Informed Consent For Service

All speech-language pathologists (SLPs) and audiologists in Alberta, regardless of practice setting, are regulated under the Health Professions Act (HPA). As such, all are considered to be “health care providers,” and are subject to the provisions and requirements of the HPA. The HPA (2000) states the key regulatory responsibilities of a college, including those relating to professional practice standards and professional conduct. As per the HPA, colleges are directed to establish, maintain, and enforce both a Code of Ethics and a Standards of Practice for their regulated members, both of which address principles of informed consent.

Informed consent for service refers to the situation when “a client[1] gives consent to receive a proposed service following a process of decision making leading to an informed choice” (ACSLPA Standards of Practice, 2022). The intent of obtaining informed consent for services is to protect and respect the integrity and autonomy of the client, to ensure that they are informed and understand the services and options for service available to them, and to ensure they understand their right to refuse consent or withdraw consent for service once given. Informed consent recognizes a client’s right to make choices regarding the professional services provided to them, regardless of whether their service provider agrees with their choices.

Consistent with ACSLPA Standard of Practice 2.3 Informed Consent (2022), this guideline provides information applicable to all SLPs and audiologists practicing in Alberta. SLPs and audiologists also have a professional responsibility to be aware of employer and/or agency policies, and any additional legislation or provincial standards regarding informed consent, where they exist. Although employer/agency policies may vary, Standard 2.3 sets the minimum requirements expected of all regulated members.

This guideline focuses exclusively on informed consent for services; it is not intended to address other forms of consent, such as consent for the sharing or disclosure of information. Please refer to ACSLPA’s Clinical Documentation and Record Keeping Guideline (2021) for information related to the management, security, and confidentiality of records.

---

[1] Refers to a recipient of speech-language pathology or audiology services, and may be an individual, family, group, community, or population. An individual client may also be referred to as a patient.

Who can Provide Informed Consent for Service?

Informed consent for service must be obtained from the client or a legally authorized representative for the client. The client or representative must have the capacity to consent to proposed services.

Regulated members should be mindful that while the law in Alberta dictates that only the client or a legally authorized representative may give consent for services, some clients may wish to have family members involved in the professional services they receive, and in their decision making regarding their care plan. Wherever practical and where the appropriate consent to share information is provided, regulated members should respect the client’s wish to have their family members involved in the information sharing process, including having opportunities to ask questions, in order to assist the client’s decision making.

When Should Informed Consent for Service be Obtained?

Informed consent is required prior to providing any professional service, which may include, but is not limited to, clinical screening, assessment, interventions, participation in clinical research activities, etc. The requirement to obtain informed consent for service applies equally to all practice settings.

Informed consent for service must be obtained:

• Prior to the implementation of any service plan (e.g., completing an assessment or starting treatment);
• Whenever there is a substantial change in the plan of care; and
• If there is a change in diagnosis, symptoms, or circumstances. Any new information relevant to the original or ongoing informed consent for service must be provided to the client in a timely manner.

Regulated members may find it prudent to review the session plan, restating their name, role, and objectives, as appropriate, at the beginning of each session (e.g., “Hi Mrs. Smith, it’s Yuri again. I’m the SLP who helps with your swallowing. We were planning to do X today. Are you okay to go ahead? Do you have any questions or is there anything new I should know about?”; or “Hi Johnny. It’s Indira and we’re going to work on your sounds today. We’re going to play a fun game. Mrs. Muller, shall we go ahead with the session? How has practice been going at home? Any updates?”)

Clients must consent to the SLP’s or audiologist’s assignment of activities to another individual (e.g., an aide or assistant), and must be informed and have the opportunity to give consent for students and/or volunteers to be present during any service.

Who is Responsible for Obtaining Informed Consent for Service?

Typically, the SLP or audiologist most responsible for the provision of care is responsible for obtaining informed consent for service from the client. As informed consent authorizes a specific person to carry out a specific service, the regulated member responsible for services is in the best position to answer any questions regarding the service or procedure. See Appendix B for a list of reflective questions for regulated members to consider when obtaining informed consent for service.

