Parent s Day/Night Out. Respite Program

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Parent s Day/Night Out Respite Program Parent/Guardian & Participant Handbook Revised 12/2013 10/2014 8/2015 9/2016 9/2017-1 -

I. General Program Information Easterseals Crossroads Respite Program provides rest and relaxation for family members and primary caregivers of individuals with special needs or disabilities. Respite enhances personal and family health by providing necessary physical care and recreational activities while offering parents and caregivers a welldeserved break. The Respite Program is designed to serve families in a number of ways. Respite programs are free and available to the public. Parents Night Out- a scheduled event for children with disabilities or special needs on the 1 st, 2 nd, 3 rd, and 4 th Fridays of every month from 6:15pm-10:00pm. The program provides care for children and their sibling s ages 6 months through 12 years and is available at several locations throughout the city. Reservations and registration forms are required to attend. Parents Day Out- a scheduled day event on the 4 th Saturday of each month. This event is offered at our Easterseals Crossroads (east) location from 10:00am-2:00pm. Parents Day/Night Out provides: A safe, nurturing environment for all children Gross motor activities and recreational experiences Care for siblings A staff/adult volunteer to child ratio of 1:3 Well-qualified and experienced staff Themed activities/crafts Snacks ParentCare Packages this program is an innovative concept that extends beyond the care of participants and affords family members or primary caregivers the opportunity to enjoy a recreational or leisure activity while your loved one is at a Respite event. ParentCare Packages may consist of providing the means to enjoy a pleasant dining experience or other entertainment options within the Indianapolis area. ParentCare Packages are offered on an every other month basis. Parents/caregivers understand that the ParentCare package is to be utilized on the night that Respite Care Services are provided by Easterseals Crossroads. It is understood that if the ParentCare package is misused in any way (i.e. not used on the designated night, used to purchase alcoholic beverages, etc.) this may prevent me/us from receiving other ParentCare packages in the future. It is clear that the misuse of ParentCare packages may result in the termination of these benefits for me/us and for others. All questions regarding ParentCare packages should be directed to Angie Hilligoss, Manager of Respite Services. Angie can be reached at ahilligoss@eastersealscrossroads.org or 317-466-2001 x 2420. - 2 -

I. Locations Parents Night Out Locations and Time: South-Indian Creek Christian Church North-Kids Kastle 1 st Friday of each month 3 rd Friday of each month 6430 S. Franklin Road 11552 Fishers Landing Drive Indianapolis, IN 46259 Fishers, IN 46038 East-Easterseals Crossroads West-Ben Davis Christian Church 1 st, 2 nd, 3 rd, 4 th Friday of each month 4 th Friday of each month 4740 Kingsway Drive 701 S. High School Road Indianapolis, IN 46205 Indianapolis, IN 46241 II. Registration Forms Current registration forms that are thoroughly completed are required for participants for all Respite events. In addition, we may require supplemental forms where deemed necessary. These include, but are not limited to, individualized education plans, behavior support plans, individualized treatment plans, seizure management plans, g-tube feeding plans, etc. Easterseals Crossroads may also request from parents/caregivers a Release of Information to seek additional information from school teachers, therapists, etc. Individuals participating in the Respite Program will be screened to determine the level of care required, and to assess how the staff can best meet the needs of the participant. The level of care assigned will be on a trial basis and is determined by Easterseals Crossroads. Should the staff determine the needs of the participant have changed; a new level of care will be assigned. Once all of the necessary documentation has been secured and a level of care has been established, an Easterseals Crossroads employee will contact you to schedule your first visit. III. Scheduling Parents Night Out Once you have completed the annual registration forms, you may begin scheduling each month for Parents Night Out events. To schedule, contact our scheduling coordinator, Brenda Dupree at 317-466-2006 or bdupree@eastersealscrossroads.org We schedule all events a month in advance ie: if you would like to schedule for October you will call at the beginning of September. Each family can attend one event per month. IV. Cancellation Policy Families must notify Easterseals Crossroads by calling 317-466-2006 or 317-466-1000 x2420 within 3 hours if they are not able to keep their reservation for the Respite Care Services that the participant is registered for. If families no - 3 -

call/no show for an event, they will be required to put down a $10.00 deposit for the participant the next time they would like to make a reservation. The deposit must be paid in full BEFORE the participant attends the next event and is NON-REFUNDABLE. If families do not cancel their reservation, they may be prohibiting other participants from utilizing Easterseals Crossroads Respite Care Services. In addition, families understand that if they no call/no show multiple times, they will be at risk of losing the opportunity to continue participating in the Respite Care Programs at Easterseals Crossroads. V. Schedule of Events A typical schedule of events: 6:15pm-6:45pm- sign in and free time 6:45pm 8:00pm: outside, group activities, crafts, games 8:00pm 9:00pm: prepare/eat snack, clean up, gym, Wii tournaments, 9:00pm 10:00pm: Movie, games, socializing VI. Required Items to Bring Each family who participates in a Parents Night Out event MUST bring a bag, labeled with participants name/names. Please include the following items: Extra set of clothes (include underwear, socks, shirt and pant, for each member participating in the event) Diapers, wipes, pull-ups (if used) Anything needed to provide special dietary restrictions Coat/jacket, hat, mittens (adjust with seasons) We enjoy going outdoors, please plan accordingly! Sensory Items (if needed) What NOT to send your child with: Any electronics (i.e. cell phone, ipod, camera, Nintendo DS, etc.) An empty belly! We do NOT feed dinner to the participants. Snacks are typically served around 8p. Dinner! Do not send your child to Parents Night Out with their dinner in hand. Please have them fed prior to coming to the event. VII. Drop-off & Pick-up Policies & Procedures Drop off Drop off to the Parents Night Out event begins at 6:15pm; Parents; Day Out event begins at 10:00am. Participants must arrive no later than 30 minutes after event begins or else the family will risk being turned away from the program for the evening. IF you know you will be running more than 15 minutes late to the program, please notify us immediately so that we can ensure proper staffing at the time of your arrival. Must be fed prior to the event (including g-tube feedings) - 4 -

