Informed Consent

Question 1

4.1 No services without informed consent

Answer 1

A registrant must obtain adequate informed consent prior to providing psychological services unless otherwise provided by law, including this Code. In such specified circumstances in which it is not possible to obtain adequate informed consent, a registrant must attempt to obtain informed assent prior to providing the psychological services, unless otherwise provided by law, including this Code. Registrants must document the informed consent and/or assent, or the steps taken to obtain either consent or assent and the basis for proceeding without either, in the record.

Question 2

If informed consent cannot be reasonably obtained

Answer 2

a registrant must attempt to obtain informed assent prior to providing the psychological services, unless otherwise provided by law, including this Code.

Question 3

Define consent

Answer 3

The process of seeking “consent” means the client has been informed regarding, and understands, all relevant significant information that might influence their decision to accept a given psychological service, has the legal capacity to accept or reject the service, and has not been unduly influenced to accept the service.

Question 4

3 cases in which assent may be sought

Answer 4

1) client lacks legal capacity to accept or reject the service
2) lacks the capacity to understand all relevant significant information that might influence their decision to accept the service
3) is compelled by law to accept the service

Question 5

Define assent

Answer 5

The process of seeking “assent” means the client has been informed to the fullest extent possible (based on their mental capacity) regarding relevant significant information that might influence their decision to accept the service, and has agreed to accept the service. In the event the client lacks legal capacity or is compelled to accept the service but does not lack the mental capacity to understand all relevant significant information that might influence a decision to accept the service, the informed assent process is the appropriate term, and use of the term “assent” rather than “consent” serves to emphasize the conditions under which the client agreed to the service. The process of seeking “assent” from the client does not substitute for any other legal requirement to seek consent from the client’s guardian, representative, or other substitute decision maker, where applicable.

Question 6

What are the 7 elements of informed consent?

Answer 6

Client must:

1. Have capacity to consent
2. Be informed of all “appropriate significant information” concerning the service
3. Freely and without undue influence express consent (no coercion)
4. be informed of fees
5. be informed of limits of confidentiality (6.7)
6. give consent in writing
7. the consent must be appropriately documented in the practice record

Question 7

What are the limits of confidentiality?

Answer 7

6.7 Disclosure where risk of harm

1. Clear and substantial risk of imminent serious harm to client or by client to another idividual
2. When needed to protect an identifiable child, consistent with applicable law
3. to protect a vulnerable adult who is unable to seek support or assistance for abuse or neglect
4. in accordance with any other lawful requirement

Question 8

If you must make a disclosure, what must you do

Answer 8

6.8. the registrant must limit disclosure of the information only to
those persons or agencies and to that content that is consistent
with applicable law; and
2) the registrant must limit disclosure of the information only to
those persons or agencies and to that content which would be consistent with this Code of Conduct.

Question 9

When an individual is not legally capable of giving informed consent…

Answer 9

a) obtain any necessary documentation to determine the identity of all parties with legal entitlement to provide or withhold consent for services;
b) obtain informed written consent from all of the parties specified in part (a), above;
c) provide an appropriate and understandable explanation of the services to the individual (e.g., child, senior, individual with SMI);
d) where possible obtain the individual’s assent to the procedure or intervention; and
e) document the explanation and any consents and assents in the registrant’s practice record.

Question 10

4.4. Informed consent and family law proceedings

Answer 10

Subject to any court order or court direction, a registrant providing psychological services to parents or to children for the purposes of a family law proceeding, including such services as custody and access assessments, must, prior to providing the services:

a) determine any issues of custody and parental rights or status prior to or as part of obtaining informed consent from all appropriate persons; and
b) obtain and document all necessary consents prior to proceeding with the services.

Question 11

4.5 Informed consent continuing throughout psychological services

Answer 11

A registrant must obtain informed consent from the recipient of their services before altering the treatment plan or changing any psychological services that they have agreed to provide to them.

