Treatment Centers

If you have a treatment center that treats clients who have experienced psychological trauma, childhood abuse, or dissociation, the Sidran Institute would like to list your services. To be included in our Treatment Centers Directory, please complete the questionnaire below. There is no charge for inclusion, and we thank you for the work that you do.

*Institution Name:

*Street Address:

*City: *State: *Zip:

*Country:

*Phone: Ext:

*Fax:

*Email: Website:

*Intake / Contact Person:

*Clinical Director:

Name of trauma program (if different from the name of the institution above) :

*Year program began operation:

Is this institution/program accredited?: YesNo

If yes, please give name of the accrediting agency:

*Populations Served: ChildrenAdolescentsAdultsMales OnlyFemales Only

*Specializations: Post Traumatic Stress DisorderDissociative DisordersEating DisordersMales onlySelf-InjuryBorderline Personality DisorderSleep DisordersDepressive DisordersAnxiety DisordersSubstance Abuse/Dual DiagnosisSexual Orientation/Identity Issues

Other Relevant Specialties:

*Philosophical Orientation (e.g. Spiritual/Religious):

Services and Capacity

Inpatient/Residential: YesNo

What is the Capacity?:

What is the ratio of staff to clients?: Staff: Clients:

Please provide a description, admission criteria, and other information a prospective client would need to know:

Emergency Shelter: YesNo

What is the Capacity?:

What is the ratio of staff to clients?: Staff: Clients:

Please provide a description, admission criteria, and other information a prospective client would need to know:

Extended Care: YesNo

What is the Capacity?:

What is the ratio of staff to clients?: Staff: Clients:

Please provide a description, admission criteria, and other information a prospective client would need to know:

Transitional Living: YesNo

What is the Capacity?:

What is the ratio of staff to clients?: Staff: Clients:

Please provide a description, admission criteria, and other information a prospective client would need to know:

Halfway House: YesNo

What is the Capacity?:

What is the ratio of staff to clients?: Staff: Clients:

Please provide a description, admission criteria, and other information a prospective client would need to know:

Intensive Outpatient: YesNo

What is the Capacity?:

What is the ratio of staff to clients?: Staff: Clients:

Please provide a description, admission criteria, and other information a prospective client would need to know:

Outpatient / Walk-In Counseling / Therapy: YesNo

What is the Capacity?:

What is the ratio of staff to clients?: Staff: Clients:

Please provide a description, admission criteria, and other information a prospective client would need to know:

School-Based Program: YesNo

What is the Capacity?:

What is the ratio of staff to clients?: Staff: Clients:

Please provide a description, admission criteria, and other information a prospective client would need to know:

Therapy

*How many therapists are in your program?

*What adjunctive therapies does your program offer?:

Do you run therapy groups?: YesNo

If YES, Please Describe:

Do you sponsor peer-run support groups?: YesNo

If YES, Please Describe:

*Briefly state your Center's treatment philosophy. What issues does your program focus on and how do you treat them?:

Describe the medical services available at your facility:

Institutional Information

Is your program affiliated with a hospital or medical center?: YesNo

If yes, please name the institution and describe the relationship:

*What types of insurance do you accept?:

Does Your Center / Program Provide:

Financial assistance?: YesNo
Sliding Fee Scale?: YesNo
Payment Plans?: YesNo