Yes
No
Planned
Question
1.
Program
License.
The program is licensed to provide mental health or drug and
alcohol treatment by the
state where they operate .
2.
Licensed
Professional Oversight. Program oversight is provided by a licensed
mental health professional who is responsible and accountable for the
program's policies, procedures and activities that pertain to health,
safety, standards of practice, ethics and therapeutic activities.
If No , please explain
who has oversight of your program's therapeutic activities and their
qualifications
3.
Clinical
Director. The program has a clinical director
specifically responsible for health and medical policies, procedures and
the well-being of students.
4.
Policy
& Procedures. Parents may request and review copies of the program's policies,
procedures, staff background summaries, organizational structure and staff
job descriptions.
5.
Licensed
Therapists & Counselors. All therapy, counseling and
evaluation services are provided by licensed professionals with
appropriate training.
Yes
No
Planned
Question
6.
Mental
Health Staff
Longevity. All mental health staff in this particular program have
more than 6 months professional experience. (not counting interns)
How many mental health staff
have more than 6 months .
The total number of mental health staff are
7.
Staff Program
Experience. The mental health staff who will be working
with a child will have at least one year's experience working in this
particular wilderness program.
8.
Staff Education. Administrative
and supervisory staff who supervise the field guides and wilderness
instructors have graduated from college with a bachelor's degree.
9.
Number
of Staff. The staffing to student ratio in the field is
no more than 4 students/participants per staff
person.
What is the supervisory staff
to student ratio (Staff : Participant)
10.
Parent
Support. Parents receive a weekly phone call
and update from the student's therapist or counselor in the program.
11.
Parent
Support. Parent's receive a regularly scheduled phone call from a field staff
person or instructor who worked directly with the student that week.
12.
Admissions.
The admissions and screening procedure is directly
supervised or conducted by a licensed mental health professional.
13.
Second
Opinion. The program was recommended by a qualified
and licensed mental health
professional who has experience referring to this the particular program.
14.
Third
Opinion. The program was recommended by a qualified educational
consultant who has experience with this particular program.
Yes
No
Planned
Question
15.
Student
Progress. Parents and approved referral sources may find out the routine status of
a child on a daily basis.
16.
Program
Maturity. The program has been in existence for at least 2 years.
How long has this program been
in existence
17.
Ownership.
The program owned at least in part by a licensed mental health
professional or the programs board on directors has a licensed mental
health professional
If No, please identify the
position, qualifications and authority of the person who is responsible to
insure that professional and ethical standards of practice are followed.
This applies to program field and therapeutic activities that affect the
health, safety, well being and treatment of students.
18.
Staff
Training. All field staff are trained in first-aide and CPR.
Please describe other training
required of staff that applies to health and safety.
19.
Advanced
Staff Training. There is a group of staff
available who
are trained
as Wilderness First
Responders or in Search and Rescue.
Yes
No
Planned
Question
20.
Follow-up
Program. The program provides an after-care
plan and follow-up monitoring of graduates.
Please describe your after care
or follow-up program.
21.
Evaluation
Services. The program offers optional or routine record reviews, psychological
or achievement evaluations.
Please describe the evaluation
services available
22.
Student
Education. The program offers school credit course
work (more than just physical education).
If yes, please describe your educational
program, certification and degree, etc..
23.
Teacher
Qualifications. The program has qualified licensed
teachers who work with students in the field.
24.
Program
Stability. The program has been redesigned or taken over
by new ownership within the past year. [A "yes "
means the program has been substantially redesigned or taken over in the past
year]
Yes
No
Planned
Last Question
25
Referral
Incentives . The program offers financial incentives to
consultants for the referrals they make to their program, or the
program offers discounts to parents to help pay for the cost of
a consultant. [A "yes " means the program offers
discounts or it offers some form of incentive to help compensate
the cost of using a consultant.]
If yes, please describe the
incentive to consultants or referral sources.