Question 12

4.6 Structuring the relationship

Answer 12

A registrant must discuss with their clients as early as practicable in the professional relationship such issues as the nature and anticipated course of the intervention or assessment, the obligation of confidentiality attached to the provision of such services, the potential risks of the intervention or assessment, and alternative treatments that may be available.

Question 13

4.7 Supervised services

Answer 13

If a student, intern, testing assistant, test scorer, or any other type of supervisee will be providing any psychological services under the supervision of a registrant, the registrant must ensure that the client (and the payer, if different from the service recipient) is informed of the supervisee’s status and the name of the supervisor. The registrant must also ensure the client (and the payer, if different from the service recipient) has provided informed consent for the supervised services prior to the initiation of those services. Any and all such informed consents must be documented in the registrant’s practice record.

Question 14

4.8 innovative services

Answer 14

A registrant must inform clients of the innovative nature of any proposed psychological service or technique or any non-standardized application of a standardized service or technique, and of the known risks associated with the service or technique, and/or its nonstandard application, including any known or anticipated risks associated with the method of service delivery (for example, possible increased risk of a confidentiality breach, access limitations imposed by the contemplated technology, etc., associated with telepsychology services).

Question 15

4.9 Avoid misunderstanding

Answer 15

A registrant must make reasonable efforts to answer clients’ questions and to avoid any apparent misunderstandings about the psychological services to be performed.

Question 16

4.10 Use understandable language

Answer 16

Whenever possible when providing information orally or in writing, a registrant must use language that is reasonably understandable to the client.

Question 17

4.11 Informing about assessment procedures

Answer 17

A registrant must ensure that each participant in an assessment process is informed at the outset of the purpose, procedures, and methods involved in the evaluation process, any involvement of third parties, the limits to confidentiality, and feedback and interpretation of test results that may be expected at the conclusion of the assessment process.

Question 18

4.12 Consent for observing and recording

Answer 18

When diagnostic interviews or therapeutic sessions with a client are to be observed by a third party or recorded in any mechanical or electronic manner for audio or visual purposes, a registrant must obtain informed consent from the client or the client’s legal guardian in advance.

Question 19

4.24 Court ordered assessments or treatments

Answer 19

First: try to obtain consent > assent > inform the individual before proceeding

if consent or assent can’t be obtained, the registrant must:

1. document why the requirements of Standard 4.1 cannot be met
2. either inform the client of significant information concerning the psychological service to be provided (including at a minimum the purpose and relevant expectations of the service, limitations to confidentiality, to whom and for what purpose the registrant may provide reports, the client’s rights in the context, and possible consequences to the client of refusing to participate), or clearly document the reason for not providing the information if retainer- terms, a court order, a court-supervised process, or legislation to the contrary prevents informing the client;
3. in all cases document the client’s informed consent or assent, or lack thereof, and state clearly in the record and in any report the ways in which the client’s consent or assent, or lack thereof, may impact on the treatment, assessment, or other psychological service (e.g., potential for non-compliance).

Question 20

4.25 Informed consent and file reviews

Answer 20

Could happen when asked to provide input to a case manager regarding a client who is not receiving direct services from the registrant or to provide an opinion regarding the sufficiency of a report itself. Registrants must:

either fully inform the individual who is the subject of the file being reviewed about the process, including that the registrant will be writing a review report, or document why it is not appropriate or possible to fully inform the individual in the circumstance;
b) either obtain the informed consent or assent of the individual who is the subject of the file being reviewed, or if consent or assent need not be obtained, inform the individual of the court order or other basis on which a file review will be conducted absent informed consent or assent, or document why it is not appropriate or possible to obtain the informed consent or assent of the individual in the circumstance; and in the case of repeated or ongoing file reviews involving the same subject, either ensure the subject is informed at the outset that this is the case and provides consent for repeated or ongoing reviews, or document why it is not appropriate or possible to fully inform the individual and obtain informed consent or assent in the circumstance.