Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Brattleboro Retreat

Name of Innovative Program: 
Emerging Adult Inpatient Program
Sponsoring Organization
Brattleboro Retreat
Name of Innovative Program Lead: 
Dr. Robert E. Simpson, Jr.
E-mail Address of Innovative Program Lead: 
rsimpson@brattlebororetreat.org
Project Description: 
In 2013, the Brattleboro Retreat launched the Emerging Adult Program to provide inpatient psychiatric and addiction care for young men and women ages 18—26 who are experiencing mental health and addiction challenges that can be compounded by the unique problems commonly associated with this time of life. These challenges include breaking free from parents, establishing long-term adult relationships, establishing career goals, and becoming financially independent.Research indicates that the onset of major psychiatric illnesses such as schizophrenia, bipolar disorder, and clinical depression occurs most commonly in the 18—26 age range. With this in mind, the Retreat’s Emerging Adult program is designed to offer empirically-based, trauma-informed treatment approaches for a wide variety of psychiatric and addiction disorders that are customized to focus concurrently on a range of challenges specific to this age group including  employment, relationship issues, communication with parents, and coping with stress.
Creativity and Innovation: 
The concept of “Emerging Adulthood” as a distinct period between adolescence and full-fledged adulthood is a relatively new one, proposed by Jeffrey Arnett in 2000. Arnett defined the 18-26 year-old range as unique demographically, subjectively, and in terms of identity exploration, also representing a peak time for risk behaviors and first onset of major mental illness.From Arnett’s concept, the Retreat identified an opportunity to improve health outcomes by addressing the lack of mental health and addiction treatment options responsive to this demographic’s unique needs.  In launching its Emerging Adult program, the Retreat positioned itself as a healthcare innovator by offering a tailored treatment approach for this group.  No hospitals in the region, and few in the nation, are currently offering similar programs.  Timing is key to this innovation’s success—more “emerging adults” are now covered by parents’ insurance through the Affordable Care Act, opening new access to healthcare services.
Leadership: 
The Emerging Adult program is led by a “triad team,” including the unit’s chief psychiatrist, lead social worker, and clinical nurse manager.  These leaders will engage in the Retreat’s Leaders Developing Leaders (LDL) process, creating a culture of transformational leadership and imbedding it into the performance management system.  As unit leadership completes the LDL program, they in turn will instill the core leadership principles with unit staff.Externally, the Retreat shares its knowledge with the broader community.  With a 180-year history, the Retreat has more recently solidified its leadership as a behavioral healthcare provider by establishing a series of specialty programs.  The Emerging Adult program will join the Retreat’s LGBT Inpatient program and Uniformed Services Program in serving specific populations with tailored treatment approaches.  The leaders of these specialty programs have become educational resources by speaking to other clinicians, educators, and peers about best practices in treating these populations.
Sustainability: 
With a strong program census (full capacity is 12 beds), the Emerging Adult program will be self-sustaining through insurance payments and patient self-pay.  The Retreat will secure philanthropic support for environment of care improvements, special programming, and patient scholarship or “charity care” for those lacking sufficient resources or insurance to afford treatment. The Brattleboro Retreat has embarked on a robust outreach and education campaign to ensure the program is known and accessible to emerging adults in need of care.  Outreach efforts have focused on potential referral sources in the region, including emerging adults (self-referrals), parents, college and university dean of students and health clinics, primary care physicians, emergency departments, and specialty care physicians, including outpatient psychiatrists.By offering detailed aftercare plans to patients and personal follow-up with referral sources, the Retreat supports patients’ success and creates channels for program feedback, both essential to the program’s ongoing success.
Replicability: 
The initial response to the Emerging Adult program has been strong and positive, indicating the Retreat correctly identified a need and created an appropriate response.  While patients have come to the program in its first months from as far away as Colorado and North Carolina, most of the patients have been from the New England region.  With the programming running at close to 100% capacity since its inception, similar programs in other regions could prove successful by providing a similar and effective treatment option for the emerging adult population.As a leading behavioral healthcare provider, the Brattleboro Retreat, led by CEO Dr. Robert Simpson, and its Emerging Adult team, led by unit chief Dr. Debra McQuade, presents a willingness and enthusiasm to share best practices learned from serving the emerging adult population with other behavioral and medical health care providers.
Results/Outcomes: 
The Retreat measures program performance quantitatively and qualitatively, answering questions of  “how much” and “how well” the program is doing.Quantitatively, early response has reflected the strong need for the program.  Launched in October, 2013, the Emerging Adult program operated at close to full capacity (90%-100%) from its first day.  In its first months, the program served 91 patients representing eight states. Qualitative outcomes are measured through changes in patients’ self-reported symptoms and feedback collected by “Perceptions of Care” survey at discharge.  Successful outcome benchmarks focus on achieving and maintaining patient safety, resolving symptoms, helping patients better understand how to cope with their illness and address problems as they arise. Early Perceptions of Care comments reflect positive experiences, including:  “It was one of the best experiences in my life.”“Thank you all for making the beginning of my treatment as painless as possible.”“(This) support has saved my life.”
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