Kairos has had a high percentage of
young adults (ages 18-24) in residence at our adult facility
located in
Many
Coordinating Agencies, PIHP’s and commercial insurers have reported a high
incidence of recidivism with this population. Our experience indicates that
this is accurate.
The brain
continues to develop through adolescents and well into young adulthood. The U.S.
Department of Health and Human services states that “many scientists are
concerned that drinking heavily during this critical developmental period may
lead to lifelong impairments in brain function, particularly as it relates to
memory, motor skills and coordination.”
The
transition from adolescent to adulthood is a time when individuals assume new
social roles and form new identities that provide the foundation for later life.
It is also a time of great risk for substance use and mental health problems.
SAHMSA reports in the 2006 National Survey on Drug Use and Health NSDUH Report
that “substance use and mental health problems tend to be highest among person
in their late adolescent and young adult years”.
They go on
to say that “males aged 18 to 25 with past year Serious Psychological Distress
(SPD) were more likely than those with past year SPD to have engaged in heavy
alcohol use, binge alcohol use and illicit drug use in the past month than those
without past year SPD”. Our experience concurs with this research and Kairos is
professionally prepared and licensed by MDCH to provide residential treatment to
this population suffering from co-occurring disorders.
Young adults are much more likely to binge drink. The U.S. Department of Health and Human data indicates that fifty-one percent (51%) of young adults who died in traffic fatalities tested positive for alcohol. Kairos agrees with their recommendation that “more targeted, systematic approaches are needed to help young adults recognize and reduce their hazardous drinking.” (Alcohol Alert, #68, 2006.)
Young
adults addicted to alcohol or other drugs have a high probability of criminal
behavior. SAHMSA’s Office of Applied Studies reports in the Drug and Alcohol
Services Information System report, issue 21, 2006 that forty-seven percent
(47%) of young adults ages 18-25 referred to treatment in 2004 were referred by
the criminal justice system. Kairos is experienced in working with this
population both in our adolescent and adult residential programs.
SAHMSA’s
Office of Applied Studies reports that their 2005 data indicates that the use of
illicit drugs was higher for young adults aged 18-25. than for youth aged 12-17
and adults aged 26 or older. Based on this fact and other research, Kairos
believes that specialty programming needs to be available to this population.
While the
target population is defined as “adults”, our young adult modality contains
many of the components
contained in our adolescent residential model
detailed earlier in this proposal.
We have found that combining these strategies with specific components used with
older adults can be extremely effective.
Many
young adults present for treatment with education issues. Many of these
consumers have not obtained a high school diploma. The research is clear that
lack of education is a prime risk factor for this population.
The
Kairos Young Adult modality offers GED preparation under the tutelage of our
certified teacher(s) utilizing the nationally articulated PLATO system. Patients
also can improve their skills utilizing our resume preparation training.
Our
model includes a modified
concept based treatment community. The use of a concept based therapeutic
community provides additional behavioral structure to increase opportunities for
patients to benefit from experiential application of skill development and
attempts at change.
Our
experience concurs with the research indicating that a high percentage of this
population suffers from co-morbid substance abuse and mental health issues.
Kairos staff is experienced and professionally prepared to meet the needs of
this population. This is evidenced by our MDCH/ODCP designation to provided
Integrated Treatment Services.
All
assessments are completed by clinician’s who are Master’s prepared or higher.
All therapy is also performed by clinician’s who are Master’s prepared or
higher. Counseling is performed by Master’s or Bachelors level clinicians. Skill
develop groups are also performed by Master’s or Bachelors level clinicians.
The Young Adult model utilizes the same Entry
Level phase of treatment concept that is currently used in our adolescent model.
During this phase of treatment, the young adult consumers
utilize
cognitive/behavioral techniques designed to help the patients identify learned
behaviors that support their current behavior and use patterns.
Clinical staff works closely with each patient to elicit “change talk” and
prepare the patients for psychotherapy. Specifics related to the Entry Level
phase of treatment is detailed earlier in this proposal in the adolescent
specialty section of this proposal.
