It’s unusual to observe collaboration as it is happening. It is far more common to celebrate the success of collaboration after its culminated.  Crestwood’s collaboration with San Diego Health Care Hospital system and San Diego County Behavioral Health Services has provided an incredible opportunity to observe it in real time with measurable milestones and outcomes. This collaboration story began in 1992 when a case manager from San Diego County was seeking a placement for a very challenging client and a Crestwood facility in northern California was willing to take a chance. Later that case manager’s program manager got a chance to visit this client at the Crestwood Facility in northern California. What she saw there that day left a very positive impression that she remembered for many years to come. This was the first collaboration between Crestwood and San Diego County and set the stage for future events. Fast forward to 2013 when that very astute and dedicated program manager, Anna La Rocca Palid, LCSW, who is now a leader as a Behavioral Health Program Coordinator in San Diego County Behavioral Health Services, contacted Crestwood about the need in San Diego County for secured behavioral healthcare services. The county had grown tremendously and there were more challenging people to serve and insufficient programs to serve them. They needed a provider to work with the community and them to serve at least 40 clients requiring intensive, secured, recovery-based services. The county also wanted a provider who thinks outside the box, has creative individualized employment programs, recovery services and focuses on integrated alternative tools for clients and they chose Crestwood to be that provider. Crestwood and San Diego County Behavioral Health Services began devising a plan to address the county’s needs. Crestwood found a beautiful site for a 42-bed Mental Health Rehabilitation Center (MHRC) on a hospital campus in San Diego and created the first of two programs – Crestwood San Diego. Crestwood San Diego opened in June 2014 and quickly filled up with 42 clients. Before long, there was a flow of individuals successfully reintegrating into the community and new admissions moving into the program. The hospitals in the area felt a sense of relief and the new services served their purpose with helping many clients with their recovery. Soon Crestwood San Diego was full and the San Diego County behavioral healthcare system again felt the pressure of impacted Emergency Departments, long waiting lists at the psychiatric hospitals and a bottleneck in the mental health system. So they looked among themselves to find a possible location for a 40-bed MHRC. Paradise Valley Hospital found a location that would work. Crestwood and Paradise Valley Hospital started discussions about creating a 40-bed MHRC on this site. Dimitrios Alexiou, FACHE, President and CEO of The Hospital Association of San Diego and Imperial Counties and San Diego County Behavioral Health Services worked very closely together to successfully garner support from the San Diego County Board of Supervisors and the community to commit to the 40-bed MHRC in Chula Vista. Crestwood and Paradise Valley Hospital invested significantly in an extensive refurbishing project to create a beautiful, homelike, welcoming recovery-based MHRC known as Crestwood Chula Vista. Crestwood Chula Vista opened in July 2015 and is Crestwood’s ninth MHRC in California. Collaboration is working with others to do a task and to achieve shared goals. The wonderful collaboration of these groups created an environment that enabled San Diego County Behavioral Health Services to provide beds to some of the clients in greatest need for these services, helping them with their recovery and easing stress in the community and local hospital emergency rooms. It is clear to see that through collaboration we can make a difference.

