Introduction

In 2003, the Vermont Legislature passed Act 53, “An Act Relating to Hospital and Health System Accountability…” Under this new law, each hospital in Vermont will produce a Community Needs Assessment that projects a four-year vision.

The Vermont Department of Health defined the Brattleboro Service Area as the sixteen (16) towns shown on the map on the title page of this document. This area includes two regional high schools – Brattleboro Union High School, in Brattleboro, and Leland & Gray High School, in Townshend. The area is served by three hospitals – Grace Cottage Hospital, Brattleboro Memorial Hospital and the Brattleboro Retreat. Patients are referred to the three hospitals, each of which has its own particular niche.

Brattleboro Memorial Hospital concentrated on the towns within the Connecticut River and Route 9 corridors, while Grace Cottage Hospital covered the towns in the hills and valleys along the West River. It should be noted that the towns of Athens and Grafton, which are contiguous to Townshend and are served by Grace Cottage Hospital, were included in the qualitative survey process, but were excluded from the quantitative data as they were assigned to the Springfield Service Area by the Vermont Department of Health.

Qualitative Data
Grace Cottage Hospital conducted a qualitative assessment of the healthcare-related needs of the community during the summer and fall of 2004. A healthcare needs assessment survey of eleven (11) questions was developed. The first section of questions assessed the respondents’ views of health care services in the area. Respondents were then asked to prioritize the top three (3) health care needs not addressed in the area. The second section of questions assessed the respondents’ views of health care services at Grace Cottage Hospital. Respondents were then asked to prioritize the top three (3) health care services (currently not available at Grace Cottage) that they would like to see added.

The questions included in the healthcare needs assessment survey were developed at a community meeting attended by twelve (12) people – including community members and Grace Cottage staff members, facilitated by The Medical Foundation of Boston MA, and held at Grace Cottage Hospital on June 21, 2004. An abbreviated survey was posted on Grace Cottage Hospital’s website and resulted in twenty-seven (27) submissions. In addition, Grace Cottage recruited ten (10) volunteers from the community, who were trained in effective interviewing techniques by The Medical Foundation. The volunteers conducted forty-seven (47) face-to-face interviews of individuals in the community from within the demographic groups listed below.

Business: Stratton Mountain, Inc. # Employees 1,800
Business: Townshend Business Association # Employees 375
Business: WCSU School District # Employees 279
Business: Windham Foundation # Employees 110
Govt: Athens
Govt: Brookline
Govt: Grafton
Govt: Jamaica
Govt: Newfane
Govt: Stratton
Govt: Townshend
Govt: Vt State Representative
Govt: Vt State Representative
Govt: Wardsboro
Govt: Windham
Govt: Winhall
Health: Council on Aging of Southeastern Vermont
Health: Dentistry
Health: Grafton Fast Squad
Health: Mental Health
Health: LGUHS/HCRS Mental Health
Health: NewBrook Fire & Rescue
Health: WCSU Health & Wellness Committee
Health: Visiting Nurses Alliance of Vermont & New Hampshire
Org: Alliance for Building Community, Youth Council
Org: Mt Lebanon Masonic Lodge
Org: Newfane Garden Club
Org: Pathfinders Snowmobile Club
Org: Valley Lions Club
Org: Windham Regional Commission
Org: Women’s Community Club of Grafton
Org: Church: Athens
Org: Church: Newfane
Org: Church: Townshend
Org: Church: Catholic, Townshend
Org: Church: SDA, Townshend
Public: Young Adult(s) with Children
Public: Young Adult(s) without Children
Public: Adult(s) with Elderly Parent
Public: Adult(s), single, mature

Forty-seven (47) healthcare needs assessment surveys were generated from this face-to-face interview process conducted by the trained volunteers. During September and October 2004, the Health Care Needs Assessment Survey was also posted on the hospital’s website in both an on-line and down-loadable format. Press releases were published in the local newspapers Brattleboro Reformer and The Original Vermont Observer, soliciting input from the general public and a news article was written by a reporter from the Brattleboro Reformer, encouraging web survey responses. Twenty-seven (27) surveys were submitted via the web site.

