Adolescent Medical
Model Residential
Phone:
989.777.4357 Facsimile:
989.777.7257
Site Director:
mchimovitz@kairoshealthcare.com
Kairos Healthcare, Inc.,
Phone: 989.777.8570
Facsimile: 989.777.8620
President/CEO:
Frederick E. Wigen Jr.
fwigen@kairoshealthcare.com
Vice President:
Wendell J. Montney, Ph.D.
wmontney@kairoshealthcare.com
Director of
Behavioral Healthcare:
Will Volesky, MA, LLP, CAAC, CCS-M
Website:
www.kairoshealthcare.com
Kairos Healthcare was fully accredited by the Commission on Accreditation of Rehabilitation Facilities
in October of 2006. The current tri-annual accreditation continues thru October of 2012. Current full CARF
accreditation includes adult, adolescent and child mental health and substance abuse treatment. Kairos is
fully accredited for both outpatient
and residential services.
Kairos Healthcare possesses a standard license as a Detoxification, Residential and Outpatient
Substance Abuse Program. Our current license (#750157) was issued by the Michigan Department
of Community Health, Bureau of Health Systems. Kairos Healthcare also possesses a license and
.designations as a Child Caring Institution (#CI730255999). This license was issued by the Michigan
Department of Consumer and Industry Services, Bureau of Family Services.
Due to a variety of factors,
facilities in
rarely accept adolescents. This has caused a huge void in detoxification services for adolescents
and when
untreated places adolescents at a high risk of various health problems
including death.
Not all adolescents referred to our medically monitored residential treatment program will require
detoxification services. However, parents and referral sources should know that this service is
available should the assessment indicate that detoxification is the appropriate level of care for the
patient.
The Kairos adolescent detoxification unit is
housed at our
This facility also houses our
adolescent substance abuse residential and outpatient treatment programs.
Our medically monitored detoxification unit utilizes nurses on duty 24/7. There is daily involvement by
physicians and physicians assistants seven days a week. Kairos physicians are approved by the
federal government to dispense Suboxone
when appropriate for our opiate addicted patients.
Private Sector - Kairos currently accepts most commercial insurances. Since health insurance
contract benefits vary, Kairos staff should be contacted prior to admission with the insurance information.
Our staff will verify benefits and explain the patient’s coverage
to the referral source and the patient’s family.
Kairos is experienced in the private sector managed care environment. The following private sector
insurers/managed care organizations are some of the organizations contracted with Kairos Healthcare for
both mental health and substance abuse treatment services:
Blue Cross Blue Shield of
Community Choice
Comp Care
MESSA
Humana
Magellan Behavioral
Connect Care
Value Options
HMSA
Health Alliance Plan(HAP)
Physician’s Health Plan
McLaren Health Plan
Aetna
United
Behavioral Health
Co-Finity
Comp Psych
Public Sector –
Kairos is contracted with various
Coordinating Agencies throughout the State of
to provide adolescent substance abuse treatment services to Medicaid recipients. We also have contracts
in place to assist un-insured and under-insured adolescents and their families. Our current contracts cover
adolescents from 64
counties.
Saginaw County Department of Public Health
Thumb
Southeast
Michigan Community
Washtenaw
Community Health Organization
Mid-South Substance Abuse Services
Riverhaven Coordinating Agency
K
Lakeshore
Coordinating Council
Department of Human Services “Fair Market Rate”: Some referral sources require that providers establish
a “Fair Market Rate” with the Department of Human Services. This rate has been established and is in place
with DHS for short and long-term residential services.
Saginaw
in a separate building in June of 2000. The adolescent residential program grew and our present
site was opened in 2003. From it’s inception, the agency has provided both substance abuse and
mental health treatment services to adults, adolescents and their families.
Kairos
currently operates from two sites:
1321
S. Fayette,
Additional
information on our organization can be accessed at our website
Insurers such as Blue Cross Blue Shield of Michigan mandate a medical model be delivered to their
subscribers. Other insurers also mandate a medical model. To meet the treatment needs of these
adolescent patients, Kairos expanded our programming to include a medically monitored model in a
separate unit at the
The Kairos triage process developed in conjunction with the Kairos Medical Director
includes the method used in determining the level of urgency of need of each individual
client, identification of the services to be performed, including transportation if necessary
and the method of assigning the priority of required services.
Nurses are on the unit 24/7.
Physical exams occur within
24 hours of admission to include but not limited to DSM-IV R diagnosis. At a
minimum, a medical follow up occurs weekly by the Kairos physician or physician
assistant.
