Dr. Crystal Brandow: Hi, everyone.
Thank you for joining us for today's webinar, hosted by SAMHSA's Program to Achieve Wellness.
I am Crystal Brandow, the assistant director of SAMHSA's Program to Achieve Wellness.
Before we get started, I'd just like to go over a quick disclaimer with everyone.
The views, opinions, and content expressed in this presentation do not necessarily reflect
the views, opinions, or policies of the Center for Mental Health Services, the Substance
Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human
Services.
We're here today to talk about integrating wellness into the community.
Setting up a wellness program.
This is part two of a webinar series.
We held part one back on September 21st and that featured Dr. Peggy Swarbrick talking
about how to set up a wellness program.
Going through the details of how to get buy ins, how to do evaluations, how to assess
the needs of the community, and other details.
For everyone who's joining us today, we can send you a link to that webinar recording
following today's session.
If you missed part one, you'll have those details.
What we're going to do today is actually talk about some successful wellness programs and
some groups that are transforming the lives of individuals with serious mental illness
and helping improve physical health outcomes, decreasing risk factors for morbidity and
mortality.
We'll be talking with Deron Drumm from Advocacy Unlimited and Andy Bernstein and Cheryl Glass
from Camp Wellness.
Before we get started and talk about those two programs, we're going to talk a little
bit more about why setting up a wellness program in a community matters and so I am happy to
introduce you to two of our moderators for today.
Chacku Mathai, who is the director of the NAMI Star Center and Ron Manderscheid, who
is a thought leader in mental health and substance use.
I'm going to hand it over to those two.
Chacku Mathai: It's an honor to be here with all of you.
Especially a program with Ron Manderscheid, Andy Bernstein, Cheryl Glass and Deron Drumm.
Ron and I would like to start by talking with you a little bit about social determinants
and the roles.
Ron, why don't I give you the room so you can introduce yourself.
Dr. Ron Manderscheid: Wonderful.
I'm delighted to be here.
Delighted to be participating in this.
These types of activities are among the most important activities we can be engaging in
as a field.
To initiate the conversation here on the role of social determinants, I recently did an
article arguing that social determinants are both the vaccination for, and the remedy for
many chronic diseases, which is what I hope we are going to get into in this presentation
today.
Chacku Mathai: Alright.
For me, I wanted to emphasize, the social determinants became a real intersecting point
between mental health and public health.
It was a great opportunity where both field supporters, like myself and the mental health
and substance abuse recovery communities really wanted to emphasize the value of listening
to and prioritizing those needs that people expressed.
They were beyond distress or disorder, kind of related issues.
They were related directly to the kinds of things people said were important for them,
or in fact, impacting them in making things harder or more difficult.
And on the other side, making things better when we address them.
That's kind of what we mean here when we talk about social determinants.
These are cultural, social, economic, health, environmental conditions that really, at all
levels, national, regional, community, and family levels that influence a person's chances
including one's future physical and behavioral health.
Ron, anything more you want to say about social determinants?
Dr. Ron Manderscheid: The social determinants here, in general, are very, very important
because we now understand the linkage between those social determinants and behavioral and
physical health problems.
The linkage is that the negative social determinants lead to trauma in a person's life and trauma
in a person's life increases the likelihood that that person will develop a behavioral
health problem as a subsequent point.
It's very important that we pay attention to the social determinants.
It's also very important, and we'll see that in the next couple of slides, that we distinguish
negative social determinants, which is what I was just talking about, from positive social
determinants that can have the opposite effect.
Chacku Mathai: Excellent.
So there's research that has been demonstrating this.
Reports from the World Health Organization on research on adverse childhood experiences.
Lots of things that have come to this point to bring social determinants to the table.
We'll talk about some examples with Ron next.
We mentioned a few categories, in terms of negative social determinants, for those of
you that are reviewing the slides it's, poverty, discrimination, social exclusion, poor quality
education, lack of access to quality health care, little or not access to quality foods,
abundant access to fructose, fatty foods, etc.
These are the kinds of things that were on the list of things that make it more difficult
for people, or start to demonstrate signs of the disorders we were talking about.
Dr. Ron Manderscheid: To amplify that a little bit, with poverty, someone tells me they were
born in poverty, we know the linkage between poverty and mortality.
Being born in poverty automatically subtracts about five years off a person's life, unless
they subsequent intervention to protect the person from the effects of poverty.
Social exclusion, today we would say social exclusion is as deadly as smoking on a person's
health.
Being socially isolated.
Being not linked to other people, absolutely a very critical issue.
Abundant access to fructose, fatty foods.
A huge problem in American society, because these types of foods are cheap and easily
accessible versus other foods, quality foods, that are more expensive and less accessible.
We've developed a very large problem with obesity in the United States, which also then
has huge consequence.
You can take each of these things and go through them and begin to see the linkage between
them and subsequent health problems that people can begin having.
Chacku Mathai: Absolutely.
Long term response and experience we've been seeing is unemployment and economic self-efficiency
issues.
People used to be discouraged to go back to work, because we had psychiatric history that
seemed to be difficult if you're under stress.
However, it turns out being unemployed made things worse.
Not just for the general population, but for everyone.
Dr. Ron Manderscheid: Exactly.
