Section
3.11 General and Informed Consent to Treatment
3.11.1
Introduction
3.11.2 Terms
3.11.3 Procedures
3.11.3-A. General requirements
3.11.3-B. General consent
3.11.3-C. Informed consent
3.11.3-D. Special requirements for children
3.11.3-E. Informed Consent during
Involuntary Treatment
3.11.3-F.
Consent for behavioral health survey or evaluation for school-based
prevention programs
3.11.4 References
3.11.1 Introduction
Each behavioral health recipient has the right to participate in decisions
regarding his or her behavioral health care, including the right to refuse
treatment. It is important for persons seeking behavioral health services
to agree to those services and be made aware of the service options and
alternatives available to them as well as specific risks and benefits
associated with these services.
The Arizona Department of
Health Services/Division of Behavioral Health Services 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:
- Complementary and Alternative Medicine (CAM)
- 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, as identified in
R9-21-206.01(c),
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 or does not agree 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
3.11.3-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.
Go
to top
3.11.2
Terms
Definitions for terms are located online at
http://www.azdhs.gov/bhs/definitions/index.php. The following terms are referenced in this section: Behavioral Health Medical Practitioner
Complementary and Alternative
Medicine (CAM)
General
Consent
Informed
Consent
Telemedicine
Voluntary
Evaluation
3.11.3
Procedures
3.11.3-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.
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.
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.
Providers treating persons in an emergency situation are not required to obtain general consent prior to the provision of emergency services. Providers treating persons pursuant to court order must obtain consent, as applicable, in accordance with
A.R.S. Title 36, Chapter 5.
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.
Go
to top
3.11.3-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 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.
Go
to top
3.11.3-C.
Informed consent
What
Information must be provided to obtain informed consent?
In all cases where informed
consent is required by this policy, informed consent must include at
a minimum:
Who can give
informed consent, and how is it documented?
Persons, or if
applicable the client’s parent, guardian or custodian shall give
informed consent for treatment by signing and dating an
acknowledgment that he or she has received the information and gives
informed consent to the proposed treatment. When informed consent is given by a
third party, the identity of the third party and the legal capability to provide
consent on behalf of the person, must be established. If the informed consent
is for psychotropic medication or telemedicine and the person, or if
applicable, the person’s guardian refuses to sign an acknowledgment
and gives verbal informed consent, the medical practitioner shall
document in the person’s record that the information was given, the
client refused to sign an acknowledgment and that the client gives
informed consent to use psychotropic medication or telemedicine.
Who can
provide informed consent and how is it communicated?
When providing
information that forms the basis of an informed consent decision for
the circumstances identified above, the information must be:
Psychotropic
Medications, Complementary and Alternative Treatment and Telemedicine
Unless treatments and procedures are court ordered, providers must obtain written
informed consent, and if written consent is not obtainable, providers must obtain
oral informed consent. If oral informed consent is obtained instead of written consent from the person,
parent or legal guardian, it must be documented in written fashion. Informed consent is required
in the following circumstances:
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 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.
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.
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.
Go
to top
3.11.3-D.
Special requirements for children
In accordance with
A.R.S. § 36-2272, except as otherwise provided by law or a court order,
no person, corporation, association, organization or state-supported institution, or any individual
employed by any of these entities, may procure, solicit to perform, arrange for the performance of
or perform mental health screening in a nonclinical setting or mental health treatment on a minor
without first obtaining consent of a parent or a legal custodian of the minor child. If the parental consent is given through telemedicine, the health professional must verify the parent’s identity at the site where the consent is given. This section does not apply when an emergency exists that requires a person to perform mental health screening or provide mental health treatment to prevent serious injury to or save the life of a minor child.
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 |
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 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, emancipated youth or any homeless minor
may provide general and, when applicable, informed consent to treatment
without parental consent (A.R.S. § 44-132).
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.
3.11.3-E: Informed Consent during Involuntary Treatment
At times, involuntary treatment can be necessary to protect
safety and meet needs when a person, due to mental disorder, is unwilling or unable to
consent to necessary treatment. In this case, a court order may serve as the legal basis
to proceed with treatment. However, capacity to give informed consent is situational, not
global, as an individual may be willing and able to give informed consent for aspects of
treatment even when not able to give general consent. Individuals should be assessed for
capacity to give informed consent for specific treatment and such consent obtained if the
individual is willing and able, even though the individual remains under court order.
3.11.3-F.
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.
Provider Manual Form 3.11.1 Substance Abuse Prevention Program and Evaluation
Consent must be used 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 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.
3.11.4
References
The following citations can serve as additional resources for this
content area:
Go
to top
3.11
General and Informed Consent to Treatment
Last Revised: 12/1/2013
Effective Date: 12/1/2013 |