Soliciting Public Input and Comment

Summary of the 2004 public meeting
The survey results were collated and presented at a public meeting held in November 2004 at which workgroups prioritized the healthcare-related needs of the community using the information collected through the surveys. Twenty-five (25) people attended this meeting. Following a brief presentation of the results of the on-line surveys and interviews, the attendees broke into four work groups to identify and prioritize the health care needs of the area. The results of the workgroups, as reported back to the large group, were surprisingly uniform. Three community health improvement areas were identified as priorities and developed into a four-year community action plan with outcomes and indicators listed below.

Summary of the 2006 public meetings
Grace Cottage Hospital held two public meetings in 2006 which were publicized in the local newspapers, Brattleboro Reformer and The Original Vermont Observer, which cover the towns in the hospital’s service area.

• The first meeting was held January 18, 2006 in the Bock EMS Training Center at Grace Cottage Hospital. The purpose of this meeting was to solicit public comment and feedback on the 2004 Community Needs Assessment, hard copies of which were available at the meeting. No members of the public attended this meeting.
• The second public meeting was held September 25, 2006 in the Community Dining Room at Grace Cottage Hospital. The purpose of this meeting was twofold: to solicit public input regarding the recently updated 2005 Community Report Card and to report on progress being made on the four-year action plan of the 2004 Community Needs Assessment. Hard copies of both reports were printed for this meeting. Two members of the public were in attendance.

Outcomes with quantitative and qualitative indicators were developed in November 2004 for the top three (3) health care needs of the area. According to the Vermont Agency of Human Services, outcomes (sometimes referred to as “results”) are expressions of a shared vision for individual, family or community well-being, and indicators are the steps required to achieve the outcomes. The outcomes listed below dovetail with the outcomes used by the Vermont Agency of Human Services to guide its work throughout the State of Vermont.

Priority Outcome #1: Elders and People with Disabilities Live with Dignity and Independence in Settings They Prefer

Strategy
Work on developing a continuum of safe affordable housing with supportive services based in Townshend. Integrate and expand home and community-based services to benefit residents of the housing project and the community at large. Help provide greater access to home and community-based services by working to improve medical-related transportation for the elderly and by obtaining public and private funding to help offset program costs.

Indicators

• Increase the number of adults (age 65+) in the West River Valley who subscribe to home and community-based services
• Increase percentage of adults (age 65+) who are satisfied with elderly housing options in the West River Valley
• Increase the number of adults (age 65+) who are counseled by a primary care professional about health behaviors (including exercise, diet, mental health, periodic screenings, immunizations, and home safety)
• Reduce hospitalizations among adults (age 65+) due to pneumonia/influenza, poor nutrition, and falls/accidents
• Reduce over time the number of nursing home admissions for the frail elderly in the service area

2006 Update
An informal group of local citizens, healthcare providers, and experts in the fields of eldercare, housing, and community development began meeting to plan a continuum of service-enriched elderly housing in the West River valley. Valley Cares, Inc., incorporated in December 2004, was born from this process.

Since that time, Valley Cares has partnered with Housing Vermont, a non-profit housing developer in Burlington, VT. This partnership has now raised $9.3 million in public and private funding for construction of a housing development containing 28 units of assisted living and 24 units of independent living. The design and permitting process for the project consumed much of 2005-2006. Construction began on Grafton Road in Townshend October 2006 and should reach completion by December 2007. For more information visit www.valleycares.org

Priority Outcome #2: Adults Lead Healthy Productive Lives

Strategy
Perform planning, outreach and project development activities related to creating an integrated prevention and education program in the community. Assess feasibility and, if feasible, develop opportunities for community-based screening and healthy lifestyles initiatives.

Indicators

• Increase the percentage of people who have specific, on-going primary care
• Increase the number of people counseled by a primary care professional about health behaviors (including smoking cessation, physical activity, diet, and cancer screening)
• Increase the number of adults with diabetes, asthma, and other chronic conditions who receive formal education to manage their disease

2006 Update
In addition to the community education programs offered in the past, Grace Cottage Hospital has now added an Arthritis Foundation Self-Help program for the public, which runs one day a week for six (6) weeks, three (3) times a year. The osteoporosis-prevention course, Strong Living, has seen such an increase in demand that more classes have been added and two more volunteer leaders are waiting to be trained by Tufts University.

