1 Crestwood San Diego Mental Health Rehabilitation Center Core Program Description of Services/Scope of Services The mission of Crestwood San Diego is to provide an alternative to traditional psychiatric care through collaboration, empowerment, a healing environment, peer providers, family partners, and a recovery-oriented milieu. Crestwood San Diego provides the structure and support needed to promote stabilization and foster recovery. Crestwood San Diego provides sub-acute psychiatric services, licensed as a Mental Health Rehabilitation Center (MHRC), in a community setting, for clients experiencing psychiatric crisis. Our goal is to restore a sense of hope, self-empowerment and realized potential of recovery in each of our clients. The Crestwood San Diego MHRC services are for clients who require support and structure, medication management, 1:1 coaching/counseling, behavioral interventions, psychosocial education and a transition plan to successfully reduce the symptomology, increase the clients management of the disease process, reduce lengthy and costly acute and sub-acute hospitalizations, and to increase a successful return to their community. It is a whole systems approach. Crestwood San Diego s treatment team shall provide 24-hr staffing/assistance including a psychiatrist, consulting general practitioner or internist, registered and licensed nurses, service coordinators, rehabilitation assistants, peer mentors, and creative arts therapist. Description of Service Modalities At Crestwood San Diego we believe that recovery is a supportive process where a person is encouraged to maximize their life and achieve a sense of balance and fulfillment. It is a deeply personal and self-directed process built on hope, empowerment, meaningful roles and spirituality. We create an environment that fosters personal choice and active participation in daily activities and life direction. Our services continually evolve based on client needs. We place a high value on client input by involving clients in designing, planning, implementing and evaluating our services;
2 find ways for clients to make choices on a daily basis; and, provide the tools to support and validate those choices. We utilize multiple modalities; here is a brief description of each: 1) WRAP: Wellness Recovery Action Plan (WRAP) is an evidence-based practice developed by Mary Ellen Copeland. It is a structured system for assisting persons served to recognize what they look like when they are well, what things help keep them well, what they look like when they are not well, and to develop a plan (including activities and support system) to help them get well. This plan is based on empowerment and personal responsibility. It encourages people to focus on strengths and wellness rather that illness and weakness. 2) DBT: Dialectical Behavior Therapy (DBT) is an evidence-based practice developed by Marsha Linehan primarily for those with a diagnosis of Borderline Personality Disorder. It has been shown through studies to be equally effective for those who experience difficulty regulating emotions and those dealing with cooccurring disorders. We offer a comprehensive DBT program (which includes two weekly one-hour groups for skills training, one individual session with the assigned primary treatment provider to address target behaviors and reinforce skills, weekly homework and a weekly diary card completed by the person served) to monitor emotions, behaviors, and skills that are practiced/used throughout the week. We also offer DBT milieu groups, which differ from the comprehensive program in that the groups are open-ended and are blended with various approaches for symptom management and coping skills. 3) Life Skills: Life Skills is a modality which utilizes both 1:1 coaching and group activities to assist persons served to develop their abilities to complete everyday tasks, including showering, grooming, household tasks, money management, general education, dressing appropriately, and effective social interaction skills. 4) Pre-Vocational and Dreamcatchers Empowerment Network: The Pre- Vocational modality offers a structured curriculum that educates and assists persons served to develop skills for vocational success including successful vocational habits, how to construct a resume, how to complete a job application, etc. Our Dreamcatchers program is supported employment, an evidenced based practice, for those who have successfully completed the Pre-Vocational program. In addition, persons served have the opportunity to develop skills in various areas, including janitorial, dietary, office assistant and retail experience within the facility and receive 1:1 coaching. Clients work in specialized positions and are personally coached/trained, further developing their vocational skills.
