Do your students receive insurance coverage for more than two weeks?
Yes

Do you have an insurance utilization person?
Contractor

Is the program on any insurance panels?
Yes

State and/or National
Joint Commission (JCAHO)
State License

Academic Accreditation
N/A

Religious Affiliation?
No

Please specify the type of religious affiliation
N/A

Minimum Age of Participants
18

Maximum Age of Participants
70

Can program support 18-year-olds if they enroll before 18?
No

Program can accept students with I-20 Visa?
Yes

Average Length of Stay (months)
2

Maximum Enrollment
N/A

Location of Program
Suburban

Dorm/Housing
Single Rooms with Shared Baths
Doubles
Triples

How does the program prevent students from leaving (running) from the program
Other

Does the program have more than one location for this particular program?
Yes

Family Involvement
MIDDLE: Family can opt in & out of their involvement based off the timing and current issues in treatment

Percentage of Aid to Adoptive Family Students
0

Percentage of Court Ordered Students
0

Percentage of Private Pay Students
50

Percentage of School Funded Students
0

Percentage of State Funded Students
0

Is there individual therapy?
Yes

Number of individual therapy hours student receives on a difficult week?
4

Number of individual therapy hours student receives on typical week?
3

Percentage of licensed therapists?
> 50%

Therapist average case load
5

Percentage of full time therapists who have a private practice outside a program?
< 50%

Does the Clinical Director carry a case load?
Yes

Is there group therapy?
Yes

Average number of hours per week facilitated by licensed therapist
20

Average number of hours per week of group processing? (i.e. run by staff, interns, grad students, etc.)
25

Average number of formal family therapy hours per week (not social calls to teen)
2

Is Skype accessible for family therapy?
Yes

Are there Additional Professionals? (Select all that apply)
Licensed Practical Nurse
Massage Therapist
Medical Doctor
Neurofeedback Specialist
Nurse Practitioner
Psychiatrist
Other

Are there Medical rule outs
Yes

Possible Medical Rule Outs
Active Psychosis
Actively Suicidal
Fire Starter
Need for Detox?
Call For more information

Is there a minimum BMI
No

Can Program accept insulin-dependent diabetics
Yes

Psychiatrist
On staff

Percentage of students on meds at enrollment
> 50%

If psychiatrist is available to students, what percentage of students change meds?
> 50%

Types of Therapy Offered
12 Steps Groups
Acceptance and Commitment Therapy
Animal-Assisted Therapy
Art Therapy(with certified art therapists)
Behavior Tech Trained staff & Therapists
Cognitive Behavioral Therapy (CBT)
Dialectical Behavioral Therapy (DBT)
Dialectical Behavior Therapy (DBT) Skills
Equine Assisted or Therapeutic Horse Back
Eye Movement & Desensitization and Reprocessing
Family Focused Therapy (FFT)
Motivational Interviewing (MI)
Neuro Feedback
Psychodynamic Therapy
Psycho educational
Recreation Therapy
Other

Does the program have a level/phase system?
Yes

If yes, are phases/levels tied to privileges?
Yes

Does program have a milieu-driven residential model? (Staff are trained in model)
N/A

If yes — select all that apply
Cognitive Behavioral Therapy
Family Teaching Model
Positive Peer Culture

Integrated Wellness
Art
Breathing Techniques/Breath Work
Meditation
Yoga

Does program use time out rooms?
No

Line staff to student ratio during awake hours
1:4

Does program run background checks on all staff?
Yes

Is there an educational requirement for staff?
Yes

If Yes, what is it?
Some College

Average number of hours staff are trained before their first shift
8

Are night staff awake or asleep
Awake

What percentage of the line staff are full time employees?
> 50%

Grades Served
Possible Community College/College
Call for more information

Average student to teacher ratio
1:0

Teaching/Classroom
N/A

Is the program able to implement IEP’s
N/A

Can Program handle a student who is more than two grade level’s behind in reading?
N/A

Academic Calendar
N/A

Can program support a student to complete a GED?
Yes

Can program support a student who wants vocational training?
Yes

Does the school have AP Classes or the ability to give or take a student to the AP Test?
Tests
Classes

Does the academic program have the ability to provide ACT or SAT Tutoring (on or off site)?
Yes

Does program have transition services for students?
Yes

If Yes, select all options that apply to your program
Transition House Associated With Program

Are there additional fees that apply to transitional options?
Call for more information

Percentage of families that participate in various transition programming?
< 50%

Scheduled or rolling admissions?
Rolling admissions

Is there an enrollment fee/outfitting fee/payment in advance?
Yes

If applicable, is the last month’s fees due at enrollment?
No

Cost per month/workshop/programming (in USD)
N/A

Percentage of clients who return home, or to a more traditional setting (like transitions to college or gap year, boarding school, etc.)
< 50%

Does a student have to sign themself into the program?
Yes

Link to Weekly or Daily Schedule
N/A

For licensed programs, but state or under 18, please select Incidents required to be reported to the state:
Infectious Disease
Major Injury | Death

What is the typical amount of time a family should expect before hearing about an major incident?
N/A

What is the average number of clients you see per year?
100

Professional Associations/Affiliations
N/A

Payment Type
Insurance (see above for specifics on insurance)
Private | Self Pay

Has the program previously been part of an evidence-based study?
Yes

Is the program presently part of an evidence-based study?
Yes

Link to the study that the organization is part of
OQ

Type of Family Therapy/Work Offered
N/A

Family involvement
MIDDLE: Family can opt in & out of their involvement based off the timing and current issues in treatment

Who completes the psychological evaluation?
Other

Minimum length of stay
45

Does the student receive a neuropsychological evaluation?
Other

Type Of Programming For Students
N/A

Typical Student
N/A

Minimum IQ
N/A

Interview Requirements for Applicants
N/A

Additional Therapy
N/A

Therapist Case Load at Peak Season
N/A

Percentage of licensed therapists?
N/A

Average number of days/week therapist is in the field
N/A

Number of Individual Sessions with Therapist
N/A

Integrated Wellness Support
N/A

Do clinical assistants work with lead therapists?
N/A

Percentage of full time therapists who have a private practice outside of wilderness?
N/A

Do any of the therapists operate more than one group at peak season?
N/A

What percentage of participants receive psychological evaluations?
> 50%

Does program receive a fee for evaluation or referral?
No

Additional levels of care offered by facility
Partial Hospitalization Program (PHP)

Types of eating disorder care provided
N/A

Specialized Programming
N/A

Is program focused on full recovery?
No

Housing
Supervised: administrative oversight, clinical services, life skills (licensed)

Community Service Requirement
N/A

Random Drug Testing
Yes

Transportation Options
Public
Can bring your own Vehicle
Provided by Program

Support Services
Resume / Job Search

House/Community Meetings
Weekly

Are participants required to do chores in the house/community?
Yes

12 Step Meetings on Location
No

Type of Students
Private Pay

Computer Access
Students have Laptops
Access to Internet turned off nightly

Cell Phones
Earned Privilege
Staff secured at Night

Academic Options
Call for more information

School Name (if applicable)
N/A

School Website (if applicable)
N/A

Types of Workshops Offered
N/A

Accommodations
N/A

Use of Personal Vehicle
N/A

Use of Electronics
N/A

Location of Workshop
N/A

Average Length of Workshop
N/A

Professional Associations/Affiliations
N/A