Last Fall we welcomed two new family members into our community at Crestwood Treatment Center in Fremont These individuals became instant local celebrities with their inquisitive demeanors, gentle dispositions, and feathered feet. Our new family members are two hens that have provided our residents and staff with the opportunity to deliver nurturing care, revisit childhood memories, and stimulate cognition, as well as being a source of therapeutic amusement. Our residents consist of men and women who have had brain injuries, as well as a combination of psychiatric and dementia-related behaviors. Many have resided here for many years, supported by the structure, consistency and kindness of our environment. Our staff’s primary goal in developing the Hen Program was to promote a sense of well-being and self-worth for our residents, that by caring for an animal, offers an opportunity for companionship and a calming and emotionally regulating experience. By promoting participation in our Hen Program, we hoped to educate our residents and minimize a sense of boredom and isolation. Our Hen Program officially started months before the arrival of the hens themselves as a truly interdisciplinary collaboration between our Administrator, Lilian Fong, our Rehab Staff/Occupational Therapists, Maintenance staff, and Program staff. A large enclosure was constructed in our Zen Garden, with a smaller henhouse inside; both are able to be locked to protect the hens. Food, wood shavings, and hay, along with storage containers, were purchased from a local feed store. When our hens arrived, residents submitted ideas for names, which were then voted on by everyone and the winning names were Buddy and Gismo. Residents then got to know each hen’s distinct personality traits, favorite foods, and daily routines. Residents are an integral part of each hen’s care and wellbeing. “We make sure the chickens know they’re loved, safe, and welcome here,” said Patti, one of the residents. The chicken coop has now become a favorite destination for socializing, restorative ambulation programs, 1:1 meetings, gardening groups, and the official Chicken Welfare Committee. Another resident, Gloria, observed, “Buddy and Gismo have potential. They help us feel good when we go outside by playing together and taking care of each other.”   Our Chicken Welfare Committee (CWC) consists of a group of 6-10 residents who meet weekly to discuss and make decisions about Buddy’s and Gismo’s health, as well as to ask questions and research answers to better understand these animals’ behavior and preferences. Each meeting begins with an egg count, overview of each hen’s health, and any significant changes in their routines/behaviors during the past week. The group then delves into activities such as cage beautification projects, scientific articles about the anatomy/cognition/evolution of chickens, or group discussion and personal anecdotes about chickens. The CWC has also led to improving our hens’ wellbeing by adding a dust bath to their enclosure, discovering a favorite treat (freeze-dried mealworms), and providing companionship. Perhaps the most notable accomplishment of the CWC was the celebration of Gismo’s and Buddy’s 1st birthday party in February. The residents spent time making a celebratory banner and birdseed birthday cakes, then converged in the Zen Garden to prepare a fruit salad and enjoy the party. This experience was immensely meaningful for the residents, who continue to talk about it. Residents are not the only ones who benefit from our chickens. Our staff, many of whom grew up in rural areas, have expressed delight, concern, and nostalgia regarding our hens. Staff is invited to take home the eggs and often compete playfully to get to the eggs first. One CNA reported that she made a quiche with our eggs and brought it to share with her co-workers. Rehab staff often elect to have their meetings outside in the garden to enjoy the calming effects of nature on their overall wellness. The hens have provided a warm and fun meeting place for residents and staff to relate to each other and share experiences. Cortney, another resident, remarked, “The chickens are role models for us; they teach us about companionship and how to interact with each other.” Buddy’s and Gismo’s presence here at Crestwood Treatment Center has benefitted our entire community immeasurably. The hens are thriving under the dedication and care provided by our residents and staff, and the humans are thriving through the provision of that care. Our Hen Program embodies our Crestwood values and will continue to do so in the years ahead. Contributed by: Amanda Lord Occupational Therapist Crestwood Treatment Center, Fremont

