Northern Utah

Program Tours

Alpine Academy Therapeutic Schools

What if residential treatment didn’t feel like treatment? What if healing could take place in a safe, nurturing family environment? What if a teen could not only recover credit but also discover that they love learning? What if the most productive therapy took place not only in the therapist’s office but also in natural environments? Two gender-affirming campuses - one for birth-assigned males and one for birth-assigned females - provide all of this through the use of a relational, brain-based learning approach that is proven to heal trauma and effect lasting change, creating an environment where students feel seen, heard, and safe.

WayPoint Academy

WayPoint Academy is a residential treatment center that provides a safe, supportive environment for adolescents struggling with OCD and Anxiety specifically. WayPoint Academy offers anxiety-specific therapy, accredited academics, medication management, holistic wellness, social practice & learning, and other coping skills taught by dedicated experts.

Program: Alpine Academy

Type: Residential Treatment

Location: Tooele, Utah

Gender: Campus 1: AFAB; Campus 2:AMAB

Age of Clients: 12-18

Average Length of Stay: 12 months

Accreditations:

• Teaching-Family Association
  
• Cognia
• NPS for CA, IL, WA
• NATSAP

Insurance Help: Bridgeway Billing contracted to obtain out-of-network insurance reimbursement for families.

Profile of Students Served: Alpine Academy students are challenged with family issues caused by unresolved trauma, anxiety, depression, attachment/adoption issues, etc. They are often referred to as behaviorally soft & and clinically complex and have a tendency to implode rather than explode, which results in isolation, self-harm, ideation, misuse of social media/technology, and risky behavior.

Specialties: LIFE-Learning In a Family Environment; trauma work; family and parent relationships and systems work; equine, identity exploration-including gender; social & life skills development, school credit recovery

Program Cost: $530 daily/$15,900 monthly

Rule Outs: Physical aggression; active eating disorders; IQ lower than 80; substance dependence as primary diagnosis.

Program: WayPoint Academy

Type: RTC

Location: Huntsville, UT

Gender: Co-ed.

Age of Clients: 12-18 years old

Average Length of Stay: 10-12 months

Accreditations:

• The Joint Commission
• NATSAP
• Department of Human Services Office of Licensing
• Cognia

Insurance Help: We have an in house advocate team that helps our families to get reimbursement.

Profile of Students Served:

• School Refusal
  
• Social Isolation
• OCD
• Anxiety
• Executive Functioning Struggles

Specialties: ERP, Brainspotting, EMDR, DBT

Program Cost: Our monthly tuition is $15,900. Our enrollment fee is $3,800.

Rule Outs: Aggression, Active Eating Disorders, Active Suicide Ideation, Active Substance Dependency, Psychosis, Insulin Dependent.

Set in a comfortable home-like environment, Bridge House provides stabilization, assessment, diagnostics, and treatment for adults struggling with mental illness, cognitive differences, and substance use disorders. Each component of the program is designed to provide our residents with a better understanding of their illness and associated challenges while developing the skills required to live a life with purpose and fulfillment.

Second Nature

For over 25 years, Second Nature has been a leader in wilderness therapy. Using a nomadic programming style, Second Nature helps students overcome challenges that have impacted their emotional growth, relationships, and self-esteem. Our program continues to expand services. In recent years, Second Nature has developed the Family Dynamic Assessment, Parent Coaching, and Family Intensives. Clients are served in groups that align with their personal and individual needs. Our latest addition is the ‘all-gender group where students can find community regardless of gender or sexual orientation.

Program: Bridge House

Type: RTC

Location: Farmington, Utah

Gender: All

Age of Clients: 18-60

Average Length of Stay: 3-4 months

Accreditations:

• NATSAP
  
• Department of Human Services Office of Licensing
  

Insurance Help: We partner with a third-party advocacy firm, SJ Health Insurance Advocates, who may advocate for reimbursement from insurance companies.

Profile of Students Served: Bridge House serves individuals from the ages of 18-60 who have questions regarding their mental health.

Specialties: Diagnostics and Stabilization

Program Cost: Bridge House bills from an all inclusive daily rate of $1,575. Our enrollment fee is $3,100

Rule Outs: Individuals who are violent and aggressive outside of their mental health presentations. Someone experiencing life threatening complications due to an eating disorder, would need to stabilize in a hospital prior to admission. Someone experiencing life threatening complications due to substance withdrawal, would need to detox prior to an admission.

