Do your students receive insurance coverage for more than two weeks?
N/A

Do you have an insurance utilization person?
Full time staff member

Is the program on any insurance panels?
Yes

State and/or National
Joint Commission (JCAHO)

Academic Accreditation
N/A

Religious Affiliation?
N/A

Please specify the type of religious affiliation
N/A

Minimum Age of Participants
N/A

Maximum Age of Participants
N/A

Can program support 18-year-olds if they enroll before 18?
N/A

Program can accept students with I-20 Visa?
N/A

Average Length of Stay (months)
N/A

Maximum Enrollment
N/A

Location of Program
N/A

Dorm/Housing
N/A

How does the program prevent students from leaving (running) from the program
N/A

Does the program have more than one location for this particular program?
N/A

Family Involvement
N/A

Percentage of Aid to Adoptive Family Students
N/A

Percentage of Court Ordered Students
N/A

Percentage of Private Pay Students
N/A

Percentage of School Funded Students
N/A

Percentage of State Funded Students
N/A

Is there individual therapy?
Yes

Number of individual therapy hours student receives on a difficult week?
N/A

Number of individual therapy hours student receives on typical week?
N/A

Percentage of licensed therapists?
N/A

Therapist average case load
N/A

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

Does the Clinical Director carry a case load?
N/A

Is there group therapy?
Yes

Average number of hours per week facilitated by licensed therapist
N/A

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

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

Is Skype accessible for family therapy?
N/A

Are there Additional Professionals? (Select all that apply)
Nurse Practitioner
Psychiatrist
Psychologist
Recreational Therapist
Registered Dietician

Are there Medical rule outs
N/A

Possible Medical Rule Outs
N/A

Is there a minimum BMI
Yes

Can Program accept insulin-dependent diabetics
N/A

Psychiatrist
On staff

Percentage of students on meds at enrollment
N/A

If psychiatrist is available to students, what percentage of students change meds?
N/A

Types of Therapy Offered
Acceptance and Commitment Therapy
Cognitive Behavioral Therapy (CBT)
Dialectical Behavioral Therapy (DBT)
Dialectical Behavior Therapy (DBT) Skills
Exposure Response Prevention Therapy (ERP , type of CBT)
Expressive Art Therapy
Eye Movement & Desensitization and Reprocessing
Mealtime Support Therapy
Narrative Therapy
Psychodynamic Therapy
Psycho educational

Does the program have a level/phase system?
Yes

If yes, are phases/levels tied to privileges?
Call for more information

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

If yes — select all that apply
Client Centered/Person Centered Therapy
Cognitive Behavioral Therapy
Positive Peer Culture

Integrated Wellness
Art
Meditation
Yoga

Does program use time out rooms?
No

Line staff to student ratio during awake hours
N/A

Does program run background checks on all staff?
N/A

Is there an educational requirement for staff?
N/A

If Yes, what is it?
N/A

Average number of hours staff are trained before their first shift
N/A

Are night staff awake or asleep
N/A

What percentage of the line staff are full time employees?
N/A

Grades Served
N/A

Average student to teacher ratio
N/A

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?
N/A

Can program support a student who wants vocational training?
N/A

Does the school have AP Classes or the ability to give or take a student to the AP Test?
N/A

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

Does program have transition services for students?
N/A

If Yes, select all options that apply to your program
N/A

Are there additional fees that apply to transitional options?
N/A

Percentage of families that participate in various transition programming?
N/A

Scheduled or rolling admissions?
Rolling admissions

Is there an enrollment fee/outfitting fee/payment in advance?
N/A

If applicable, is the last month’s fees due at enrollment?
N/A

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.)
N/A

Does a student have to sign themself into the program?
N/A

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:
N/A

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?
N/A

Professional Associations/Affiliations
National Association of Therapeutic Schools & Programs (Professional Member)
Other

Payment Type
Insurance (see above for specifics on insurance)
Private | Self Pay
Breakout Billing For Insurance | ‘Superbill’

Has the program previously been part of an evidence-based study?
N/A

Is the program presently part of an evidence-based study?
N/A

Link to the study that the organization is part of
N/A

Type of Family Therapy/Work Offered
Family Handbook
Family process facilitated by another therapist
Family Workshops Available
Flexible length of call with therapist per week
Parents Visit as Needed

Family involvement
HIGH: Family Expected on weekly calls (or more) & to attend all family workshops (weekly , monthly or quarterly)

Who completes the psychological evaluation?
N/A

Minimum length of stay
N/A

Does the student receive a neuropsychological evaluation?
N/A

Type Of Programming For Students
N/A

Typical Student
ADHD/ADD
Autism Spectrum Disorders
Mood Deregulation &/or Anxiety
Post Traumatic Stress Disorder (PTSD)

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?
N/A

Does program receive a fee for evaluation or referral?
N/A

Additional levels of care offered by facility
Intensive Outpatient Treatment / Program (IOP)

Types of eating disorder care provided
Anorexia
Binge Eating
Bulimia
Eating Disorder & Diabetes
Eating Disorder & Substance Abuse
Exercise Addiction (Athletes & Eating Disorders)
Orthorexia
Other Specified Feeding or Eating Disorder (OSFED)

Specialized Programming
N/A

Is program focused on full recovery?
Yes

Housing
N/A

Community Service Requirement
N/A

Random Drug Testing
N/A

Transportation Options
N/A

Support Services
N/A

House/Community Meetings
N/A

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

12 Step Meetings on Location
N/A

Type of Students
N/A

Computer Access
N/A

Cell Phones
Other

Academic Options
N/A

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