Question: "I am looking for information that will help me develop a consent for counseling form that meets guidelines for informed consent. This will be a form that parents sign when I work with students (K-4) for several weeks."

Response: If you go to our website Quick Find topic on "Confidentiality" (http://smhp.psych.ucla.edu/qf/confid.htm), you will find a number of relevant resources.

Note that the discussion of Informed Consent goes beyond legal and ethical concerns to include a focus on the motivational impact on students and families. Research shows commitment, motivation, and performance are related directly to the experience of choice, control, and self-determination. Studies with children and adolescents found dropout from counseling was reduced when minors were given preliminary information and choice. Resistance to treatment is reduced when children and adolescents are allowed to help plan and evaluate their treatment. Thus, given parent consent, there is still the matter of whether the child's assent is sought. (This involves procedures that provide the same information and options in words appropriate to the youngster's developmental level.)

Remember that critical elements in the informed consent process are (1) provision of relevant information, (2) ensuring that the information is communicated in a manner that ensures it is understood, and (3) ensuring that participation is truly voluntary.

With regard to the type of information to be conveyed, think minimally about clarifying the following matters:

1. How students are "selected" for counseling (e.g., teacher referral, parent referral)
2. Who provides the counseling (degrees, training, experience)
3. Freedom to decline without prejudice
4. What will be involved (number of sessions, general description of the intervention)
5. How information will be shared with parents and students
6. Confidentiality procedures (will record of counseling be in school records, release of information to share info with teacher/referrer)
7. What positive outcomes are anticipated; what possible negative outcomes might occur
8. Practical matters (cost, when the sessions occur, how to reach the counselor)

Center Note: This request raised our curiosity about what was being shared on the internet. Below are a couple of samples of what we found. As is evident, they include only a minimum of information.

Example 1:

In order to assist students in their adjustment at school and to help them with emotional and/or personal problems that may develop, counseling services are available at no cost to the student

The counseling is provided by:

All records regarding a student's counseling are kept confidential and are not included with other student records.

If your son or daughter is under age 18, then we need your permission to provide psychological services or counseling. In some situations, including mental health emergencies, a signed permission form would not be required in order for us to render help. However, it is strongly recommended that you sign the attached form and return it so that professional help in nonemergency situations may be provided to the student.

PARENTAL CONSENT FORM

I agree to allow (Student''s Name)_________________________to receive counseling services for the academic school year 2003-2004.

I understand that I may revoke this consent at any time by signing and dating a written notice to that effect.

Parent/Guardian(Print Name)
_____________________________________

Parent/Guardian (Signature)
______________________________________

Date ____________

Example 2.

Dear :(Parent or Legal Guardian)

Your child, has been referred for counseling by the Student Support Team at and/or (Name)_____________ (Position)________________ .

The staff who will provide this service is _____________and can be reached at ________. You are invited to call to offer any input or to make an appointment to discuss your child's needs.

Counseling services provided to the child are confidential between the psychologist and the child.

Check one below:
I agree for the school to provide counseling for my child._______
I do not agree._________

(Signature of Parent or Legal Guardian)___________(Date)___________

"Here is the form we use at my school"

Consent for Counseling of Minor
I hereby acknowledge that I am legal guardian of the below named minor child, and do consent to the provision of counseling services to the child at school by the school guidance counselor. I understand that while counseling is generally confidential, where there is risk of harm to self or others, child abuse, or other legal requirements, the counselor may be required to release information to protect clients or others. I understand that in order to provide service in accord with the highest ethical and legal guidelines and to insure the highest quality of service, the above information complies with state law, federal privacy acts, and professional ethical standards.
Name of Minor Child __________________
Parent or Legal Guardian ______________ Date________

Response #2: "The question about consent forms raised some questions about how we provide mental health services for our students. At risk students are identified by building staff (teachers & administration) on an assessment form developed by our state. Basically, those students with the most at-risk traits (neglected, atypical behavior/attendance, family history of school failure, etc.) are the ones most in need of our services. We must provide services to them first, then to the rest of the building, & those services must be different than what the general population receive. I usually don't request parental consent unless it's for a specific program, peer mediators, for example, that's different from mental health. If a parent has a problem with me seeing their child without their permission, I've said that it can be done because I'm part of the support services of the building, like the school nurse. There's been no further problem. After reading this post, maybe I shouldn't be doing it this way? But what do I do when those identified by staff aren't allowed to participate? Is the parental refusal sufficient when the child needs help? I'd hate to just leave it at that and think that I'm covered because the parent would not give permission."

Center Response:

The question of when support services can be provided to a student without parental consent (seen as a regular part of educational programs) and when parental consent is needed is important to understand as we move to strengthen prevention and early intervention programs. To get a perspective on what support service leaders have to say about this, we asked a number of them to weigh in with responses. Here is a sample:

>>"This is a frequent question. In Indiana, the Indiana State Board of Education has defined the services provided by rule: http://www.doe.state.in.us/sservices/pdf/ssrule.pdf ‘Student Assistance Services' shall be provided to students and families in schools in Indiana. Intervention with students is expected. While parental involvement is an important part of the services to children, the state board has not given any authority to parents to dictate the services provided.One caveat. I have seen well meaning student service workers intervene with a child already in therapy with an outside therapist. That is counterproductive without collaboration with the parent and the therapist. As usual, a proper assessment is critical."

