• Please note: Days are attributed to the quarter of admit, though complete numbers may not be reflected until all admits of a quarter have discharged.

This measure is important because it shows the number of days and the reasons why the Clinical Integrity Unit (CIU) authorizes days to cover disposition delays for children and adolescents at the Brattleboro Retreat (BR).  Disposition delays are when children/adolescents at the BR are no longer meeting acute level of care (LOC) but are unable to discharge. 

The Brattleboro Retreat (BR) provides essential capacity to Vermont’s mental health system of care; they are the only inpatient psychiatric facility that serves children and adolescents in Vermont. When a member is no longer meeting acute LOC criteria, the goal is to discharge the member to a lower LOC to include residential placements, step down (e.g., Hospital Diversion), or to the community with outpatient supports.  The BR is not responsible for disposition delays; rather, these are situations such as the member is waiting for residential LOC and can’t return to the community in the interim; the member refuses to return home with the parent/guardian; or the parent/guardian refuses to pick the member up upon discharge.  

Representatives from DCF, DMH, DVHA and the BR meet weekly to discuss members with potential disposition issues and to problem solve so that members who are not meeting acute LOC do not remain inpatient longer than necessary.  There are limited residential placements in the State of Vermont, currently there are approximately 95 residential beds. A member must be approved by the Case Review Committee (CRC) for a referral to be made to a residential placement.  Once a member is accepted into a residential placement, waitlists can be several months.  The member’s local team explores interim placements while members wait for residential treatment if a member can be held safely in the community.  Therefore, stays at the BR can be extended while a member waits for residential treatment.     

In the data above for CY23 Q1, there was an increase in the number of disposition days. There were two outlier situations in which members were admitted in January, were stable and clinically appropriate for discharge, but did not discharge for several months due to disposition issues related to member’s complex presentations. We saw a downward trendline for CY23 Q2. For CY23 Q3 was a significant increase in the number of disposition days. This is attributed to an increase in members with disposition delays from Q2 to Q3. For CY23 Q4 we are initially seeing an upward trendline, yet it is important to note that this data is not final until open admissions close and members are discharged. 

Narrative last updated: 04/16/24

• Brattleboro Retreat 
• Department of Children and Families (DCF) 
• Department of Mental Health (DMH)
• Department of Aging and Independent Living (DAIL)

DVHA, DMH and BR have weekly calls to discuss complex cases including disposition delays. Additionally, there are biweekly Shared Response to Emergency Placements meetings that include AHS partners (DVHA, DMH, DAIL), during which discussions cover specific cases, challenges in the system of care, and how to align the system of care.  DVHA has also worked with a Vermont Special Services Agency (SSA) to expand the type of presentation of members that they would accept who need treatment outside of acute stabilization level of care.