Is Counseling Integral to Buprenorphine-Assisted Opioid Addiction Treatment? Examining Counseling Participation and Treatment Retention at a Richmond, Virginia Clinic

Treatment providers in Virginia are required by law to offer counseling or referrals to all clients receiving medication-assisted opioid use disorder (OUD) treatment (American Society of Addiction Medicine, 2016; Medical Society of Virginia, 2018). Prescribing physicians widely regard counseling as a critical component of medication-assisted OUD treatment (Lin, Lofwall, Walsh, & Knudsen, 2019), and clients perceive counseling to be among the most important factors promoting recovery from opioid dependence (Hay, Huhn, Tompkins, & Dunn, 2019). Research investigating the efficacy of counseling as an OUD treatment component, however, has been equivocal to date (Brown, 2018; Dugosh et al., 2016). The current study explored associations between counseling type, counseling attendance rates, and treatment duration among a convenience sample of 71 clients receiving buprenorphine-assisted OUD treatment at a Richmond, Virginia outpatient clinic. Among early phase clients (in treatment for 1 to 11 months) only, counseling type was significantly associated with treatment length (p = .019). Among all clients, counseling attendance rate was significantly associated with treatment length (p = .006). Findings suggest that treatment phase moderates the effects of counseling on retention. While this study corroborates previous research linking counseling to positive OUD treatment outcomes for some clients (Dugosh et al., 2016), results emphasize the need for individualized, client-centered treatment planning with ongoing adjustment according to evolving client needs and treatment goals

The stark implications of abolishing child welfare: An alternative path towards support and safety

Abstract: Scholars and advocates are at odds about how to achieve higher levels of child safety and permanency. Calls for change include the recent upEND focus on eradication of child welfare services to a radical refocusing of the present system towards prevention/early intervention. To clarify the implications of reform over abolition, we seek to portray a future in which the abolition of child welfare has occurred, in juxtaposition to maintaining four core elements of established child maltreatment programmes around the world: (1) receiving and responding to community signals about the risk to children; (2) assessment of need coupled with a proportionate response; (3) rights protections to ensure fairness when placement outside the family is required; and (4) procedures for accountability and quality improvement. For each of these functions, we outline abolitionist advocates' positions and implications for children and parents. Across these elements, we delineate how assigning these responsibilities to communities, as suggested by upEND, would likely (1) exaggerate racial and economic inequities and (2) create structural barriers that would increase harm to children. We suggest several evidence‐informed enhancements to practice, research and policy that would mitigate these inequities while also increasing safety and permanency