Professional Ethics and Law in California, 2nd Edition _ ____________________________________________
The Belmont Report remains an important basic docu- ment in human research and is especially important as it relates to informed consent, which according to the report requires information, comprehension, and “voluntariness.” However, informed consent is an important concept not just in research and experimentation but also in the provi- sion of services. For example, in the NASW Code of Ethics, informed consent falls within Standard 1, Social Workers’ Ethi- cal Responsibilities to Clients. Standard 1.01, Commitment to Clients, and Standard 1.02, Self-Determination, both figure in the concept of informed consent, and the first sentence under Standard 1.03(a), reads, “Social workers should provide services only in the context of a professional relationship based, when appropriate, on valid informed consent.” Informed consent services should only be provided when valid informed consent can be obtained. Therefore, clients must know the exceptions to self-determination before consent- ing to treatment or other services. Mental health professionals working in child welfare or forensic practice settings are faced with additional challenges. In their article about informed con- sent in court-ordered practice, Regehr and Antle (1997) state: “Informed consent is a legal construct that is intended to ensure that individuals entering a process of investiga- tion or treatment have adequate information to fully assess whether they wish to participate. This concept of informed consent is closely linked with the value of self- determination.” Generally, potential threats and factors to be considered in ensuring the validity of informed consent are: • Language and comprehension • Capacity for decision making • Limits of service refusal by involuntary clients (including court-mandated clients) • Limitations and risks associated with electronic media services • Audio and video taping A young child cannot be expected to provide informed consent. However, in the state of California (Family Code, Section 6924), A minor who is 12 years of age or older may consent to mental health treatment or counseling on an outpatient basis, or to residential shelter services, if both of the fol- lowing requirements are satisfied: (1) The minor, in the opinion of the attending pro- fessional person, is mature enough to participate intelligently in the outpatient services or residential shelter services.
(2) The minor (a) would present a danger of serious physical or mental harm to self or to others without the mental health treatment or counseling or resi- dential shelter services, or (b) is the alleged victim of incest or child abuse. Regarding “serious physical or mental harm,” the state offers no definition for serious harm, and whether the child or adolescent is in danger of serious harm is up to the profes- sional judgment of the provider (California Adolescent Health Collaborative, 2010). An informed consent is a required document in the provision of mental health services. In addition to being one of the first documents to comprise a record, it is one of the best risk-management tools. Informed consent in today’s healthcare milieu demands details not previously considered, including potential benefits and risks of engaging in treatment, the nuances of technology use, limitations on confidentiality, and mandated reporting. COMPETENCE (OR PROFESSIONAL AND ETHICAL COMPETENCE) Another issue that relates to informed consent, compe- tence, is mental health professionals’ responsibility to represent themselves and to practice only within the boundaries of their education, experience, training, license or certification, and level of supervisory or consultant support. For example, poor practice, or the failure of a worker to provide services within accepted standards, was the second most common form of violation found in Strom-Gottfried’s study of code violation allegations resulting in findings of ethical misconduct in social work practice (2000). The study also revealed findings of incompetence in conjunction with other forms of unethical behavior in 21% of the cases. In these cases, reasons that a social worker was not competent to deliver services included: • Personal impairments • Lack of adequate knowledge or preparation • Lack of needed supervision Ingrao (2015) outlined five generally agreed-upon core competencies of social work practice: 1. Practicing with professionalism: Every social worker is a representative of the profession, and for this reason all social workers should know the history of social work and commit themselves to the conduct and growth of the profession. They should advocate for access to social work services and constantly reflect on their work and ways to improve. They should be aware of professional roles and boundaries, make use of supervision and consultation, and keep learning. It is also important that social workers maintain a professional demeanor.
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