Program: Second Nature Wilderness Family Therapy

Type: Wilderness

Location: Duchesne, UT

Gender: All Gender

Age of Clients: 13-17

Average Length of Stay: 9 - 12 Weeks

Accreditations:

• AEE
  

Insurance Help: Reimbursement for Individual, Group, and Family Therapy

Admissions Director: Jennifer Charrier

(801) 903-7242

jennc@second-nature.com

Profile of Students Served:

Second Nature works with a diverse group of individuals. Groups are designed to address specific needs.

Specialties:

Second Nature was the first wilderness program to include an all gender group to serve LGBTQ+ clients.

Program Cost: $665 per day...Enrollment fee $4900

Rule Outs:

Aggression, active eating disorders, actively suicidal, some medical conditions.

• Executive Director: Jennifer Wilde, LCSW jwilde@elevationsrtc.com
• Assessment Director: Jordan Rigby, PsyD jrigby@viewpointcenter.com

• Clinical Director: Brandon Burr, LCSW bburr@viewpointcenter.com
• Admissions Director: Randi Nelson rnelson@viewpointcenter.com
  

ViewPoint Center

Live Strong House

The ViewPoint Center is a comprehensive therapeutic assessment facility licensed as a specialty psychiatric hospital for adolescents of all genders ages 12-18. ViewPoint employs two tracks, to be used independently or in succession, to accommodate the individualized needs of each patient. The short-term stabilization track provides a safe and nurturing environment that helps to stabilize a patient psychiatrically and clinically so that they can return to a program/boarding school in a matter of 1-3 weeks. The assessment track provides a comprehensive interdisciplinary evaluation involving psychiatry, clinical, medical, academic, neuropsychological, and social milieu functioning. The 8 week clinical assessment provides answers to the most complex diagnostic questions as well as recommendations for longer-term treatment.

Live Strong house is a residential support center for adolescents and young adult men. We specialize in students who struggle with information processing issues, substance abuse, PTSD, ADHD, depression, and anxiety. Many of our students do not fit the traditional school environment and may be heavily influenced by negative peer groups. The mission of Live Strong House is to develop a lasting change in the lives of young men by providing the highest quality of treatment, living our core values, creating interpersonal relationships, loving self and others, and understanding how to Live Strong. The work we do at Live Strong House is centered around developing a connection with each of our students and using that connection to facilitate personal growth. Our ability to focus on each student creates a lasting bond that allows us to influence and engender internal change.

Program: The ViewPoint Center

Type: Specialty Psychiatric Hospital

Location: Syracuse, UT

Gender: All Genders

Children ages: 6-12

Adolescents ages: 12-18

Average Length of Stay: 8 week assessment, stabilization is individualized

Accreditations:

• The Joint Commission
  
• Utah Department of Health
• NATSAP
  

Insurance Help: ViewPoint successfully bills out-of-network benefits and averages 35-45 days of ins. coverage. Billing out-of-network allows VP to manages each case as needed without Insurance dictating treatment.

Profile of Students Served: Actively suicidal, psychosis, PTSD, attachment disorder, unexplained behaviors or psychiatric symptoms, autism, anxiety, depression, mild aggression, OCD, eating disorder, self-injurious behaviors, borderline traits, bipolar disorder, failed placements.

Specialties: CBT, Trauma Focused DBT, ACT, Trauma, Attachment, Complex Family Systems, LGBTQIA, Easting Disorders.

Program Cost: $1340 daily, collect first 15 days at admission and then every 15 days throughout the stay.

Rule Outs: Significant aggression towards peers, eating disorder that requires feeding tube.

Profile of Students Served:

Depression, Anxiety, Defiance & behavioral issues, ADHD, Executive Functioning

Learning differences, Addictions, Autism or other Neurodivergence, Suicidal ideation, Substance use, Trauma, Adoption and attachment issues.

Specialties: Neurofeedback, EMDR, CBT, motivational interviewing, ACT, DBT, Family-Systems, addiction support groups, adoption neurodiversity, grief, parent coaching, weekly parent training, learning struggles support

Rule Outs: Physical aggression; active eating disorders; Active cutting, Primary substance dependence as primary diagnosis.