Various treatment modalities are
utilized during the length of stay:
Group Therapy
Focus Group
(2 hr. group counseling
emphasizing skill development)
Didactic
(Structured information available
for dissemination, explanation & response)
Individual Therapy
(Delivered by Kairos Therapists)
Individual Counseling (Delivered
by Kairos Residential Counselors)
Family Therapy/Counseling
(Delivered by Therapist or Residential Counselor
as needed)
Medical Monitoring
(Delivered by Kairos Nurse, Physician or Physicians Assistant)
Kairos
believes in welcoming and meeting the patients “where they are” instead of where
others think they should be. Upon admission to the medically monitored unit,
patients focus on:
Crisis Stabilization:
Many patients and families present for treatment in crisis. Kairos staff
Assists the family system is stabilizing the crisis and looking for alternatives
that will
minimize a similar crisis in the future.
Boundaries:
Physical, emotional, sexual and mental. Particular focus on directed at verbal
boundaries to establish the fact that “street” and/or “drug” talk is not allowed
during the treatment process.
Family Roles & Relationships:
Patients explore their family systems. This includes
relationships with parents and siblings. Patients analyze the use in their
family and begin to
identify those who are using alcohol or illegal drugs.
Behaviors:
Patients identify current behaviors that interfere with treatment and recovery.
Alternate healthy behaviors are explored and discussed. An objective for all
patients in the
Entry
Level phase of treatment is to demonstrate compliance with following the rules,
respecting authority and sharing of self in a group setting.
Decision Making:
Patients identify unhealthy decision making patterns that cause problems in
their lives and promote their illegal drug and/or alcohol use.
Triggers:
Patients identify external and internal triggers that lead to their illegal
drug and/or alcohol use.
Defense Mechanisms:
Staff assists adolescent patients in achieving a basic understanding of the
defense mechanisms that foster continuing drug and/or alcohol use. Denial is a
common defense mechanism that receives constant focus.
Peer Pressure:
Patients verbalize that they have friends who use. Identification of these
friends and the results of peer pressure are explored so patients have a
thorough understanding of how their peers impact their behavior.
Treatment Goals and Objectives:
Patients verbalize the purpose of their being in treatment at Kairos. They learn
to verbalize their personalized treatment goals and objectives. It is our
expectation that prior to leaving the Entry Level, all patients have verbalized
their alcohol/drug use history, identified family use and are familiar with
therapeutic community constructs. Patients should also be able to articulate an
understanding of the First Step of AA/NA.
Resiliency:
Recognizing that many adolescents face life with diverse circumstances
representing incredible challenges, Kairos embraces the principles of
resiliency. Studies conducted on the characteristics of resiliency suggest
there is an ecological approach toward risk and protective factors.
The
approach to treatment must encourage a multifaceted intervention to involve the
adolescent in developing protective factors and eliminating risk factors across
domains relating to the individual, family, peer, school, work setting and
community.
The
cumulative risk is the best indicator of the likelihood of problem behavior. The
influence of treatment must impact the adolescent during the course of treatment
and remain effectively engaged with the adolescent as they return to daily
function within their family and community.
The
Transtheoretical Model of Change is a critical component of the Kairos
concept-based model. The following highlights the model.
Transtheoretical Model of Change
Level I:
Pre-Contemplative to Contemplative
Ø Consumers explore what makes up who they are at this point in time
Ø
Functionality in core groups
i.e. family, social, friendships
Ø
What is working and what is
not working?
Ø
Consideration of change
Ø
What would change look and
be like and what skills are needed to make change happen?
Ø
Consumer explores their
skills to determine what skills can be used and what skills must be learned or
developed
Ø
Cost benefit relationship to
dysfunctional behavior
Ø Pathological relationship to mood altering substances with expectation of a rewarding experienceØ
Level II:
Preparation
Ø
Identify skills to be
obtained
Ø
Recognize precipitous events
Ø
Understand patterns of
precipitous event to dysfunctional behavior
Ø
Recognize the relationship
between dysfunctional behavior and consequences
Ø
Develop skills necessary to
facilitate change behavior
Level III: Action
Ø
Practice using target
behaviors
Ø
Solicit feedback regarding
target behaviors
Ø
Identify success target
behavior
Ø
Identify lapses into
dysfunctional behavior
Ø
Develop relapse prevention
strategies
Ø
Understand de-compensation
signs
Ø
Repeated use of target
behaviors
Ø
Habituation to use of target
behavior
Level IV:
Maintenance
Ø
Develop a pattern of self
initiated use of target behaviors
Ø
Readily identify with
relapse triggers
Ø
Self initiate use of relapse
prevention plan
Ø
Self awareness of
de-compensation signs and symptoms
Ø
Accountability structures
intact for feedback and support
Level V:
Alumni
Ø
Open forum for friendship,
support, conversation and community
Ø
Available to all alumni
This model allows for
clinical judgment to be exercised upon admission with adolescents. By
identifying the stage at which an adolescent consumer may be, the clinical team
can utilize various interventions specific to increasing motivation or
addressing individual needs.
