Individualized Respite Care Guide

For Community Outings • What to bring (check all that apply and describe any specifics)  Change of clothes  Visual schedule  Reinforcers  Other:

• Transportation plan (should car doors be kept locked, where (s)he should sit in the car, etc.)

• Toileting plan (ladies’ or men’s room, alone or with provider, diapers/pull-ups, etc.)

• Notes for specific locations within the community (go into restaurant or use drive-through, favorites, etc.)

• Level of supervision needed in various environments (hold hands, be at his/her side at all times, stay back if with friends, etc.)

At Home • Any areas that are off limits • Doors/windows (lock, keep closed, okay to open) • Telephone (answer or let it go to voicemail) • Directions for operating TV, DVD player, computer (password) , and anything else (s)he might want to use

• Favorite items and activities (indoor and outdoor)

• Items and activities (s)he does NOT like

• Activities that (s)he might want but are not recommended

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