>>"In our district, we do receive consent for counseling services. However, we only do not provide counseling if a parent says ‘no' to the services offered. That rarely happens. If we send the consent home and it is not returned, we do go ahead and see the student. We do continue to try to obtain the written consent, as we provide the counseling services."

>>"In our state, all social workers who are licensed in this state must have parent written consent to provide mental health counseling by the Professional Standard Board. Guidance Counselor in this state operate in ‘loco parentis' which mean instead of the parent. I would suggest the counselor try working with the parent by showing them how this intervention would help their child and that the information is keep confidential outside of the regular academic records."

For other perspectives and guidelines, take a look at these websites:

• Michigan Laws Related to Minors (http://www.miplannedparenthood.org/minors.htm)

• "The Public Health Code does not require parent consent for substance abuse counseling and treatment" http://www.ag.state.mi.us/opinion/datafiles/1990s/op06682.htm

• "Confidential care for minors" (http://www.ama-assn.org/ama/pub/category/8355.html)

• A brief guide to the state law: an act concerning outpatient mental health treatment for minors (http://www.naswct.org/professional/mentalhealthminors.htm)

• School Board policy related to parental consent for student services (http://www.fcps.k12.va.us/Directives/P2501.pdf)

• Procedural Safeguards: Due Process Procedures for Parents and Children (300.505) Parental Consent (http://www.ideapractices.org/law/regulations/regs/SubpartE.php)

• Parental Consent and Minor Assent (http://www.research.psu.edu/orp/hum/guide/I.html)

1. "This conversation regarding the provision of counseling services to students in public schools with or without parental consent is very interesting and thought provoking. However, I would suggest that except under fairly extreme circumstances, parental consent and involvement be obtained regardless of the legal issues and boundaries, unless it directly violates client confidentiality to do so (as in substance abuse treatment in some states). Not involving the parents of a child is a failure to recognize and respect the value of the family unit. It's also likely to be counter-productive."

2. "I think this is an incredibly important topic and I'm not surprised to see such a broad range of responses. I think that one of the best sources on this is "Ethics and Law for School Psychologists (Jacob-Timm & Hartshorne, 1998, Wiley and Sons, pp. 42-66). As a Marriage and Family Therapist and new Director of Counseling Services for a private, independent high school, I took some pains to research the question and utilized much of SMHP's materials on confidentiality and informed consent. My concern with some of the responses here is the general tone that if the procedure implemented for informed consent to treatment passes muster with the parents, i.e. if you can ‘sell it to the parents', then the procedure is okay. This can create enormous problems and may not only be unethical but potentially illegal in some states.

In some cases with the posted responses, personnel are providing ‘notice' as opposed to ‘informed consent.' Notice means that the school is giving parents information about action that is about to take place. But informed consent requires the ‘affirmative permission' prior to action being taken.

In many cases in the schools, personnel provide simple notice or a blanket consent (e.g., a description of potential services offered at the school and a request for blanket agreement to those services, should they be deem necessary by school personnel). Blanket consents for treatment have been ruled in courts to not constitute informed consent.

In addition, there is now substantial case law as regards to the type of information to be contained in informed consent forms -- that is, the nature, scope, goals of the counseling sessions or interventions, their duration, any expectable risks to the student or impact on privacy for the student or family, any costs, benefits expected, alternative services available and the expected consequences of not receiving the service for which consent is being sought. While informed consent does not seem to be necessary for each intervention within a program that includes multiple types of interventions, consent should be sought for each type of program, e.g., a peer counseling group; a sexuality education forum; a one-to-one counseling session, etc. In most states, there are specific exceptions to the informed consent rules, relating to provision of emergency services or services which, if not provided, would constitute a danger to the student AND the services are demonstrably necessary). This is a complex notion so care should be taken to consult with state and local laws as well as the ethical requirements of the licensed professional in the school."

(1) "States have varying laws about a minor's ability to consent to treatment, such as for reproductive health care without parental permission. The laws vary by state. The best source for state laws that might pertain would be the National Conference of State Legislators (ncsl.org). They track state-by-state legislation on a variety of topics, including minor consent laws. The minor consent laws apply especially when there is the dispensing of a medical product or device or when there is a payment involved. As far as I know, they do not address school services directly. Generally, school-employed nurses treat and counsel students without express parental consent. Most school-based health centers, on the other hand, which are usually third-party entities, do require parental consent. It is usually blanket consent for the school year -- not consent for individual procedures, consultations, or treatments. In those cases, they will provide emergency care for students without parental consent, but no additional or routine care. They usually refer them back to the school for whatever resources the school can provide."

(2)"Working with children of any age has always been difficult because of the environment they live in with family is so primary that the small amount of time we are able to spend with them has little effect on them. I have always involved parents in the therapy process. With some it is easy as DSS mandates and then we are only left to engage with all of our skills to turn this into a positive experience for all involved. In others, the family is willing, but don't really know that means they will have to make changes and in very few there is a genuine desire to work on the mental health of the child and the family. It really is helpful to hear comments and ideas that strengthen my desire to continue to fight the good fight."

Submit a request or comment now.

UCLA Center for Mental Health in Schools
Dept. of Psychology, P.O.Box 951563, Los Angeles, CA 90095.
tel: (310)825-3634
email: Linda Taylor ~ web: https://smhp.psych.ucla.edu