Type of Service (Single Location)

SM

Section 2: View 2.1 Version 1.1

Type of Service (Single location)

Enter the common name of your organization

Summit Achievement

Please enter your name and contact information -- phone or email address (person preparing).

Christopher Mays, Executive Director207.697.2020,

Remember to determine your unique ID and your submission number. These two entries must be identical on each Section of the Questionnaire.

This is where direct service providers tell us their prototype of service so we can direct them to questions appropriate to what they do. You will likely answer yes to more than one item. Please respond “yes” or “no” to each.

This section applies only to organizations with an “A number” of 1 or 2.

Be careful to include as many entries as you should. For example, a Therapeutic school that offers adventure programs and an extensive transition support service for students graduating, might have “B numbers” of 10, 11,20,21,31, 41, and, 45. Please don’t stop until you have checked on all possibilities.

2.1 Therapeutic/Clinical questions

2.10 ___Yes X No Does your organization provide behavioral change or therapeutic services? If yes, you have a B number of 10 and either 11 or 12but not both. If no, then 2.11 and 2.12should be “no.” However 2.13 might be “yes” and you might have a B number of 13.

2.11 XYes ___ No Does your organization directly provide therapeutic services? By “therapeutic service” we mean services by one or more persons holding a license or other standard credentials to provide mental health services in the jurisdiction where those services are rendered. If you answer “Yes” you have a “B number” of 11.

2.12 ___ Yes X No If you answered “No” to 2.11, does your organization includeservices for the purpose of providing behavioral change or emotional growthin those you serve that do not include credentialed clinicians? If you answer “Yes” you have “B number” of 12.

2.13 ___ Yes X No If you answered no to 2.11 and 2.12, Do you facilitate access to therapeutic services or other services directed toward change and/or emotional growth although you don’t provide it yourselves? This would apply to some transitional schools and some conventional schools that accept students in transition. If your answer to 2.11 or 2.12 was “yes,” then your answer to 2.13 is “no.” If you answer “Yes” you have “B number” of 13.

2.2 Education Questions

2.20 X Yes ___No Does your organization provide or facilitate access to educational services? If “yes” you have a B number of 20. If no, you may skip 2.21 through 2.24.

2.21 ___Yes X No Does your organization include a school that can grant credit for school work as an integral part of your organization, in some grades K through 12 (if US; local equivalent if not in US) or at the post high school level, according to law in the jurisdiction(s) where you operate? If “yes” you have a B number 21.

2.22 XYes ___No Does your organization provide access to external educational resources that are transferrable, diploma granting, or degree granting? If Yes, you have “B number” of 22

2.23 X Yes ___No Does your organization provide online “distance learning” educational services that are accessed by students in a therapeutic or behavioral change facility? If “yes” you have “B number of 23.” You probably also have B number of 34.

2.24 X Yes ___No Does your organization provide “distance learning”educational services that are accessed by students in a therapeutic or behavioral change facility?If “yes” you have “B number” of 24.You probably also have B number of 34.

2.25 ___Yes X No Does your organization provide in person on-siteeducational services for students in a therapeutic or behavioral change facility that is a separate organization? (This applies even of the “separate organization” is affiliated in some way. Discovery Academy and Discovery Ranch have common ownership, but educational services at Discovery Ranch are provided by Discovery Academy (or at least this was true in the recent past). Under these conditions, Discovery Academy would respond “yes” at least to 2.20, 2.21, and 2.25. If “yes” you have “B number of 23.”

2.26 ___Yes X No Does your organization provide in personeducational services for students in a therapeutic or behavioral change facility, but at your location and not on site for the therapeutic or behavioral change facility? If “yes” you have “B number of 26.”

2.28 ___Yes X No Does your organization provide academic credit under conditions not otherwise specified in the 2.2 group of questions?An example of “yes” would be a wilderness program that is not licensed as a school issuing “Credit” for activities intrinsic to the wilderness program, such as Physical Education and/or ecology. If “yes” you have “B number of 28.”

2.29 ___Yes X No Does your organization offer educational services or facilitate educational services for your clients in a manner that does not fit any of the choices between 2.21 and 2.28 inclusive) If “yes” you have “B number of 29.”

