Public Sector - Substance Abuse: Kairos has a background of treating Medicaid recipients, un-insured and under insured consumers. Kairos is currently funded by and contracted as a Block Grant and Medicaid provider with the following Coordinating Agencies covering over 65 Michigan counties:  

  Saginaw County Department of Public Health                             Genesee County Health Department

  St. Clair County Health Department                                           Southeast Michigan Community Alliance

  Northern Michigan Substance Abuse Services                          Macomb County Office of Substance Abuse

  Oakland County Office of Substance Abuse Services                 Mid-South Substance Abuse Services

  Riverhaven Coordinating Agency                                                Kalamazoo Community Mental Health

  Lakeshore Coordinating Council                                                Washtenaw Community Mental Health  

Public Sector - Mental Health: Kairos is experienced in providing mental health services to consumers funded by public sector organizations. We are contracted with the Family Independence Agency to provide mental health services at our outpatient sites. Kairos is also contracted with HMO=s such as HealthPlus and Community Choice to provide outpatient mental health services to Medicaid recipients enrolled with these HMO's.  

Private Sector: 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 Michigan           Blue Care Network of MI            Wausau               CIGNA            HealthPlus of Michigan                           Community Choice                     M-Care              MESSA            Magellan Behavioral                               Connect Care                            Value Options                          Health Mgt. Systems                                 Health Alliance Plan                      Physician=s Health Plan  

While the Kairos Women and Children Specialty program opened in 2005, it should be noted that Kairos  has provided residential treatment services to pregnant and post-partum women at our Fayette Street Campus since 1998. Due to the freedom of choice available to Medicaid and Block Grant funded consumers, many women who qualified for Women and Children services have requested substance abuse treatment at Kairos based on our reputation as a quality treatment agency.  

Kairos has also met the needs of pregnant and post-partum adolescents at our Family Care Center in Bridgeport . Our Teen Parent Program meets the treatment needs of adjudicated youth and their children. at our Family Care Center in Bridgeport . The teen mothers come to the program pregnant or post-partum. The mothers and children then remain in treatment at Kairos for up to one year.  

Kairos is experienced and professionally prepared to care for the children of adult mothers based on our experience in providing services to the children of our teen mothers. We are aware of the needs of the children in this population and our nursery/day care operations could easily be expanded to accommodate the children of adult patients. Agreements are in place with medical facilities and other community agencies to provide services to the children of our patients.  

Population Served  

The Kairos Healthcare Women & Children residential program accepts pregnant women 18 years or older with an identified substance abuse/dependency diagnosis. The Kairos program also accepts post-partum women 18 years or older with an identified substance abuse/dependency diagnosis. In addition to the mothers, Kairos accepts non-school age children of the mothers.  

While a mental health diagnosis is not necessary for admission, it is our experience that a large percentage of the women presenting for treatment will have co-occurring disorders. It is also our expectation that the children of our patients will have behavioral healthcare issues.  

Some women require long-term care while other women require short-term residential care. The Kairos modality accommodates both of these populations.

Access To Care  

Kairos Healthcare’s admission procedures call for adult residential admissions to be facilitated within 24 hours of the patient/family/referral source contacting our agency. It is not uncommon that the admission is facilitated on the same day of contact.  

Meeting The Population’s Needs

 Substance abuse with the pregnant and post-partum female population continues to be a major issue in the State of Michigan . Substance abuse in this population is directly linked to infant mortality, child abuse, sexual abuse, domestic violence, crime, health issues including transmission of sexual transmitted diseases and high utilization of social services in our state.

 Treating women and children has historically been laden with barriers. Women are more likely than men to have consequences associated with addiction and treatment. It is imperative the barriers to treatment be removed and advocacy for the needs of women and children are met on a consistent basis. It is to this end Kairos Healthcare commits time and resource to our program.

Case management is a vital role in providing lineages to appropriate services. Many among this population use emergency services or after hours clinics and may not have a consistent primary care physician. Kairos Healthcare will assist women in linking to medical care for themselves and for their children. They are encouraged to develop an ongoing consistent primary care physician relationship as an effort to improve their healthcare and the healthcare of their children.

 Kairos Healthcare understands the importance of immunizations for children. Our agency is experienced in obtaining this information through the statewide system available to county health departments. It is our goal to secure immunizations for every child participating in the Women and Children program.

Research has shown the efficacy of gender specific treatment. In excess of 40% of women substance abusers have had some type of sexual violation. It is important to create a safe open environment where women can work on both substance use and mental health issues concurrently. Kairos is aware of this fact and our programming provides the environment necessary for positive patient outcomes.

Kairos Healthcare encourages participation of children in our services in every way possible. Children under the age of 7 often carry guilt and shame for their parent’s addictive behavior. The needs of children are often unmet.

Meeting The Population’s Needs  (cont)  

It is the effort of Kairos Healthcare to provide services by way of helping each child to develop self-esteem, recognize they are not the cause of the addictive behavior and to help them realize their own person mental health.

Children in homes where addiction is prominent often do not receive adequate medical care. Through our case management activities, Kairos links children to appropriate healthcare services.

Transportation is often a key barrier inhibiting services to women and children. Kairos Healthcare assists in providing or assisting in the provision of transportation for necessary services.

Through our case management and programs, Kairos Healthcare links to or provides for each of the five core services specific to women and children’s specialty programs:  

1.      Primary and comprehensive medical services for women, including pre and postnatal care.  

2.      Primary pediatric care, including immunizations for their children.  

3. Gender specific substance abuse treatment and other therapeutic interventions for women    which may address issues of relationships, sexual abuse, physical abuse, parenting and Childcare.

