Beatrice Caffrey Youth Service, Inc by den54914


									                           Beatrice Caffrey Youth Service

                         Client Rights and Responsibilities

This statement summaries your rights as a client at Beatrice Caffrey Youth Service.

Services will be provided to you and/or your family members without discrimination of
age, race, gender, spiritual belief, sexual orientation, disability, HIV status as specified in
the Americans With Disabilities Act of 1990.

You will be treated with respect and consideration, in a manner that is responsible for the
means of communication.

You have the right to:

      Receive quality services in a respectful manner without discrimination
      Make an informed choice of services
      Receive and understand information and instructions about your needs
      Consent to or refuse services before they are provided
      Know the nature and purpose of services
      Refuse services with the receipt of information and the consequences of refusal
      Be informed prior to any transfer or discharge of services
      Expect confidentiality of information and protection of your child welfare records
      Receive timely responses to your needs along with reasonable continuity and
       coordination of services
      Know about changes for services
      Know how to voice any grievance about your services
      Receive services based on an individual service plan
      Be part of the process of updating the service plan when changes are needed
      Have the right to receive services and be free from retaliation if a grievance is
      Services are available seven days per week, twenty four hours per day. Regular
       office hours are from 9am-5pm. Services can be accessed through calling the
       agency’s regular phone number from 5pm-9am. The agency has on-call workers
       that will answer your questions or respond in person in the event of a crisis

Clients have the responsibility to:

      Give accurate information about their medical health, substance use, and domestic
       violence issues as well as other circumstances which might impact upon the care
       of their children
      Assist by making and keeping a safe environment
      Notify the agency if scheduled appointments need to be changed
          Notify the agency if there is a change in your living arrangement
          Work with staff in planning, reviewing and changing their individual service
          Inform staff immediately if they have any concerns or problems with the service
           they are receiving
          Make themselves available for involvement in services with a worker
          Follow-through with tasks that are assigned to you
          Actively participate in services to avoid having your case referred back to court
           for closure due to lack of progress or refusal to comply with services

____ Yes ____ No        I understand my rights and responsibilities.

____ Yes ____ No          I have been informed that my individual service plan will be developed.

____ Yes ____ No        I have received a copy of the Service Appeal Process brochure.

____ Yes ____ No The information contained in the brochure has been explained to me.

_________________________________________                          __________________________
Client Signature                                                   Date

_________________________________________                          __________________________
Worker Signature                                                   Date


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