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

Do you have an insurance utilization person?
N/A

Is the program on any insurance panels?
N/A

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

Academic Accreditation
Other

Religious Affiliation?
No

Please specify the type of religious affiliation
N/A

Minimum Age of Participants
17.5

Maximum Age of Participants
28

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)
3

Maximum Enrollment
80

Location of Program
Suburban

Dorm/Housing
Single Rooms with Shared Baths
Doubles

How does the program prevent students from leaving (running) from the program
Locked Facility

Does the program have more than one location for this particular program?
Yes

Family Involvement
N/A

Percentage of Aid to Adoptive Family Students
0

Percentage of Court Ordered Students
50

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?
0

Percentage of licensed therapists?
N/A

Therapist average case load
10

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

Does the Clinical Director carry a case load?
Yes

Is there group therapy?
Yes

Average number of hours per week facilitated by licensed therapist
10

Average number of hours per week of group processing? (i.e. run by staff, interns, grad students, etc.)
10

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)
N/A

Are there Medical rule outs
N/A

Possible Medical Rule Outs
N/A

Is there a minimum BMI
N/A

Can Program accept insulin-dependent diabetics
N/A

Psychiatrist
N/A

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
N/A

Does the program have a level/phase system?
N/A

If yes, are phases/levels tied to privileges?
N/A

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

If yes — select all that apply
N/A

Integrated Wellness
N/A

Does program use time out rooms?
N/A

Line staff to student ratio during awake hours
1:0

Does program run background checks on all staff?
Yes

Is there an educational requirement for staff?
Yes

If Yes, what is it?
N/A

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

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
1:0

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?
Yes

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?
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)
12500

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
Other

Payment Type
N/A

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

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
MIDDLE: Family can opt in & out of their involvement based off the timing and current issues in treatment

Who completes the psychological evaluation?
N/A

Minimum length of stay
30

Does the student receive a neuropsychological evaluation?
N/A

Type Of Programming For Students
N/A

Typical Student
N/A

Minimum IQ
86

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
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
N/A

Cell Phones
N/A

Academic Options
College University or Community

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