4. Therapeutic interventions for children in custody of women in treatment which   may,                 among other things, address the child’s developmental and medical needs as well as issues related to abuse and neglect.

5. Sufficient case management and transportation services to ensure that women and                 their children have continued success.  

One of the best opportunities we have to approach and intervene with the substance-using woman is when she is pregnant.  The child’s birth may give her a powerful motive to seek treatment for her addiction.  Early intervention efforts during the prenatal period increase the likelihood that she will successfully recover from alcohol and other drug abuse.   

Women who are pregnant are the highest priority for admission and treatment. The tetrogenic effects of addictive substances are a primary concern. The earlier we can intervene with a woman who is pregnant the better. Assisting in maintaining abstinence throughout the pregnancy is key element to reducing risk to both mother and child. The woman’s recovery will have a direct positive effect on the child’s development and wellbeing.  

A significantly high percentage of women in recovery who deliver encounter post-partum blues. It is critical they are assisted through this time with counseling and support. The simultaneous treatment of the addiction with any mental health issues is the method used by Kairos Healthcare.  

Women who are addicted may not have sufficient parenting skills and as a result fail to provide necessary nurturing behaviors essential for healthy emotional and cognitive growth of their children. It is the goal of Kairos Healthcare to teach, coach and supplement necessary components of parenting.  

Kairos Healthcare understands that women who are linked to appropriate resources can be effectively supported to recover and manage their multiple roles.  Efforts to familiarize women with the array of social services will foster independence and self-reliance with employment and housing needs as well as with their children’s medical, emotional and educational needs.  

Admission Criteria

The admission criteria for the population targeted is as follows:  

·         Voluntary participation in the program.  

Women and Children Specialty Modalities Offered  

1.  Short Term Residential  

All women participating in short-term residential participate in five hours of therapeutic activities Monday-Friday and three hours of therapeutic activities on week-ends and holidays. 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)

·         Individual Therapy (45-60 minute session with Therapist or Counselor -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)  

LOS: The average length of stay in short term residential is 30 to 60 days.  

2.  Long Term Residential  

Long-term patients receive the same intensity for the first thirty days. The intensity then titrates to three hours of therapeutic activities seven (7) days a week. The treatment modalities detailed above are components of the long term model.  

LOS:  Patients in long term care can receive treatment for up to six (6) months.  

3.  Intensive Outpatient Therapy  

Kairos offers Intensive Outpatient Therapy (IOP) three times a week. A minimum of three hours of therapeutic activities occur each day. Group therapy is supported by Individual/Family therapy.  

For some patients, IOP is the entry modality. Some women titrate to IOP following a short term residential length of stay. Patients titrate from IOP to outpatient therapy which consists of Group, Individual and Family therapy.  

LOS:  Twelve (15) to Fifteen (15) sessions.  

Treatment Program Description

 All assessments are performed by clinician’s who are Master’s prepared or higher.  Assessments include significant mental status examination sufficient to determine mental health issues along with a comprehensive grid of alcohol/drug usage. 

 Master’s prepared clinicians are responsible for conducting individual, family and child psychotherapy to assist and promote insight and self-awareness to facilitate change and resolution of substance abuse and mental health problems. Bachelor’s prepared staff are responsible for case management and skill development services.  The case manager assists the patient in accessing services and monitors her participation and progress in treatment.

 The therapists and residential counselors are expected to have a working knowledge of co-occurring issues as well as having a sound understanding of the women and children being served.  The clinical staff work in concert with one another promoting patients awareness, insight, skill development and motivation for change.

 Residential Technicians possess high school degrees.  They also monitor patients during non-structured times, provide feedback of the residents’ progress/regression to the clinical team.

 Kairos Healthcare utilizes a multifaceted intervention that involves patients developing protective factors and eliminating risk factors across domains relating to the individual, family, peer, school, work setting and community.  Kairos incorporates, among others, the Transtheoretical Model of Change, motivational interviewing/enhancement, change talk and cognitive behavioral strategies to promote growth.

 Kairos Healthcare Women and Children’s program is a fully comprehensive, gender-specific substance abuse program for adult woman who are either pregnant and/or with dependent non-school aged children.  Kairos Healthcare’s continuum of services of care serves women and their children from early intervention through residential services. This includes Intensive Outpatient, Outpatient, crisis stabilization, short and long term residential stays.

 The fully comprehensive continuum of care promotes barrier free access and assistance to care no matter where the patient’s point of entry into the treatment system.  Access to care is simplified and the patient will receive whatever support is needed.  The continuum of care offered promotes an environment that is nonjudgmental, non-punitive, nurturing, and culturally and linguistically sensitive.

 Kairos Healthcare’s treatment incorporates strategies to increase protective factors while eliminating risk factors across domains.  Patient’s treatment outcomes are measured via the ASAM criteria and the Transtheoretical model of change.  Outcomes are also evaluated via data collection from satisfaction surveys, BASIS 32 and Socrates.  Data information is used to scrutinize the effectiveness of the program and study implementations that have the greatest positive effect/outcomes.  

All treatment plans are individualized for each patient. All patients are involved in the development and updating of their treatment plan. 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.

Treatment Program Description (cont)

The following ASAM Domains are project indicators for initial and continuing care placement for  residential and Intensive Outpatient care: (1) Intoxication/withdrawal, (2) Treatment acceptance or 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?