Entered into this day of, 200 (the Effective Date ) between: Mr./Mrs./Miss/Ms., residing at

Transcription

1 Consulting Agreement Entered into this day of, 200 (the Effective Date ) between: Mr./Mrs./Miss/Ms., residing at ( Parents ); and AUTISM OUTREACH, INC., a corporation organized under the laws of the Commonwealth of Virginia, with a principal place of business at 701 Emerald Hill Drive, Leesburg, VA ( Consultant ). WHEREAS, Consultant has expertise in the development, implementation, and supervision of an educational program known as Applied Behavior Analysis therapy ("ABA") which has been used in the treatment and education of children with pervasive developmental disorders (PDD) and/or autism; and WHEREAS, Parents are the parents of a child with PDD and/or autism and wish to engage Consultant in an advisory capacity to assist in developing and/or implementing an ABA program for their child; and WHEREAS, the Parties wish to document their understanding of their relationship with respect to the development, implementation, and supervision of the ABA program. 1. This Agreement sets forth the understandings of the Parties as to their relative responsibilities in establishing and managing the ABA program. It is understood that Consultant is engaged in an advisory capacity specifically with respect to the ABA program and that Parents shall be ultimately responsible for choosing any additional or supplemental therapies, drugs, or other treatments or programs for their child. Further, the Parents acknowledge that they have independently determined, through research, discussions with medical professionals, specialists, or others that ABA is an appropriate treatment for their child and have not been induced by Consultant or relied on any representations made by Consultant regarding the likelihood of success of the program in engaging Consultant's services with respect to the ABA program. 1

2 WHILE ABA HAS BEEN USED SUCCESSFULLY IN THE TREATMENT OF SOME CHILDREN DIAGNOSED WITH PDD AND/OR AUTISM, NOT ALL CHILDREN BENEFIT FROM THIS TYPE OF PROGRAM NOR DO THOSE WHO DO BENEFIT ALL BENEFIT TO THE SAME EXTENT. THE SUCCESS OF ABA IS HIGHLY DEPENDENT UPON THE NATURAL ABILITIES OF THE CHILD, THE DEDICATION AND CONSISTENCY OF TREATMENT, NUMBER OF HOURS, QUALITY OF THERAPISTS, AND OTHER FACTORS BEYOND THE CONTROL OF CONSULTANT. CONSULTANT MAKES NO WARRANTIES, NOR SHALL CONSULTANT HAVE ANY LIABILITY, REGARDING THE OUTCOME OF THE ABA PROGRAM OR THE SUCCESS OF THE CHILD IN ACHIEVING POSITIVE RESULTS FROM THE ABA PROGRAM. Appendix 2 contains waivers of liability and consents for certain accommodations that may be provided by Consultant at the request of Parents which accommodations are outside the scope of the ABA program. The Parties agree that the granting by Parent(s) of these waivers of liability and consents in connection with the performance of any such Parent-requested accommodations are a material inducement on which Consultant relies in providing such accommodations. 2. Consultant shall be responsible for: developing an ABA program, following protocols based on an ABA method and Consultant's assessment of the child's current abilities and skill levels; and recommending materials to be incorporated into the ABA program; and assisting Parents in recruiting therapists to administer the ABA program; and providing training to therapist candidates, if requested by the Parents; and monitoring the ABA program, including chairing team meetings with therapists and Parents, analyzing statistical information kept on the ABA Program and advising Parents of modifications, enhancements, or other changes to the ABA program as dictated by the child's progress. It is specifically understood that Consultant is not engaged as a therapist and does not actually perform ABA therapy with the child. In addition, Parents understand that ABA programs vary and that not all ABA programs are identical, depending on the training of the consultant involved. 3. Parents shall be responsible for: establishing a day-to-day therapy schedule with the therapists; and arranging fees, making all payments (including withholding for taxes, as appropriate) to therapists; and day-to-day management of the therapists; and making all hire and/or fire decisions with regard to therapists; and 2

3 providing materials and accommodations for the ABA program (e.g., therapy room, materials, reinforcers, etc.) 4. This Agreement does not set a specific schedule of hours or days on which the services of Consultant will be performed. All meetings, evaluations, and other services to be performed by the Consultant will be scheduled with the Parents at a mutually convenient time. Consultant makes every attempt to accommodate the schedules of parents, however, it is understood that Consultant has other clients and commitments and may not always be available for Parent's first choice of meeting dates and times. 5. Consultant's fees are set forth in Appendix 1 hereto. The initial services to provided by Consultant are: [List the services from Appendix 1 that have been agreed] a) Payment of the fees for an Initial Consultation are due at the time of the appointment and include, in addition to the meeting with Parent(s), the review of the Parent questionnaire and other relevant history of the Child prior to the meeting. b) Fees for all other services shall be invoiced at the end of the month in which the services were rendered. Consultant will render an invoice to Parents at the end of the billing period, detailing the hours worked and services provided. All invoiced charges other than amounts disputed on the basis of incorrect application of rates or hours worked, shall be paid by the last day of the month in which the invoice is rendered. c) Parents will immediately notify Consultant of any disputed amounts contained on any invoice. Unless Consultant is so notified, in writing, at the time the invoice is rendered, the calculation of charges on the invoice shall be deemed accepted. Consultant reserves the right to require payment in advance where Parent(s) has been delinquent in paying its invoices twice in any consecutive three (3) month period. Lack of progress by the Child shall not be a defense against the payment obligations of Parent(s) hereunder. 6. Consultant shall be deemed at all times to be an independent contractor, and, as such, will not be eligible for any employee benefits and Parents shall not make deductions or withhold funds from fees paid hereunder for the purpose of Social Security, federal, state, or local income tax. Nothing contained in this Agreement shall be construed as creating the relation of employer and employee between the Parties during the term of this Agreement. 7. Either Party may terminate this Agreement at any time for any reason, provided that such termination shall not affect any obligations or liabilities accrued hereunder as of the date of termination. In no event shall Consultant be liable to Parents or to the child for the (i) the failure of the child to make progress under the ABA program; or 3

