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

Do you have an insurance utilization person?
Contractor

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
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)
18

Maximum Enrollment
15

Location of Program
Rural

Dorm/Housing
Doubles
Triples
Quads

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?
Yes

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
80

Percentage of School Funded Students
20

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?
2

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

Therapist average case load
6

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?
Yes

Average number of hours per week facilitated by licensed therapist
5

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)
2

Is Skype accessible for family therapy?
Yes

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

Are there Medical rule outs
Yes

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

Is there a minimum BMI
No

Can Program accept insulin-dependent diabetics
No

Psychiatrist
Contracted psychiatrist as needed

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
Animal-Assisted Therapy
Behavior Modification
Behavior Tech Trained staff & Therapists
Canine Therapy
Cognitive Behavioral Therapy (CBT)
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
Occupational Therapy
Play Therapy
Psychodynamic Therapy
Psycho educational
Recreation Therapy
Sand Therapy
Social Thinking model
Other

Does the program have a level/phase system?
No

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)
No

If yes — select all that apply
N/A

Integrated Wellness
Art
Breathing Techniques/Breath Work
Meditation
Other

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?
Other

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
1:5

Teaching/Classroom
Traditional teacher-led class

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?
No

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

Are there additional fees that apply to transitional options?
No

Percentage of families that participate in various transition programming?
Call for more Information

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?
Yes

Cost per month/workshop/programming (in USD)
14500

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://www.maplelakeacademy.com

For licensed programs, but state or under 18, please select Incidents required to be reported to the state:
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?
46

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

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

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

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 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?
Contracted separately by family/client

Minimum length of stay
365

Does the student receive a neuropsychological evaluation?
Other

Type Of Programming For Students
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”)
Mood Deregulation &/or Anxiety
Non-Verbal Learning Disabilities (NLD)
Pervasive Developmental Disabilities (PDD)
Post Traumatic Stress Disorder (PTSD)
Primarily DX Learning Disability
Speech & Language Disorders

Minimum IQ
N/A

Interview Requirements for Applicants
Call for More Information

Additional Therapy
Speech and Language Therapy

Therapist Case Load at Peak Season
< 8

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

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

Number of Individual Sessions with Therapist
1

Integrated Wellness Support
Art
Breathing Techniques/Breath Work
Meditation
Other

Do clinical assistants work with lead therapists?
No

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?
No

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
N/A

Types of eating disorder care provided
N/A

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

Is program focused on full recovery?
Call for more information

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
Other

Academic Options
Call for more information

School Name (if applicable)
Maple Lake Academy

School Website (if applicable)
www.maplelakeacademy.com

Types of Workshops Offered
Equine
Family | Group
Individualized | Custom
Trauma-Focused
Other
Call for more information

Accommodations
Call For More Information

Use of Personal Vehicle
No

Use of Electronics
Other

Location of Workshop
Call For More Information

Average Length of Workshop
Call for more information

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