You MUST have a completed, medication administration form turned in for medications. You can fill one out the night of the event or we have them available on our website. Pick up ParentCare Packages at sign-in to event (every other month) Pick up Late arrival Parents Night Out ends promptly at 10:00pm and Parents Day Out ends promptly at 2:00pm. Per the Respite Program policy, a second late arrival will result in a fee of $10 for the first minute and $1 for every minute thereafter. I understand that this fee must be paid in full to Easterseals Crossroads before the participant can attend Teen Night Out again. In addition, I am aware that multiple late arrivals could result in the possible termination of Respite Program services in the future. Intoxicated or impaired parent/caregiver it is policy at Easterseals Crossroads that no consumer will be allowed to leave an ESC facility, program or sponsored activity with a parent, guardian or caregiver who presents in a condition which may prevent them from assuring the consumers welfare. o Staff will use their best judgment in determining if a parent, guardian or caregiver presents in a condition which may prevent them from assuring the consumers welfare. o If deemed necessary, staff will contact another authorized user or emergency contact on the registration form. If they are not available, Yellow Cab will be contacted and paid for by Easterseals Crossroads to ensure the families safety. VIII. Behavior Policy and Consultation In the event that a participant is posing a threat to his or her own safety or to the safety of others while at an event, the Respite staff will request a behavioral consultation from behavior support staff at Easterseals Crossroads. Behavior support staff will work with Respite staff to provide behavior recommendations to aid in reducing the target behavior(s). If the participant s behavior does not improve with the assistance of behavioral support, the participant may need to be withdrawn from the Respite program. IX. Specific Medical Needs Feeding Tubes Participants who require the use of a feeding tube will be allowed to participate in Respite events, but feedings will not be provided unless medical documentation indicates it is medically necessary during the hours of the Respite event. Should it be deemed medically necessary, the parent/caregiver will need to submit a supplemental form to Easterseals Crossroads with the specifics of the feeding. Supplemental forms can be obtained by contacting Angie Hilligoss at 317-466-1000 x2420. Food Allergies and Special Food Preparation Requirements - 5 -

If the registered participant has a significant food or environmental allergy, please contact Easterseals Crossroads (Angie see above) to secure a supplemental form. The supplemental form will help us to understand the specifics of the allergy and the procedures to follow in case of an allergic reaction. Respite staff will do their best to avoid common food allergies such as nuts and gluten, but may not be able to accommodate all allergies at every event. It is best to always send a back-up snack for the participant to enjoy during snack time if they have specific food allergies. If the registered participant has specific food preparation needs, please contact Easterseals Crossroads (Angie see above) to secure a supplemental form. The supplemental form will help us to better understand the specific dietary needs of the participant and to ensure proper nutrition during Respite events. Please note, it is likely that staff will not have access to supplies such as thickening solutions for liquids; please plan to provide the necessary supplies if needed. This also includes children who are bottle fed. Seizures A seizure management plan and/or a supplemental form should be completed for all participants with a seizure disorder. Supplemental forms can be obtained from Angie (see above for contact info). If the participant has emergency seizure medication, this will need to be brought to each Respite event and registered with staff at sign-in to the event. Medication Administration The process for handling and administering medications must be well structured and carefully followed in order to ensure that the interests of the children and the providers are best served. When possible, a child s parents and physician should try to minimize the need for medication while participating in Easterseals Crossroads programs. Medicines ordered twice a day should normally be given before and after, rather than during, childcare hours. Medications ordered to be given three times daily also may be planned to that they are given in the morning before the child leaves for childcare, in the afternoon after the child returns home, and again during the evening. However, in some cases, administration of medications during program hours is unavoidable. - 6 -

X. Emergency or Crisis Situations Parents & caregivers are expected to always be available via cell phone while their loved one is with us at a Respite event. If the primary parent or caregiver is not able to be reached, staff will contact the emergency contacts listed on the registration form. If emergency contacts cannot be reached, Easterseals Crossroads reserves the right to contact emergency medical help (911) for assistance. Crisis or emergencies could include situations such as (but not limited to): fire, tornado, late pick up from a Respite event, medical concerns, or behavioral concerns. XI. Compliments/Concerns/Questions? Please direct all compliments/concerns/questions to Angie Hilligoss, Manager of Respite Services. Angie can be reached at 317-466-2001 X2420 or ahilligoss@eastersealscrossroads.org. - 7 -

2017 Acknowledgement of Receipt Parent/Guardian & Participant Handbook Respite Services I,, the parent/guardian of (Parent/Guardian Name) (Primary Participant s Name) sign below acknowledging the receipt of the Parent/Guardian & Participant Handbook and agree to comply with the policies and procedures set in place. I understand that it is my responsibility to read through and familiarize myself with the handbook and to ask questions about anything I do not understand. Signature Date - 8 -