4 (ii) the acts or omissions of any therapist employed by the Parents; or (iii) any act or omission that was outside Consultant's reasonable control. 8. This Agreement represents the entire Agreement between the Parties and is governed in all respects by the laws of the Commonwealth of Virginia. AUTISM OUTREACH, INC. Parent 1 Parent 2 Date Signature Title Date 4

5 Appendix 1 Master Consultant A Master s level consultant that is a Board Certified Behavior Analyst (BCBA) Hourly Rate: $175 Senior Consultant A Bachelor s level consultant that is a (BCaBA) Hourly Rate: $150 Associate Consultant A Bachelor s level consultant that is pursuing Board Certification as a BcaBA Hourly Rate: $125 Master Therapist Pursuing or has received a degree in the field, with 5+ years of experience Hourly Rate: $65 in office $70 in home Senior Therapist Pursuing a degree in the field, with 2-5 years of experience Hourly Rate: $50 in office $55 in home Associate Therapist High school diploma with 0-2 years of experience Hourly Rate: $35 in office $40 in home The following is a list of the services we offer. Each service is accompanied by an estimate amount of hours this service typically takes. Please note that this is just an estimate, when creating individualized programs, certain services may take longer than expected. Initial Consultation $200 Conducted in our offices Observation of the child (please note we will not be directly working with your child during this visit) Review of relevant information (reports, IEPs, assessments, etc.), this may be done outside of the initial consultation Discussion of possible interventions Overview of program 5

6 Service Hours Assessment (Initial and On-going) 5 Working session with child Present levels Recommendations for programming Report Program Preparation 5 Review and analyze information regarding the child gleaned from work session, parent checklist, IEPs, etc. Develop drill book Training 10 Program training (parents, therapists, speech and language, occupational therapists, etc.) Orientation to program (basic philosophy) Components of program Reinforcement Prompting system Data collection Preparation Training Packets Video Feed Back Hourly Watching and giving written feedback to therapists and families 3-4 hours of video Team Meetings 3 Therapists, parents, consultant meet to discuss program; fine tune/modify as required IEP Development/Attendance (Assessment Required) Review of proposed objectives and goals Develop objectives and goals School Visits/Observation Visit to school Consultation with teacher (in amenable) Report Hourly Hourly Potty Training 10 Intensive 1 day training 6

7 Service Hours Social Groups 2 Held in our offices after school during the school year An intake visit is required before beginning Supplies TBD Supplies are agreed based on the program; where obtained by consultant, supplies are charged with a minimal service fee Consultations Phone Consultations Increments 15 Minute Increments 15 Minute Other Services All other services provided at Consultant's hourly rate Mileage Current Rate Charged for families out of the consultant s 10 mile radius to 50 mile radius The fee will appear on your monthly invoice Travel Time Half of Hourly Rate Charged for families out of the consultant s 50 mile radius Airfare Current Fare Charged for families more than 2 hours of driving time away Hotel Accommodations Current Rate Charged for families out of the consultant s 50 miles radius AND 8 or more hours of consulting in one day Per Diem $35/day Charged for families the consultant will spending 8 or more hours a day with Referral Compensation $100 Credited to the family s invoice for referrals to other families that schedule an initial consultation with our organization 7

8 APPENDIX 2 Waiver of Liability and Consents The undersigned parent ( Parent ) of, a minor child with autism (the Child ), hereby confirms that he/she has engaged Consultant to provide therapeutic services to the Child. The following consents and waivers of liability are provided by the Parent to Consultant in furtherance of the performance of the services contemplated by this Agreement and are intended by the Parties to be fully enforceable except in the case of gross negligence or willful misconduct by Consultant. 1) Consent to Obtain Medical Treatment: Parent hereby requests that Consultant provide services to the Child, from time to time, in the family home with or without supervision by the Parent. The Parent understands that Consultant recommends that Parent or another responsible person over the age of 18 years be present during any such services. Where the Parent elects not to be present during therapy sessions, the Parent agrees that he/she will provide the Consultant with up-to-date emergency contact information and Parent will be available at the number(s) provided during the therapy session. In the event of an emergency, if the Parent cannot be reached in a reasonable period of time, then the Consultant shall, in his/her sole discretion, contact emergency medical personnel or seek other emergency assistance, as dictated by the circumstances. The Parent agrees that neither the Consultant, nor any individual employed by Consultant, shall be held liable by Parent for any reasonable action taken in response to an emergency situation where the Parent has elected not to be present during a therapy session. Parent Initials 2) Consent to Provide Transportation: Parent hereby requests that Consultant provide transportation services for the Child to/from therapy sessions from time to time. Parent hereby releases Consultant and any of its employees, from any and all liability arising out of the transportation of the Child at the Parent s request. Where recommended due to the age or weight of the Child, Parent shall provide a car seat or other appropriate restraint and, where requested by Consultant, Parent shall install such restraints in the Consultant s vehicle. Parent Initials This consent and waiver of liability shall be effective as of the date executed by the Parent until revoked in writing. Parent Signature 8