The
Kairos Young Adult Residential modality is a therapeutic model as opposed to a
medical model. This should generate savings for OSAS.
The model is intensive with a minimum of five hours of therapeutic
services delivered seven days a week.
Modalities include:
·
Intensive Group Therapy (Daily 3 hr. group therapeutic process 7 days a week)
·
Focus Group (2 hr. group counseling emphasizing skill development 7 days per
week)
·
Individual/Family Therapy (45-60 minute session with Therapist -minimum 1x
weekly)
·
Individual/Family Counseling (20-30 minute session with Residential Counselor)
All
clinical staff possess education and professional training to deliver treatment
services and case management services to young adults and their families. This
is evidenced by site visits, audits and personnel chart reviews by various
PIHP’s and our home Coordinating Agency.
Kairos staff also has professional training and
education related to young adult and family systems. Kairos is also
professionally prepared to work with adjudicated youth. Kairos staff participate
in on-going training/education related to gender specific issues. Weekly
supervision also focuses on gender specific issues.
Dual Diagnosis Focus
Kairos
Healthcare has built a statewide reputation as a provider who meets the needs of
adults suffering from co-morbid substance abuse and mental health issues. Our
agency has been recognized and is licensed by the Michigan Department of
Community Health, Office of Drug Control Policy as an “Integrated Treatment”
provider.
Experience, education and competency of clinical staff is critical when
providing treatment services to dually diagnosed patients. All Kairos
Therapists are Master’s prepared or higher. These clinicians are experienced in
both substance abuse and mental health treatment.
Effective treatment for
patients suffering from co-morbid substance abuse and mental health issues
begins at assessment.
All patient assessments are performed by Kairos clinicians who are Master’s
prepared or higher.
The
research clearly indicates that a simultaneous model is effective in
treating dually diagnosed populations. Kairos concurs with the research. When a
dually diagnosed consumer enters treatment at Kairos, both substance abuse and
mental health issues are treated in a simultaneous fashion.
Kairos is also experienced in providing
residential treatment services to dually diagnosed patients.
We are experienced in delivering skill development and case management
services that are critical components to positive patient outcomes.
Residential Counselors assist Kairos Therapists as we focus on AXIS IV
issues and case management issues.
Kairos
therapists are experienced in delivering our proprietary Intensive Crisis
Treatment services to dually diagnosed patients in crisis and at imminent risk
of psychiatric hospitalization. This expertise allows our staff to utilize
crisis stabilization strategies in a residential setting.
Kairos
Healthcare will accept dually diagnosed patients who are stable on their
medication(s). We ask that patients present with a thirty (30) day supply of
medications.
The
research clearly indicates that confrontational approaches are not
effective with dually diagnosed young adult patients.
Kairos concurs with this research and
does not utilize confrontation with this population.
A
continuum of care in tandem with active case management is critical to positive
patient outcomes. Kairos Therapist and Counselors work closely with referral
sources and outpatient providers to insure that dually diagnosed patient’s
transition into their home community with supports in place.
The research is clear that patients present at various levels of motivation.
Kairos utilizes Motivational Interviewing and Motivational Enhancement Therapies
to assist patients in becoming motivated for change. The Transtheoretical Model
of Change is a critical component of the Kairos concept-based young adult
residential model.
This
model allows for clinical judgment to be exercised upon admission. By
identifying the stage at which a patient may be, the clinical team can utilize
various interventions specific to increasing motivation or addressing
individual needs.
If a
young adult patient is willing to participate in the processes of residential
treatment but is in the pre-contemplative stage of change, the clinical team has
the opportunity to shape intervention strategies designed to increase motivation
for change. In conjunction with
motivational interviewing, these opportunities create an atmosphere conducive to
change.
