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

Academic Accreditation
Other

Religious Affiliation?
No

Please specify the type of religious affiliation
N/A

Minimum Age of Participants
12

Maximum Age of Participants
17

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)
0

Maximum Enrollment
0

Location of Program
Suburban

Dorm/Housing
Single Rooms with Shared Baths
Doubles
Triples

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
0

Percentage of School Funded Students
0

Percentage of State Funded Students
0

Is there individual therapy?
Yes

Number of individual therapy hours student receives on a difficult week?
6

Number of individual therapy hours student receives on typical week?
5

Percentage of licensed therapists?
> 50%

Therapist average case load
3

Percentage of full time therapists who have a private practice outside a program?
< 50%

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)
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
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
Art Therapy(with certified art therapists)
Behavior Modification
Cognitive Behavioral Therapy (CBT)
Dialectical Behavioral Therapy (DBT)
Dialectical Behavior Therapy (DBT) Skills
Equine Assisted or Therapeutic Horse Back
Expressive Art Therapy
Eye Movement & Desensitization and Reprocessing
Psycho educational
Recreation Therapy
Seeking Safety

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)
Yes

If yes — select all that apply
Cognitive Behavioral Therapy
Positive Peer Culture

Integrated Wellness
Art
Breathing Techniques/Breath Work
Meditation
Yoga

Does program use time out rooms?
No

Line staff to student ratio during awake hours
1:3

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
20

Are night staff awake or asleep
Awake

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

Grades Served
N/A

Average student to teacher ratio
1:5

Teaching/Classroom
Traditional teacher-led class

Is the program able to implement IEP’s
No

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?
No

Can program support a student who wants vocational training?
No

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)?
No

Does program have transition services for students?
Yes

If Yes, select all options that apply to your program
Other

Are there additional fees that apply to transitional options?
No

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)
60000

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:
Infectious Disease
Major Injury | Death

What is the typical amount of time a family should expect before hearing about an major incident?
0

What is the average number of clients you see per year?
250

Professional Associations/Affiliations
National Association for Addiction Professionals (NAADAC)
National Association of Addiction Treatment Providers (NAATP)

Payment Type
N/A

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

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

Link to the study that the organization is part of
Conducted by Kyle Van Duser of the University of Hawaii.

Type of Family Therapy/Work Offered
N/A

Family involvement
N/A

Who completes the psychological evaluation?
N/A

Minimum length of stay
N/A

Does the student receive a neuropsychological evaluation?
N/A

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
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
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