Excellent example.
There's a lot of work underway right now to say that it's very important that we work
towards equity in the workplace and for people with behavioral health conditions that will
be enhancing the likelihood that people are able to get jobs.
Jobs that pay a meaningful amount of money so that they can live a meaningful life in
the community.
It's a very important issue and one that's beginning to be recognized nationally.
Chacku Mathai: Let's talk about the positive social determinants.
Ron, why don't you introduce this one?
Dr. Ron Manderscheid: Just as we said there are negative social determinants that adversely
impact people principally through the traumas that they cause, there are positive social
determinants that can vaccinate people against subsequent behavior health and physical health
problems.
Some examples of those are shown in this slide.
Social support and inclusion, I've always said social support is the antidote to being
excluded when somebody is mentally ill.
By inclusion you create the opportunity for that person to engage in recovery, to regain
their voice, to regain their voice in the community, etc., etc.
A nurturing family for children, the aces that Chacku mentioned are causes by an environment
that's not a nurturing environment where children are abused.
A nurturing environment is the reverse of that.
That protects children against the effects of aces.
Adverse Childhood Events.
Good education, if you're going to become activated and you're going to have health
literacy, you're going to need to have a base in good health education to know what good
health literacy is about behavioral health and to know how to become activated about
it.
Positive role models, if you're going to ultimately go into the workforce and work in one way
and you're going to start at the bottom and work your way to the top, you'll probably
need a peer of some type.
If you're a young woman starting, you probably need a female peer who can help you make the
transitions there and so on.
Each of these things creates opportunities for engagement in the community, and they
really represent the adverse of the negative social determinants.
Our hope is that in behavioral health, we're going to start looking at both sides of this
issue.
Historically we've begun by looking at the negative determinants.
We need to devote just as much time to the positive determinants and how we can enhance
many people's lives.
Chacku Mathai: That means really being attentive to what we can learn from our resource perspective
as well.
Really giving meaning to the - I find when those kind of positive determinants are being
focused on.
One example of that is you were talking to this was when people are feeling a loss of
control, especially around social exclusion or discrimination, being able to feel some
control over their lives and actually start to have rights and other kinds of things,
be a priority, it increases our economy, increases independence, increases a lot of opportunities
for someone to engage those things like employment and other outcomes.
The connection we want to make here though, is not only are we talking about prevention,
we're talking about the kind of interventions that can happen for all kinds of issues that
people are facing in behavioral health and one of those important areas are the domains
of wellness.
That's where we want to go next and introduce the opportunities for how to really bring,
not only the concept of wellness, but really bring it to a level of a programmatic effect.
Now, before I move on, anything you want to say?
Dr. Ron Manderscheid: The only thing, again, I want to headline here is that the social
determinants are both the vaccinations, the way we just talked about them and as Chacku
was saying, they are the remedy for chronic diseases.
So, I think our presentations are going to go in today to the whole issue of how we can
promote wellness and wellbeing in people who already have behavioral health conditions
and correlated physical health conditions.
Very excited about this.
Very important area, as I said before.
Chacku Mathai: Thank you, Ron.
The next step, I'm going to introduce you to Andy Bernstein and Cheryl Glass from Camp
Wellness.
Cheryl, back to you.
Cheryl Glass: [inaudible 00:11:59] my background is in community health education.
Andy Bernstein: And I'm a community and clinical psychologist.
My work history before coming here involved a lot of work in the recovery community, which
is why I got my CPRP, the certification as a psychiatric rehabilitation practitioner.
I worked a lot in the peer workforce.
The evolution of the consumer, provider movement.
When people were looking for someone to be involved in a peer delivered program at Camp
Wellness, it was a good match.
Our program, try to get this down to the next slide.
How do we advance the ... I'm trying to advance the slides to the next one.
There we go.
Thank you.
Our computer is acting strangely.
We called it Camp Wellness, starting it 2009, because we wanted other behavioral health
agencies to know that people were coming here for a limited amount of time and to have fun.
It was important so that we got referrals from folks who were perhaps afraid that we
would take their clients or their members and keep them.
Camp Wellness is called that for several reasons.
It's recovery oriented, it's adult education.
We treat people with respect and let them come and go from classes as they need to.
There are no distinctions between staff and client bathrooms.
We're essentially a learning community.
Most of the staff are peers.
There are a few of us that really have not had our lives interrupted by mental health
issues, even though we've all received mental health services at different times in our
lives.
We're housed in the University of Arizona in the Department of Family and Community
Medicine, which means we have opportunities for research and we also have connections
to other aspects of the medical system.
Our funding comes from Medicaid, which sends money to the states and Phoenix, the capital
of Arizona, sends money to the different programs throughout Northern, Central, and Southern
Arizona.
Our program is in Tucson, which is the Southern part of the state.
We serve about 200 adults per year.
Initially, we only served people with SMI, but then we expanded it to mental health and
substance use disorders.
General mental health conditions.
Let's go to the next slide, if we can.
Our program is designed, really, to help people increase their knowledge, their skills, and
their abilities around health and wellness.
The idea is to help people activate their own intention to become healthier and live
better lives.
