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

Do you have an insurance utilization person?

Is the program on any insurance panels?
N/A

State and/or National
N/A

Academic Accreditation
N/A

Religious Affiliation?

Please specify the type of religious affiliation
N/A

Minimum Age of Participants
N/A

Maximum Age of Participants
N/A

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

Program can accept students with I-20 Visa?

Average Length of Stay (months)
N/A

Maximum Enrollment
N/A

Location of Program

Dorm/Housing
N/A

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

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

Family Involvement

Percentage of Aid to Adoptive Family Students
N/A

Percentage of Court Ordered Students
N/A

Percentage of Private Pay Students
N/A

Percentage of School Funded Students
N/A

Percentage of State Funded Students
N/A

Is there individual therapy?

Number of individual therapy hours student receives on a difficult week?
N/A

Number of individual therapy hours student receives on typical week?
N/A

Percentage of licensed therapists?

Therapist average case load
N/A

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

Does the Clinical Director carry a case load?
N/A

Is there group therapy?
N/A

Average number of hours per week facilitated by licensed therapist
N/A

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

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

Is Skype accessible for family therapy?
N/A

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

Percentage of students on meds at enrollment

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

Types of Therapy Offered
N/A

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

If yes, are phases/levels tied to privileges?

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
N/A

Does program run background checks on all staff?
N/A

Is there an educational requirement for staff?
N/A

If Yes, what is it?

Average number of hours staff are trained before their first shift
N/A

Are night staff awake or asleep

What percentage of the line staff are full time employees?

Grades Served
N/A

Average student to teacher ratio
N/A

Teaching/Classroom
N/A

Is the program able to implement IEP’s

Can Program handle a student who is more than two grade level’s behind in reading?

Academic Calendar

Can program support a student to complete a GED?
N/A

Can program support a student who wants vocational training?

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)?

Does program have transition services for students?
N/A

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

Are there additional fees that apply to transitional options?

Percentage of families that participate in various transition programming?

Scheduled or rolling admissions?

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

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

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.)

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
N/A

Payment Type
N/A

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

Is the program presently part of an evidence-based study?
N/A

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