2.3 Group: Location of Service

2.31 X Yes ___NoIs your organization a boarding/residential school or other residential facility, in whole or in part? If “yes” you have either a “B number” 311 or 312. Ifthe boarding environment is virtually identical for all residents, your “B number” is 311. If you have more than one boarding environment, your “B number” is 312. (This includes outdoor and wilderness programs, if overnight stay is involved)

2.32 ___Yes X NoDoes your organization serve people who go to your location or facility? (Example: an outpatient clinic or a day school) A boarding and day school would say “yes” to both 2.31 and 2.32, as would a hospital with both inpatient and outpatient services. If “yes” you have “B number of 32.”

2.33 ___Yes X No Does your organization travel to the homes or other immediate location of the people you serve? This would apply to most transport services. If “yes” you have “B number of 33.”

2.34 ___Yes X No Does your organization work with the people you serve by only by distance communications (phone, fax, email, webcam, etc.)? We assume that all or nearly all organizations use these methods at some times. Our question applies to serving some clients only by such methods. If so, you have a “B number” of 34.

2.4 Modalities

2.41 ___Yes X No Does your organization offer a specific transition service. A transition service is a hands-on service intended to lower the risk of loss of prior gains during transition from a more restrictive environment to less restrictive. A conventional discharge planning service is not a transition service as we intend. We are seeking a discrete service focused on the transition process. If offered by the more restrictive environment the student/client is leaving, it must include staff specifically assigned to this service and direct interaction with the student/client that is individually goal oriented after the discharge from the more restrictive setting. As examples, this would include Carlbrook School with its very elaborate built in transition system, transitional schools like Oakley, Mountain Springs, and Auldern, and more family based transition services like Vive and Homeward Bound. Some locally based outpatient services will fit this as well, if the service is exclusively for people making that transition. Intensive Outpatient Services (IOPs) Do NOT qualify unless they are operating a discreet service for clients transitioning from more intensive settings, not mixed with people with no prior treatment history. If so, you have a “B number” of 41.

2.42 X Yes ___No Does your organization serve clients some or all clients in an outdoor or wilderness setting? Schools and programs that are primarily indoor programs but offer “adventure” trips similar to wilderness are included here. If so, you have a “B number” of 42.

2.43 ___Yes X No Does your organization provide family services for people seeking service because of a different family member, where that person might not be a student/client/patient of the organization? This applies to progams like family/co-dependency services at place like Hazelden and Caron Foundation. It also includes most intervention services. If yes, you have a “B number” of 43.

2.44 ___Yes X No Does your organization provide temporary housing for the limited purpose of offering a “safe place?” This would apply to a place people can go between residential schools or programs, programs, or waiting for a bed or on vacation from a programs that shuts down during vacations or after a run-away episode while making a decision about further action. If yes, you have a “B number” of 43.

2.45 ___Yes X No Is your program a summer (or other seasonal) Camp or does it include a summer camp?A special summer program that does not resemble a camp might best be presented by selecting a B number of 46 in response to 2.46 following. In some cases you might simply be able to choose between the two. If yes, you have a “B number” of 45.

2.46 X Yes ___No Does your organization provide a short term service with specific, limited goals within a period of time that is usually less than 60-120 days (excluding programs with a B number of 44)?Among residential programs, this would include places like Aspen Institute for Behavioral Assessment, Turnabout Ranch, and San Marcos Treatment Center’s Prescription Program, as well as most wilderness programs. If so, you have a “B number” of 46. If you are a short term assessment center, you probably also have a B number of 62.

2.47 ___Yes X No Does your organization provide a travel program? Academic field trips and travel to interscholastic athletic events or weekend recreational outings do not trigger a “yes” but extended travel that is not part of the regular curriculum should trigger a yes for organizations where travel is not the primary service offered.If so, you have a “B number” of 47.

2.49 ___Yes X No Are you or do you include a direct service modality not adequately described in 2.41 through 2.49? This excludes intervention and assessment services. If so, you have a “B number” of 49.

