Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Brattleboro Retreat

Name of Innovative Program: 
Brattleboro Retreat Uniform Services Program
Sponsoring Organization
Brattleboro Retreat
Name of Innovative Program Lead: 
Dr. Robert Simpson
E-mail Address of Innovative Program Lead: 
rsimpson@brattlebororetreat.org
Project Description: 
 In 2009 the Brattleboro Retreat implemented a niche program to serve America’s heroes: those who serve the nation as uniformed professionals. The Uniformed Services Program provides 24 hour a day admission and rapid intensive intervention for the treatment of PTSD and its clinical sequela, including alcohol and substance abuse, depression, and suicidality.This population often experiences intense trauma at work. Additionally, issues of shame, stigma and fear of repercussions decrease the likelihood of engagement in treatment. As a result, individuals coming into this level of intensive treatment have exceeded the standard norm for tolerance of their symptoms. In most cases they are facing significant life stressors, such as loss of employment and relationship discord. The USP provides innovative individual and group treatment using specially designed protocols to assist in the return to health for these men and women. 
Creativity and Innovation: 
 The USP is an original program using Acceptance and Commitment Therapy (ACT) as an organizing approach to treating different uniformed service professionals in group therapy. The program offers from an ACT perspective a variety of groups: mindfulness, ACT, stages of change, sleep, and dream therapy, chronic pain, yoga, family therapy, adventure programming, and specialty groups like work culture themes and ideology. Group coherence across the program curriculum provides for consistency. A focus on learning by doing through experiential exercises in groups gives patients access to tactile learning used commonly in the uniformed service professions. Actively performing and participating in activities helps patients to derive meaning from direct experiences.In addition, the USP offers a unique intensive outpatient program for posttraumatic stress disorder (PTSD). Developed at the USP, the treatment uses ACT with mental imagery and movement to construct and treat dynamic expectations of trauma memories in uniformed service professionals. 
Leadership: 
 To develop innovative leadership for this specialty program we embarked on a collaborative relationship with the University of Massachusetts’ Department of Psychology in which the Retreat began training interns in the university’s re-specialization doctoral program. Our program director, a retired police officer with Ph.Ds. in both research and clinical psychologies, began as an intern. As an intern he was instrumental in the design of clinical protocols for the program. As an academic, he is well published and rigorous in his research. As a former police officer, he has substantial credibility with both referral sources and patients themselves.This ongoing collaboration with UMASS allows the program access to innovative and upcoming leaders in the fields of neuro-psychology and seasoned clinical and research faculty. In the past year, program leaders have presented our unique treatment protocols at conferences, police and fire departments across the country in the past year.
Sustainability: 
 Support for innovation and delivery services has come from donors like Verizon. Recently, the USP received a $10,000.00 donation to use technology in the delivery of support services. We developed an Aftercare Outpost, a web portal that now provides USP alumni with lifelong support and resources for returning to valued living.Building relationships with other stakeholders vested in providing services to uniformed service professionals is important. We have developed and presented a specialized training seminar to help agencies establish a continuity of wellness training from pre-service to treatment. For mental health professionals, the USP also offers a specialized training seminar to assist them in the delivery of psychological services to uniformed service personnel. These training seminars introduce a model of mental health and wellness that can influence healthy changes in uniformed service professionals’ resiliency, vulnerability, valued living, and work performance.
Replicability: 
 The program staff of the USP has developed standardized procedures for delivering the program curriculum to minimize the variability within each treatment group and across the treatment program to ensure that patients are treated essentially the same. Standardized aspects of the treatment setting include admission and discharge flow, group content and targeted processes, group time, program schedule, aftercare planning, and patient assessment. These standardizing procedures make it easier for other mental health professionals to understand the delivery of the program and outcome data, and to replicate and implement the program in their own treatment facility.
Results/Outcomes: 
The USP uses the Treatment Outcome Package (TOP) to assess patients’ strengths, psychopathology, and track patients’ improvement during and after treatment. The TOP assesses a wide variety of behavioral health symptoms, functioning, and demographics. The clinical scales assess symptom and functional domains including: work functioning, sexual functioning, depression, life quality, anxiety, mania, substance abuse, sleep, suicidal ideation, and violence. Since implementing the TOP in September 2012, patients (n = 205) who completed it at the start and end of care reported significant decreases in the domain areas of depression, substance abuse, social conflict, sleep, suicidality, and problems in the workforce,  as well as increases in life quality.
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