Program: Live Strong House

Type: Residential Support

Location: Layton, Utah

Gender: Adolescent & Young Adult Male

Age of Clients: 15- 18

Average Length of Stay: 9-10 months

Accreditations:

• Cognia
• CARF
  

Insurance Help: Bridgeway Billing

Program Cost: Daily Rate $485

• Executive Director- Jennifer Wilde, LCSW, jwilde@elevationsrtc.com
• Clinical Director: Jenn Maddock, LMFT jmaddock@elevationsrtc.com
• Medical Director: Michael Connolly, MD
• mconnolly@elevationsrtc.om
• Admissions Director: Tamra Foy, BSW tfoy@elevationsrtc.com
• Marketing Director: Laura Burt lburt@elevationsrtc.com

Elevations Residential Treatment Center

Elevations RTC provides an intensive, highly professional, therapeutic program, utilizing an interdisciplinary approach for adolescents of all genders, ages 13-18. The Elevations program includes college preparatory academics, therapeutic recreation activities, and individual, family, and group psychotherapy as well as onsite medical and psychiatric services available to all students. The clinical philosophy is based upon Systematic, Relational, and Social Learning Theories. Elevations is a certified DBT Campus and clinical cared provided relies on Evidence Based Practices. Elevations offers a nurturing, safe, affirming environment and is a leader in the treatment and support of LGBTQIA students and their families.

Program: Elevations

Type: Residential Treatment Center

Location: Syracuse, UT

Gender: all genders, transgender students can dorm on the dorm of their identity.

Age of Clients: 13-18

Average Length of Stay: 8-10 months, but can be individualized. No set time frame.

Accreditations:

• The Joint Commission
  
• Utah Office of Human Services Office of Licensing
• NATSAP
• NPS w/California & Washington State

Insurance Help: Elevations is out of network with insurance but will work with families to check out of network benefits.

Profile of Students Served: Elevations students typically need a higher level of care and benefit from our psychiatric team and full time nursing team, Depression, Anxiety, Complex Trauma, Complex Family Issues, Mood Disorders, Academic Issues, Self-Harm/Suicidal Ideation, substance use. .

Specialties: DBT, LGBTQIA, Trauma work utilizing EMDR, Trauma Focused CBT, ADHD & Executive Functioning, Family Systems, OCD/ERP

Program Cost: $625 daily/$19,200 monthly avg $2500 enrollment fee.

Rule Outs: Actively psychotic, IQ lower than 95, physical aggression towards peers, primary diagnosis substance dependence, active eating disorder.

Discover Seven Stars

Seven Stars is a program within the Elevations program, licensed to provide services for adolescents between the ages of 13 and 18 who struggle with neurodevelopmental disorders, autism spectrum disorder, executive functioning deficits, and learning issues. Seven Stars is an all gender program, which bases its therapeutic environment on a strengths based relational and social learning model. Seven Stars' unique treatment model combines residential treatment, teacher instructed classroom academics, outdoor adventure, and experiential therapy to build social skills development, life skill building, community activities, academic and behavioral shaping.

Program: Seven Stars

Type: Residential Treatment Center

Location: Syracuse, UT

Gender: all genders,

Age of Clients: 13-18

Average Length of Stay: 8-10 months, but can be individualized. No set time frame.

Accreditations:

• The Joint Commission
  
• Utah Office of Human Services Office of Licensing
• NATSAP
• NPS w/California & Washington State

Insurance Help: Seven Stars is out of network with insurance but will work with families to check out of network benefits.

Profile of Students Served: Seven Stars students typically need a higher level of care and benefit from our psychiatric team and full time nursing. Depression, Anxiety, Complex Trauma, Complex Family Issues, Mood Disorders, Academic Issues, Self-Harm/Suicidal Ideation, substance use. .

Specialties: DBT, LGBTQIA, Trauma work utilizing EMDR, Trauma Focused CBT, ADHD & Executive Functioning, Family Systems, Neurodevelopmental Disorders, Clinically Complex, Co-occurring diagnosis.

Program Cost: $640daily/$19,800 mo avg $2500 enrollment fee.

