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Event ID: 2351884
Event Started: 8/6/2014 10:21:04 AM ET
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Good morning and thank you for joining us. This is Lori with UNTY an today's webinar is the second part of our webinar series on Informed Choice: It's a Matter of Ethics and talking about making choices is an important part of gaining independence at achieving employment success. Again we have Dr. Chandra Donal with us to make sure that we have everybody on board and being able to hear us, I see that she looked you have already sent a note, if you could go down to the question box everyone in the control panel and send me a note if you can hear my voice okay so that everything is loud and clear on your end. So just send me a yes or Howdy. Hi Rosa, thank you so much. Margaret, José, Barbara, Catherine, Dan, Anthony, awesome. Debbie as well. And just as a reminder if you have any questions or comments for our speaker today you can use the question box to give those comments and we will certainly share them with the rest of the audience.
If you're on the phone only and not using your computer [ Indiscernible-distorted audio ] send an e-mail to join us while we are in session. I will be back with you later towards the end of the session, the session is over at 10:30 AM, to give you a few more ideas of what is going to happen in regards to getting credit for your presence today on this webinar. Without further ado I want to introduce Dr. Donal again who is a professor at Rehabilitation got counseling at UNC and is lots of work experience in counseling and therapy and she gave us a wonderful introduction to the concepts and ethics during last session, and today she will either through some case studies. To take it away.
Good morning everyone and thank you all for joining us again. I know last week we went over a lot of information and I just wanted to make sure that as you have questions you do feel free to use the question box and hopefully I can respond to those as we move along. Our focus for today will still be on looking at informed consent. But we're going to look a little bit more at some case studies that applied. I cannot remember exactly who was last week was one asked a great question about individuals who may have some sort of cognitive impairment. Based on that and some additional research I did, just think about areas where people are mostly challenged in regards to informed consent aside from the time management challenge and we will talk more about that today.
I decided to focus on the case for Web and individual who has a psychiatric disability and also transitioning minor. The minor is individual is one of the more challenging cases to deal with. Just as a review here are golden 5+ one of our ethical principles that kind of got all of our work and our embedded deeply into the ethical standards. In regard to informed consent it is important to remember that it has a foundation in making sure that we support client and consumer autonomy.
And really focusing on beneficence and making sure that we're working toward their well-being and looking at Fidelity making your list of commitments and making promises so the information set forth in our informed consent form that we verbally discussed with them, it is important to maintain that. It is our agreement or document with the client or consumer groups and also veracity to make sure that we are being truthful and dealing honestly with our clients. All of our consumers and clients are coming to us for assistance and so our wallets helpers is to make sure that we do so or that we do so in a more objective and most honest way possible so they have the full information about what they might experience so they can make informed choices, and maintain autonomy throughout the process.
The next couple of slides are also review from last week in a religious cover what should be included in informed consent. One additional piece I'll add to this, I will not go over these agree to you tell again, but I do want to make sure that you understand informed consent can be a recurring process. Just simply because of the treatment plan, the intervention or the services might be altered based on assessment results, how well a client or consumer is doing in their current service or the treatment they are in. There are different things a client may need to come out of treatment services for point in time to go for hospitalization or something to that effect. It is not something we should visit just once in the process. It can be re-occurring and that is important that we do that just to remind the client and consumers about what we are focusing on and so that they are able to react to make choices they still missed changing needs.
The next two slides go over all the different types of things that are typically included in informed consent. There was a question last week that focused a little bit on some or a comment, that focused on the time that it takes. In informed consent because we are handling so many different anxiety the time but we are working with our clients and consumers, and we have limited time, just working the issues with them, all these different components seems like it might not be achievable.
When these services are mentioned or the aspects of informed consent are discussed each and every single one of them may not need to be reiterated as the same level of another. Talk a lot lasted about confidentiality and the limits on that and we definitely want to talk specifically about that in addition to what the client is using to sign off on as confirming their understanding of it. We want to spend time on our duty to warn and what it looks like for agency in our state and want to talk about what our role is in with the client or consumer's role is in this relationship.
We want to spend a little bit of time regarding our role if we have any in determining eligibility and in fits and want to make sure that if there's a separate form for HIPAA that we talk specifically about HIPAA in their rights to review the records and what that tells and then talk about what will happen as a result of their treatment, the positive in the narrative. They can use that information to make the best decision on how they want to move forward and that includes themselves or their legally authorized representative.
The last thing we always want to make sure that we carefully states our clients and consumers is to make sure that we give them specific information about it is their appeal rights within the agency. So if they find that for whatever reason they are not satisfied with the services or they have questions, that they do have the right to seek assistance from someone other than their counselor or service provider so they can have those questions or concerns remedied.
What I want to focus on today, and the two cases that I have really do harken back to the concept of capacity for informed consent. As you remember from last week we talk a lot about capacity kind of being the terminology to determine whether or not a person is able to make informed decisions. What their ability to understand is, the information that they are relating to them and to know they have the ability to voluntarily consent and that they understand that they can also withdraw services at any point in time.
If they choose to withdraw, spinning, nature of the person that you are seeing, they need to know clearly what the consequences of the withdrawal might be. They may know longer want the services and that might mean they cannot work with the vendors providing job development services and we could no longer provide oversight for any other types of services, whatever the case is, what's make sure that as they know they have the ability to withdraw that they also understand the consequences. The whole point of this again is to make sure that they are fully aware of what their rights are in the process.
Here is the case study and this is a case that focuses on a case with minors and I tried to make a very general so that might apply across the board with a very serious you guys are working in. There is a 14-year-old that walked up to therapist who is a transition counselor at his high school, there is many personal family problems, extreme difficulties physically and attention in the classroom which includes some comments about some physical abuse is receiving at home. The client asked the therapist not to discuss this with anyone especially his parents. The therapist explained his options to the client states he cannot offer treatment to anyone under the age of 18 without parental consent and also expresses his duty to report suspected child abuse to child protective services. After hearing the information the client and feels betrayed.
