths and asking them open-ended questions? Are we offering them choices and engaging with them in relationship and community? Are we seeing a power surge of recovery and resilience outcomes from a utility of humility? If we can answer a resounding “YES” to all of these questions, then we’re doing what we get paid for… giving the power switch to our guests - the people we serve.  Contributed by: Chris W. Martin, Crestwood Director of Learning and Performance

Communication is the linchpin of the work that we do within Crestwood, and it is a primary means for conveying our Crestwood values of Compassion, Commitment, Family, Enthusiasm, Flexibility and Character. As we strive to become more trauma-informed and committed to conveying an unconditional positive regard for those we serve, the words we choose and how we convey them become ever more important as they are the vehicles with which we convey our attitudes, perceptions, and beliefs. Sometimes, even with the very best intentions, we choose words or say something in a certain way that is received as offensive by another. There are layers of cultural, ideological, identity, and historical dynamics that contribute to this. It is therefore crucial that we become educated about and sensitive to the individual triggers of those that we serve, those of our colleagues, as well as our own. At Crestwood Treatment Center in Fremont, we practice a method of communication that we call “Non-Aversive Communication.” Essentially, we avoid using language or communication styles that are perceived as triggering with our residents.  Common to the experience of those we serve at our Crestwood campuses, is a loss of independence. Whether it’s a short stay at one of our PHFs or a long-term placement at one of our SNFs, within our programs the people we serve do not have the full breadth of their prior independence. It is thus fair to assume that a primary trigger is any circumstance or interaction that indicates that the resident is not in control. We run the risk of communicating this when our actions or words suggest that we are in control when we don’t create space for choice or voice and when we suggest that we know what is right for that individual.  This is the difference between telling a resident who has a limited income and whose goal is to obtain their own apartment, “That’s nice, but let’s find a goal that’s more realistic for you,” and instead saying, “That’s an admirable goal. Tell me a little bit about why this is important to you.” It is the difference between telling a resident with severe dementia who has had an episode of incontinence, “You’re wet,” and instead saying, “Here’s something nice for you to wear.” It is the difference between telling a resident who is in acute distress and agitated, “You need to calm down,” and instead approaching that person and saying, “My office is open, I’m here to listen.” It is the difference between saying “That’s breaking a rule of your program,” and instead saying, “You’re usually really on top of your goals. What’s different for you today?” It is the difference between saying, “No,” and instead saying, “This seems important to you, tell me more.” There is a power dynamic inherent to the roles we hold with those we serve. Communicating transparency about this power dynamic further conveys respect, validation, and compassion. The intention of each of the latter of the previous statements is the same. It is an intention to acknowledge the individual by conveying respect that their experience, opinions, and choices may be different than our own, but are equally valued.  It is conveying that each individual’s aspirations are valued and worthy of dignity and that they are deserving and have very real and important thoughts and feelings. It is through such conveyance that trust, and therapeutic relationships are built.  It is our privilege to accompany those we serve as they work towards recovery and wellness. It is our responsibility to clear the driver’s seat for them on that journey. The driver’s seat does not mean that the people we serve know how to drive yet or where and how they will reach their destination. But making the driver’s seat available, ensures that we are not creating additional barriers to getting in that seat. It means that we communicate our belief in the driver’s ability to get there and on the road that they choose.  Contributed by: Karen Scott, Program Director, Crestwood Treatment Center, Fremont

