This form is a sample of an agreement between an elderly or disabled client and a Caregiver who operates as an independent contractor and provides personnel to assist Client to live at home and to have as much control over the home environment and life as possible under the circumstances. Caregiver's personnel also assist Client with the activities of daily living, scheduling medication, assistance with mobility, accompanying Client on errands and appointments, and such other services as agreed between Client and Caregiver.
In this agreement, Client waives damages for simple negligence of Caregiver, but not gross negligence or misconduct that is intentional or criminal in nature. Courts generally will not enforce waivers of this type of misconduct since such a waiver would be deemed to be against public policy because it would encourage dangerous and illegal behavior.
Caregiver Form Sample For Ages 1.5-5 Scoring In Travis
Category:
State:
Multi-State
County:
Travis
Control #:
US-00458BG
Format:
Word;
Rich Text
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FAQ
Behavior checklists are often initially introduced to monitor behaviors by caregivers and therapists. After, they are used as a self-management system as an individual becomes ready to independently self-monitor their own behaviors.
Behavior rating scales are often used as screening devices to obtain information on and help to identify individuals who may benefit from a more detailed assessment or who may be at risk for developing more serious problem and who may benefit from early interventions.
Response format 3-point Likert scale (0 = “Absent”, 1 = “Occurs sometimes”, 2 = “Occurs often”). Strengths: The CBCL is a valid and reliable measure which is sensitive to change in short interventions.
Ing to the normative data of the CBCL, a t-score ≤ 59 indicates non-clinical symptoms, a t-score between 60 and 64 indicates that the child is at risk for problem behaviors, and a t-score ≥ 65 indicates clinical symptoms (for demographical, cognitive, and psychopathological measures of participants, see Table 1).
The CBCL provides information on six scales: affective problems, attention-deficit/hyperactivity, anxiety, oppositional defiance, somatic problems, and conduct problems. An additional version is available for parents or caregivers of children aged 1.5–5 years.
The Achenbach System of Empirically Based Assessment (ASEBA) is a tool that can be used to assess behavioral and emotional problems in children. The ASEBA-PC is a computer-based version of the ASEBA that includes the Child Behavior Checklist (CBCL) for children ages 1.5–5.
The CBCL measures factors such as depression, somatic complaints, hyperactivity, aggressiveness, sexual behavior, anxiety, and delinquent behavior.