Our Community Health Team (CHT) holds monthly public meetings to collaborate and partner with area agencies to remove barriers and improve access to care. The team now approximates 45 organizations and communicates regularly with hundreds of individual participants. New members are welcomed at each meeting as word of the team spreads throughout the community. The Team serves as a central community contact point (similar to a hub and spoke model) to facilitate communications, networking and collaboration among all area services.

Services to help manage pain and symptoms, provide emotional and spiritual support, coordinate community resources and end-of-life planning, and include home health aides and 24/7 nurse support. An interdisciplinary team of doctors, nurses, aides, social workers, spiritual care counselors, and trained volunteers creates individualized care plans for patients and supports families. Hospice care can be provided wherever the patient lives, is covered by Medicare and most insurance, and can be started or stopped at any time. VNH also offers ongoing support for families after a loved one’s death, including bereavement groups.

Skilled nursing support for expectant mothers and children, focusing on wellness education, development, feeding, immunizations, and connecting families with medical homes and community resources. The program also includes pediatric palliative care to help relieve symptoms and improve quality of life for children with life-limiting illnesses. In partnership with Strong Families Vermont, nurses offer free home visits from pregnancy through a child’s second birthday to support parenting and healthy family development.

VNH offers assistance with errands, transportation, housekeeping, personal care (like bathing and dressing), meal preparation, medication reminders, and companionship, with flexible scheduling and no upfront cost. VNH also provides long-term care options through Medicaid-sponsored programs that include case management, personal care support, respite/companion care, adult day services, emergency response systems, and home modifications to support independence at home.

Services include skilled nursing care to assess and treat health needs in collaboration with physicians, and rehabilitation therapies (physical, occupational, and speech) to support recovery and daily functioning. VNH also offers home health aides for basic health tasks and daily living assistance, and medical social work to help patients and families with emotional support and access to community resources. The program serves people of all ages, may be covered by Medicare and other insurance, and requires a physician referral for certified home health care.

Valley Health Connections helps patients establish with a Primary Care Provider (PCP) by helping to fill out new patient paperwork and assisting with calls to set up an appointment.

Valley Health Connections can help patients in our service area access cleanings, extractions, x-rays, dentures, and other necessary treatment. We cannot assist with dental implants, braces or cosmetic procedures. Dental funding is limited and based on available grant funds.

Licensed Mental Health Clinician from the Brattleboro Retreat for 40 hours/ week – offering early recovery and clinical counseling support to clients and residents of our shelters.
Vulnerable Population Care Coordinator is a RN from Brattleboro Memorial Hospital (BMH) available on-site for 24 hours/week. VPCC helps clients to connect with a PCP, makes referrals to dental, mental health, and other specialists, and may accompany clients to medical appointments as an advocate.
Case Manager from HCRS (Health Care and Rehabilitation Services) on site at Groundworks for 16 hours/week providing outreach and engagement to those struggling with substance use.