Wilderness Therapy Programs

E-mail: info@Wilderness-Programs.Org
More Information: www.Wilderness-Programs.Org

Program Based Information On Wilderness Therapy Treatment

This form is optional and may be contrasted with consumer and professional feedback about programs.

The following is a list of questions and criteria that may be used to document, contrast, discuss and evaluate wilderness programs. No single criteria is necessarily critical. Programs can have unique populations, services, durations and activities. You are under no obligation to complete or to submit this form. We rely heavily on consumer and professional feedback and do not require this form to be completed by programs. This form is primarily intended to provide programs with a review and self-examination process. Feedback to programs is provided by e-mail to help insure efficiency and provide documentation. Completing this form may help a program's rating.

Program responses to this questionnaire will be kept private. This web site is not affiliated with any wilderness therapy treatment programs. 

Wilderness Therapy Program Name: 

Your full name: (required)

Your e-mail address: (required) Please be sure your address is correct.

Is the program open-ended?   Yes      No

The cost of the program (estimated range of costs in dollars)  (required)

May we contact you by e-mail to verify your responses?   Yes     No  

Your position with the program: (required)

Please describe you program options, duration, costs and services in detail.

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 per staff person. 

What is your supervisory staff to student ratio (Staff : Students)

 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 can be recommended by a qualified and licensed mental health professional who has experience referring to this the particular program. 

Please give the name and contact information for such a person.
 14.

Third Opinion. The program can be recommended by a qualified educational consultant who has experience with this particular program. 

Please give the name and contact information for such a person.
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 is owned or owned in part by 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 you require that applies to health and safety.
 19.

Advanced Staff Training. There is a group of staff available who are trained as Wilderness First Responders and 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).

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]

If Yes, please describe any changes to program design and ownership within 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.

Please provide us with information and your comments with regard to the following questions. This information and your opinion will will be kept private and will not be published without your permission.

Local Sheriff phone number

Local State Child and Youth Protective Services phone number

Please give us the contact information for any State Agencies that license, accredit and certify your program or elements in your program.

The name and phone number of the health care provider professional(s) who work(s) with your program (physician, nurse, or nurse practitioner). If it is not a one person, then please describe how medical services are routinely provided and arranged for students.

Please describe your program's policy and procedure regarding restraint or  the use of force. Please be specific about when and how force or restraint may be used.

Please describe in detail your program's policy and procedure regarding parent complaints. (Please explain the procedure, review process and appeal process). 

Please describe in detail your program's policy and procedure if student comments, threatens or behaves in a manner suggesting a dangerous, suicidal or violent state of mind. How is this handled for each issue?

Please describe the educational program, staff, curriculum and what credit is awarded to students.  (e.g. correspondence school, certified school, registered school, private teachers, certified teachers, free standing school, state certified, etc...). 

Please describe the screening policy and procedure, interviews, instruments and questionnaires that your program uses to select students appropriate for your program. In addition, What students are appropriate and not appropriate for your program?

Please give us any information regarding future plans and any reasons why any of the questions above may not pertain to your program.

Form Submission Information and Agreement.

Check that you have read and that you agree to the terms set forth below.  

Please e-mail us if you have any questions. 

Please check each item after you have read and agreed to the following.

   I am authorized to submit this information and agree to the following terms on behalf of my program.

   I agree that you may use this information for research and other consumer protection, education and information activities without restriction. I understand that this form will not be published and will be kept private.

   I agree and acknowledge that I do not have the right to have my program rated or post my  program on the wilderness program web site.  

   I agree that I am responsible for the accuracy of content that I submit. 

   I understand that the security of this transmission by e-mail is high, but may be no more secure than standard mail delivery. 

You are submitting this information by e-mail from this web site directly to an e-mail account on the same computer system. The risk of interception by non-authorized personnel is extremely low. 

 

                   

If you know of a program, or would like your program listed on our site, please send the internet address to  Webmaster@Wilderness-Programs.Org or you may submit your program on line at www.Wilderness-Programs.Org/SubmitProgram.html. We reserve the right to not list a program.