For the past year, the Crestwood Bakersfield Campus has been piloting an Empathy Enhancement training for our staff as a way to provide more compassionate care, improve customer service, and combat burn out. Last year, after conducting several new employee orientation trainings, we began to discover there was a topic missing in our curriculum and that was empathy. Empathy is defined by Psychology Today as the experience of understanding another person's thoughts, feelings, and condition from his or her point of view, rather than from one's own. Empathy facilitates prosocial or helping behaviors that come from within, rather than being forced, so that people behave in a more compassionate manner.  We began to research the idea of how to improve our ability to empathize and support our staff, and we discovered so much. According to Frontiers in Public Health Journal, “ Greater empathy in healthcare professionals improves client outcomes and satisfaction.” In the early 1990s, Theresa Wiseman, RN, began developing empathy training for hospital staff and discovered there are four qualities to empathy: perspective taking; staying out of judgment; recognizing emotions; and communicating empathy. Studies have shown people served are more likely to adhere to treatment plans when their providers are empathetic.  Also, when staff are more empathetic there is a reduction in recidivism   At Crestwood Bakersfield, our approach is to utilize self-reflection and skill building to improve and increase these individual empathy qualities amongst our staff. In the four-hour Empathy Enhancement training our staff receive in orientation, we practice specific skills and exercises that have been shown to improve these individual qualities.  We have measured our training success by adapting a widely-used empathy measurement tool, the Toronto Empathy Questionnaire (TEQ), to measure our staff empathy at Day 1, Day 30, and Day 90. To date, we have had more than 80 staff participate in the Empathy Enhancement training, in addition to another 60 hours of training that includes Wellness Recovery Action Plan (WRAP), Dialectical Behavior Therapy (DBT), Trauma-Informed Approaches, and Cultural Diversity. We have seen an increase in TEQ scores by 1-2 points 30 days after receiving the initial training (average score of 49.8 to an increase average score of 51) and another 2 points after 90 days! In addition to numerical statistics, we have also heard comments from staff regarding their own personal insights into their ability to empathize with positive self-reflection, changes in habits and better communication when interacting with our clients. Staff have said that they are building stronger relationships with those that we are serving simply by making better eye contact, respecting a differing perspective, and using reflective statements. Other staff have commented that it has also strengthened their personal relationships outside of the workplace. Rhonda Van Cleve, the Bakersfield Campus Administrator, and I have been very fortunate to be able attend and present at several CASRA conferences on what we have discovered since beginning our empathy pilot program.  It’s been an honor to teach empathy skills and share with other organizations how helpful this training has been for our staff and clients.  At Crestwood Bakersfield, we look forward to continuing our Empathy Enhancement training at our campus and are hopeful that these skills will continue to spread beyond our Crestwood campuses and into local communities throughout California. Contributed by: Sarah Wood, Director of Staff Development, Crestwood Bakersfield

This week has been a week to pause and search our hearts. We have had moments of elation with space travel. We have had reminders that although some businesses are now open, we are still in the early stages of a global pandemic, with increased numbers of COVID-19 cases and deaths. We have also had one of the most tragic and painful moments of our lifetime, witnessing police brutality that resulted in the death of George Floyd. As a result, we have seen our communities around the country rise up and march side-by-side seeking justice. We have seen community after community stand up for equality, integrity, commitment and compassion. There is nothing more aligned with our Crestwood values than the dignity of human life and the ability to treat people with respect and kindness. We condemn racism and bigotry as we battle stigma for people. We have the profound duty and opportunity as a community of diverse Crestwood family members to dismantle generations of inequity and racism. We are committed to supporting justice, as we look for a way forward to create a better world that will be based on compassion, love and equality and it will take the commitment and effort of every one of us to make it happen.

From the Santa Barbara Independant: The Department of Behavioral Wellness has contracted with Crestwood Behavioral Health Inc. for the operation of the county’s first ever Mental Health Rehabilitation Center (MHRC).  Located at the Champion’s Center in Lompoc, this program will open on Monday, November 30 and provide 34 beds for people experiencing the impact of mental illness.  With the support of this program, many individuals will be able to return from out of county care, to live within their community.  After further renovations occur, additional beds will be added. Read the full article here.

From KCLU in Santa Barbara By  LANCE OROZCO •  DEC 2, 2020 KCLU's Lance Orozco looks at the opening of a long sought new mental health facility in Santa Barbara County which is designed to transition people from inpatient care back into the community. Click here to read the full article.