Section
3.11 General and Informed Consent to Treatment
3.11.1
Introduction
3.11.2 References
3.11.3 Scope
3.11.4 Did you know?
3.11.5 Definitions
3.11.6 Objectives
3.11.7 Procedures
3.11.7-A. General requirements
3.11.7-B: General consent
3.11.7-C: Informed consent
3.11.7-D: Special requirements for children
3.11.7-E:
Consent for behavioral health survey or evaluation for school-based
prevention programs
3.11.1 Introduction
It is important for persons seeking behavioral health services to
agree to those services and to be made aware of the behavioral health
service options available to them. When a specific treatment has
risks and benefits associated with it, a person must be made aware
of those risks and benefits and any other relevant information.
ADHS/DBHS recognizes
two primary types of consent: general consent and informed consent.
General consent
is a one-time agreement to receive behavioral health services that
is usually obtained from a person during the intake process at the
initial appointment, and is always obtained prior to the provision
of any behavioral health services. General consent must be verified
by a behavioral health recipient’s or legal guardian’s
signature.
Informed consent
must be obtained before the provision of a specific treatment that
has associated risks and benefits. Informed consent is required
prior to the provision of the following services and procedures:
- Psychotropic
medications;
- Electro-convulsive
therapy (ECT)
- Use of telemedicine;
- Application
for a voluntary evaluation;
- Research;
- Admission
for medical detoxification, an inpatient facility or a residential
program (for persons determined to have a serious mental illness);
and
- Procedures
or services with known substantial risks or side effects.
Prior to obtaining
informed consent, an appropriate behavioral health representative
must present the facts necessary for a person to make an informed
decision regarding whether to agree to the specific treatment and/or
procedures. Documentation that the required information was given
and that the person agrees to the specific treatment must be included
in the comprehensive clinical record, as well as the person’s/guardian’s
signature when required.
In addition to
general and informed consent for treatment, statue statute (A.R.S.
§ 15-104) requires written consent from
a child's parent or legal guardian for any behavioral health survey,
analysis, or evaluation conducted in reference to a
school-based prevention program. See subsection 3.11.7-E.
The intent of
this section is to describe the requirements for reviewing and obtaining
general and informed consent for persons receiving services within
the public behavioral health system, as well as consent for any
behavioral health survey or evaluation in connection with an ADHS/DBHS
school-based prevention program.
3.11.2
References
The following citations can serve as additional resources for this
content area:
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3.11.3
Scope
To whom does this apply?
All persons
enrolled in the behavioral health system.
3.11.4
Did you know?
- ADHS/DBHS
has developed a performance improvement project regarding informed
consent, entitled “Medication Management: Informed Consent
for Psychotropic Medication Prescription”. The project is
designed to improve the practice of obtaining and documenting
informed consent from persons, parents and legal guardians for
all prescribed psychotropic medications (See Section
8.4, Quality Improvement Projects).
- Behavioral
health services delivered through telemedicine require informed
co nsent from the person receiving the service(s). Appendix
B-2 of the ADHS/DBHS
Covered Behavioral Health Services Guide includes
information regarding behavioral health service codes that can
be encountered through the use of telemedicine.
3.11.5
Definitions Behavioral Health Medical Practitioner
General
Consent
Informed
Consent
Telemedicine
Voluntary
Evaluation
3.11.6
Objectives
To describe requirements for behavioral health providers to:
- Ensure a
behavioral health recipient’s understanding of the risks
and benefits of behavioral health services, including the risks
associated with declining a specific service or procedure; and
- Document
a person’s agreement to the delivery of behavioral health
treatment services and obtain a person’s or legal guardian’s
signature to verify general and, when required, informed consent.
3.11.7
Procedures
3.11.7-A.
General requirements
Any person, aged 18 years and older, in need of behavioral health
services must give voluntary general consent to treatment, demonstrated
by the person’s or legal guardian’s signature on a general
consent form, before receiving behavioral health services except
in an emergency situation or pursuant to a court order.
