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

Do you have an insurance utilization person?
Full Time Staff Member

Is the program on any insurance panels?
No

State and/or National
CARF (Commission on Accreditation of Rehabilitation)
State License

Academic Accreditation
AdvancED (formally Northwest Association of Schools)
Northwest Accreditation Commission

Religious Affiliation?
No

Please specify the type of religious affiliation
N/A

Minimum Age of Participants
12

Maximum Age of Participants
18

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)
9

Maximum Enrollment
16

Location of Program
Rural

Dorm/Housing
Doubles
Triples
Other

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
20

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?
Yes, part of the program cost

Number of individual therapy hours student receives on a difficult week?
3

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

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

Therapist average case load
8

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
3

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)
2

Is Skype accessible for family therapy?
Yes

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

Are there Medical rule outs
Yes

Possible Medical Rule Outs
N/A

Is there a minimum BMI
No

Can Program accept insulin-dependent diabetics
Yes

Psychiatrist

Percentage of students on meds at enrollment
< 50%

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

Types of Therapy Offered
12 Steps Groups
Behavior Modification
Cognitive Behavioral Therapy (CBT)
Dialectical Behavioral Therapy (DBT)
Dialectical Behavior Therapy (DBT) Skills
Exposure Response Prevention Therapy (ERP , type of CBT)
Maudlsey Method (a type of FFT)
Narrative Therapy
PEERS Model
Psycho educational
Rational Emotive Behavior Therapy (REBT) (pioneer to CBT)
Recreation Therapy
Seven Challenges
Telephone Therapy
Other
Not Available
Family Focused Therapy(FFT)
Motivational Interviewing(MI)
Moral Reconation Therapy(MRT)

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)
Yes

If yes — select all that apply
Seven Challenges
Twelve Step Facilitation Therapy
Cognitive Behavioral Therapy
Positive Peer Culture

Integrated Wellness
Breathing Techniques/Breath Work
Meditation

Does program use time out rooms?
No

Line staff to student ratio during awake hours
1:6

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
12

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
1:8

Teaching/Classroom
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
Support Family And Participant Until 18 Years

Are there additional fees that apply to transitional options?
Yes

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

Scheduled or rolling admissions?
Yes

Is there an enrollment fee/outfitting fee/payment in advance?
1000

If applicable, is the last month’s fees due at enrollment?
8060

Cost per month/workshop/programming (in USD)
8060

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://?

For licensed programs, but state or under 18, please select Incidents required to be reported to the state:
Elopement
Infectious Disease
Major Injury | Death
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?
20

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

Payment Type
N/A

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
N/A

Family involvement

Who completes the psychological evaluation?

Minimum length of stay
N/A

Does the student receive a neuropsychological evaluation?

Type Of Programming For Students
N/A

Typical Student
N/A

Minimum IQ
N/A

Interview Requirements for Applicants
N/A

Additional Therapy

Therapist Case Load at Peak Season

Percentage of licensed therapists?

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?

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

What percentage of participants receive psychological evaluations?

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

Additional levels of care offered by facility

Types of eating disorder care provided
N/A

Specialized Programming
N/A

Is program focused on full recovery?

Housing
N/A

Community Service Requirement

Random Drug Testing
N/A

Transportation Options
N/A

Support Services

House/Community Meetings

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

12 Step Meetings on Location
N/A

Type of Students

Computer Access
N/A

Cell Phones
N/A

Academic Options

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

Use of Electronics

Location of Workshop

Average Length of Workshop

Professional Associations/Affiliations
N/A