3 5) Relapse Prevention: Relapse Prevention modality utilizes both 1:1 counseling and groups (Relapse Prevention, Dual Recovery Anonymous, Dual Dx and DBT) with our certified recovery trainer and DBT trained staff to address co-occurring disorders. We offer Seeking Safety, which is a program for those who are in the pre-contemplative stage regarding their substance abuse; this program also incorporates a trauma-informed care approach. Additionally we offer linkage to co-occurring disorder groups, as we are finding that substance use and mental health issues are more often the rule rather than the exception today than in years past. 6) Health and Medication Education: This modality is facilitated by our nursing staff and covers a spectrum of issues from basic health issues to education on specific medications, side effects, etc. It is provided in a group forum weekly and individually on a daily basis. 7) Process Groups: This modality encompasses our AM Social Group (which assists persons served in getting ready for their day address issues and reviewing events for the day and evening), Peer Support (led by a Peer Specialist), and Resident Council (led by persons served and providing a forum to bring issues and requests to the attention of management). It also includes groups in the community at the Consumer Family Learning Center, including Schizophrenics Anonymous, Recovery Seekers, and Creative Expression (all of these are peer-facilitated). 8) Recreation: Provides fun and engaging activities for persons served, including physical activities, games, arts & crafts, movies and community outings. Once per month our Recreation Department facilitates a special event for staff and clients to enjoy together! Philosophy The philosophy of the therapeutic program here at Crestwood San Diego is to provide persons served with a highly structured and diverse treatment milieu that addresses and subsequently improves those areas in their lives which have been negatively impacted by mental illness. The focus is psychosocial rehabilitation, which will ultimately lead to a reduction of symptoms, psychiatric crises, and acute hospitalization. Program Goals Program Goals are to (1) identify general problem areas and those behavioral patterns or thought processes that serve to perpetuate them, (2) identify clear, specific, and reasonable objectives of treatment, (3) establish appropriate therapeutic interventions for each individual and their respective service need, (4) encourage and foster the individual s, facility, county agency and family involvement in the recovery plan, and (5)
4 establish overall expectations for discharge, as well as identifying needs for continued success post-discharge Population Served The persons we served have a diagnosed chronic mental illness, from age years. Our population includes those on LPS conservatorship, Murphy conservatorship, 180 day post-certification holds, and those who have been determined incompetent to stand trial for misdemeanor offenses (MIST). Entry, Transition and Discharge Criteria Typically, persons coming to our facility for recovery services are coming from an acute setting, an IMD or MHRC, state hospital or county jail. They have shown motivation and potential for recovery, have been taking medications and generally are without violent incidents for at least 2 weeks. When someone comes to the MHRC, there is a period of transition which allows the person served to get to know the facility, program and staff through an orientation and partnering with a peer. Discharge planning starts the day of admission, in coordination with the person served, their county representatives, the family and the facility and varies depending on the individual; typically, the individual will have made substantial progress toward their recovery needs (i.e. absence of/decrease in symptomatology, taking medications regularly, and completing ADLs regularly) that will allow them to maintain living in the community. Settings Generally, our services are provided within our facility, however, we strongly encourage connection to community resources so that once discharged, individuals will have that resource. We also provide opportunity for persons served to participate in other community events, such as NAMI events. Our recreation program provides community outings for exercise and social activities at least three times per week. Frequency of Services days and hours of Services Crestwood San Diego is a 24-hour facility and provides staffing for individual services around the clock. The medical doctor is available seven days per week, and our psychiatrist is available seven days per week by phone and is in the facility twice per month. Our therapeutic groups start at 9 am and ends at 4 pm Monday through Friday; our recreational program operates from 3 pm to 9 pm Monday through Friday and from 10 am to 9 pm on weekends.
5 Payer Services Crestwood San Diego does not provide payee services, however, upon admission, either the person served or the conservator gives written permission for Crestwood to receive monies, place in resident trust fund and disburse monies weekly and as needed. Fees Rates for Crestwood Bakersfield MHRC are as follows: $250.00, $300.00, $ Private pay is approximately $6,000/month. Referral Sources Referral Sources come from San Diego County Health and Human Services Agency s, Behavioral Health Services and Optum.
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