Homelessness is a national challenge and evident in the streets of our cities. The number of homeless across the country is staggering, however, in California, it is a crisis. The state auditor stated in April 2018 that California is doing a poor job of sheltering the nation’s largest homeless population and needs to provide statewide leadership to address it. California has approximately 134,000 homeless people, roughly 24 percent of the nation’s total homeless population. Of this homeless population, 34 percent lived in a place not meant for human habitation, such as the street, under freeways, grassy fields, parks and abandoned buildings. Our Crestwood San Diego campus had an opportunity to interface and participate in relieving homelessness for some individuals in the community. In 2017, Crestwood San Diego took its first steps toward a major expansion project to increase their bed capacity by an additional 80 beds throughout the campus. As we assumed responsibility for the entire property, we had opportunities, as well as challenges. We found a sizable homeless encampment on our property, in a large canyon adjacent to the parking lot. There were 15 to 20 individuals living in the canyon, with an enormous amount of belongings and trash. The status of the canyon posed safety risks, leaving Crestwood with no choice but to address the homeless camps that had taken over the canyon. Our approach was to address these campsites and its inhabitants with dignity and compassion. We assembled a team of caring community partners that included San Diego County Behavioral Health Services, local law enforcement, the city’s Homeless Outreach Team (HOT), the San Diego Public Health Department, Alpha Project, Episcopal Community Services, and local city government. Preparation for the upcoming move-out day was very thoughtful and deliberate. We worked together to provide as much notice as we could, to prepare the homeless individuals for their need to relocate. Our goal was to provide support to them every step of the way, to connect them to needed services while considering the major impact this would have on their current living situation and sense of safety. The homeless safety risk in San Diego was also increased by an outbreak of Hepatitis A, that had already killed 17 people. The canyon encampments were visited by Terry Hoskins, San Diego Police Department’s Communi- ty Outreach Officer, and Crestwood staff, who provided them with information and resources, as well as notification of their need to relocate. Months of preparation went into this project and by the time the day of the move arrived, many of the inhabitants had already found alternative housing. The few that remained were assisted by our team of compassionate workers who provided counseling and supportive services to those who were dealing with issues of substance abuse, family displacement, unemployment, financial issues and health concerns. Once the inhabitants had vacated, another large project lay ahead. There was an abundant amount of trash and belongings left in the encampment, as well as the overgrowth of trees and bushes. We contracted with an amazing local organization, Alpha Project, to spearhead this phase of the project. Alpha Project is a not-for-profit human services organization that serves more than 4,000 people each day with affordable housing and residential substance abuse treatment. They have a program called Take Back the Streets (TBS) that is a catalyst for homeless people who are able to work, providing them with immediate transitional employment and training while providing the community with vital cost-saving services. TBS arrived within an hour with a crew of 10 able-bodied adults, many of them with their own life experiences with substance abuse and homelessness. They worked tirelessly for two weeks to clean out the canyon and restore it to its natural beauty. Addressing this homeless challenge aligned beautifully with Crestwood’s mission and values. Crestwood’s values of compassion, character and family were prominently displayed throughout this project, teaching us all that such challenges are best handled with sensitivity, respectful care and teamwork. Contributed by: Patricia Blum, PhD Crestwood Executive Vice President

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

At our Crestwood San Jose Psychiatric Health Facility (PHF) we are constantly striving to meet the needs of our clients and recognize the importance of an active recovery. As an acute PHF, we are a short-term, stabilization crisis center that helps our clients move forward with their recovery goals, and often that means they may be with us two or three months if they are waiting for long-term care. Our staff works on providing holistic recovery services that addresses the mind, body and spirit for every client who comes into our program, so that we can meet as many of their needs as possible. In taking this holistic approach, we have added many new features and programs such as, each client is met with a welcome basket which provides a variety of toiletries, a journal, and a water bottle to meet their basic needs, while promoting self-care. Every morning we also introduce a new DBT skill of the day, which is incorporated into each group we provide. We have added a gym to our unit to help our clients practice the skills we are teaching related to distress tolerance and physical wellbeing. We have also added a prevocational track called Achieving Success, which allows our clients to be productive and engaged in their recovery throughout the day. Feeling safe, individualized and progressive allows our clients to meet their ongoing mental health recovery needs. Every day, our team looks for ways on how we can best ensure the dignity, recovery and care of the people we serve. Contributed by: Angele Suarez, Clinical Director, Crestwood San Jose PHF and Michael Bargagliotti, Campus Administrator, Crestwood San JoseMichael Bargagliotti