If an adolescent 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.
Most adolescents are
expected to 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 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, and (4) roll with resistance and (5) support self efficacy.
Family Support:
Adolescents need a close relationship with at least one family member.
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.
Community Linkages:
Linkage to
community supports and outpatient services are essential following
residential treatment. The integration into services and supports include
individual counseling/therapy, a peer involved group process, family counseling
and an opportunity for parents to participate in counseling/and or support group
processes.
Relapse Prevention Strategies:
Numerous strategies are
interwoven throughout the program to optimize each patient’s opportunities for
success following discharge.
Cognitive-Behavioral Techniques:
Cognitive-behavioral techniques are the primary methods used in the Kairos
model.
Gender-Specific Therapy:
The adolescent residential model provides gender-specific programming on
separate floors. Male and female patients are also separated as they participate
in education, recreation and meals.
Concept Based Therapeutic
Community Strategies:
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. Concept based therapeutic community
strategies include:
The Kairos
model
assists patients with the self-examination of attitudes and behaviors and how
they reflect inner core values and beliefs related to addiction and mental
health. Privileges are earned. The adolescent patient internalizes recovery
concepts which allows the to gain awareness between substance use and emotional
outcomes.
Clinical staff
break through and reduce the defenses that all adolescent patients present with.
Specific strategies assist the patient in identifying the consequences
associated with their use.
Autobiographies are initiated in the Inventory Program and continued throughout
the resident’s course of care. The autobiography addresses the substance use,
mental health, physical health and co-dependency issues in resident’s life. This
includes relationships, self-evaluation, roles of substance use, Steps 1,2,3 and
a continuing care plan / recovery plan / relapse prevention plan.
Patients complete recovery workbook(s). Daily written self-assessments and daily
task worksheets are utilized. There is a strong focus on skill development
including:
*Powerlessness
*Surrender – Making the Decision
*Loss of control
*Anger Management
*Boundaries
*Higher power
*Mental health management
The average length of stay for
short-term patients is 28 days.
Kairos mandates family
involvement. This includes family therapy sessions as appropriate during the
adolescent’s residential course of care.
In these family
sessions, each clinician is entrusted with the task of helping the family to
understand the effect of the family on the adolescent and the effect of the
adolescent on the family. When this is accomplished, understanding and family
goals can be established and processed over time.
The issues brought up in both group therapy and family therapy during the
residential course of care include but are not limited to the following:
Dealing with cravings
Resolving conflicts
The biology of addiction
Recreational and leisure activities
Improving communication
Substance use: positive and negative effects
Managing stress
Work: finding and keeping a job
Coping with holiday
stress
Household rules
Dealing with high-risk
situations
Reducing family burden
Coping with depression
Planning for the future
Self-help groups (AA, NA)
New advances in medication treatment
Dealing with anxiety
Money management
Finding and improving
relationships
Coping with negative symptoms
Recovery
Coping with positive symptoms
Abuse and Neglect
Custody issues and
recovery
When referrals
are made to Kairos Healthcare, an inquiry is completed identifying the consumer,
the potential need for services, referral source information and insurance
information along with demographic information. It is our practice 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 adolescent 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 adolescent 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:
Be
comprehensive in scope;
Make use of
person-centered planning;
Be
realistic; be achievable with available resources;
Be
measurable (Behavioral,
scaleable and observable)
Include
objectives
when achieved satisfies the respective treatment goal which in turn resolves or
contributes to the resolution the problem addressed.
Include
discharge criteria:
Establish
measures to identify specific achievement precipitating discharge,
Expectation
of progress, and Response to regression;
What
intervention strategies will be used?
How long
will it take?
Complicating factors (from assessment and individual context)
Include
behavioral indicators;
What with
consumer do?
Who will
make observations?
Who will
report observation or results?
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.
Note Regarding Parents of Adjudicated Youth:
In some instances, the court may have recommended or ordered that the parent(s)
participate in the treatment process. When this occurs, it is imperative that
the probation officer or case manager informs Kairos of this fact. This alerts
Kairos staff to report parental participation or lack thereof.
The majority of the adolescent
patients presenting for treatment at Kairos Healthcare suffer from co-morbid
substance abuse and mental health issues.
Based on this fact, Kairos has staff, programming and services in place to meet
the needs of the dually diagnosed patients referred to our facilities. This is
evidenced by the granting of
licensure as an Integrated Treatment Program issued by the Michigan
Department of Health, Bureau of Health Systems.
All assessments are performed by
clinicians who are Master’s prepared or higher. Therapists assessing
dually diagnosed adolescents must have at least five years experience in mental
health and substance abuse treatment.