For persons
under the age of 18, the parent, legal guardian, or a lawfully authorized
custodial agency must give general consent to treatment, demonstrated
by the parent, legal guardian, or a lawfully authorized custodial
agency representative’s signature on a general consent form
prior to the delivery of behavioral health services, except in an
emergency situation or pursuant to a court order.
Unless pursuant
to a court order or in an emergency situation, any person aged 18
years and older or the person’s legal guardian, or in the
case of persons under the age of 18, the parent, legal guardian
or a lawfully authorized custodial agency, after being fully informed
of the consequences, benefits and risks of treatment, has the right
not to consent to receive behavioral health services.
Any person aged
18 years and older or the person’s legal guardian, or in the
case of persons under the age of 18, the parent, legal guardian
or a lawfully authorized custodial agency has the right to refuse
medications unless specifically required by a court order or in
an emergency situation.
All evidence
of informed consent and general consent to treatment must be documented
in the comprehensive clinical record per Section
4.2, Behavioral Health Medical Record Standards.
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3.11.7-B.
General consent
Administrative functions associated with a behavioral health
recipient’s enrollment do not require consent, but before
any services are provided, general consent must be obtained. General
consent is usually obtained during the intake process (see Section
3.9, Intake, Assessment and Service Planning) and represents
a person’s, or if under the age of 18, the person’s
parent, legal guardian or lawfully authorized custodial agency representative’s,
written agreement to participate in and to receive non-specified
(general) behavioral health services. The Gila River RBHA utilizes
PM
Form 3.11-GR to document general consent.
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3.11.7-C.
Informed consent
Psychotropic Medications and Telemedicine
Oral or written informed consent must be obtained from the person,
parent or legal guardian, unless treatments and procedures are under
court order, in the following circumstances:
- Prior to
the initiation of any psychotropic medication (see Section 3.15,
Psychotropic Medication Prescribing and Monitoring). The use of
PM Form 3.15.1 is recommended as a tool to review and document
informed consent for psychotropic medications; and
- Prior to
the delivery of behavioral health services through telemedicine.
Electro-Convulsive
Therapy (ECT), research activities, voluntary evaluation and procedures
or services with known substantial risks or side effects
Written informed consent must be obtained from the person, parent
or legal guardian, unless treatments and procedures are under court
order, in the following circumstances:
- Before the
provision of electro-convulsive therapy (ECT);
- Prior to
the involvement of the person in research activities;
- Prior to
the provision of a voluntary evaluation for a person. The use
of ADHS/DBHS
Form MH-103 is required for persons determined to
have a serious mental illness and is recommended as a tool to
review and document informed consent for voluntary evaluation
of all other populations; and
- Prior to
the delivery of any other procedure or service with known substantial
risks or side effects.
Information
Sharing
When providing information that forms the basis of an informed consent
decision for the circumstances identified above, the information
must be:
- Presented
in a manner that is understandable to the person, parent, legal
guardian or an appropriate court; and
- Presented
by a credentialed Behavioral Health medical Practitioner or a registered nurse with at least
one year of behavioral health experience.
Additional
Provisions
Written informed consent must be obtained from the person, legal
guardian or an appropriate court prior to the person’s admission
to any medical detoxification, inpatient facility or residential
program operated by a behavioral health provider.
What must
be reviewed as part of informed consent?
In all cases where informed consent is required by this policy,
informed consent must include at a minimum:
- Information
about the person’s diagnosis and the proposed treatment,
including the intended outcome, nature and all available procedures
involved in the proposed treatment;
- The risks,
including any side effects, of the proposed treatment, as well
as the risks of not proceeding;
- The alternatives
to the proposed treatment, particularly alternatives offering
less risk or other adverse effects;
- That any
consent given may be withheld or withdrawn in writing or verbally
at any time. When this occurs the provider must document the person’s
choice in the medical record;
- The potential
consequences of revoking the informed consent to treatment; and
- A description
of any clinical indications that might require suspension or termination
of the proposed treatment.