At 50 years, being thankful seems natural. You have lived enough life to appreciate and comprehend the value of the gifts and friends that have supported you and you also have the experience and knowledge to know what it’s like to go without and to go it alone. Gratitude is the practice Crestwood Behavioral Health, Inc. is choosing to celebrate for our 50th Anniversary. According to Yale University Center for Emotional Intelligence, “Gratitude isn’t just an emotion that occurs, but a virtue we can cultivate. Gratitude is something you practice as you might a sport, piano or meditation. Gratitude practice begins by paying attention, being mindful. Notice all the good things and relationships that you normally take for granted.” Gratitude means saying thank you, demonstrating appreciation, and sharing your gifts with others. Gratitude implies a relationship. You can be grateful to your higher power and that is relational. You can be grateful to someone who has given you a gift and that is relational. Relationships are central to gratitude. And so, for the past 50 years, relationships and partnerships have been at Crestwood’s core as a company. Our Mission Statement begins with two statements related to relationships: Our mission at Crestwood Behavioral Health 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 energies to enhance the quality of life, social integration, community support and empowerment of mental health clients. The relationships we have built during the past 50 years are what have enabled us to grow and support so many people in their recovery journey. These relationships are significant commitments; some are memorialized in contracts and others with a handshake and a smile. Our relationships are our investment in communities and they start with our county partners; local NAMI organizations; universities and colleges; Rotary Clubs; our employees and their families; peer-led recovery centers; statewide and national advocacy organizations; faith communities; and local businesses that all come together to support the people we serve. We are grateful for and have become a better organization because of these wonderful relationships. We want to especially thank all of our amazing and supportive county stakeholders who we have been honored to partner with during the past 50 years. These partnerships have helped us to grow, so we now serve more than 5,000 people annually, in 22 communities, with 32 programs that are all dedicated to support recovery and resilience. We are grateful to be part of a team that is truly making a difference in peoples’ lives every day. Contributed by: Patty Blum, PhD, Crestwood Executive Vice President

Peer Provider Research Study Louise Byrne, PhD , recently visited Crestwood Behavioral Health as part of a peer provider research study she is working on in the United States. Louise who has lived experience, is from Australia and based at Yale University. She is conducting research as part of a Fulbright Scholarship, which emphasizes exchange of knowledge and learning about local culture, that includes traveling to many different states and learning about the types of services provided by different organizations. The purpose of her research study is to gain information about how to support the peer workforce more effectively within organizations, particularly those organizations with a multi-disciplinary workforce. The organizations for the study were selected by first bringing together an advisory group of experts from across the United States. This group was asked to nominate five organizations with a multi-disciplinary workforce, including peers, that “demonstrated commitment to the effective employment of peer workers.” Crestwood, as one of the leaders in peer provider services, was one of the organizations that was chosen to be part of the study. At each organization’s site visits, Louise spoke with people in management roles, traditional mental health roles/clinicians and peers. The range of organizational types was deliberately broad, including County Behavioral Health Departments, managed care, private and not-for-profit. The sites were located throughout the United States and served different types of communities from metropolitan to rural. During her visit to Crestwood, Louise visited the Crestwood Sacramento Home Office and was invited to tour our Crestwood Recovery and Rehabilitation Center in Vallejo. She said, “I was provided with a warm and colorful welcome from the Administrator, Minda Bunggay, whose enthusiasm was absolutely infectious! I found that Minda’s sincere commitment to the wellbeing of people staying at Vallejo was evident and reflected in the passion of staff. I was fortunate enough to be guided in my tour by a resident and member of the Dreamcatchers Empowerment Network program, who shared his excitement for what he saw as a wonderful service and, with Dreamcatchers, a wonderful opportunity to gain skills and confidence. Throughout the campus the principles and components of recovery are featured on the walls of the hallways, as are the rights of people accessing mental health services. Beautiful gardens provide a sanctuary that truly felt healing, and the relaxation rooms were fantastic. I could have spent much longer there. While I was there I was told about the impressive schedule of events and got to participate in a drum workshop. As a person with lived experience, Crestwood Vallejo felt like a genuinely warm and nurturing environment.” Louise’s observations about the research study so far are that fairly similar conditions exist in the United States and Australia, where peer work is still struggling to be seen as a necessary part of the wider mental health workforce. She observed, “We still have a long way to go to gain mainstream acceptance, but there were some encouraging pockets where organizations have made a very strong philosophical and financial commitment to the development of peer work and the outcomes for organizations, service users and colleagues in traditional roles were outstanding and very exciting.” Employment of peers has a long history at Crestwood, but expansion from one or two roles to a more robust workforce has become very prominent in the company. This is really encouraging as the data also shows that a few peers in isolation are much less likely to be successful in their roles, whereas a more significant investment provides opportunity for networking/mutual support between peers, for the roles not to be too stretched and for the value of the role to become more apparent within both the workplace and wider community,” observed Louise. For more information on Louise Byrne’s research study, please visit Research Gate at  www.researchgate.net/profile/Louise_Byrne2 . Contributed by: Louise Byrne, PhD, RMIT University, Fulbright fellow/Vice-Chancellors Research Fellow

