Beatrice Caffrey Youth Service, Inc.
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Client Rights and Responsibilities
This statement summaries your rights as a client at Beatrice Caffrey Youth Service, Inc.
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 filed.
• 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 situation.
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 plans
• 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.
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Client Signature Date
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Worker Signature Date