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
adolescent. 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 adolescent consumer 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.
Kairos offers psychiatric services delivered by a
Kairos physician. When patients do not live in a Kairos service area, the Kairos
Therapist and Case Manager will facilitate referrals to agencies with dual
diagnosis and adolescent expertise.
When appropriate, psychiatric interventions will also
occur at a Kairos site. When geographic issues do not allow access to
psychiatric services to be delivered at Kairos, the agency will facilitate
delivery of the services in the consumer’s county of residence.
Staffing Pattern/Shift Ratio
A typical day @ a census of
12 patients would at a minimum include:
1st shift
1 Program Director or Assistant Director on site and/or available.
1 Nurse
1 Residential Therapist
1 Residential Counselor
1 Residential Technician
1 Support Staff (located @ the campus office)
1 Cook
Ratio 1:2 to 1:4
2nd shift
1 Program Director or Assistant Director available by answering service
or pager)
1 Nurse
1 Residential Counselor
2 Residential Technician
Ratio 1:3 to 1:4
3rd shift
1 Program Director or Assistant Director available by answering service
or pager)
1 Nurse
2 Residential Technician
Ratio 1:4
Weekend
1st shift
1 Program Director or Assistant Director on site and/or available.
1 Nurse
1 Residential Therapist
1 Residential Counselor
2 Residential Technician
Ratio 1:2 to 1:3
2nd shift
1 Program Director or Assistant Director available by answering service
or pager)
1 Nurse
2 Residential Technician
Ratio 1:4 to 1:6
3rd shift
1 Program Director or Assistant Director available by answering service
or pager)
1 Nurse
2 Residential Technician
Kairos
is an alternative education site of the
Students are tested and begin their work at their appropriate level. Students
work at their own pace. Motivated students can accelerate their education
earning extra credits. When a patient leaves the residential facility and they
have made progress related to their education, transcripts are sent to the home
school.
Definition Satisfactory
Completion of Treatment:
Adolescent patients will have
achieved at least 80% on each objective (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.
Kairos 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.
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
parental programs within an intensive outpatient model. It may require
establishing a collaborative referral to accomplish the necessary follow-up
criteria.
Continuum of Care:
The expectation is for adolescent consumers and
their families to proceed through a residential/outpatient continuum of care.
This may be entirely at the Kairos Healthcare site located in
The Kairos
expectation of the continuum of care following adolescent residential
treatment includes Individual Therapy, Family Therapy, Group Therapy
(adolescents), Group Support (parents/guardians), Skill Development and
Psychiatric Interventions (when necessary).
Following discharge from residential treatment, adolescent consumers who will be served at other Kairos sites will participate in individual and family outpatient therapies. They will also participate in group therapy sessions with their peers. Consumers who will not receive continuing care at Kairos following residential services will be linked with outpatient therapists/agencies in their home area.
All treatment modalities delivered at Kairos include
the treatment of dual diagnosis issues utilizing a simultaneous model. When
patients do not live in a Kairos service area, the Kairos Therapist facilitates
referrals to agencies with dual diagnosis and adolescent expertise.
Adolescent patients are
encouraged to access community supports and Twelve Step programs. Participation
in community supports is continually reinforced by Kairos staff. Community
reintegration is an integral component of the treatment plan. Treatment planning
(which began at assessment) is reviewed during each outpatient session.
Each progress note
prompts a response to any need for modification of treatment contract. Goals and
objectives established during residential care will be achieved and new
goals/objectives are implemented.
The
continuum of care for adolescents require a significant amount of effort from
the clinical team to increase the likelihood the consumer will transition to
outpatient and community support services. Kairos works closely with referral
sources to insure that this occurs. Kairos has a history of navigating the
complexity of the public systems, community mental health, and public health and
social services agencies. Our agency is prepared to advocate or assist in any
way possible to insure a smooth transition to outpatient treatment and community
supports.
To Make A Referral To Our
Adolescent Residential Program Call 989.777.4357
*** CHECK OUT OUR WEBSITE
www.kairoshealthcare.com
***
Directions To The
The
Coming From The South on
I-75 – Take
I-75 north to the Bridgeport Exits. The
There are two
The exit curves around
and places you at the
Travel about 300 feet to
our driveway. Turn right and come back to the 4-story building. We are the only
4-story building at the I-75/Dixie Highway exchange.
Coming From The North on
I-75 – Take
I-75 south to the Bridgeport Exit. Exit 144 is the next exit approximately two
miles south of the M-46 exit.
Take Exit 144. You will
see the 4-story
Travel about 300 feet to
our driveway. Turn right and come back to the 4-story building. We are the only
4-story building at the I-75/Dixie Highway exchange.
Have a
safe trip.
If you
have any travel problems, call 989-777-4357.