Crestwood’s Values Providing a Compass for Growth At Crestwood Behavioral Health Inc., we are excited about new opportunities. So, as Crestwood continues to grow, we always use our corporate values as the lens for every decision and change in direction. Our values are our compass to move forward as an organization and are revisited frequently throughout the year and always when we are faced with new opportunities, threats or decisions. Our values are simple: Commitment, Enthusiasm, Flexibility,  Integrity, Family, and Compassion. Each of these values holds its own set of principles and beliefs that act as a guiding force to us as a company internally, as well as externally in our relationships with stakeholders and partners. Commitment is the glue that holds our organization together. It is the promise to follow through and to stay uncompromising to our vows and obligations.  Commitment is what binds us together as a work force; it is the motivation to get up and be on time for work because you don’t want to let your coworkers or clients down. It is the pledge to provide recovery-based, socially-responsible services for our clients. Enthusiasm is exemplified in our tenure of excited and motivated employees. The average length of employment for Crestwood isseven years. Crestwood employees have  a strong pride in themselves and a natural enthusiasm for the work they do.  It is often seen in our facilities that staff members with 20 years of tenure are still as excited about what they do as our newest employees. Flexibility is the hallmark of Crestwood. We continuously adjust and reinvent service models to utilize the most current research, evidenced-based practices and to meet the ever evolving needs of our communities. Flexibility allows us to provide our clients with the most appropriate programs and services. We understand – and strive to meet – the range and variety of mental health needs of our clients, their families and their communities. We provide innovative and effective programs and services that enhance our clients’ wellness and promote their recovery. Integrity/Ethics is the cornerstone for all we do. Ethics is defined as morals, beliefs, and principles that are a system or defense for right and wrong conduct.  It seems simple, yet as we often read in news articles, hear at industry meetings, or observe in our own communities, it is often not so simple. Crestwood as an organization holds ethics as a core value.  In all of our partnerships, integrity, trust, respect and dependability are all non-negotiable. We hold corporate responsibility at the highest level of commitment. Through our continuous quality improvement and our performance improvement process, we analyze and recommit to providing the most ethical and efficient services to all of our stakeholders. Family is the foundation that Crestwood was built on. We have a rich background of being founded by a family who are committed to the operations. Our partnerships with clients, their families, our staff, the community, business associates and volunteers all comprise the Crestwood family. We focus on family involvement and education and make every attempt, where appropriate, to bring in families as a part of client care. Compassion at Crestwood is demonstrated with warmth, kindness and caring in everything we do for our clients and staff. We seek compassionate employees in the recruitment process and we nurture compassion in the training, supervision and general operations.  We honor the preservation of each client’s self-respect and dignity. At Crestwood we live these values and use them as the barometer for our success and view all of our corporate decisions through this lens. And with our values, Crestwood is excited to take on the challenges and opportunities that this new period in behavioral healthcare brings.