Crestwood Treatment Center’s Dream Team Celebrating Wellness “Health is wellness, health is power,” declared a resident at Crestwood Treatment Center in Fremont.  This powerful statement came as a result of the facility’s first Wellness Fair that was held on March 18, 2015.  In preparation for the Wellness Fair, a few small groups of residents known as the “Dream Team” spent three months exploring with staff members different wellness topics related to stress management, both through research and experiential activities.  These small groups met once a week to investigate each wellness topic and prepare a related presentation.  After three months of creative collaboration, they selected the topics of Aromatherapy, Exercise, Music Appreciation, Guided Imagery, and Assertive Communication to feature at their Wellness Fair. The Dream Team residents then prepared and distributed invitations to facility residents and staff, and announcement banners were hung throughout the facility.  The conference room and adjoining outdoor Zen Garden were transformed into a presentation hall, with five separate stations, one for each wellness topic.  The Wellness Fair kicked off on a beautiful day with the Zen Garden fountain bubbling and relaxing music playing.  Seats were available in the garden for attendees to reflect quietly and/or relax together.  Residents and staff were invited to make their way throughout the fair, stopping at each booth to connect with their Dream Team hosts.  Pairs of Dream Team members handed out informational packets and discussed their topic of wellness with participants, and invited them to join them in their wellness activity.  One resident remarked, “I was able to get a lot of information proving that music really does relieve stress.  It is my favorite way to take the stress away.  Music even relieves stress during dental procedures!”  Refreshments were also served and participants were invited to share hummus, cucumber toast, a fresh fruit salad, and lemon mint water as they further relaxed in the Zen Garden. The education, exchange of wellness information and the entire experience was very empowering for Dream Team members and well received by all who participated.  “The Wellness Fair was a complete success.  It was so much fun and informative for everyone.  Participating residents were very enthusiastic and knowledgeable about their respective topics.  They were able to communicate and explain the importance on how to live a healthy lifestyle.  The visitors who attended the Fair were all impressed with the way the booths were set up and organized by staff and residents,” said Luis de Vera, Assistant Director of Nursing The facility is still buzzing about the Wellness Fair and Dream Team members are eager to start preparing for next year’s event. They have big plans to expand the fair and possibly invite other Crestwood facilities to share in the experience. Lillian Fong, Program Administrator, remarked, “I am so impressed with our residents’ enthusiasm and “can do” attitude. Their confidence was evident that day for all to see.”

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

Resiliency is the ability to recover readily from illness, depression, adversity, or the like, and is one of the cornerstones to health and recovery for individuals and communities. Trauma is an emotional and psychological result of extraordinarily stressful events that shatter a person’s sense of security, making them feel helpless and vulnerable in a dangerous world. The necessity to treat and heal trauma has never been more evident than in today’s environment and culture. In recovery services, treating, mitigating and preventing trauma is a primary expectation for us at Crestwood. It is the starting point for most people as they embark on their recovery paths. The ability to restore and build resiliency through a variety of trauma-informed techniques, including engagement, resourcing, spirituality and somatic work is the basis for this integrated trauma-approach to services. The research in neuroscience provides a foundation for the understanding that neuroplasticity and neurogenesis enables the brain to reprogram and develop new pathways for survival and growth. This has led to an understanding that we can expand the resiliency skills, thus enabling people to be less vulnerable to re-trauma, prevent trauma and heal existing trauma.  The premise is that if you teach a person to identify and access their resilient innate abilities, aptitudes or inner wellness tools, the individual can practice using these tools as a means to heal and prevent trauma. These tools are skill-based and use a wide-range of evidence-based practices, promising practices and spiritual practices as the building blocks. The practices are integrated and enable the staff at Crestwood to walk with our clients, support and stand behind our clients and guide our clients when needed.  The skills and practices are based on the premise that you meet the client exactly where they currently are.  This methodology creates a client- centered and culturally-sensitive service model. Recovery services now have shifted from patterns that created ongoing dependency for clients, to interventions that support resiliency, self-reliance, and prevention. This trauma-informed model of building resiliency enables our clients to become more empowered, more independent of the mental health system, and more intimately connected to their communities. As Crestwood programs seek to build resiliency in our clients, communities benefit from mitigating the trauma from occurring in the first place, reducing the likelihood of diagnosed conditions recurring, and build resiliency through the community. Trauma-informed care approaches have been the basis of the resiliency skills building. At Crestwood we utilize these trauma-informed care approaches along with culturally-sensitive multidisciplinary approaches and integrating spiritual practices by utilizing evidence-based practices including Wellness Recovery Action Plan (WRAP), Dialectical Behavior Therapy (DBT), and Peer Providers to provide a rich source for mitigating and healing the impact of trauma for our clients.  In our Crestwood programs we will continue to work with and support our clients with developing resiliency skills to create a strong foundation from which they can build from and use in their recovery.

