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

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

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

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

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

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

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

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

Check out this excellent video PSA on how to use gloves and masks properly, so you don't spread germs. Courtesy of our very own Terry Mayo, DON, at our San Diego campus and Shanel Mayo, Director of Staff Development, at our Chula Vista campus! Thank you Terry and Shanel! https://youtu.be/MHA4o0P0ND4