Rule Outs: Actively psychotic, IQ lower than 80, physical aggression towards peers, primary diagnosis substance dependence, active eating disorder

Melodie

Hayes

Lara Oakley

Ben Brown

Billy Nicola

Business Outreach

Chief Financial

Officer

Family Systems &

Parent Coach

Chief Operations

Officer

Atlas Life

Program: Atlas Life

Type: Life Coach & Gap Year Program

Location: 380 S 400 E Salt Lake City, UT

Gender: ALL

Age of Clients: 17.5-35

Average Length of Stay: 9-12 months

Accreditations:

Insurance Help: Reimbursement for individual therapy, group therapy, and psychiatry.

Profile of Students Served: We provide an inclusive community to anyone 17.5-35 regardless of location or struggle who are seeking support in transitioning to independent life but are unsure of how to navigate this stage or are facing challenges.

Specialties: Life Skills - We fill the gap of teaching students how to thrive in the real world

Program Cost: $9300 per month (Everything included)

Rule Outs: Anyone that requires 24/7 Line of Sight Care.

Logan River Academy

Logan River Academy is a residential therapeutic school serving neurotypical and neurodiverse teens of all genders between the ages 12-18 and post-18 if licensing criteria is met. Our multi-disciplinary team members provide regular and special education, structured residential and recreation programs, and supportive therapies.

We utilize a robust adventure learning program to provide students with rafting, skiing, camping, rock climbing, recreational sports, and more!

Program: Logan River Academy

Type: Residential Treatment Center

Location: Logan, UT

Gender: All

Age of Clients: 12-18

Average Length of Stay: 10-12 months

Accreditations:

• The Joint Commission
  
• SEVIS
• Utah DHS License
  
• CDE and ISBE
• Cognia
• NATSAP
  

Insurance Help: Provide super bill so parents can seek reimbursement for individual, group, and family therapy.

Profile of Students Served: All genders, ages 12-18. Emotional Dysregulation, Anxiety, Depression, ADHD, Learning Deficits, Trauma, Attachment Issues, Autism Spectrum Disorder - Level 1

Specialties: LGBQT+ inclusive environment specializing in treatment and care of neurodiverse students.

Rule Outs: Active suicidal/homicidal ideation, active psychosis, conduct disorder/ODD, severe sexualized behaviors, severe aggression/violence/property destruction, severe eating disorders, substance abuse as a primary treatment need.

Uinta Academy

Uinta Academy is the nation’s leading multi-dimensional residential treatment center for teens and young adults, ages 12-21. We work with those assigned female at birth: nonbinary and transgender students welcome! We specialize in working with teens and young adults who struggle with relationships, attachment or who have experienced trauma. Uinta’s therapeutic and sophisticated treatment program is balanced by a warm, nurturing, family-style living environment. Our equine program is the most purposeful and comprehensive equine program in residential treatment.

Program: Unita Academy

Type: RTC

Location: Wellsville, UT

Gender: Assigned female at birth, nonbinary and transgender students welcome

Age of Clients: 12-21

Average Length of Stay: 10-12 months

Accreditations:

• Cognia
• SEVIS
  

Insurance Help: We work with a third-party company to help families get reimbursement. Bridgeway Billing

Profile of Students Served: We work with those struggling with attachment disorders, relationship struggles, trauma, mood disorders, anxiety and depression. We work well with ASD level 1 and those struggling with executive functioning skills.

Specialties: Equine Therapy: ours is one of the most robust in the country. Trauma, Attachment disorder, Identity work and LGBTQIA, EMDR & Brainspotting

Program Cost: $540 per day, one time enrollment fee of $3,500

Rule Outs: Active psychosis, unstable Eating Disordered behavior, IQ below 88, Acute Suicidal behavior, Physical aggression, Conduct disorder, Substance use requiring detox

Balance House

Balance House is a gender-specific young adult program for men struggling with..

Program: Balance House

Type: RTC, Extended Care, Sober Living, Independent Living

Location: Holladay, UT

Gender: Male

Age of Clients: 18-35

Average Length of Stay: 9-15 months

Insurance Help: Out of Network with all insurances. We work with a third-party company to help families get reimbursement. RevWerx

Profile of Students Served: We work with those struggling with substance use disorders and co-occurring mental health attachment disorders, relationship struggles, trauma, mood disorders, anxiety and depression. We work well with ASD level 1 and those struggling with executive functioning skills.

