Informed Consent and Safety Planning A comprehensive informed consent should be reviewed and signed by the client (Lustgarten, 2017; Swenson et al., 2016). A clinician must check the jurisdiction’s requirements (i.e., the originating site or client’s location) for real versus electronic signatures for informed consent (Kramer & Luxton, 2016; Lustgarten, 2017; Swenson et al., 2016). Informed consent should include several components usually found in consents for traditional psychotherapy, including the following: Session length, scheduling information, cancellation policies, fees, record keeping, and mandatory reporting guidelines. These components are typical of most consent forms. However, telemental health consent forms may significantly differ from traditional
forms by including additional information, such as threats to confidentiality, security breaches, privacy concerns, terms, and conditions for third-party software, such as Skype and Google Hangouts, which are not currently HIPAA compliant (Lustgarten, 2017). In addition, information specific to telemental health services should include a written emergency plan, what to do in case of technological failure, how contacts between sessions will be handled, under what conditions telemental health services would no longer be appropriate, and how referrals for face-to-face services will be made (Swenson et al., 2016). Box 2 provides an example of a teletherapy consent form that is used in addition to an agency’s typical consent form.
Box 2: Consent for Treatment Using Teletherapy Client Name: I, _______________________________, agree to participate in teletherapy with a mental health provider at ABC agency. This means that: ● I authorize information about my medical and mental healthcare to be transferred electronically through an interactive video connection between ABC Agency and XYZ Agency [if a clinic-based service is offered]. ● I understand that I will be informed of the identities of all people who are present during the teletherapy session and informed of their purpose for attending the session. ● My therapist/psychiatrist has explained how the teletherapy system works and how it will be used for my treatment. ● My therapist/psychiatrist has explained how this service will differ from face-to-face sessions, including emotional reactions that may arise due to technology use. ● I understand that my therapist will not be physically present during my teletherapy session. Instead, we will see each other electronically. ● I understand that teletherapy is a newer form of treatment. Although research shows effectiveness of this mode of treatment for a variety of needs and settings, there may be potential risks that are not yet recognized. ● Potential risks include the following: (a) at times the video image may be unclear or inadequate; (b) a disruption in the connection may occur; and (c) in rare circumstances, the information may be intercepted by unauthorized persons. ● I authorize the release of information pertaining to me determined by my mental healthcare providers or by my insurance company for the purpose of processing insurance claims. ● I understand that at any time, I may decide to discontinue teletherapy sessions with my provider. My therapist will refer me to a local mental health provider who can provide face-to-face services. ● I understand that, under the law, my mental health provider may be required to report to the authorities any information suggesting that I have engaged in behaviors that are dangerous to myself or others. ● My therapist/psychiatrist have explained the risks and benefits of receiving teletherapy. I understand that I still may need to see a specialist in person. ● I understand that information from my teletherapy sessions will be protected by HIPPA privacy laws. I may request a copy of my electronic record in writing. ● I understand that as part of receiving teletherapy, some information will be used for research purposes. No identifying information will be revealed to anyone other than those involved in my treatment at ABC Agency. These are the names and phone numbers of my local emergency contacts: ● Therapist: ● Psychiatrist: ● Primary care physician: ● Local hospital emergency room: I voluntarily consent to participate in telemental health services using video-conferencing equipment for the care, treatment, and services deemed necessary and advisable under the terms set forth herein. Signatures Name: Date: Witness: Date: Parent or Legal Guardian: Date:
Patient safety is the cornerstone of behavioral health care. A clinician should consider how to obtain consent (face-to- face vs. telemental health), what should be included in the consent, and how to manage emergencies. The guidelines for treatment must be organized and established prior to service provision. The practitioner should ideally have multiple backup plans in place in case a situation arises where assistance is required but not immediately available,
as discussed later in the course. Both the client and clinician will benefit from a well-thought-out plan of action. Certain risks to client safety can occur in both office settings and telemental health settings (Luxton, Nelson, & Maheu, 2016), and elucidating these risks is an important part of thorough informed consent. These risks include suicidal or homicidal ideation, worsening symptoms, and medical emergencies such as cardiac arrest.
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Book Code: PCUS1525
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