We do that by focusing on the eight dimensions of wellness, as Peggy Swarbrick has developed,
and SAMHSA has been promulgating.
We'll get back to the eight dimensions in a moment, but one of the important aspects
of our program is we're trying to help people, not only get better in terms of their health,
but also their social health.
Being able to integrate back into the community.
We have several aspects of the program, as Cheryl will go into, that include getting
people out into the community from our program.
Of course, the central tenant of this, is that people can get better.
Recovery is possible.
The fact that 95% of the classes here are taught by people with history, peers, means
that the role modeling effect takes place and the students who are participating ... We
call our participants students, because it really is an education program.
They see this as a possibility for them that they could in fact move forward in their lives.
As you'll see when we identify two of our graduates, that in fact happens frequently.
Let's go to the next slide, which shows the eight dimensions of wellness.
I don't think we need to go into detail here.
You guys have heard about this, but if you'll notice, they interconnect in so many ways.
One of the ways that we do that in our program is to help people recognize certain activities
that help them a long a number of the dimensions at the same time.
For example, participating in classes is involving their intellectual wellness as well as their
physical and their social wellness as they interact with each other.
Obviously these dimensions cross over and one of the important aspects that we see,
is helping people acknowledge where they are when they enter our program, which is a nine
week program, and what's most important for them to focus on.
We don't deal with traditional DSM5 or ICD-10 diagnosis.
In our program, we basically want to ask people, where do you want to go?
In terms of these dimensions of wellness.
Their individual service plans are oriented around this kind of assessment and the progress
that they make is regularly evaluated by them and their health mentors.
Let's go to the next slide.
In terms of setting up a program like this, the first item is making sure that people
can get there.
That's a kind of geographic factor.
You need public transportation in order to get people who, very often as it's been identified
in the social determinants, do not have a lot of money.
Having public transportation and a location that is easily recognizable is important.
Then, the rest of these items are essentially structural, except for the last.
The items that we need in a program are those that will help people move physically, including
basic and advanced gym equipment.
Learning how to prepare food and cook it in a healthy way.
Buying it in super markets, which is one of our out of camp activities.
Also, having a place for people to eat, share food with each other and then in class rooms,
the need is to have a variety of different class rooms where people have an opportunity
to look at the front and have projections and computers and screens, but also have an
opportunity to sit around and talk with each other in circles.
Being able to have flexible arrangements in the class rooms is a really important part.
The last item is really a kind of social element and that is being able to establish collaborative
relationships with community agencies.
I think that Peggy identified the importance of buy-in communities, in terms of establishing
health and wellness programs.
It's the community agencies that essentially create this meta-structure of connectedness.
It's a dense social network of agencies, which allows people to move from one agency to another
and get what they need from different agencies.
Fortunately, Arizona Behavioral Health System emphasizes voice in choice.
So people get to choose what programs they go to and they let their feet do the walking.
I think we're going to move on to financing, which is where Cheryl is going to pick up
the ball.
Cheryl Glass: We're in a rapidly changing healthcare environment.
When we first started out, all of our funding came for us to serve people with serious mental
illness and the covered services through Arizona's Medicaid program included health promotion,
skills training, peer support, educational service and support to maintain employment.
Now, we're moving over into integrated healthcare.
The SMI population was already integrated and GMH and substantiates was moving over
as well.
Not all insurance companies are covering these services.
We're working to try to expand those services to be covered by a variety of insurance companies.
We're looking for alternative funding sources in addition to the ones we're currently working
with.
I'll speak more to that in a minute.
We are an interdisciplinary team of health mentors.
I'm a health educator.
We also have a registered nurse.
Andy is our community psychologist, and Dr. Randa Kutob is our family practitioner.
She specializes in diabetes, obesity management, and district populations.
Andy spoke of the eight dimensions of wellness.
We use those wellness wheel assessments using those eight dimensions to make sure that the
service plans we're creating with the population we serve are person centered.
People participate in all of our curriculum, including health education, tobacco free lifestyles,
nutrition, stress management, mindfulness and exercise, and other classes.
Their wellness wheel really focuses on the areas they specifically want to work on.
They get education across the board but they're going to fine tune their services according
to their needs.
We do things like field trips to the grocery store, to local gyms, we have the opportunity
to earn gym memberships with the YMCA.
We actually have a certified personal trainer from the YMCA come here once a week so students
get familiar with one YMCA staff member and then we help facilitate a stronger relationship
with YMCA for after they complete our program.
In terms of data collection, when students start in our program and again in nine weeks,
we check their weight, their waist circumference, both at the occipital crest and at the navel,
we calculate their body mass index, we take blood pressure, six minute walk test which
measures cardiovascular endurance, we also administer some surveys.
Including the SF-12, the lifestyles profile and the recovery assessment scale.
We conduct qualitative interviews and focus groups.
We have a student and an alumni advisory board to help further inform our program.
If you want to skip forward to the next slide.
Our outcomes, as you can see, are significant.
We saw decreases in weight and body mass index.
Decrease in waist circumference, blood pressure.
The six minute walk test, we saw an increase, which we were looking for.
It's a very boring test to administer, but it's very powerful to see the impact of the
nine weeks of improvement.
The SF-12 and the mental health scale.
Next slide please?
