Adolescent Residential
Substance Abuse Treatment
Adolescent Residential Site:
Kairos
Corporate Offices:
Kairos
Healthcare, Inc.,
Phone:
989.777.4357 B
Facsimile: 989.777.7257
President/CEO: Frederick E. Wigen Jr.
fwigen@kairoshealthcare.com
Vice
President: Wendell
J. Montney, Ph.D. wmontney@kairoshealthcare.com
Kairos
Healthcare, Inc. is fully accredited by the Commission on Accreditation
of Rehabilitation Facilities (CARF). The current 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 Residential and Outpatient Substance Abuse Program. Our current license (#730157) was issued by the Michigan Department of Consumer and Industry Services, 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.
The
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 Connect Care HMSA
Health Plus
of
Comp Care Cofinity Aetna
Physician=s Health Plan Value Options Wausau
Public
Sector – Kairos is
contracted with various Coordinating Agencies throughout the State of
Saginaw County Department of Public Health
Genesee County Health Department
St. Clair County Health Department
Southeast Michigan Community
Washtenaw Community Health
Organization
Oakland
Riverhaven Coordinating Agency
Macomb County Community Health
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.
Kairos
opened outpatient clinics in
Kairos
currently operates from five sites:
§ Family
Care Center, (Adolescent Residential & OP), 6379 Dixie
Hwy.,
§ Fayette Street
Campus
(Adult Residential/IOP/OP), 1321 S. Fayette,
Additional information on our organization can
be accessed at our website
Kairos
believes in meeting the patients “where they are” instead of where others
think they should be. Upon admission, all patients enter the residential program
at the Entry Level phase of treatment. Specific strategies and programming
distinguish this phase of treatment.
Our
experience has shown that most adolescent patients benefit from preparation for
the group therapeutic process. This preparation also benefits other patients as
it protects the cohesiveness of the therapeutic groups for patients who have
been in treatment for a period of time.
The
Entry Level phase of treatment utilizes 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. Kairos
staff focus on the following issues with each new patient:
Crisis Stabilization: Many patients and families present for treatment in crisis.Kairos staff Assists thefamily system is stabilizing the crisis and looking for
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 and 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 Behavioral Detoxification 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: Kairos staff assist patients in achieving a basis 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 at
Kairos. They also 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.
The
normal length of stay in Entry Level is 4-7 days. Following this phase of
treatment, the adolescent progress
to the advanced therapeutic process.
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
experience
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 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, 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.
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.
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.
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.
Treatment
Modalities: Various
treatment modalities are utilized during the length of stay:
·
Intensive Group Therapy
(3 hr. group therapeutic process)
·
Focus Group (2 hr.
group counseling emphasizing skill development)
·
Didactic (1.5 hr. with
structured information available for dissemination, explanation & response)
·
Individual Therapy
(45-60 minute session with Therapist -minimum 2x weekly)
·
Individual Counseling
(20-30 minute session with Residential Counselor – minimum 2x weekly)
·
Family
Therapy/Counseling (45-90 minute with Therapist or Residential Counselor –
PRN)
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 residents
course of care. The patient’s 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
*Unmanageability
*Boundaries
*Higher power
*Communication
*Insanity/Sanity
*Disease concept
*Mental health management
Length
of Stay: NIDA research indicates that this average
length of stay is appropriate for the population served. The research
indicates that completion of these lengths of stay increase abstinence by 1.5
times. Adolescents are 1.2 times less likely to participate in crime and they
are 1.34 times more likely to achieve better than average grades following
residential care.
The average length of stay for short-term patients is 28 days. The average length of stay for long-term patients is 75 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.
Unless family therapy is contraindicated, it is
important to follow up on the sustained family emphasis in treatment. This is
why family therapy is a part of all continuing care plans generated for
residential patients and their families.
In addition to family therapy sessions, Kairos
offers Parenting Sessions every-other Saturday throughout the year. The
multiple-family group gives the parent(s) a focused open-ended question and the
group is drawn into the discussion lead by the clinician. Within the context of
the discussion, opportunity is given to shape the conversation and coach parents
on various aspects of parenting and family life.
Each multiple-family session is
approximately 3 hours in duration. There is no cost to the parent(s) if their
child is in residential care at Kairos.
The group is open-ended meaning new
participants may be expected to attend each week while others may complete and
not return to group. The beginning of each group starts with an introduction of
participants, establishing basic norms for the group and setting out the basic
agenda for the session.
This period of time is followed by
the Socratic didactic. The final portion of the session is a wrap up or summary
of the basic issues and discoveries of the session. In all the session is
approximately, Introductions (15 to 30 minutes), Socratic Didactic (1 1/2 hr to
2 1/2 hrs) and Wrap Up or Summary (15 minutes to 30 minutes).
The issues brought into the
Socratic didactic 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: +/- 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) Dealing with anxiety
New advances in medication treatment
Finding
and improving relationships
Coping with negative symptoms
Recovery
Coping with positive symptoms
Abuse
and Neglect
Custody issues and recovery
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.
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 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 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.
Assessment and treatment policies for persons with
co-occurring or multiple diagnosed disorders on both
Axis I and Axis II
The
majority of the adolescent patients presenting for treatment at Kairos suffer
from comorbid substance abuse and mental health issues.
All assessments are performed by clinician=s
that are Master=s prepared or higher. Therapists assessing dually diagnosed adolescents 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 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 include:
1st shift 1 Program Director or Assistant Director on site and/or available.
1 Therapist
1 Residential Counselor
1 Residential Technician
1 Support Staff (located @ the
campus office
Cook
Ratio
1:2 to 1:4
2nd
shift 1
Program Director or Assistant Director available by answering service or pager)
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)
2
Residential Technician
Ratio
1:4
1
Residential Therapist
1
Residential Counselor
2
Residential Technician
Ratio
1:2 to 1:3
2
Residential Technician
Ratio
1:4 to 1:6
2
Residential Technician
Ratio 1:4 to 1:6
Education
Component:
All
patients participate in education five days a week. Our accredited education
program credentialed teaches combined with a nationally recognized web-based
education system.
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, transcripts are sent to
the home school.
Definition
B
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.
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
continuum of care. This may be entirely at Kairos Healthcare sites 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) and Psychiatric Interventions
(when necessary).
Following
discharge from residential treatment, adolescent consumers who will be served at
Kairos sites will participate in individual and family outpatient therapies.
They will also participate in 12
hour 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
Simply Call
989.777.4357
*** CHECK OUT OUR WEBSITE www.kairoshealthcare.com ***