by Louis Josephson, PhD Vermont is fortunate to have an established system of outpatient care for people who are recovering from opioid addiction. In fact, our state’s Hub and Spoke system has been nationally recognized as a model for other states struggling with the current opioid epidemic. Hub and Spoke has been in place in Vermont since 2012. To understand its basic structure, Hubs are opioid treatment programs located across the state. They provide daily dosing of medications like buprenorphine (a medicine that lessens the effects of physical dependency to opioids, such as withdrawal symptoms and cravings).
Spokes are office-based physicians who prescribe buprenorphine to patients who have graduated from Hubs. Both aspects of the program involve the supervised administration of medications combined with counseling and behavioral therapies.
While this approach has proven to be more effective and less costly over time than other forms of treatment for opioid addiction, the intensive nature of the Hub and Spoke model (often requiring treatment over an extended period) has posed some challenges for people who are working to achieve and maintain recovery.
One of the most significant challenges for parents is childcare. That’s because daily appointments at a Hub can take between 30 and 90 minutes. And for a variety of clinical and safety reasons, children may not accompany their parent while he or she receives treatment.
Over time we have come to understand the negative impact this situation has had on people’s ability to participate in treatment, often forcing parents to make heartbreaking decisions between leaving their children in sub-optimal settings or dropping out of treatment.
Thanks to input from a variety of concerned community members affiliated with groups including the Building Bright Futures regional council, the Windham Childcare Association, It Takes a Village, the Vermont Department of Health’s Division of Alcohol & Drug Abuse Programs, and Children’s Integrated Services at Winston Prouty, my hospital, the Brattleboro Retreat, is opening a free, short-term childcare program to serve children whose parents are receiving care through our Hub program. Quality childcare, in my view, is an essential ingredient that strengthens the fabric of families and communities. It has also become nothing less than a requirement for working mothers and fathers in a society where two income households have become the norm. Extending these services to people in treatment and recovery from opioid addiction seems like a natural extension of the role of childcare and early learning in our society.
I am proud that the Retreat is launching this first-of-its-kind program in Vermont. And I hope our program, called The Welcoming Place, will serve as a model for other hospitals and healthcare centers across the state and nation.
The Welcoming Place will provide much more than a safe place for children to wait for their parents as they complete daily treatment. It is a true early learning center. It was designed and will be run by early childhood professionals who will provide children with opportunities to develop their social, emotional, physical, and cognitive abilities.
Research tells us that children who have access to positive supports and opportunities to grow and learn will enjoy better health later in life. This means we are twice blessed to know that this new program will not only allow parents to remain in treatment and maintain a strong recovery, but will also contribute to positive health outcomes for young people farther down the path of life.
Dr Louis Josephson is the President and CEO of the Brattleboro Retreat