Regulated members are responsible for obtaining informed consent for the services they provide. However, certain aspects of the process of obtaining consent may be performed by others, for example the distribution and collection of an agency’s informed consent for service form. When procedural steps are assigned to another person, it remains the professional responsibility of the regulated member to ensure that consent is valid and informed, and that they are available to answer any questions the client or their legally authorized representative may have about the proposed service.

How Should Informed Consent for Service be Obtained?

Consent must be given voluntarily, and free of coercion, undue influence, or intentional misrepresentation. Consent requires regulated members to take appropriate steps to assist clients to understand information presented to them and satisfy themselves that clients have the competency required to make decisions about their care.

Obtaining informed consent for service from a client is an interactive, two-way process rather than a static, one-time event. It involves working collaboratively with the client rather than simply signing a form. To that end, an agreed-upon plan of service and client involvement in discussions and decision making should serve as the foundation of consent.

Informed consent for service, irrespective of communication mode (i.e., face-to-face, telephone, electronic correspondence), should address the following considerations:

• The nature or purpose of the activity or service;
• The name of the person most responsible for providing the service;
• The intended duration (i.e., day, number of weeks, months) of the service;
• The benefits and risks associated with the service;
• Any alternatives to the service;
• Any likely consequences of delaying or refusing the proposed service;
• The option to refuse or withdraw at any time without fear of reprisal; and
• The opportunity to ask and be given answers to questions about the service, and its risks, benefits, or alternatives.

Consent can be expressed or implied, according to the following principles:

• Expressed consent can be written or verbal. If consent is verbal, then a notation should be made to that effect in the client’s file.
• Implied consent can be implied from the client’s words or actions (e.g., the client continually attends ongoing sessions).
• Written consent may be advantageous in providing further evidence that the process took place, but a signed form does not in and of itself provide evidence of the process.
• Lack of refusal (sometimes referred to as negative consent) is not the same as consent and should not be used as justification to proceed with the delivery of a service.
• Clients have the right to refuse service or discontinue participation at any time.

Professional translators or interpreters are recommended if the ability of the client to understand the language spoken by the service provider is in question. Depending on the client’s background, a cultural facilitator or liaison may also be useful resource personnel who can assist with the client’s understanding of the information provided to them.

Regardless of whether it is expressed or implied, a client’s consent to service must be documented in the client file, including the date, signed name or electronic identifier (e.g., audit trail) of the person obtaining the consent, how consent was obtained (e.g., expressed, implied), and whether consent was limited or refused. In the event that consent is withdrawn, this should be documented in the client file, including the date and name of the service provider.

There may be rare circumstances where a legally authorized representative’s refusal to consent for services for a minor client or for an adult client in their care places the client at significant risk of harm. In such circumstances, where the regulated member has reasonable and probable grounds to believe that refusal of or withdrawal from services by a legally authorized representative amounts to neglect [2] of a minor client, the member should take the reporting steps outlined in the Child, Youth and Family Enhancement Act. Where refusal or withdrawal from services is likely to cause harm to the physical or mental health of an adult client under guardianship, members should take the reporting steps outlined in Adult Guardianship and Trusteeship Act.

In the event of an emergency situation, informed consent for service is not required if the delay in obtaining the consent would prolong suffering or place the client at risk of sustaining serious harm. It is unlikely that the services provided by ACSLPA regulated members would qualify as emergency services.

---

[2] Refers to situations where a guardian is unable or unwilling to provide a child with the necessities of life; or is unable or unwilling to obtain for a child, or to permit the child to receive, essential medical, surgical, or other remedial treatment that is necessary for the health or well-being of the child (Child, Youth and Family Enhancement Act, 2000).