The Discharge with Dignity Program that has produced extraordinary results. Crestwood Wellness and Recovery Center in Redding has created the Discharge with Dignity Program that is helping to instill self-esteem and confidence in their clients who are being discharged. Many of the clients at the facility have found themselves, due to a variety of reasons, owning very little possessions. Although the facility has helped many of them to obtain needed clothing and personal care supplies, it wasn’t uncommon for the clients to pack their limited possessions in plastic bags as they left the facility. So even though the clients had progressed in their wellness, enjoyed relief from their recent troubling symptoms and gained new tools to effectively re-engage in the community, they often felt undignified arriving at their new residence with their possessions packed in plastic shopping and garbage bags. To help alleviate this issue, the facility staff began the Discharge with Dignity Program to collect backpacks, suitcases, and related items. Now as clients prepare for discharge, they are notified of the Discharge with Dignity Program and are offered suitcases or backpacks to store and transport their possessions in. They are also offered toiletry items, such as travel-size soaps and shampoos, to accompany their luggage. This simple gesture and assistance has made a remarkable difference in the attitude and confidence of the facility’s clients who are continuing on their journey of wellness and recovery. “It is heartwarming to see clients hold their heads up high with their suitcase in hand,” said Nicoletta Groff, Administrator.  Many of their clients have stated that arriving at a new residence with nice luggage, instead of garbage bags, has fostered self-worth and pride. First impressions and perceptions are very powerful, not only for the new acquaintances, but also for the clients.  The Discharge with Dignity Program gives these clients that little boost of confidence that helps them to shine.

Two Amazing Graduates who are Making a Difference and Giving Back When Crestwood San Diego opened in June 2014, a client named J. was admitted to the program in its second week of services. It was then that J. and staff created and began working on her personal plan for recovery. In just a little over three months, J. became Crestwood San Diego’s first “graduate” meaning that she had successfully completed the program and was ready for discharge to the community.  J. felt that her experience at Crestwood was so valuable that she decided to return to the facility as a peer volunteer to assist others on their personal journeys of recovery.  After a couple of months of work as a peer volunteer, J. was offered a paid position as a Rehabilitation Assistant at Crestwood San Diego. She accepted that offer and has since completed a Peer Training course through NAMI.  J. continues to work in this capacity at the facility, providing inspiration and support to the clients, as well as staff. Crestwood Chula Vista  opened in June 2015, and one of the clients  adm itted there shortly after was A.   A.  soon became a participant in the Crestwood Chula Vista’s Dreamcatchers  Empowerment Network  Vocational Program , designed to provide support and education to those with the goal of finding employment. Following J.’s lead from Crestwood San Diego ,  A. became  Crestwood C hula Vista’s second “graduate”.  A. n ow  returns twice  a week to the facility  in the role of peer volunteer, providing meaningful support to others. In addition to providing peer support, A.  also  leads a  weekly bible study group at the  facility .  He currently has the  goal of becoming a Rehabilitation Assistant like J., and is well on his way to achieving that goal with the support of staff at Crestwood Chula Vista.

Yoga Providing Balance at Crestwood Wellness & Recovery Center in Redding Some people may think that to participate in a Yoga class would require a certain physical aptitude, conditioning, and frame of mind. Yet really the only requirement is being willing and able to stretch the mind and body. Through a structured and repetitive Yoga class routine, clients are learning just that at Crestwood Wellness & Recovery Center in Redding. The Yoga program offers classes every Tuesday night for any clients or staff who wish to participate. Deanna Voorhees, Wellness Manager at the facility, teaches the Yoga program.  Deanna has studied and taught ballet, tap, jazz, modern dance and Yoga for more than 20 years. “Consistency is an important component of recovery,” said Deanna. “And when a client consistently attends any group, it speaks to their ability to commit to something and hopefully that will carry over into their community living skills.” Studies have shown that controlled breathing, which is an integral part of Yoga, provides relief for depression. During the Yoga class, clients and staff are taught to focus on deep breathing, range of motion, balance, and centeredness. The clients learn about their body’s potential, rather than limitations. The class also helps clients to increase self-awareness, enhance physical and mental stamina, detoxify the body, find a new social circle, and connect to their inner spirituality. Studies have shown that controlled breathing, which is an integral part of Yoga, provides relief for depression. Yoga also calms anxiety by reducing heart rate, lowering blood pressure, and easing respiration. Clients report feeling more rested, relaxed, and that they sleep much better.  One client, Dan G., commented, “The Yoga class is relaxing and meditative. I feel better and can do it on my own.” The  Wellness  &  Recovery Center’s  Yoga program has  become so popular that there have  been requests for  an additional class.  The  program provides clients  and staff  at the Center with a  chance to experience and learn there  is  much to be gained mentally, physically, and  spiritually through Yoga .

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