While
exploring the possibilities of change, consumers are able to begin risk
reduction and protective factor development within the context of the individual
and their environment. The stages of change are continuously monitored to
shape the type of intervention strategy and approach. This allows clinical
time to be optimized toward the appropriate type of intervention.
Some
patients enter treatment at the contemplative stage of change. This suggests the
consumer is aware of the need to change or at least change is desired. This is a
factor influencing the length of treatment and directly relates to treatment
response by the consumer. It also translates into ASAM placement criteria
relative to several domains.
Motivational Interviewing:
Kairos therapists,
counselors and direct care staff use principles
of motivational interviewing in relating to consumers at all levels in the
program. The application of motivational interviewing in this project is a
primary intervention that helps the clinical team in avoiding confrontational
styles of treatment. It forms the basis of a treatment approach guided by five
principles: (1) express empathy, (2) develop discrepancy, (3) avoiding
argumentation, (4) roll with resistance and (5) support self efficacy.
Family Support:
Identifying and including supportive family participation in the process
of treatment is essential to success with this population. This is also an
element necessary to sustain through transitions such as movement from one
treatment modality to another, transitions in relationships, academic or work
situations.
Dialectic Approach: The Kairos model
utilizes the dialectic approach which considers not only the
interactions of the constituent parts but also the relationship between the
individual and all other aspects of the individual’s context. The dialectic
approach forces us to consider the dynamic interactions between aspects of the
individual (his or her biological, psychological, historical and socio-cultural
influences) and the continual changes that occur within and around the
individual.
Community Linkages:
Linkage to community
supports and outpatient services are essential following residential
treatment. The integration into services and supports may include Intensive
Outpatient therapy, individual counseling/therapy and Twelve Step participation.
Relapse
Prevention Strategies: Numerous
strategies are interwoven throughout the program to optimize each patient’s
opportunities for success following discharge.
Length of Stay:
The length of stay in based
on the needs of the patient. Our current average length of stay for young adult
residential patients is 20.6 days.
Program Admission Criteria
When referrals
are made to Kairos Healthcare, an inquiry is completed identifying the patient,
the potential need for services, referral source information and insurance
information along with demographic information. It is Kairos’ expectation to
meet access to care criteria that adheres to emergent, urgent and routine
standard time lines.
The intake
assessment is then scheduled. At the time of the initial assessment, information
is gathered by interview and solicitation of information from previous treatment
episodes. Information is also solicited from referral sources and significant
others including family members. Initial diagnostic impressions will be
represented and if ASAM PPC-II criteria for level III.1, III.5 or III.7 are met,
the patient is admitted for treatment. Instruments such as BASIS-32 are
administered.
The following ASAM Domains are project indicators for
initial and continuing care placement for adult residential care:
(1) Intoxication/withdrawal, (2)
Treatment acceptance/resistance,(3) Biological/medical, (4) Relapse potential,
(5) Emotional/mental and (6) Recovery environment.
The initial assessment must and does include:
Data
Collection-
interview; self completed questionnaires/forms; referral source information;
prior treatment record; input from significant others; Clinical impression of
reporter reliability.
Comprehensive
in Scope Background-
(family, genetic, cultural, ethnic/race, significant life events); education;
employment; relationships; history of abuse; health history; nutritional
history; leisure; ATOD history; and a mental status examination.
Diagnostics-
encompasses the full constellation of symptoms; be represented in DSM IV
multi-axis diagnostic categories; and represent the influence of one axis on the
other.
Formulation
- clinical
evaluation of the data; problems identified in context; development of a
clinical hypothesis (alternative hypothesis); recommended intervention; assure
admission criteria (medical necessity) and (least restrictive) are met;
represent the interrelationship between problems; prioritization of problems;
establish realistic prognosis; and adherence to ASAM PPC-II criteria for Levels
III.1, III.5 and III.7.
