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

Do you have an insurance utilization person?
N/A

Is the program on any insurance panels?
No

State and/or National
Joint Commission (JCAHO)
State License
Student and Exchange Visitor Information System (SEVIS)

Academic Accreditation
AdvancED (formally Northwest Association of Schools)
Other

Religious Affiliation?
No

Please specify the type of religious affiliation
N/A

Minimum Age of Participants
13

Maximum Age of Participants
16

Can program support 18-year-olds if they enroll before 18?
Yes

Program can accept students with I-20 Visa?
Yes

Average Length of Stay (months)
6

Maximum Enrollment
60

Location of Program
Rural

Dorm/Housing
Doubles

How does the program prevent students from leaving (running) from the program
Students are Always in “Line-of-Sight” with staff

Does the program have more than one location for this particular program?
No

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
0

Percentage of School Funded Students
0

Percentage of State Funded Students
0

Is there individual therapy?
N/A

Number of individual therapy hours student receives on a difficult week?
0

Number of individual therapy hours student receives on typical week?
0

Percentage of licensed therapists?
Not Applicable

Therapist average case load
0

Percentage of full time therapists who have a private practice outside a program?
Not Applicable

Does the Clinical Director carry a case load?
No

Is there group therapy?
No

Average number of hours per week facilitated by licensed therapist
0

Average number of hours per week of group processing? (i.e. run by staff, interns, grad students, etc.)
0

Average number of formal family therapy hours per week (not social calls to teen)
0

Is Skype accessible for family therapy?
No

Are there Additional Professionals? (Select all that apply)
N/A

Are there Medical rule outs
No

Possible Medical Rule Outs
N/A

Is there a minimum BMI
No

Can Program accept insulin-dependent diabetics
No

Psychiatrist
N/A

Percentage of students on meds at enrollment
> 50%

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

Types of Therapy Offered
Cognitive Behavioral Therapy (CBT)
Dialectical Behavioral Therapy (DBT)
Dialectical Behavior Therapy (DBT) Skills

Does the program have a level/phase system?
No

If yes, are phases/levels tied to privileges?
No

Does program have a milieu-driven residential model? (Staff are trained in model)
No

If yes — select all that apply
N/A

Integrated Wellness
Meditation
Yoga

Does program use time out rooms?
No

Line staff to student ratio during awake hours
1:8

Does program run background checks on all staff?
Yes

Is there an educational requirement for staff?
Yes

If Yes, what is it?
High School Diploma

Average number of hours staff are trained before their first shift
24

Are night staff awake or asleep
Awake

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

Grades Served
K-12
Possible Community College/College

Average student to teacher ratio
1:3

Teaching/Classroom
Traditional teacher-led class
Teachers support blended learning
Packets with teacher support
Online school/Classes

Is the program able to implement IEP’s
Yes

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

Academic Calendar
Year Round School (either quarters, trimester, semesters)

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
Additional Therapist To Work With Student Or Family As Transition
Transition House Associated With Program
Formal Transition To Another Therapist
Family Or Student Coaching Support For Certain Amount

Are there additional fees that apply to transitional options?
Yes

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?
No

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?
No

Link to Weekly or Daily Schedule
http://innercept.com

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

What is the typical amount of time a family should expect before hearing about an major incident?
1

What is the average number of clients you see per year?
N/A

Professional Associations/Affiliations
Young Adult Transition Association (YATA)
Other

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

Has the program previously been part of an evidence-based study?
No

Is the program presently part of an evidence-based study?
No

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?
Multidisciplinary Team

Minimum length of stay
90

Does the student receive a neuropsychological evaluation?
No

Type Of Programming For Students
Academic & life skill Focus
Academic focus
Academic, functional living skills, life skills and social skills focused
Clinically-driven programming (addresses individual life, living, social and academic needs)

Typical Student
ADHD/ADD
Autism Spectrum Disorders
Clinically Complex (possible behavior, genetic, students “who are puzzles”)
Development Delay
Genetic Disorders
Intellectual Disabilities
Mood Deregulation &/or Anxiety
Non-Verbal Learning Disabilities (NLD)
Post Traumatic Stress Disorder (PTSD)
Speech & Language Disorders

Minimum IQ
N/A

Interview Requirements for Applicants
Call for More Information

Additional Therapy
N/A

Therapist Case Load at Peak Season
< 8

Percentage of licensed therapists?
> 50%

Average number of days/week therapist is in the field
5

Number of Individual Sessions with Therapist
4

Integrated Wellness Support
Other

Do clinical assistants work with lead therapists?
Yes

Percentage of full time therapists who have a private practice outside of wilderness?
Not Applicable

Do any of the therapists operate more than one group at peak season?
Yes

What percentage of participants receive psychological evaluations?
N/A

Does program receive a fee for evaluation or referral?
No

Additional levels of care offered by facility
N/A

Types of eating disorder care provided
N/A

Specialized Programming
N/A

Is program focused on full recovery?
N/A

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
Call for more information

Cell Phones
Earned Privilege

Academic Options
Call for more information

School Name (if applicable)
Innercept Academy

School Website (if applicable)
N/A

Types of Workshops Offered
Family | Group
Individualized | Custom
Personalized/Custom Workshop for Family, Couple, or Individual

Accommodations
On Site

Use of Personal Vehicle
No

Use of Electronics
Not Available

Location of Workshop
Address Listed Above

Average Length of Workshop
Call for more information

Professional Associations/Affiliations
National Association of Therapeutic Schools & Programs (Professional Member)
Young Adult Transition Association (YATA)