A couple of success stories.
We have many, but these are two that I really felt show how the eight dimensions of wellness
play in.
We'll talk about Betty.
She started Camp Wellness right after an inpatient psychiatric hospitalization.
The first couple weeks were really tough for Betty.
She stopped attending.
She had severe depression symptoms, and her health mentor called her every single day
encouraging her to return, and finally said, "You can come in your pajamas and slippers,
we really don't care."
She did.
She attended in jammies and slippers.
Didn't necessarily get her hair brushed and she was welcomed here.
Over the nine weeks, we could just see the improvements.
Our evaluation showed she had improved BMI, waist circumference, and blood pressure.
We also saw her making these powerful friendships and people were getting together outside of
our program to spend time together and enjoy each other's company.
Cooking for each other.
She participated in our alumni program.
She volunteered here.
She assisted us with collecting measurements and offering basic first aid.
She worked to get her nursing license reinstated and she was successful.
She became employed at the local emergency department.
Then, when she had the opportunity, we happened to have an opening here for a Camp Wellness
nurse, she applied and was amazing and got the job.
From that point, we were able to send her to our sister program, the recovery support
specialist institute.
So she could offer our peer support services as well.
While she was working here, she also earned her Master's degree and after completing her
Master's, she moved on.
She is working in healthcare administration and she's working towards her goal of improving
the healthcare system, specifically for people with mental illness.
Gerard started Camp Wellness with severe diabetes complications.
He had recently had an amputation.
He was actively using substances and heavy tobacco use.
He, like Betty, stopped attending early on, but in his case it was because he had just
gotten accepted into a detox program.
So his health mentor encouraged him, "Absolutely, go work on your substance use, and come back
when you're done."
We figured we'd see him in a few months.
Instead, he came back exactly two weeks later.
No longer using substances and then while he continued in our program, he quit smoking.
Bye the end of the program, he was managing his diabetes so well that he was able to get
off of insulin.
Gerard actually increased his BMI.
He gained weight, but he decreased his waist circumference, which is something that we
often see here.
Where people increase their BMI, but they lose weight in their waist.
He increased his walk steps and his blood pressure.
We saw him connecting with other people.
He participated in our alumni program.
He volunteers here teaching art classes.
He worked on getting his GED and he worked out frequently at the YMCA.
Next he set the goal to increase his financial independence.
He became his own payee and he gained employment.
He had a setback when he ended up working nights at work and he found that that lead
to depression and then with the depression, it lead to ... He actually had an accident
where he was unable to work for a period of time.
What did he do?
He returned to Camp Wellness, got back on track and then from Camp Wellness, he went
on to an art therapy program and they helped him set up his own studio and his ability
to be an artist.
He supplements his income with other work as well.
Andy Bernstein: When individuals have experience that launches them, they also serve as role
models for each other.
One of the things that we discovered was that cohort effect in which people impact each
other's lives beyond what we're doing.
They get a sense of being part of a social community, which reduces isolation and obviously
increases that aspect of their life in the community.
We think that our outcomes are important because not only are we improving people's individual
health, but as the other agencies are trying to do their work in behavioral health.
We know that they're trying to improve their HEDIS scores.
All of the different elements that go into that are supported by the kind of activities
that we have students engage in here.
We do know that there is decreased healthcare system costs and decreased emergency hospitalizations
because of people's ability to connect with each other and also to become more knowledgeable
consumers of community services rather than waiting until the last minute.
Additionally, people understand that in order to be healthy, they have to identify situations
earlier in the sequence.
That's one of the ways that Camp Wellness has been really helpful, because they understand
the disease process as well as how to monitor themselves.
The fact that people get healthier and become more connected into the community really leads
them to become more willing to get more involved in doing activities and the activities add
meaning to their lives.
Of course, when people's lives have meaning and purpose, they're more motivated to take
better care of themselves and the people that they love.
That's kind of the way our program works.
Dr. Crystal Brandow: Wonderful.
Thank you so much, Andy and Cheryl, for sharing that information about Camp Wellness.
As a friendly reminder to all of our participants, there's a Q&A box on your screen, we have
some questions coming in now, but feel free to use that section to put any questions that
you have for Andy or Cheryl about Camp Wellness.
Or, to Ron and Chacku about social determinants.
At the end of our session, we'll go through as many questions as we possibly can and help
get you the answers that you're looking for.
I am very excited to introduce our next speaker, Deron Drumm, who is the executive director
of Advocacy Unlimited and founder of Toivo, a center for holistic healing and stress management.
I will mention that both Camp Wellness and Advocacy Unlimited were recognized by SAMHSA
in 2016 recognition of excellence in wellness for the great work that both of these organizations
are doing to improve health outcomes.
Congratulations again for that.
I will introduce Daren and hand it over to you to talk a little bit about your work.
Deron Drumm: Thank you, Crystal, I really appreciate that and all the work you've done
setting this up.
It's an honor to be on here with all of you.
Chacku, my dear friend and mentor, such an honor to be here with you.
I'm going to share a little bit of what got me into this work.
I have a real passion to support people and find ways to access the healing capacities
that lie in the human body.
My experience is – this is just a thumbnail version of my kind of narrative – I struggled
a lot as a kid in a lot of ways, had daily rituals.