The treatment plan utilized must and
will:
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Make use of person-centered planning | ||||||
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Be realistic; be achievable with available resources | ||||||
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Be measurable - Behavioral, scaleable and observable | ||||||
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Include objectives when achieved satisfies the respective treatment goal which in turn resolves or contributes to the resolution the problem addressed. | ||||||
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Include discharge criteria | ||||||
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Establish measures to identify specific achievement precipitating discharge | ||||||
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Expectation of progress, and response to regression | ||||||
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What intervention strategies will be used? | ||||||
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How
long will it take? | ||||||
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Complicating
factors
(from assessment and
individual context) | ||||||
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Include behavioral indicators
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Treatment planning
begins at assessment
with the development of a
consumer treatment contract.
This is reviewed at least monthly in long term residential with modifications
being considered following each episode of care. Each progress note prompts a
response to any need for modification of treatment contract. Case management
begins within the treatment setting to determine available resources and
supports.
Assessment and
treatment policies for persons with co-occurring or multiple diagnosed disorders
on both Axis I and Axis II
The majority of the young adult
patients presenting for treatment at Kairos suffer from co-morbid substance
abuse and mental health issues.
All assessments are performed by clinicians who are Master’s prepared or
higher. Therapists assessing dually diagnosed adults must have at least five
years experience in mental health.
Kairos utilizes a collegial design
where consultation is available and encouraged. Dual diagnosis cases are peer
reviewed with a high occurrence of consultation.
Assessment includes significant
mental status examination sufficient to determine mental health issues along
with a comprehensive grid of alcohol/drug usage. Ancillary information is
requested and made part of the process. Prior treatment is evaluated including
outcomes and barriers to treatment.
All treatment modalities delivered
at Kairos include the treatment of dual diagnosis issues utilizing a
simultaneous model. Denial is
often a barrier for the dually diagnosed adult. Denial is complicated by
conflicting information between addiction and mental health prior to treatment
exposure. The simultaneous model allows the Kairos team to break myths about
recovery from addiction as well as mental health issues.
Dual diagnosis treatment requires
significant understanding of the mental health issues to allow appropriate
confrontation and redirection for the consumer. Traditional methods of
confrontation are often inappropriate or ill advised. Kairos looks to
identify the characteristics motivating the patient and utilize these factors to
develop an internal locus of control sufficient to support ongoing recovery.
Therapists and residential
counselors are expected to have a working knowledge of typical medications
prescribed by our psychiatric staff. Ongoing training support is available to
our staff through pharmaceutical representatives and staff. It is a part of
their role to support medication compliance while deferring necessary medical
questions to the physician responsible.
Definition Satisfactory
Completion of Treatment
Young adult patients will have
achieved at least 80% on each objectives (or equivalent objective) satisfying
each goal with 100% on any objective requiring abstinence and the completion of
these objectives satisfy the designated goal for the stated problem it is
designed to resolve. And there are no identified treatment issues present or
having arisen that necessitate continued treatment according to ASAM PPC-II for
level III.1, III.5 or III.7 3.
Discharge Criteria
Complications
arising across the ASAM domains (Intoxication/withdrawal, Biological/medical,
Emotional/mental, Treatment acceptance/resistance, Relapse potential and
Recovery environment) are key elements influencing length of stay. Consumers
will no longer meet ASAM PPC II for continued stay at each level of care and
will proceed to the appropriate level of care until ASAM PPC II discharge
criteria is met.
Depending on
the county where the patient resides, consumers titrate to IOP and Outpatient at
our Fayette Street Campus in Saginaw. When an agency or combination of agencies
is used by Kairos to refer a consumer, the aforementioned criteria must be met.
Some agencies may be able to sustain individual, group, family and family
programs within an intensive outpatient model. It may require establishing a
collaborative referral to accomplish the necessary follow-up criteria.
Outcome Measures:
Kairos
Healthcare is committed to the analysis of outcome measures to improve quality
and monitor the efficacy of treatment. For more information on the outcome
measures utilized at Kairos Healthcare, please contact
To Make A Referral To Our
Young Adult Residential Program
Simply Call 989.792.8000