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

Do you have an insurance utilization person?
N/A

Is the program on any insurance panels?
No

State and/or National
State License

Academic Accreditation
Other

Religious Affiliation?
No

Please specify the type of religious affiliation
N/A

Minimum Age of Participants
11

Maximum Age of Participants
100

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

Program can accept students with I-20 Visa?
No

Average Length of Stay (months)
1

Maximum Enrollment
8

Location of Program
Suburban

Dorm/Housing
Single Rooms with Private Baths

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?
No

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

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?
2

Percentage of licensed therapists?
All therapists are licensed by the state of operation

Therapist average case load
5

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

Does the Clinical Director carry a case load?
Yes

Is there group therapy?
Yes

Average number of hours per week facilitated by licensed therapist
2

Average number of hours per week of group processing? (i.e. run by staff, interns, grad students, etc.)
2

Average number of formal family therapy hours per week (not social calls to teen)
1

Is Skype accessible for family therapy?
Yes

Are there Additional Professionals? (Select all that apply)
Advanced Practice Master Nurse
Behavior Specialist
Doctor of Osteopath
Licensed Practical Nurse
Massage Therapist
Medical Doctor
Neurofeedback Specialist
Nurse Practitioner
Occupational Therapist
Psychiatrist
Psychologist
Reading Specialist
Recreational Therapist
Registered Dietician
Registered Nurse
Speech & Language Pathologist

Are there Medical rule outs
No

Possible Medical Rule Outs
N/A

Is there a minimum BMI
No

Can Program accept insulin-dependent diabetics
Yes

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
12 Steps Groups
Acceptance and Commitment Therapy
Animal-Assisted Therapy
Art Therapy(with certified art therapists)
Behavior Modification
Behavior Tech Trained staff & Therapists
Canine Therapy
Child Trauma Academy
Cogmed
Cognitive Analytic Therapy (CAT)
Cognitive Behavioral Therapy (CBT)
Cognitive Remediation Therapy (CRT)
Dialectical Behavioral Therapy (DBT)
Dialectical Behavior Therapy (DBT) Skills
Equine Assisted or Therapeutic Horse Back
Exposure Response Prevention Therapy (ERP , type of CBT)
Expressive Art Therapy
Eye Movement & Desensitization and Reprocessing
Hypnobehavioral Therapy
Maudlsey Method (a type of FFT)
Mealtime Support Therapy
Motivational Enhancement Therapy
Narrative Therapy
Neuro Feedback
Occupational Therapy
PEERS Model
Play Therapy
Psychodynamic Therapy
Psycho educational
Rational Emotive Behavior Therapy (REBT) (pioneer to CBT)
Recreation Therapy
Sand Therapy
Seeking Safety
Seven Challenges
Social Thinking model
Telephone Therapy
Vision Therapy
Mandometer

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)
No

If yes — select all that apply
N/A

Integrated Wellness
Art
Breathing Techniques/Breath Work
Meditation
Yoga

Does program use time out rooms?
No

Line staff to student ratio during awake hours
1:0

Does program run background checks on all staff?
No

Is there an educational requirement for staff?
No

If Yes, what is it?
High School Diploma

Average number of hours staff are trained before their first shift
0

Are night staff awake or asleep
Asleep

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

Grades Served
K-12

Average student to teacher ratio
1:1

Teaching/Classroom
Other

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
Other

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?
Not Applicable

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?
No

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

Are there additional fees that apply to transitional options?
Yes

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

Scheduled or rolling admissions?
N/A

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.)
> 50%

Does a student have to sign themself into the program?
No

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:
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?
150

Professional Associations/Affiliations
Other

Payment Type
N/A

Has the program previously been part of an evidence-based study?
Call for more information

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

Link to the study that the organization is part of
Please call for more information

Type of Family Therapy/Work Offered
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
0

Does the student receive a neuropsychological evaluation?
Yes

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?
N/A

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

Additional levels of care offered by facility
Acute Inpatient Treatment (evaluation & assessment)

Types of eating disorder care provided
Anorexia
Binge Eating
Bulimia
Eating Disorder & Diabetes
Exercise Addiction (Athletes & Eating Disorders)
Orthorexia

Specialized Programming
Age (pre-teen, adolescent, young adult)

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
N/A

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