2.5 Intervention

2.51 ___Yes X No Does your program offer intervention services in which close friends and family are guided to persuade a person to accept change or treatment? The concept is (very roughly) the kind of intervention that we saw on the TV production “Intervention” and the kinds of process promoted in the 1980s by the Johnson Institute and Dr. Joseph Pursch. If yes, you have a “B number” of 51.

2.52 ___Yes X No Do you transport people to treatment, including minors who might be involuntary? If yes, you have a “B number” of 52.

2.59 ___Yes X No Do you offer an intervention service not otherwise described in the 2.5 Intervention section?If yes, you have a “B number” of 59.

2.6 Assessment -- In the case of assessment services, choose either 2.61 or 2.62, whichever comes closer to your service, even if neither matches your situation exactly.

2.61 ___Yes X No Does your organization work with the people you serve by providing diagnostic evaluations primarily for use outside your organization? This applies primarily to psychologists who travel to wilderness programs and other locations to do testing. It also applies to organizations who employ such people. Assessment and evaluation services done by therapeutic schools and programs entirely or primarily for their own internal use do not qualify for this. If so, you have a “B number” of 61.

2.62 ___Yes X No Are you or do you include a program primarily for intensive short term evaluation?This refers to organizations and facilities that offer a multidisciplinary diagnostic evaluation, usually in a residential or inpatient setting. This does not include diagnostic assessment and evaluation primarily or exclusively for internal treatment planning. If so, you have a “B” number of 62.

2.69 X Yes ___No Are you or do you include an evaluation or assessment service that does not fit the above categories and is more than the routine assessment needed for treatment or educational planning in your own facility?. If so, you have a “B” number of 69.

2.7Finance -- In the case of assessment services, choose either 2.61 or 2.62, whichever comes closer to your service, even if neither matches your situation exactly.

2.71 ___Yes X No Are you or do you include a service for financing (loan) opportunities for education and or therapy? This choice applies primarily to organizations, whether for profit or not for profit that make or broker loans in the commercial market. It does not apply to financing services that are part of a direct provider organization and serve only the clients of that direct provider. If so, you have a “B” number of 71.

2.72 ___Yes X No Are you or do you include a service for assisting families with grants or loans and/or negotiating lowered rates for education and or therapy, targeting families that would likely be unable to afford the cost of services without assistance? This choice applies primarily to not for profit foundations. This does not apply to direct service providers who offer such assistance only to people patronizing their own services. If so, you have a “B” number of 72.

2.73 X Yes ___No Are you a direct provider of service with an internal financing or financial assistance service?If so, you have a “B” number of 73.

2.79 ___Yes X No Are you or do you include a service of benefit to people in need of service that will help with finance and does not fit the above categories?If so, you have a “B” number of 73.

2.8 Not Primarily for Special Needs

2.81 ___Yes X No Are you a facility that primarily serves a population that is not special needs but will serve special needs people occasionally? Typically this would include a conventional boarding school that serves special needs students only on an occasional basis. If so, you have a “B” number of 81.

2.9 Description Missing

2.91 ___Yes X No Were you either unable to give a “yes” response to any question up to 2.34 or uncertain about a definition up to 2.34? That applies if you were too If so you have a “B number” of 91.

2.92 ___Yes X No Were you either unable to give a “yes” response to any question between 2.41 and 2.50 or uncertain about a definition up to 2.39? That applies if you were too If so you have a “B number” of 92.

Please list your B numbers here:

10-11-20-22-23-24-311-42-46-69

Please enter any comments here (attach additional page if necessary):

Summit Achievement provides Therapeutic services by licensed clinicians. (I checked NO to behavioral change because I assumed this pertained to emotional growth programs) Our Academic Program is licensed by the Maine Department of Education to issue transfer credit (hence the NO answer to 2.21. ) However, we provide a full high school curriculum and credit is readily accepted at most schools.

Your response here (expand space if necessary)

Please remember to enter Unique ID and Submission number in the “footer” section of this document. Do not enter “New Page Number” or “Initials” until after printing when the entire questionnaire is complete.

Thank you!!

1

New page number ______Unique ID 04037SUMXX Submission # 1 Initials ______

Section 2 View 2.1 © 2009 Thomas J. Croke and Associates, Inc.