ASCA: Informed Consent This section is included in the standard for confidentiality issues. A.2. Confidentiality b. Inform students of the purposes, goals, techniques, rules and procedures under which they may receive counseling. Disclosure includes informed consent and clarification of the limits of confidentiality. c. Recognize that informed consent requires competence, voluntariness, and knowledge on students’ part to understand the limits of confidentiality and, therefore, can be difficult to obtain from students of certain developmental levels and special-needs populations. The school counselor should make attempts to gain assent appropriate to the individual student (e.g., in the student’s preferred language) prior to disclosure. d. Are aware that even though attempts are made to obtain informed consent, it is not always possible. When needed, school counselors make decisions on students’ behalf that promote students’ welfare. e. Recognize their primary ethical obligation for confidentiality is to the students but balance that obligation with an understanding of parents’/guardians’ legal and inherent rights to be the guiding voice in their children’s lives. School counselors understand the need to balance students’ ethical rights to make choices, their capacity to give consent or assent, and parental or familial legal rights and responsibilities to make decisions on their child’s behalf. Even with the best of intentions, preparation, training, and experience of the counselor, it may still be impossible to know if some clients or children truly understand the concepts to give consent. Carolyn Stone, Ed.D., provides some suggestions for Avoiding Informed Consent Errors The National Institute of Health published research concerning ethical and legal consent issues in therapy. The study contains detailed information on strategies for obtaining written and verbal consent that can assisted in avoiding ethical dilemmas related to informed consent. Here are the condensed tenets from the research of Avasthi, Grover, and Nischal (2020): ● Use the language that the client understands easily and comfortably. ● Evaluate the competency issues of the client to provide consent. ● Consider obtaining informed consent/assent as a separate procedure and discuss all relevant issues separately, rather than in one setting. ● Inform about available alternative treatment options. ● Explain to the client what is expected from them during and in between the therapy sessions. ● Clarify fees, payments methods and schedules. ● Discuss confidentiality and exceptions to confidentiality clauses. ● Inform the client about counselor status, license, trainees, or student participation or need for supervision, and the role of supervisor. Here are some additional areas to considerations when communicating consent issues with clients. 1. Determine the client’s native language, speech, or hearing ability. Obtain an interpreter who has some understanding of the counseling process rather than a lay person, friend, or family member to ensure information is presented properly. 2. Assess the educational and cognitive level, age, psychological impairment or diagnosis, medical conditions that may impair communication, information processing, and ability to focus, attend to, and retain information. Written information and visual aids may be used to reinforce information in their native language.
school counselors working toward informed consent that can apply to clients with challenges as well. Stone (2014) provides the following list, abbreviated here, for consideration: Being the custodian or guardian of informed consent means: ● Foregoing services when the potential risks outweigh the benefits. ● Honoring the elusiveness of informed consent, while diligently trying to obtain it. ● Enhancing students’ ability to give informed consent and providing many opportunities for students to ask questions and to check for understanding. ● Avoiding a mechanistic, routine approach and finding developmentally appropriate words and opportunities to explain informed consent. ● Protecting voluntariness. Schools by their nature are not voluntary for the overwhelming majority of students. If an educator or parent/guardian asks for services a student does not want, avoid coercion and persuasion. ● Continuing to obtain written or oral permission from a parent or guardian for counseling services but still assuming the responsibility to protect the student. Heighten your vigilance to monitor what students say in front of each other. ● Attending to the role that language, cultural background and other elements of diversity play in the informed consent process. ● Reminding yourself that informed consent is not an event but a process to help students move toward self-governance. ● Evaluating and considering other approaches to help, such as generic groups on school success issues, to support students when a theme or topic group may possibly place them in harm’s way. 3. Clients dealing with trauma or crisis may need additional time to destress and regain composure to complete the consent process. In some cases, the client may require a spouse, parent, surrogate, interpreter, or other representative to assist if the client is unable to give consent due to age, competency level, or other impairments. 4. Multicultural diversity is another component to consider when communicating with clients and obtaining informed consent. Individuals may have preconceived ideas about their role in the counseling process and defer to the therapist as an authority figure. They may be reluctant or fearful to express their feelings, avoid eye contact, differ in personal space boundaries, and have differing speech characteristics of pace or volume that could be misinterpreted as anger or lack of engagement for instance. 5. Counselors may need to plan additional time to ensure clients are understanding consent information and to develop rapport and trust in the process. This includes time for explanations and answering questions. 6. Clients with cognitive or information processing delays, language, or hearing issues may benefit from visual aids, augmentative, or assisted communication devices and extended time to ensure comprehension of components of consent. 7. Security issues must always be part of any initial contact to ensure that the counselors, staff, and client can participate in a safe, risk-free environment. Clear rules for communication and behavior must be established with consequences for rule violations including terminating counseling sessions as part of the consent process. 8. Comprehensive client intake procedures, including background and history, should be detailed enough to provide information that would alert staff and clinicians of possible safety and security issues. This would include any clients who reside, or have been recently discharged from, psychiatric or criminal institutions.
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