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

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

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

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

Last November, Humboldt County Department of Human and Health Services, through a grant from California Office of Statewide Health, Planning and Development (OSHPD) hosted a 10-day Peer Support Specialist Certification training that was led by Recovery Innovations (RI) to train 10 mental health staff and volunteers in the Eureka area. A lucky member of our Crestwood Eureka campus, Rebecca, a Peer Support Specialist through Dreamcatchers Empowerment Network, was invited to attend. This training is designed to enhance the peer support skills of participants, while empowering them to be more self-directed and competent in providing recovery and resilience services to clients. “The Peer Support Specialist Certification training turned out to be one of the most interesting classes I have ever taken. I was excited to be included in the two-week course, which opened new doors for me to learn how I could partner and relate to people seeking services.” It has been a year since Rebecca began working as a Peer Support Specialist at Crestwood Eureka, and she is grateful for the conceptual framework and the set of skills which this training gives to her job. “I felt empowered to learn these things in the company of other peer support and mental health workers, who have been working to combat stigma and provide support within the county mental health system,” said Rebecca. “I have learned to better understand my role in the comprehensive health facility that I work in. I have gained valuable resources to guide me, to set my own goals, and to provide meaningful direction for my work. This Peer Support Specialist Certification training provided a wealth of a wealth of information and skills to participants. Rebecca reported that the train- ing was relevant not only to her, but to anyone doing mental health work. She said, “The concept of helping people find their own strengths to make decisions leading to recovery is a powerful idea and is useful at any level of the mental health community.” Contributed by: Rebecca, Peer Support Specialist, Dreamcatchers Empowerment Network, Crestwood Eureka Campus

At Crestwood Center San Jose MHRC, they have been going through major changes, both physically and programmatically. The campus has undergone major reconstructive surgery, and now has a beautiful design similar to our other Crestwood programs. The design changes have brought about a more homelike environment and their clients are enjoying new areas, such as two living rooms, a comfort room, a serenity room, a group room, a library, and a den. Walls have been painted in soothing colors, lovely decor has been placed throughout the building, and new, stylish flooring has been installed. On the program side, a mindful effort has been made to not only embrace the Crestwood Values (Family, Commitment, Compassion, Enthusiasm, Collaboration, Character, and Flexibility), but to also actively practice them in the staff’s daily activities. They have also incorporated a more comprehensive program schedule, opened up the patio area, and expanded their outing and pass policy. With these efforts, they continue to maintain the important focus on recovery, program success, and preparedness for community re-entry for their clients. During this remodel and program changes, the staff learned some important lessons, such as any major change starts with the Administrator and Department Heads, and then it needs to be embraced by the entire team. “The change process may be challenging for some, even if it is perceived as positive or good, because it means saying goodbye to what we are familiar and comfortable with,” said Angele Suarez, the MHRC’s Program Director. Campus Administrator, Michael Bargagliotti, added, “It is human nature to be drawn to comfort and security, regardless of the outcome, because it is something that is known and we know what to expect. The change process introduces an insecurity and emotional instability that can cause people to react with resistance, fear or anger.” To help with managing the challenges of change, the staff at Crestwood Center San Jose found that implementing a few key measures such as maintaining an open mind, being optimistic, asking questions and helping others with the changes, made a huge difference in how everyone dealt with what was happening around them. “By maintaining an open mind, even though we may not always agree with the changes being implemented, we can actively listen and analyze the information, and then we can form an honest and genuine opinion about the changes. We might even surprise ourselves on how much we like the ideas,” said Angele. The staff found that by being optimistic, even though people might be currently unhappy with the changes, can be helpful since negativity usually comes from a fear of the unknown. By not being able to predict the future, a good strategy is to then focus on the present moment with a positive attitude, which can create an optimistic outlook towards the future. The staff also encouraged everyone to ask a lot of questions because it is important for each person to not only be notified of the changes that are occurring, but to also understand the reason behind the changes. Asking questions provides everyone with the needed information to make informed choices. “And we found that one of the best ways to help ourselves with change is to focus on helping others with change. Helping others takes the focus off ourselves, allowing us to connect with our peers, and we can then become a part of the change process through positive interactions,” said Angele. “At Crestwood, we know that we will always be part of innovative recovery practices and leadership. The best part of innovative change is that you end up creating a culture that is not only open to the concept, but takes on that personality. At Crestwood Center San Jose, as we continually work towards providing the best recovery program for our clients, going through change will allow us to continue our evolution, and never stop searching for our better self,” said Michael. Change is inevitable in life and usually out of our control; however, how we respond to the change is completely in our control. How will you choose to change and how will you choose to respond? It is all up to you. Contributed by: Angele Suarez, Crestwood Center San Jose MHRC, Program Director, Michael Bargagliotti, Crestwood Center San Jose, Campus Administrator