Revocation
of Informed Consent
If informed consent is revoked, treatment must be promptly discontinued,
except in cases in which abrupt discontinuation of treatment may
pose an imminent risk to the person. In such cases, treatment may
be phased out to avoid any harmful effects.
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3.11.7-D.
Special requirements for children
Non-emergency Situations
In cases where the parent is unavailable to provide general or informed
consent and the child is being supervised by a caregiver who is
not the child’s legal guardian (e.g., grandparent) and does
not have power of attorney, general and informed consent must be
obtained from one of the following:
- Lawfully
authorized legal guardian;
- Foster parent,
group home staff or other person with whom the Department of Economic
Security/Child Protective Services (DES/CPS) has placed the child;
or
- Government
agency authorized by the court.
If someone other
than the child’s parent intends to provide general and, when
applicable, informed consent to treatment, the following documentation
must be obtained and filed in the child’s comprehensive clinical
record:
| Individual/Entity |
Documentation |
| Legal
guardian |
Copy
of court order assigning custody |
| Relatives |
Relatives
Copy of power of attorney document |
| Other
person/agency |
Copy
of court order assigning custody |
| DES/CPS
Placements (for children removed from the home by DES/CPS),
such as:
- Foster
parents
- Group
home staff
- Foster
home staff
- Relatives
- Other
person/agency in whose care DES/CPS has placed the child
|
None
required* |
For any child who has been removed from the home by Child Protective
Services (CPS), the foster parent, group home staff, foster home
staff, relative or other person or agency in whose care the child
is currently placed may give consent for the following behavioral
health services:
- Evaluation
and treatment for emergency conditions that are not life threatening;
and
- Routine
medical and dental treatment and procedures, including early periodic
screening, diagnosis and treatment services, and services by health
care providers to relieve pain or treat symptoms of common childhood
illnesses or conditions (including behavioral health services
and psychotropic medications).
Any minor who
has entered into a lawful contract of marriage, whether or not that
marriage has been dissolved subsequently, or any homeless minor
may provide general and, when applicable, informed consent to treatment
without parental consent.
Emergency
Situations
In emergency situations involving a child in need of immediate hospitalization
or medical attention, general and, when applicable, informed consent
to treatment is not required.
Any child, 12
years of age or older, who is determined upon diagnosis of a licensed
physician, to be under the influence of a dangerous drug or narcotic,
not including alcohol, may be considered an emergency situation
and can receive behavioral health care as needed for the treatment
of the condition without general and, when applicable, informed
consent to treatment.
* If behavioral
health providers doubt whether the individual bringing the child
in for services is a person/agency representative in whose care
DES/CPS has placed the child, the provider may ask to review verification,
such as documentation given to the individual by DES indicating
that the individual is an authorized DES/CPS placement. If the individual
does not have this documentation, then the provider may also contact
the child’s DES/CPS caseworker to verify the individual’s
identity.
3.11.7-E.
Consent for behavioral health survey
or evaluation for school-based prevention programs
Written
consent must be obtained from a child’s parent or legal guardian for
any behavioral health survey, analysis or evaluation conducted in
reference to a school-based prevention program administered by ADHS/DBHS.
The use
of
PM Form 3.11.1 Substance Abuse Prevention Program and Evaluation
Consent must be used in order to gain parental consent for
evaluation of school based prevention programs. Providers may use an
alternative consent form only with the prior written approval of
ADHS/DBHS. The written consent must satisfy all of the following
requirements:
-
Contain language
that clearly explains the nature of the screening program and when
and where the screening will take place;
-
Be signed by the
child’s parent or legal guardian; and
-
Provide notice that
a copy of the actual survey, analysis or evaluation questions to
be asked of the student is available for inspection upon request
by the parent or legal guardian .
Completion of
PM Form 3.11.1 Substance Abuse Prevention Program and Evaluation
Consent applies solely to consent for a survey, analysis, or
evaluation only, and does not constitute consent for participation
in the program itself.
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3.11
General and Informed Consent to Treatment
Last Revised: 11/16/2006
Effective Date: 06/15/2007 |