With the objective of raising health awareness, speakers from Grace Cottage have attended the local Senior Congregate Meals, and worked with Windham Central Supervisory Union, Mount Snow Ski Resort, Mary Meyer Inc., and CIC Inc.

Grace Cottage Hospital was one of the eight (8) hospitals participating in the Vermont Diabetes Information Systems Project (VDIS). 203 patients from Grace Cottage’s physicians’ practices were involved. Unfortunately, due to problems with computer interfacing, the University of Vermont was unable to process the data that Grace Cottage sent and Grace Cottage Hospital needed to withdraw from VDIS.

The Anticoagulation Clinic at Grace Cottage, initiated during the summer of 2004, is a comprehensive approach to counseling and monitoring patients with heart and circulatory conditions requiring oral anticoagulation therapy. This clinic has been well-received in the community and the clinical pharmacist now has more than 100 patients with whom she is meeting. The primary care physicians at Grace Cottage are consistently sending new referrals and Grace Cottage is currently looking to add another pharmacist to the roster so that the clinic can accommodate more patients.

Priority Outcome #3: Youth Choose Healthy Behaviors

Strategy
Improve adolescent health by collaborating with Windham Central Supervisory Union and local schools to enhance the district’s Comprehensive School Health Program. Concentrate and develop resources to help improve health education, form stronger links between the schools and primary care, preventive care and health promotion services, and help the school district engender greater parent-community involvement through its School Health Advisory Council.

Indicators

• Increase adolescent skills regarding health-related interactions; increase personal care and hygiene behaviors
• Increase healthy attitudes and behaviors among adolescents as indicated by Youth Risk Behavior Survey data related to alcohol, tobacco, and other drug use, sexuality, personal safety, and other relevant lifestyle indicators

2006 Update
Stronger collaboration between Grace Cottage Hospital, the local schools, and area health agencies has been achieved in helping youth choose healthy behaviors.

Grace Cottage Hospital currently makes the services of medical professionals available for on-going health education in the classrooms at the local elementary schools as well as at Leland & Gray High School. Topics include tobacco-caused disease and tobacco cessation, general health, and healthy travel (many of the high school students participate in trips abroad, including a month in China).
Condoms are now being made available, at no charge, in the rest rooms of the Grace Cottage Family Health physicians’ offices. The Brattleboro Area AIDS Project has begun donating condoms to meet the ever-increasing demand. Students at the high school, which is located one block from the physicians’ offices, know that the condoms are free and available, so the baskets in the restrooms are emptied almost as soon as they are filled. Students are now approaching individual staff members to ask about obtaining condoms if the baskets are empty.

Leland & Gray High School, in an organized effort to help students make healthy behavior choices outside of school hours, now has a volunteer Activities Coordinator who matches students with after-school activities. This has been a boon to those students who are not oriented towards sports, music or drama activities (which have been available through the high school for many years).

Community Health Care Resource Priorities

The continuum of safe, affordable housing called for in Priority Outcome #1 is not technically a healthcare issue. But this community has designated elder housing as a health-related issue and is looking for funding beyond the healthcare field.

The serious substance abuse, mental health and lifestyle issues identified as a priority need within the adolescent population addressed in Priority Outcome #3 involve not just hospital resources, but also involve education funding (through Windham Central Supervisory Union and Leland & Gray High School), mental health funding and substance abuse funding through the Vermont Department of Health and other funding sources. In addition, the following local organizations were identified in the survey and prioritization process as being important resources for the community’s adolescents:

• Grace Cottage Hospital
• Windham Central Supervisory Union school district
• Health Care and Rehabilitation Services, a non-profit organization with local offices in Brattleboro and Bellows Falls is the area’s designated Mental Health Agency
• Youth Services of Windham County, a non-profit organization based in Brattleboro, provides Substance Abuse Professionals (SAPs) to Leland & Gray High School
• Planned Parenthood of Northern New England, a regional non-profit organization with an office in Brattleboro, was identified by the community as having expertise in adolescent reproductive health

Each of these agencies has limited financial resources to bring to bear on these serious issues, which is seen as an impediment to successfully achieve the priority outcomes and is a major concern for the community.

More Information

Detailed information or hard copies of the 2004 Community Needs Assessment can be obtained by contacting Grace Cottage Foundation at info@gracecottage.org or (802) 365-9109.

Back to top