Comprehensive
Day Treatment
Site:
The Comprehensive Day Treatment modality is delivered at our New Center
Clinic
located at
Phone:
989.777.4357 B
Facsimile: 989.777.7257
President/CEO: Frederick E. Wigen Jr.
fwigen@kairoshealthcare.com
Director
of Behavioral Healthcare: Wendell
J. Montney, Ph.D. wmontney@kairoshealthcare.com
Accreditation
Kairos
Healthcare, Inc. was 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.
Licensure
All
Kairos sites are licensed by the Michigan Department of Consumer and Industry
Services, Bureau of Health Systems as substance abuse treatment facilities.
The New Center Campus is licensed as an outpatient facility.
Kairos
Healthcare possesses a license and designation as a Child Caring
Institution (#CI730255999) at our residential facility located in
Provider Experience
Kairos
opened outpatient clinics in
In
2003 Kairos expanded our adolescent services with the opening of our 72-bed
adolescent residential facility in
Kairos
currently operates from five sites:
New
Center Clinic, (Adolescent Comprehensive Day Treatment,
Family
Care Center, (Adolescent
Residential & OP),
6379 Dixie Highway,
Secure
Residential,
520 W.
Care Management Services
Organizations – Kairos
is currently contracted with all five of the Care Management Services
organizations in
Kairos
understands the treatment and case management needs of adjudicated youth
managed by the CMS’s. The expansion to the Kairos New Center Campus and the
development/implementation of the Comprehensive Day Treatment modality and 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
HealthPlus
of
Magellan Behavioral Connect Care Value Options
HMSA
MESSA
Wausau
Health
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
Northern
Michigan Substance Abuse Services
Riverhaven
Coordinating Agency
Lakeshore
Coordinating Council
Washtenaw Community Health Organization
Care
Management Services Organizations face a variety of challenges. The Kairos
Comprehensive Day Treatment model is designed to meet these challenges.
v
Financial issues constantly challenge the CMS’s to
look at effective alternatives to residential care for youth who have
substance abuse issues. It is imperative that the CMS and the provider
have a relationship based on professional trust allowing them to determine if
a comprehensive community based model can be effective without a residential
course of care.
v
The CMS’s need community-based treatment modalities
that facilitate a reduction in the residential lengths of stay.
The availability of an intensive model provides a “safety net”
effect that allows shorter lengths of stay in residential care.
v
It is critical that an effective day treatment for
youth with substance abuse issues be available to the judges and case managers
for youth requiring intensive services in a community-based setting.
Kairos is confident that the Comprehensive Day Treatment model is such a
program.
v
A constant challenge is identifying if the
youth’s behavior/delinquency issues are a result of substance
abuse/addiction or mental health issues. The CMS’s need a collegial partner
to assist in identifying the SA/MH
issues and providing the appropriate care.
v
Aggressive
case management focusing on outcomes is critical with the population
requiring intensive treatment services. The Kairos model contains a case
management component that is designed to generate positive patient outcomes.
A
“No Wrong Door” Modality
The
Kairos Comprehensive Day Treatment modality accommodates the following patient
profiles:
v
Titration
From Residential Care: Some youth will enter the Kairos Comprehensive Day
Treatment program as the next step in their continuum of care following
residential care.
It is not automatic that all youth titrate to Comprehensive Day Treatment
following a residential course of care. Some patients will move to the less
intense Outpatient level of care based on their progress in residential
treatment.
v
Initial
Treatment Modality: Some
patients will begin the treatment process in Comprehensive Day Treatment.
v
Patients
Failing In Outpatient:
Some youth will begin the treatment process in traditional outpatient
(individual/family/group). Others may enter the process in Intensive
Outpatient. Some youth will not be able to stay alcohol and drug free in these
services. They can enter the Comprehensive Day Treatment program when it is
determined that they require the intensity provided by the modality.
It will occur that some youth will not succeed when placed in the Comprehensive Day Treatment. When this occurs, Kairos staff may recommend residential care. Following the residential stay, the youth will titrate back to the Comprehensive Day Treatment program or may be placed in Outpatient.
Entry
Level Strategies: 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 Comprehensive Day 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
believes in meeting the patients “where they are” instead of where others
think they should be. Kairos 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 focuses on the following issues with each new patient:
Crisis
Stabilization: Many patients and families present for treatment in crisis. Kairos staff
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
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 adolescentmoves 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. 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 Comprehensive Day 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.
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 Comprehensive Day Treatment model provides gender-specific
programming. Male and female patients are also separated as they participate
in education, recreation and meals.
Autobiographies
are initiated in the Inventory Program and continued throughout the
patient’s 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
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 allow them 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.
Kairos Healthcare understands the fact that we must effectively
meet the needs of adolescents in their community. The focus of this program is
to remove the barriers to treatment while enhancing the program to encourage
participation.
Personal development of each adolescent in a safe environment
where they can build upon their strengths and successes, while having help and
hope during their failures. Adolescents are encouraged to remain abstinent
however when an adolescent uses it is precisely the time
Kairos Healthcare will apply effort and a safe environment
for the adolescent to become sober/ clear from the substances and discover
what the antecedents to their relapse. This effort combines the concerns of
all resources including case management, referral source, funding sources and
caregivers.
Kairos
Healthcare believes if we continue to do things the way they have been done we
will continue to achieve similar results. Kairos Healthcare is committed to
breaking the cycles of addiction and establishing hope for adolescents who
strive for freedom from addiction.
Key Components:
The Kairos Comprehensive Day Treatment modality is not a traditional day
treatment model. The following
are key components of the Kairos model that is delivered Monday
thru Saturday.
 | Transportation provided to and from the Kairos site. |
| Three (3) well balanced meals served each day. |
| Education |
 | Individualized
and self paced |
| Computer-based
|
| Two
hours on computer each day |
| Students
can catch up lost credits |
| Nationally
articulated |
| Supervision of a State Certified Teacher |
| Clinical Services |
| Intensive
group therapy ( 3 hrs. each day/6 days a week ) |
| Focus
group counseling ( 2 hrs. each day/6 days a week) |
| Individual
therapy and/or counseling (PRN) |
| Family
therapy and/or counseling (PRN) |
| Outcomes-focused case management & coordination of care |
| Supportive Services |
| Line
of sight support by youth
advisors |
| Recreational
after school activities |
| Twelve
Step opportunities |
| Availability
of parenting classes & family therapy |
| Transportation |
| Full scheduled activity from 8am to 8pm |
| Sleep at home |
Family Involvement
Kairos mandates family involvement. This includes family therapy
sessions as appropriate during the adolescent’s 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 week 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 treatment 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)
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
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 CMS case manager informs Kairos of this fact. This alerts Kairos staff to
report parental participation or lack thereof.
Program Admission Criteria
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 weekly 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.
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.
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 or by referral to the
community where the consumer resides.
The
Kairos expectation of the continuum of care following Comprehensive Day
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.
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 positive 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.
Fee-For-Service
Rates: The
fee-for-service rate for the Comprehensive Day Treatment modality is $180 per
diem. The Comprehensive Day Treatment modality has many components not found in
traditional Day Treatment or Intensive Outpatient models. In addition to the
various treatment modalities, patients receive transportation and three meals a
day. Kairos also facilitates a full membership for each patient at Youthville
Detroit. This provides access to recreation and other extra-curricular
activities available at this state-of-the-art facility.
To Make A Referral To
Our Comprehensive Day Treatment Program
Simply Call
313.556.2600
*** CHECK OUT OUR
WEBSITE AT www.kairoshealthcare.com
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