Counting and checking, I can remember being five years old being outside my dad's condo
complex picking up garbage and cigarette butts and holding a garbage bag and crying hysterically,
because I felt if I didn't do that, something bad would happen to my family.
Those kind of experiences pretty much daily all my life, all my childhood.
Then, at 19, asking for help and I remember being 19 with a psychiatrist and the courage
it took to ask for help and finally tell my story.
I'm older, there was no Google.
I had no idea what was going on with me for all those years.
Then, this doctor not looking me in the eyes and very impersonal and that path they suggested
there, which I followed there for a while, it didn't bring me a lot of relief.
As many humans do, I was in a lot of pain and I found ways to not be in pain and I found
those in casinos and I found those in bars.
I went down a very dark road of addiction and I also had a massive stroke and spent
a couple months in the hospital.
I was in a wheelchair, walker, and cane.
Then, I had another stroke and I ended up having all kinds of surgery.
During my struggles, I did do well in school.
I managed to become an attorney and had a successful business on the outside, I was
a successful person.
Internally, I was still hurting.
In so much pain.
Ended up losing all that and 30 years old, sleeping in my mother's basement and going
to rehab and court and all these hospitals.
Trying to find other ways.
The way I transformed my life is to look at the impact that stress had in my life.
I started to research and I pursued a Master's degree in integrated health, became a teacher
of Tai chi and meditation.
In just learning the impact of the nervous system on my healing and it's changed my life
learning how to relax.
How to balance my nervous system.
How to tap into the healing capacities of my body.
My life has transformed and I had this amazing opportunity to work at Advocacy Unlimited
and for this webinar, more importantly, Toivo, which is a center for holistic healing and
stress management.
The mission of the general organization, Advocacy Unlimited, which has been around for over
20 years, considered peer organization in Connecticut.
We have 30 employees, we do a lot of important work.
Our mission promotes individual growth, human rights, and systems transformation through
education, advocacy, and support.
Vision, we recognize the power of inner healing in connection with others will change the
world.
In Toivo, which means, hope in Finnish, my mother, Dr. Karen Kangas has done a lot of
great work for people with psychiatric histories and their own systems changed, the way people
are supported, they're struggling with their emotions.
Honoring her with that name, her family is from Finland.
Toivo is naturally recognized wellness initiative offers groups, classes, workshops, centered
in mind-body practices and everyone that works here has used their personal practice that
they teach to transform their own lives.
Some of our beliefs are really centered around healing.
Going deep into the people's narratives and the context of their lives to find out where
the healing is needed.
We believe when it comes to healing, it really needs to be around ... it's really helpful
to be around people that see you, that hear you, they value you for who you are.
Really see the humanity in you.
Here we were hold that as a value to really accept people and see the humanity in people.
We're not seeking to fix, change or rearrange them.
We're just trying to be present for each other as we walk in this journey together.
We think it's very important to find ways to be in your body.
Not stuck in your head.
Find ways to be present for emotions and sensations.
Often difficult emotions.
We also believe very much that retaining personal agency throughout whatever you're going through
is really important, to not be at the mercy of professionals and the universe, but to
really have some measure of control of your life as you're moving forward.
Learning how to do breath practices or meditate or taking time to intentionally be in nature.
Just doing something for yourself as part of whatever you're going through.
The Center for Holistic Healing and Stress Management, again, I really focus on the stress.
The impact of stress on people's lives.
It's such a contributing factor to so many illnesses.
We were hearing a Dr. John Cabot from the University of Massachusetts speak and he,
of course, started the mind-body stress reduction in BSR.
He talked about when he started his center at UMass in 1979, how health organizations
were not seeing stress as a contributing factor to illness.
Of course now, here we are with over 80% of illnesses, stress being a major contributing
factor.
The shift there is so significant.
We've been four years in operation and we've reached over 1,900 un-duplicated participants.
I think the number is probably higher.
We teach all over Connecticut and often beyond.
We surveyed 175 participants that came in here.
We've had a lot of conversations about how to do research around what we do.
There's certain mixed feelings about what that should look like or if it should happen
at all.
This particular one, we did do surveys over six months.
You can see there was 73% of the people reporting feeling much less stress in their lives and
the source or impact of stress.
One of the things we've done, that I've really done through, that's a passion of mine, is
to work with law enforcement officers.
We work with a couple departments.
One particular here in the town we're in.
Around the impact of stress and they've been really receptive.
We bring in really fair amounts of help.
Officers find tools to help deal with the stresses that they deal with, which are considerable.
We collect a lot of testimonials.
This one by Jessica.
"I want to extend my gratitude and appreciation to Toivo and AU.
Words can't begin to express the immense support that you have freely and kindly given to me
during my crisis and stay here at the shelter.
Your abundant sponsorship and encouragement on how life does go on after a hardship, has
humbly and gracefully lifted and eased my heavy heart in my time of emergency."
I think, for all of us at Toivo, these transformations we watch in people is just so moving.
We feel that so deeply in our hearts.
Of course, even with each other as we grow together, grow and awaken together.
It's one of our favorite parts.
We just feel we're being of service.
I know in my class, I teach Tai chi.
