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Act 140, Section 5: Brattleboro Retreat Conditions of Funding a 2021

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Act 140, Section 5: Brattleboro Retreat Conditions of Funding a 2021 ACT 140, SECTION 5: BRATTLEBORO RETREAT CONDITIONS OF FUNDING A 2021 REPORT TO THE LEGISLATURE 280 STATE DRIVE, NOB 2 NORTHWATERBURY, VT 05671 I PHONE: 802-241-0137 I FAX: 802-241-0100 Vermont Department of Mental Health A Report to the Legislature: Act 140, Section 5: Brattleboro Retreat 1 Vermont Department of Mental Health TABLE OF CONTENTS Requirement ................................................................................................................................................................................ 3 Overview ...................................................................................................................................................................................... 4 Patient Experiences and Quality of Care ..................................................................................................................................... 6 DMH Quality: Hospital Inpatient Unit Designation .............................................................................................................. 6 Patient Care Experiences: Data from Inpatient Consumer Survey 2018 – 2020 ................................................................. 6 Treatment Quality: Rates of Inpatient Hospital Readmission within 30-days ................................................................... 12 Brattleboro Retreat Patient Grievances ............................................................................................................................ 16 Summary of Grievances ..................................................................................................................................................... 18 Brattleboro Retreat Relationships with the Designated Agencies 2021 ............................................................................ 21 Connecting with Vermont Psychiatric Survivors During the Covid Pandemic ................................................................... 22 Brattleboro Retreat Average Length of Stay Data ............................................................................................................. 23 NRI Behavioral Healthcare Performance Measurement System (BHPMS) 2019-2020 ..................................................... 26 Brattleboro Retreat Inpatient Care: Emergency Involuntary Procedures ......................................................................... 29 Brattleboro Retreat Quality Improvement Project: Six Core Strategies ............................................................................ 36 DMH Quality: Emergency Involuntary Procedure / Certificate of Need Review Process .................................................. 37 Designated Agency: Brattleboro Retreat Collaboration .................................................................................................... 38 Disability Rights Vermont and Vermont Psychiatry Survivors: Collaboration with Brattleboro Retreat ........................... 42 Status and Next Steps ................................................................................................................................................. 43 Attachment 1: Brattleboro Retreat Re-designation Letter Attachment 2: 2019 DMH Quality Report Attachment 3: Brattleboro Retreat-NRI HBIPS Monthly Comparison Charts with Targets Attachment 4: Comments Offered by Disability Rights Vermont A Report to the Legislature: Act 140, Section 5: Brattleboro Retreat 2 Vermont Department of Mental Health REQUIREMENT H.960 (MISCELLANEOUS HEALTH CARE BILL) – CONDITIONS OF STATE FUNDING Sec. 5. BRATTLEBORO RETREAT; CONDITIONS OF STATE FUNDING a) Findings. In recognition of the significant need within Vermont’s health care system for inpatient psychiatric capacity, the General Assembly has made significant investments in capital funds and in rate adjustments to assist the Brattleboro Retreat in its financial sustainability. The General Assembly has a significant interest in the quality of care provided at the Brattleboro Retreat, which provides 100 percent of the State’s inpatient psychiatric care for children and youth, and more than half of the adult inpatient care, of which approximately 50 percent is paid for with State funding. b) Conditions. As a condition of further State funding, the General Assembly requires that the following quality oversight measures be implemented by the Brattleboro Retreat under the oversight of the Department of Mental Health: 1) allow the existing mental health patient representative under contract with the Department pursuant to 18 V.S.A. §7253(1)(J) to have full access to inpatient units to ensure that the mental health patient representative is available to individuals who are not in the custody of the Commissioner; 2) in addition to existing policies regarding the provision of certificates of need for emergency involuntary procedures, provide to the Department deidentified certificates of need for emergency involuntary procedures used on individuals who are not in the custody of the Commissioner; and 3) ensure that the mental health patient representative be a regular presenter at the Brattleboro Retreat’s employee orientation programming. c) 1) Patient experience and quality of care. To support proactive, continuous quality and practice improvement and to ensure timely access to high-quality patient care, the Department and the Brattleboro Retreat shall: A. to the extent feasible by the Department, meet jointly each month with the mental health patient representative contracted pursuant to 18 V.S.A. § 7253(1)(J) and the mental health care ombudsman established pursuant to 18 V.S.A. § 7259 to review patient experiences of care; and B. identify clinical teams within the Department and the Brattleboro Retreat to meet monthly for discussions on quality issues, including service delivery, clinical practices, practice improvement and training, case review, admission and discharge coordination, and other patient care and safety topics. 2) On or before February 1, 2021, the Department shall report to the House Committee on Health Care and to the Senate Committee on Health and Welfare regarding patient experiences and quality of care at the Brattleboro Retreat. A Report to the Legislature: Act 140, Section 5: Brattleboro Retreat 3 Vermont Department of Mental Health d) 1) On or before October 1, 2020, as part of the reporting requirements of the Sustainability Report between the Agency of Human Services and the Brattleboro Retreat, the Agency and the Brattleboro Retreat shall submit an interim report to the Joint Fiscal Committee, and to the Chairs of the Senate Committee on Health and Welfare and the House Committee on Health Care describing the steps that the Brattleboro Retreat is taking to improve communication and relations with its employees. 2) On or before February 1, 2021, as part of the reporting requirements of the Sustainability Report between the Agency of Human Services and the Brattleboro Retreat, the Agency and the Brattleboro Retreat shall submit a final report to the Senate Committee on Health and Welfare and to the House Committee on Health Care describing the steps that the Brattleboro Retreat is taking to improve communication and relations with its employees, the Brattleboro Retreat’s assessment of the effectiveness of those efforts, and how the Brattleboro Retreat plans to manage future communications and relations with its employees. OVERVIEW The Vermont Department of Mental Health (DMH), with the Designated Hospitals (DHs), Designated Agencies (DAs), Specialized Services Agencies (SSAs) and other community and Agency of Human Services (AHS) partners, has continued to work throughout the past year to move the system of care forward within Vermont for people with mental health needs. The year 2020 introduced additional and novel challenges for advancing the mental health system of care. With the onset of the Coronavirus (COVID-19) Pandemic in early 2020, Vermont’s health care system has adapted to shifts in finances, service delivery guidelines and workforce capacity fluctuation as it became necessary to ensure a public health informed response for all Vermonters that included staying at home when possible and closure of non-essential businesses following the Governor’s executive orders put in place March 2020. Providers including the Brattleboro Retreat (the Retreat) managed staffing shortages as the workforce struggled to care for children unexpectedly home from school and shifting domestic and financial stressors, while adapting to new workplace environments or transitions to remote work requirements. The inpatient and outpatient mental health provider systems adapted and continue to adapt to new physical distancing, interactions through necessary environmental modifications and the fundamental shifts in finance, service delivery and workforce challenges. Act 190 (2018) initially provided $5.5 million dollars for the development of 12 inpatient Level-I beds at the Brattleboro Retreat. A construction agreement was completed between the Retreat and Department of Buildings and General Services (BGS) in December 2018. Renovation of space at the Brattleboro Retreat, formerly the Linden Lodge building, began in 2019 with intent to address ongoing wait times in local emergency departments for individuals in need of higher acuity inpatient psychiatric care. In 2020, COVID-19 significantly threatened the Retreat’s ability to provide mental health care to Vermonters, and the Retreat’s financial situation is tenuous due to low client
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