Brattleboro Retreat approves strategic plan

By Pamela Berard
October 1st, 2017

Responding to challenges facing mental health and addiction treatment providers nationwide, Brattleboro Retreat of Vermont has approved a three-year strategic plan.

President and CEO Louis Josephson, Ph.D., said Brattleboro Retreat is facing increasing demand for services in an era of falling or flat reimbursement rates. The new strategic plan takes on these and other challenges with a four-pronged approach: Focus on clinical excellence; Achieve financial stability; Increase accountability; and Re-envision the campus.

When crafting the plan, the Retreat cast a broad net in talking to various stakeholders. “That feedback did sync up with what we are trying to do,” Josephson said. “It’s not a super glamorous plan. It’s more like we are just going to really get ourselves in great shape, with all of the challenges swirling around on healthcare.

“The best shield in all of this is doing great work with patients,” he said. “That’s our best protection.”

Josephson said he believes patients are facing increasingly complex medical challenges in recent years and Brattleboro Retreat has been seeing more acute cases. As part of a focus on clinical excellence, the facility introduced evidence-based clinical practices in all programs and services. Among changes, Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT), both treatments based on concepts of mindfulness, are being adopted by programs across the Retreat.

“When I got here a year-and-a-half ago, I really wanted to upgrade our core foundation clinical practice in our inpatient units and residential care,” Josephson said. “So, we opened up a survey to 350 direct care staff and said we wanted to move toward evidence-based practices.”

Staff were given options to consider. “ACT and DBT were the two that rose to the top,” Josephson said. Josephson said two issues that frequently bring patients into the inpatient setting are trauma and emotional dysregulation. “Both ACT and DBT really work well for those symptom clusters,” he said. “In addition, we really liked ACT because it’s very much of a trans-diagnostic model. In some of our units, we have a mixed diagnostic picture so we needed a model that talked to people at different points in their health needs.”

In the past year, the Retreat has invested more than a quarter-million dollars training workers on one of those two models to be a core foundational practice.

Additionally, Brattleboro Retreat is optimizing its electronic medical records and improving access to services through its telemedicine program, bringing the expertise of its medical staff to hospital emergency departments across the state through telemedicine.

It has a program with one local hospital set to begin this fall and in late August had eight letters of interest from other hospitals throughout the state. Because Retreat staff know the mental health system well, they can help emergency departments better and more quickly direct patients to appropriate services and medications, Josephson said.

Brattleboro is also instituting a child care center to watch the children of patients for a short time, while the parent receives treatment.

The Retreat is taking steps to optimize its electronic medical records and implementing a modernization plan for its financial systems to invest in the technology, talent and training to best manage healthcare reimbursement; and to improve cash flow and realize an annual operating margin to best support its long-term financial needs.

As part of its effort to increase accountability, the plan calls on the organization to clarify the roles and expectations of all employees, while providing the training and support they need to perform at their best. The Retreat is working to overhaul its performance management process and bring new ideas to recruitment and retention efforts.

As part of re-envisioning the campus, the Retreat is establishing a capital planning process that assesses risks and creates action plans to ensure patient and staff safety.

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