Set classes every Friday and Saturday, Tai chi and chi gong and just watching the people
come and tell me that they're having less troubles in different areas of their life,
is just so meaningful.
It propels me forward to learn more and to try to give more.
Another one, "I have been on disability for eight years and I just applied for two part-time
jobs as a homemaker and a companion.
I felt confident that I could handle the work because of how much healing I have experienced
the last few months."
One of the things I mentioned the connections.
We believe very much in the power of mind-body practices.
Connecting the mind, body, and spirit.
For me, in qigong, the mind, body, and breath.
Whether it's yoga, whether it's qigong, or creative expression or Zumba or an [inaudible
00:37:56] class or a peer special class.
We believe the content of all those is always second to connecting.
Connecting with others, being seen, being heard, being part of a community.
To me, it's the most important part of what we do.
We bring our work in different places.
We have a center here in Hartford, which is open seven days a week.
We offer a lot of different things, which I'll talk about.
We also bring ourselves to schools.
We have weekly groups in prisons, in homeless shelters.
One of the participants is someone who is currently in a homeless shelter.
I mentioned the work we do in police departments.
We do the weekly groups in psychiatric settings and inpatient settings.
We've also kind of branched out.
We had one of the local law schools reached out wanting to know if we'd do weekly mindfulness
classes.
The dental association asked us to do stuff with them.
We get a lot of requests for different things.
Healing from within is our program that brings mind-body practices, holistic healing practices,
to two inpatient settings in Connecticut, in Hartford.
This is funded by SAMHSA.
So we bring in a lot of stuff every week and it's been really amazing to watch what's happening.
A lot of staff are coming as well.
We do other inpatient settings too, but this particular program includes two.
We have a healing journey web series which features a lot of writers and people like
Don Miguel Ruiz who wrote the four agreements people like that talking about tools they
use to get through difficult times and talk about their work in the world.
We also include people from Connecticut.
Talk about their own healing journeys or recovery journeys.
One story that really stuck out to me was there was a spiritual teacher named Karl Brock,
who was a guest on our show and she told this story of walking in the park and seeing a
dog, a cute dog, and what that made her feel.
She's a dog lover.
She sees the dog and she walks closer to the dog and the dog starts barking and growling
and fangs are bared.
That real intense state the dog's in.
What it did to her, it brings up some fear and kind of changed the feelings around the
cute dog.
This dog is mean.
Then, she noticed that the dog's leg was caught in a trap.
Just how quickly her perception changes.
Here's a dog in pain.
The dog's needs aren't being met.
It just really struck me when I heard that story.
I think of our society.
We'd all say, the dog's got an anger problem.
We need to treat an anger problem.
No, the dog's caught in a trap.
It's in pain.
I think a lot of people are caught in traps and we're treating the symptoms.
The anger, instead of helping people get out of those traps, metaphorically.
Or really.
I just really loved that story.
What we offer is things like yoga, meditation and qigong, which is what I teach.
Which is like a moving meditation.
Tai chi is like beginner martial arts.
We offer creative expression, writing, painting.
We offer a lot of different workshops on finding your purpose.
One of the great things about mitigating stress is finding what your heart wants for you.
Finding your purpose, something you feel passionate about in your life.
We offer different support groups like alternatives to suicide, that's developed by the Western
Mass learning community.
We have hearing voices network groups.
Just gaining a lot of ways to build communities so people can feel seen and heard and supported
as they try to move through whatever they're moving through.
Also it's important to us, we're open to everyone.
My classes will have police officers that have really struggled with life's experiences.
People in senior services.
People in missions come.
We just ... Like here, my friend Chacku, he comes.
Inside of our space in our classes, he's Chacku, I'm Deron, our titles, our diagnosis,
that stuff can all stay outside.
We're just humans trying to connect and trying to support each other forward.
That's really something we hold dear to us.
When we started we had a director at the Kampala Institute that's helped with a lot of things.
We liked a lot of the work they do.
Connecting people, teaching people how to connect with themselves.
Obviously we value what they've given to us as we move forward.
That's kind of the short version of what we do, but I appreciate the opportunity to talk
about it.
Dr. Crystal Brandow: Wonderful.
Thank you so much, Deron.
We really appreciate it.
And to everyone on the line, we'll have about 10 minutes at the end of today's webinar so
please use the box on the screen and ask any questions that you might have for Deron, Andy,
or Cheryl.
Again, this is part two of integrating wellness into the community, setting up a wellness
program.
In part one, we really talked about the how to's of how to organize a wellness program
in a community.
Today you just heard from two programs that have wonderful outcomes and what some reductions
in stress or weight loss helping to improve overall well-being and decrease risk factors
for premature morbidity and mortality for individuals with serious mental illness.
So, thank you all again for sharing your experience and your successes with us.
Before we wrap up, I'm going to give it back to Chacku and Ron, who are going to wrap this
up a little bit and put this all together for everyone.
Chacku Mathai: Great.
I don't know if we'll be able to put it all together for everyone.
The incredible work of everyone on this call and all of you that are listening.
I have a bunch of thoughts.
First of all I just want to thank Deron and Andy and Cheryl for their presentation on
just a glimpse of what they're already doing and the impact you've had.