National Award Recognizing Dr. Gordon Muir Giles’ Innovative Neurobehavioral Rehabilitation Approach at Crestwood. Crestwood Behavioral Health’s own Dr. Gordon Muir Giles, Director of Neurobehavioral Services at Crestwood Treatment Center in Fremont and Idylwood Care Center, was awarded the most prestigious honor related to clinical practice in the occupational therapy profession, the Eleanor Clarke Slagle Lectureship Award . This award was made in recognition of his “innovating the clinical practice of cognitive neurorehabilitation” through his groundbreaking work with clients who have severe neurological impair- ments. Dr. Giles was presented with the Eleanor Clarke Slagle Lectureship Award by the Ameri- can Occupational Therapy Association (AOTA) at its 2017 Annual Conference and Centennial Celebration on April 1st in Philadelphia. The Eleanor Clark Slagle Lecture- ship Award was named after a pioneer of the occupational therapy profession, and recog-nizes achievements in research, education, and clinical practice that make substantial and lasting contributions to the occupational therapy profession’s body of knowledge. This award recognizes Dr. Giles’ efforts to improve the lives of Crestwood’s clients through innovative clinical practices, including his relational neurobehavioral approach to neurorehabilitation. This non-aversive method, which has been described as “relentless kindness,” assists clients with severe behavioral and emotional problems by empowering them through person-centered care and building positive relationships with them, rather than relying on confrontation, seclusion, or restraints. Dr. Giles uses this compassionate approach to treat clients whose neurological impairments have caused many of them to fail in other treatment settings due to difficult-to-manage behaviors. An example of this compassionate approach is being used with a client at Crestwood Treatment Center, Fremont who has had post-severe Trauma Brain Injury for 23 years. This client believes that he is a billionaire and that people are stealing his money. He would joke to the staff that they are stealing from him and if they would joke back, he would become very upset. To help deescalate this behavior, the staff now meet with him daily to review any areas of concern, assist him with solving any perceived problems, review his finances with him weekly and have him sign-off on any expenditures. Additionally, the staff responds to any of his questions about money by stating that taking money from him is unlawful and that if they did steal from him, they would go to jail. This increased focus on interpersonal factors and therapeutic relationships has made an amazing difference in this client’s life by helping to reduce his anxiety, stress, and negative attributional bias. Karen Scott, Program Director at Crestwood Treatment Center, Fremont said, “The positive impact Dr. Giles has made with both his clients and colleagues is immeasurable. He is a tireless advocate for persons with neurobehavioral differences.” As part of winning the Slagle Award, Dr. Giles will deliver an AOTA lecture in 2018 that will discuss how best to meet the needs of clients with neurobehavioral disability in a changing healthcare environment. Contributed by: Karen Scott, Program Director Crestwood Treatment Center, Fremont

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