Specialties: Trauma, Attachment disorder, Substance Use Disorder, Depression, Anxiety, Life Skills

Program Cost: $1000 per day for RTC, one time enrollment fee of $2,000

Rule Outs: Active psychosis, Convicted Sex Offenders, Unstable Eating Disordered Behavior

Location: Nationwide/International

Gender: All Genders/Transgender

Age of Clients: All ages assessed appropriate (commonly 13-25)

Credentials: Licensed in OR, Registered in UT, Member of AMATS

Insurance Help: Billable insurance vendor ID

Program Type/Cost: Intervention and transport. Typical range: $1000-$5000 plus expenses depending on distance, duration and staffing.

Rule Outs: No Medical Transport. No mechanical restraints. Must have Parent/Guardian involvement for the intervention.

Eva Carlston Academy

Located in urban Salt Lake City, Eva Carlston Academy is a unique program for youth aged 12-18. Eva Carlston operates in two elegantly appointed houses that give the youth an intimate sense of home as well as access to the cultural resources and opportunities of a large city. In this family-style setting, girls feel safe, valued, and at ease. In addition to teaching functional life skills, this family-style approach helps girls develop a strong sense of personal identity, a clear vision for their own life goals and aspirations, and the confidence to speak with their own voice. In addition to regular family and individual therapy, students participate in daily group therapy and our robust experiential program that is catered to students experiencing anxiety, depression, and trauma. Eva Carlston Academy students benefit from all aspects of our dynamic arts program that includes everything from studio ceramics and painting, music, theater, and more.

Program:

Type: Residential Treatment

Location: Salt Lake City, Utah

Gender: Assigned Female at Birth, Gender Non-conforming

Age of Clients: 12-18

Average Length of Stay: 10-12 months

Accreditations:

• JCAHO
• Cognia
  

Insurance Help: Bridgeway Billing

Profile of Students Served:

Students experiencing difficulties associated with: Depression, Anxiety, Defiance & behavioral issues, ADHD

Learning differences, Emerging personality disorders, Self-harm, Addictions, Autism or other Neurodivergence, Eating disorders, Suicidal ideation, Substance abuse, Bipolar Disorder, Trauma, Adoption and attachment issues, Emotional, physical, and sexual abuse

Specialties:

EMDR, CBT, motivational interviewing, Seeking Safety, ACT, DBT, Family-Systems, specialty group work including but not limited to substance abuse, adoption, sexual trauma, neurodiversity, grief, and body image, parent coaching, monthly parent training, learning differences

Program Cost:

$15,000/30 day month

Rule Outs:

Non-medically stable eating disorder, active substance addiction requiring detox, IQ lower than 80, serious flight risk, serious history of violence towards others.

La Europa Academy

At La Europa Academy, a premier Residential Treatment Center, we help our students step confidently into young adulthood with the resilience to meet life’s challenges. La Europa Academy is a place of healing where our students, adolescents ages 14-17 find themselves and unlock their potential through creativity, intensive therapeutic modalities, and expressive therapy groups. We combine a nurturing environment, a sophisticated clinical approach and a challenging academic curriculum to help our students heal and grow as they develop coping skills, find their voice, discover their identity and find joy in their journey.

Program: La Europa Academy

Type: Residental Treatment & Transition

Location: Salt Lake City, Utah

Gender: Female assigned at birth. We happily work with students exploring gender identity.

Age of Clients: 14-17, can choose to stay at 18

Average Length of Stay: 9-12 months

Accreditations:

• The Joint Commission
  
• Utah DHS Licensed
• NATSAP
• Cognia
• CDE
  

Insurance Help: We work with Bridgeway Billing, a third-party billing company that works directly with families and insurance companies on reimbursement.

Profile of Students Served: Emotional Dysregulation (over-controlled and under-controlled), Depression, Anxiety, ADHD, Self-harm, School resistance or refusal, Emerging personality disorders, Identity and body image challenges, ASD level 1, Trauma/PTSD, Complex family systems, Technology misuse/overuse

Specialties: Robust Expressive therapies, LGBTQ+ inclusive environment, and our built-in transition facility, Mosaic House.