The situation for this is actually one that I am familiar with from a person I worked with before, they were a transition counselor at a school and this was a student who had been assessed for ADHD but I was not sure of the actual diagnosis that come in yet, and decided to seek out this individual because they knew they help other students with disabilities and during that drop-in visit the student went over everything they were experiencing, and during that reticular session or meeting time talk about some abuse that the child was experiencing at home.
At that point because this person was not an actual client for the therapist, they had not gone over all the different information and informed components. And at the end indicated they could not work with anyone under the age of 18 without consent that they did have a duty to report. Here are some questions I would love for us to ponder a bit and to take time to think for this situation and what we know about informed consent to see whether or not there is an ethical issue that exists here. If there is, what principles are at play? And if you do feel like the therapist could've done anything differently what would that have been?
Chandra do what some people are going to make comments and the question box or go ahead and here response to any of the questions?
That would be great.
The therapist should have given the child the information regarding the services before he was allowed to discuss the personal issues. [ Indiscernible-low volume ] so that was a different way to approach it.
I have not received any other comments at this point.
Let's just go over that. Certainly the therapist had a right, and should have disclosed the full information. The challenge here in the ethical issue that exists here is that some individual feels like the person was not exactly the client of the therapist and so the therapist did not legally have to go through informed consent procedures because of this drop-in student. However, on the other side of that, if you think about your role in during the school system in your seen as a provider of services, within that role you deaf I have the duty to warn city that the student I come in during your drop-in hours the very first thing you should go over, and Medra is absolutely correct, is talking about some of the rules surrounding informed consent, particularly when dealing with minors. The method of you have been around kids are teenagers, I have a 13-year-old niece in the first issue always says is due not so my mom. So I have a little more flexibility in interpreting what I do with that as a professional we know that is how teenagers operate, they're coming to confide in us for various reasons of this particular client felt as though there was not a safe home environment to talk to some of these issues.
That as professionals we know that if a minor is seeking services and they are going to speak with us the very first thing you want to let them know is one, we cannot provide actual treatment to them without parental consent, and number two, if in the process of talking with them that we hear anything that falls underneath our duty to warn requirements than as an agent of the state, you are required to warn and provide notice to the appropriate authorities.
The concern that some people have is that will shut the person down, they will not want to talk in me or confide in me but I don't know if that is always the case. I think yes& Like it happened, but depending upon how you preface it, depending on how you are able to speak with the client and relay some of the reasons as to why it is necessary, then I think those clients who are in the situation where they really need to share information or they are seeking help without knowing that is exactly what they are doing, and you still can have a beneficial relationship with them. So she is absolutely correct, the therapist in this particular situation should happen for the client started to speak kind of briefly going over here are some things wait to be mindful of that I have to honor for my own ethical code as an agent of the state to make sure that everyone is protected in the process.
We did get a couple of additional comments, one is from Mark I would have little more time because he said he cannot type fast enough. The simple solution would have been to review the information ahead of the conversation. And also from Freda, consumer provided info before informed consent was given in the referral was given an order for the school counselor [ Indiscernible-low volume ] . Appreciate this interaction.
Great. For the next case we can definitely slow down a little bit so you guys can get some additional information I get some time to type things out. I want to refer back to the comment Freda made about the student confiding prior to consent being given in the referral being required. For this particular student in this particular situation or have someone who is there in the role of transitional counselor and certainly any of you all who love working transition services no yes your main goal is to focus on aspects of transition was mandated by the law and what is required by the school in order to help the person move through the process. However we also know that in any situation we are working with a client or consumer, they inevitably personalize and their situation comes into the picture.
There are times where that type of information also that our scope of practice to address in their times and that type of information falls outside of our scope of practice. If you think back to a couple of slides previously we were talking about informed consent one of those was to talk about what the counselor's role is that it is not only to relate to our clients to make sure that we understand what our role is as a professional in a particular setting. Informed consent having been talked about, the person has given you this information and because the KB's information prior to you receiving informed consent now you want to refer the client on any matter for the months of psychotherapy which I think is a creep -- completely appropriate. However the lingering question for you is a practitioner, and maybe this is the question we should consider as well, you know how this information regarding this particular client and so what do you do with it? Let me know what you guys think.
Call CPS.
[ laughter ]
Yeah.
[ Silence ]
And there is a duty to report.
Okay. I see that there are some of you guys that are out there and really weighing the ethical consequences on what the duties are and I those would definitely be appropriate responses. You start receiving permission as an agent of the state and as someone who is interacting with minors you do have a duty to report information and as I mentioned before, in the state of Texas, in regards to how your duty to warn a third-party, there is not as much protection just because of the state of Texas statute and how they interpreted as federal law. However when it comes to minors, there is a lot more minor and vulnerable populations there is more protection in place for practitioners which is to report.
One of the things I think that is really important also is that now that you've mentioned to the client at the very and this is something that you will have to report in the client feels betrayed, I think it is important that in order to maintain a relationship that will allow the client, I don't know if the word willingly is a good phrase or not, but to willingly going to therapy with another person that feeling as though the entire therapeutic process is against them. It is to say I understand that you are upset and I understand that you are concerned but this is what my responsibility and duty is as an agent of the state and as an employee of the school system, so on and so forth. And it is in your best interest as we investigate was on in your own. I'll transfer you to another counselor and I went to take care of what my duties are in regards to my position and don't make sure that the other counselor has the information they need to move forward with you and they can talk with you more specifically about what your rights are and what their duties are so you have a better understanding as we move forward with the next person.