Informed consent and assent

“Discuss and obtain informed consent/assent from client or guardian” (NBCC, 2027 task 2A.1)

Informed consent is the process by which a client, or a guardian for a client who cannot legally consent, agrees to counseling after understanding what it involves. Minors and others who cannot give legal consent are asked for their assent, their own agreement in words they understand. The exam tests the components of informed consent, who can give it, and how consent continues through treatment.

Key points

The ACA Code of Ethics (A.2) treats informed consent as an ongoing process, documented in writing and discussed verbally throughout the relationship.
Core components include the nature and purpose of services, the counselor's credentials, risks and benefits, the limits of confidentiality, fees and billing, record keeping, the right to refuse or end services, and the role of supervision or technology where relevant.
Consent must be given voluntarily, by a person with capacity, in language the person understands (with interpretation if needed).
For minors, a parent or legal guardian usually consents, and the counselor seeks the minor's assent; state laws vary on when minors may consent to counseling on their own and on what parents may access.
With divorced or separated parents, check custody orders to confirm who has legal authority to consent.
For adults with a court-appointed guardian, the guardian consents, and the client is still included in decisions as far as possible (ACA A.2.d).
Revisit consent when anything changes: new modality, new participants, recording, or a change in limits of confidentiality.

In practice

At a first session with a 14-year-old and her mother, the counselor explains confidentiality and its limits to both, describing in plain words what she will and will not share with the mother. The mother signs consent, and the counselor asks the teen whether she agrees to take part and notes her assent.

A father brings his son for counseling after a divorce. The counselor asks for the parenting plan, sees that both parents share legal custody, and confirms the state's rules on whether one parent's consent is enough before starting.

Check yourself

What is the difference between consent and assent?

Consent is legal agreement by a person with authority to give it, while assent is the agreement of a person, such as a minor, who cannot legally consent but is included in the decision.

Is informed consent complete once the intake form is signed?

No, because informed consent is an ongoing process revisited as treatment changes.

Why ask for custody documents when a separated parent brings a child?

To confirm who has legal authority to consent to treatment, which depends on the custody order and state law.

NBCC's knowledge and skills for 2A. Intake

Knowledge of: Barriers to service; Components of informed consent; Client suitability for telemental health services.

Skill in: Discussing informed consent; Explaining policies and procedures; Conducting a clinical/diagnostic interview.

A study guide written by ExamDragon from NBCC's published task; not NBCC material and not part of the exam.