Program Cost: $15,750/month plus a $2,500 enrollment fee

Rule Outs: Psychosis, medical instability, history of aggression/violence, AWOL history, parent or resident non-participation, active eating disorder, substance use as primary treatment needed

Huntsman Mental Health Institute

CAT Programs Youth and Young Adult

FOCUS • CLARITY • DIRECTION

WHO WE SERVE:

The CAT Program for youth ages 4-12, teens ages 12-17, and young adults ages 18-30 at the Huntsman Mental Health Institute (formerly University Neuropsychiatric Institute) is a clinical program designed to help gain an understanding of mental health and behavioral issues. It is a five to eight week program with a multidisciplinary team that works closely together to evaluate, accurately identify diagnoses, and actively begin treatment. Our strong psychiatric presence and multidisciplinary approach help us stand out from other programs. Our program is grounded in Acceptance and Commitment Therapy (ACT) in a safe and secure environment, for youth in our free-standing psychiatric hospital and our young adults in our 24/7 supervised living setting.

Program: Huntsman Mental Health Institute CAT program

Type: Inpatient Assessment program

Location: Salt Lake City and Murray, Utah

Gender: All Genders

Age of Clients: 4- 30

Average Length of Stay: 5-8 weeks

Accreditations:

• DNV
• NATSAP
  

Insurance Help: Youth programs potentially-partial/ Young Adult-no

Profile of Students Served: Mood disorders (e.g., depression, bipolar disorder), Anxiety disorders (e.g., generalized anxiety disorder and OCD) Psychosis and thought disorders (e.g., schizophrenia) Autism spectrum disorders, Trauma-related issues (e.g., PTSD), Personality development, Substance Use

Specialties: Psychiatry – child, adol, adult specialists, Neuropsychological eval, ACT, DBT, Individualized and evidence-based treatment, Diagnostic clarification, Psychological/neuropsychological, nursing and educational assessment

Program Cost: $1550/day

Rule Outs: primary Eating Disorder, primary SUD, IQ lower than 80, nonverbal

Mary Kay Kennedy

Executive Director

Program: Pinnacle Recovery Center

Type: Adult Inpatient Residential Program

Location: Holiday, UT

Gender: All Genders

Age of Clients: 18-45

Average Length of Stay: 45-65 days

Accreditations:

• The Joint Commission
• Utah DHS Licensed
  

Insurance Help: Out of network basis. Billing is done in house. We utilize insurance for doctor/physicatric visits and medications as well.

Profile of Students Served: 16

Specialties:

Program Cost: 30k/monthly

Rule Outs: Active Psychosis, History of Violence, Active Self Harming, Active Eating Disorder, Substance Use as Primary Treatment is Required.

Solstice West RTC

Solstice West is a clinically sophisticated residential program serving adolescent youth* struggling with non-working patterns of thinking, feeling and behaving, which are a result of complex and developmental trauma. To serve our youth, Solstice utilizes a developmental model, emphasizing a strong family systems lens, trauma-informed interactions with teachers and residential staff, and a multitude of trauma and developmental based therapeutic modalities. Unique to Solstice West is our Substance Use Disorder track, led by our Addictions Specialist. Typically up to 50% of our students may struggle with some form of substance or process abuse in relation to their unresolved trauma.

Program: Solstice West, RTC

Type: Residential Treatment Center

Location: Layton, UT

Gender: Assigned female at birth. We welcome and support teens who are gender questioning, non-binary, or identify as male.*

Age of Clients: 13 - 18

Average Length of Stay: 9 - 12 months

Accreditations:

• CARF
  
• NPS w/ California and Washington State
  
• Cognia
  
• Utah DHS
  

Insurance Help: Solstice West is partnered with Brideway Billing, a third party insurance billing entity who works directly with families and the program to attempt to obtain reimbursement.

Profile of Students Served: A Solstice West

student is often struggling with anxiety,

depression, unresolved trauma, substance

and/or process abuse, impulse control, low

self -esteem, ADHD, mild to moderate mood

disorders (stabilized on medication),

attachment struggles, grief and loss, learning

differences and family relational issues

Specialties: EMDR, Brainspotting, Trauma

Focused CBT, motivational interviewing,

quarterly family workshops, family camping

trips, LGBTQ+ affirming, specialty groups

focused on current client needs, Substance

Use Disorder program led by our certified

Addictions Director.

Program Cost: $555/day

Rule Outs: History ofignificant physical

aggression, diagnosis of conduct disorder,

medical instability/diabetes, IQ below 90,

active suicidality or suicidal ideation, active

eating disorder, current psychosis or impaired

reality.