I have some questions that I know I could ask, but I'll hold off for now.
Ron, how about you?
Your reaction?
Dr. Ron Manderscheid: Wonderful presentation.
Wonderful programs and exactly where we need to be moving in this field.
A couple of related thoughts, I think a couple of highlights here, it isn't just about having
a longer life, it's also about having a higher quality of life during your life and being
more happy during your life.
I think both of these programs address that in a very positive way.
When you put that all together, I would say we're beginning, we're on the cusp of beginning
to move into what's called the culture of well-being.
We want to make certain that behavioral health isn't left behind as we move into that culture
of well-being and these programs are very good examples of leading edge type activities
of moving into that new culture.
Chacku Mathai: You emphasized earlier on the webinar, Ron, there's a social connection,
network, and the building of the community.
I could feel the unifying characteristics between Camp Wellness and Toivo.
It was exactly that.
They were doing, from an activity perspective, building community and connection.
The quality that they did, so Deron, I just want to ask you to start off with, I remember
you're bringing this idea to me only a few years ago.
It's amazing how much has happened.
What has happened that is different than what you first envisioned when setting up the wellness
program?
Deron Drumm: Thanks, Chacku.
I do remember the conversation.
Certainly a lot has changed.
I think, I stress the importance of building community and connecting people to others
and to themselves.
I think all of our understanding about that really grew and just the importance of opening
our space to everyone.
I remember when I ... We have three different funders and being ready to sell or present
what we wanted and often we're told our center should be open to everyone, but that was the
community.
The integration.
The connection.
There was no argument there, but also entrusting the talking about the benefits of things like
yoga or chi gong, which have been around thousands of years and have a great resurge.
Having that all prepared.
Our biggest funder, I remember her saying, it wouldn't be around for thousands of years
if it wasn't providing benefit to people.
You can put all the research studies aside, which was really cool and it's true.
There's such incredible value in connecting mind and body.
It's grown a lot, Chacku.
If we had talked about it and you had said, you can train police officers in stress management.
I'd probably laugh.
Here we are, doing that.
Just the number of places that we've been asked to go.
It's been such an honor to be of service.
For me, I know that you can have the money and have good ideas but it takes champions
and we've had champions here.
The director now, Hillary Brian, just ran through walls to make sure this worked.
The passion and love she brought to this.
And Kelvin Young, it just takes that.
We've had that here.
Very grateful for that.
Chacku Mathai: I want to echo that point you're making, which is similar.
I think it's getting to this issue that Ron was raising too, which is that because this
is also about public health and social determinants on a broader level.
One of the things you've tried to deal with was do we carve out a specific population
or open it up, and really have it accessible.
It sounds like you found a way to do both.
That's pretty impressive.
Deron Drumm: One little quick thing that was funny, I don't know if funny is the word.
Interesting for us to watch.
Is clinicians coming and doing yoga or doing these classes or doing groups and saying,
"We're here to learn better ways to support the people we work with.
Our clients."
We're watching that kind of shift to, "We're here because we want to find better ways to
be in this world.
For our families and loved ones."
Interesting, okay.
We kind of knew that to begin with, but it's great to see that awareness come to life for
you.
It's so beautiful to watch that.
We're all just trying to find better ways to be in this world and show up for loved
ones and show up for ourselves and that's what we're trying to do here.
Chacku Mathai: Are there other questions coming in that you want to raise?
Dr. Crystal Brandow: Yes, thank you Chacku.
We have a question that I think can go both to Andy, Cheryl, and Deron.
It's about what a day looks like in your program.
We'll start with Andy and Cheryl.
The question is really about whether or not these are residential programs, are people
dropping in and dropping out?
Are people saying for any given period of time with any set goals?
Andy and Cheryl, if you'd get us started and talk a little bit about what a day is like
at Camp Wellness?
Cheryl Glass: Sure.
At Camp Wellness, we have a couple different programs.
Here in Tucson, we have our nine week program where people attend Monday through Friday
from nine in the morning until three in the afternoon, and they're following an established
plan of classes.
We also have our alumni program which is more of a choose your own adventure kind of program
where alumni can pick which classes they want to attend and those are focusing more on the
dimensions of wellness, like occupational, financial, environmental and social.
Some physical health and nutrition as well.
Then, we have the discovery program for people who aren't comfortable committing to the nine
week program or they're waiting for the nine week to begin and again, that's more along
the lines of choose your own adventure, where they're selecting just a few classes that
are most appealing to them.
Our staff arrives a little before eight in the morning and we start our day with an 8:00
meeting to review the schedule.
Any concerns, but we also spend time getting ourselves into position of gratitude or excitement,
we call it awesomeness of the day.
To help us get ready to spread hope and inspiration.
Students start arriving between 7:30 and 9:00.
The building is open to them once there's at least two staff members in the building.
They tend to congregate in the dining room.
They have coffee or tea.
The eat apples or oranges.
They tend to hang out until 9:00 when the first class starts.
Classes are 45 minutes.
Lunch is served at noon, but lunch also includes a lesson or a social activity and then classes
go until 2:45.
They have the opportunity for setting appointments with their health mentors for one on one peer
support from 2:45 to 3:30.
