module 5 Informed consent for Psychological Services Flashcards
explain informed consent and why it is an integral part of ethical and professional psychological practice
Informed consent means client/family/dyad is given all information including fees, so that they are able to decide if willing or not, to go along with. Clients have a right to autonomy (make own decisions) and can only do this if fully informed.
describe the different methods of gaining consent for psychological services
In general there are four elements that are considered to form valid consent.
The first two elements are that the client must be considered competent and the consent
should be given voluntarily, without any coercion. This requires the psychologist to make
a determination about whether the person has understood the information provided and
has freely made his or her own decision about whether to proceed. The third element is
that the consent must be specific, i.e., the scope of what the client is consenting to has
been made clear. Finally, the information must be provided to the client in language that
he or she is able to understand.
Consent for services is essentially an agreement between the psychologist and the client,
and, while there is no legal requirement to document the provision of consent, the APS
Code of Ethics instructs psychologists to document a client’s consent prior to the
provision of a service. Although it is preferable to have a signed agreement from the client,
there are times when this may not be possible or necessary, for example, if the client
provides verbal consent by phone or as part of a regular checking in with the client to
confirm agreement for continuation of services. In this instance a file note outlining the
discussion and the provision of consent may suffice, although that will not provide the
psychologist or the client with the same protection in a legal context as a signed consent
form.
The material covered in the consent form will in part be determined by the type of service
you offer. In general, you need to provide sufficient information about what the service will
involve to allow the client to make an informed decision about whether to proceed. This
commonly includes a description of the service that will be provided, any potential risks
and benefits of the service, how you will manage the client’s personal information, limits
to confidentiality, the estimated length of treatment, and the costs and billing practices.
You should obtain client consent before disclosing any information with third parties
except under exceptional circumstances (e.g., risk of harm to client or others, responding
to a subpoena or warrant – see Section A.5.2 of the Code of Ethics for details).
Psychologists may provide services to a young person without parental consent as long
as the young person is deemed to have the capacity to give informed consent. A young
person is considered capable of giving informed consent when he or she achieves a
sufficient understanding and intelligence to enable full understanding of what is proposed
(see next question). Sometimes the age at which a young person can provide consent
independently is clarified in legislation. For example, under Medicare there are specific requirements regarding the management of information and the age at which a young
person can make decisions. For a young person aged 14 or 15, Medicare information can
only be disclosed to a parent or others with the young person’s signed authority, although
a parent or guardian can dispute this until their child is 16 years old.
There is no single test to determine if a person is ‘competent’ to provide informed
consent. . In cases where this is questionable a psychologist
must make a judgement based on an assessment of the client. A formal, structured
assessment of capacity is recommended, which may require referral to a psychologist
experienced in this type of assessment.
Where a psychologist believes that a person does not have the capacity to provide
informed consent, consent needs to be obtained from an authorised person. An authorised person may be:
Understand the information that is provided, including the benefits and risks of
proceeding or not with the service
Understand the limits to confidentiality
Be able to retain and consider the information and make a decision whether to
consent or refuse
Be able to communicate his or her consent.
A parent or guardian in the case of a young child
A person’s spouse or partner
A person appointed under a medical treatment act
A person appointed under a guardianship order
An enduring guardian appointed by the person while competent
A person appointed in writing by the patient with power to make such decisions
The nearest relative.
A lawyer has sent me a consent form from a client I have seen in the past and
has requested a copy of the client’s file. How should I respond to this?
It is always a good idea to attempt to contact the client directly to ensure that he or she
fully understands the implications of giving consent and that the consent has been
provided contemporaneously. For example, clients may not be aware that consenting to
the provision of file notes may lead to the release of sensitive information not relevant to
the legal case. Discussing these implications with the client provides him or her with the
opportunity to make an informed decision about whether to restrict access to some of the
content.
I work in a school where parents sign a standard consent form for psychology
services at the time of their child’s enrolment. Is this an appropriate way to
gain informed consent?Whether these forms meet the threshold of informed consent
depends on the extent to which the form includes the essential elements outlined in an
earlier question. If the forms are not comprehensive or are ambiguous in terms of the type
of contact that might occur with the psychologist, they may not meet the key principles of
informed consent. Often the aim of these forms is to seek initial consent for engagement
with a service provider, such as a psychologist. It will then be up to the psychologist to go
through the informed consent process prior to commencing the service.
identify the sections of the Code and the Guidelines that promote the acquisition of informed consent in psychological practice
Clients need to be informed that third parties such as Medicare etc can be informed re some information eg visit numbers, dx etc.
Client’s also need to be informed that in the case of team management, other team members/health professionals will also be informed of client’s details and possibly disclosures. Plus client’s need to be informed re psychologist has mandated requirements of eg reporting child abuse to authorities. Also psychologists must report to relevant parties any reported potential threat.(duty to warn)(ie if there is a threat to anyone else by client or by another). Supervisors can also be held responsible for what their supervisees do.
Breach of confidentiality is considered negligence (duty to warn /mandated reporting trump this though),
. In order for a therapist to breach the confidentiality of a client,
the therapist must ascertain that the client ‘‘is predictably or certainly harmful to self or others’’
(Ahia & Martin, 1993, p. 20). The therapist cannot simply suspect, think or feel that a client is dangerous.
Because of the Tarasoff case and other cases that followed, there are several legal concepts that help the therapist determine level of dangerousness of a client (Ahia & Martin, 1993).
Imminent or Immediate Danger. Imminent or immediate danger can be defined as the likelihood of a client ‘‘to behave dangerously in the very near future’’ (Ahia & Martin, 1993, p. 20).
Foreseeable Danger. When determining the foreseeability of danger, a therapist must consider the clients present potential to commit a harmful act, the planning involved, and past behavior that is relevant to the potential harmful act (Ahia & Martin, 1993). With this issue, the therapist is expected to correctly predict the violent behavior of a client because of training, expertise, experience, and knowledge in his/her profession.
Danger to an Identifiable Victim. One aspect for a therapist to consider when determining the predictability of dangerousness of a client is the identifiability of the victim. If a victim can be accurately identified by the therapist, it may be that the client is no longer potentially dangerous, but must now be considered predictability dangerous (Ahia & Martin, 1993).
Existing Danger. The concept of existing danger can be defined as the
relationship of the dangerousness of the client to his/her background or personality (Ahia & Martin, 1993). The question is whether or not the client, given any history of violence, is now likely to commit a harmful act. When making this determination, the therapist should consider social circumstances of the client, his or her feelings of being provoked, a history of violence, or his or her mental state (Ahia & Martin, 1993).
apply the ethical decision-making model to a dilemma involving informed consent.
4