Again, we tend to see people hang out from 2:45 to 3:30.
Some people use the computer lab.
Other people just socialize in the lobby or out in our garden.
Then, we do close the building at 3:30 so the staff can focus on their documentation
until 5:00.
Andy Bernstein: One of the elements of the program also, is preparing lunch.
We have a full commercial kitchen and students participate in preparing lunch and serving
it.
That's one route that students sometimes take to becoming employable, by learning how to
manage food service tasks.
Staff also have to be certified through the county health department.
Knowing how long things can stay out at what temperature, etc.
The classes vary from more deictic ones where there's a presenter in front and a power point
and a lesson plan.
To more interactional classes in which there's open discussion on topics that students choose
themselves.
That also is skills building.
They're learning how what other people have said, how to participate in group discussions,
which are relevant for going back to school, being involved in meetings if they're going
to go back to work.
There's tobacco cessation, there's nutrition classes, computer classes, there's also a
class in Gelotology, which is the study of laughter and people discover how important
laughter is, not only emotionally but physically in terms of facial muscles and breathing.
The idea that we try and maintain here, is that people are learning things, but they're
also having fun.
The classes have to be enjoyable or students are not going to want to attend.
We want people to be coming because they want to be here.
That's what's critical.
Dr. Crystal Brandow: It looks like we have time for about one more.
It's a two part question.
We'll start with Deron.
How does somebody get into Toivo, for example?
How does somebody become eligible and actually enroll in the program?
Are you familiar with any similar types of programs anywhere else in the country?
In interest of time, if you wouldn't mind, Deron, just taking a minute or two to answer
that and then we'll give Andy and Cheryl a minute or two.
Deron Drumm: Yeah, sure, Crystal.
As far as how do they get involved?
How do they gain access?
You just show up.
We're open.
We have our other office, Advocacy Unlimited, has peer certification and ER training.
There's different classes that are multiple weeks.
You have to sign up, you have to apply for.
But Toivo, the wellness center, our focus is to make it really accessible.
We offer a lot of different things.
We know what's going to work with people, what resonates with them.
Here you can wear jeans, if you do five minutes of my class and you realize it's not resonating,
walk out.
It's not going to hurt my feelings.
It's really just showing up and word of mouth has traveled so far.
We have a website.
We have a foundation that has generously offered to fund a really big website.
It's going to have a lot of practices on video tape on the website for people outside can
use.
It's really open to anyone.
Dr. Crystal Brandow: Great.
Thank you, Deron.
Andy and Cheryl?
Cheryl Glass: For people that want to participate in Camp Wellness, they do need to be a member
of our public health system at this time.
They approach our health helm and request a referral to our program or they come here
and then we help them start the referral process.
We also do outreach recruitment in a variety of settings.
Including the local jails so that people getting out of jail can work to coordinate their referrals
so upon release they can come here as well.
We do outreach in the behavioral health hospitals and clinics as well.
We're currently working to contract with additional health insurance companies so that people
that are not necessarily in the public behavioral health system will be able to attend.
Dr. Crystal Brandow: Wonderful.
Thank you both so much.
Before I wrap up, I just want to hand it back to Chacku or Ron, and just see if you have
any closing thoughts.
Anything you'd like to end today's webinar on.
Chacku Mathai: I'll just say that if you are listening to this and thinking, "I would love
to do that, but I just don't know where to start."
I would encourage you to consider Deron, Cheryl and Andy as future people to contact and help
you through that next step, because this is something that we want to see more of.
It's part of why Deron and I were talking just a few years ago about his vision towards
this, was because of both of us recognizing the need to really translate these kinds of
outcomes to our communities and to have these social determinants that Ron and I started
off talking about, really be seen as a path forward and a path out of a lot of the struggles
that people are struggling with.
Ron, I'll turn it back to you.
Dr. Ron Manderscheid: I would just say ditto to what you're saying.
We're delighted to hear about this wonderful progress in Camp Wellness and Toivo and also
hoping that some of you who are participating in the webinar today will pick up the mantle
and actually begin developing similar programs in your own area.
I think this is the wave of the future.
This is exactly where we need to be going.
It's delightful work, actually.
Dr. Crystal Brandow: Great.
Thank you so very much.
I'd like to echo Chacku's comment for those of you on the line interested in setting up
a wellness program.
Feel free to reach out to any of the speakers today.
Feel free to contact the program to achieve wellness for any support and again, everyone
that's on the line today will get an email with a link to the first webinar that we had
with Dr. Peggy Swarbrick that really did go through the how to's for setting up that
wellness program.
We hope between that webinar and today's event and feeling free to be in touch with any of
us with any questions or concerns, we can help you move forward in the work that you're
trying to do in your own communities.
Thank you again for joining us.
When you exit today's webinar, you'll be prompted to please submit an evaluation.
We hope that you will tell us what you thought about today's session as well as give us some
recommendations for some future topics.
Again, thank you to Chacku and Ron, Andy and Cheryl, and Deron for the time and expertise
that you offered today.
We hope everyone has a great day.
Deron Drumm: Thanks guys.
Chacku Mathai: Well done.
Dr. Ron Manderscheid: Thank you, Chacku.
Everybody.
Wonderful presentations.
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