Competency for Making Informed Consent for Service Decisions

It is the responsibility of the professional to make a reasonable judgment of an individual’s capacity and authority to give consent based on the information available to them. According to Section 26 of the Mental Health Act (2000), “a person is mentally competent to make treatment decisions if the person is able to understand the subject matter relating to the decisions and able to appreciate the consequences of making the decisions”.  A regulated member of ACSLPA must presume competency for decision making unless proven otherwise. Please see Appendix A of this guideline for suggestions for facilitating informed consent for service discussions with individuals with communication impairments.

When the regulated member has concerns about a client’s competency with regard to decision making, they should request that a capacity assessment be conducted by a trained capacity assessor. If a client has been identified as lacking capacity for decision making, consent must be given by a family member or designate with legal authority to do so, a legally appointed guardian, or the Court. Regulated members should note that capacity to provide informed consent can change over time and with respect to the type of service proposed.

Mature Minors

In the province of Alberta anyone under the age of 18 is considered a minor. Typically, informed consent for service for minor clients must be obtained from the parent/guardian of the child and, when possible and appropriate, from the minor as well. However, it is recognized that as minors age they develop a greater ability to make independent decisions about their bodies and their well-being. As such, clients who are deemed mature minors are entitled to give or refuse consent for services. In such circumstances, consent from parents/guardians is not required, and the parents/guardians may not override the decision of the mature minor.

Alberta does not have an established set age for a child or youth to be considered a mature minor. Several factors must be considered when assessing whether someone can be deemed a mature minor, including:

• The complexity and seriousness/severity of the proposed treatment/procedure;
• The age, intelligence, and maturity of the child;
• The seriousness of the health care concern or treatment;
• The child’s understanding of the information relevant to making the decision, i.e., of the risks, alternatives, and consequences of their consent for, or refusal of service;
• Indications of independence that may support a minor’s increased level of maturity (e.g., they are self-supporting or living independently); and
• Any other relevant information from adults who know the child, e.g., parents, caregivers, teachers, or other health professionals.

The decision to designate a minor as mature should be made prior to the provision of services. The rationale for the determination that a minor is mature should be clearly documented. If a professional decides that a minor is sufficiently mature, steps should be taken to document the basis for this finding in the client file.

Please refer to the Mature Minors Algorithm (Alberta Health Services, 2010) for more information on the informed consent process for mature minors in Alberta.

Special circumstances regarding consent may arise that warrant consultation on a case-by-case basis. In these instances, regulated members are urged to consult with their employer regarding informed consent policies, and/or to contact their profession’s ACSLPA Practice Advisor with any specific questions they may have.

Adapted from CASLPO (2006) Obtaining Consent for Services: A Guide for Audiologists and Speech-Language Pathologists and Communication Disabilities Canada Access (2020) Communication Supports for People who have Speech, Language and Communication Disabilities

For individuals with communication impairments, giving consent may pose a significant challenge. SLPs and audiologists play an important role in supporting and ensuring two-way effective communication in the informed consent for service process with all clients. As communication professionals, ACSLPA regulated members must ensure that all reasonable steps are taken to allow for information exchange and for the client to understand the service options and express their wishes in the process of obtaining informed consent for service.

A client is presumed to be capable of giving consent unless the regulated member has reasonable grounds to assume otherwise. Accordingly, when a person makes a decision that is unanticipated or disagrees with the regulated member’s recommendations, the member cannot assume there is a lack of competence. The regulated member should clarify and confirm the client’s response, as appropriate. They must respect the client’s wishes and may engage in further discussion to increase understanding of the client’s rationale, as desired by the client.

SUGGESTIONS FOR FACILITATING AN INFORMED CONSENT DISCUSSION

• Identify the communication needs of the client in the areas of understanding, expressive communication, assistance with decision making, accommodations required, etc.
• Use language that is appropriate to the age and abilities of the client. Provide communication supports as needed (e.g., eliminating jargon, using a slowed rate of speech, using language that is within the person’s lived experience).
• Provide alternative methods of communication for clients whose competence to provide consent may be masked by a communication disorder.
• Use language that is appropriate to the linguistic and cultural background of the client.
• Ensure that the client can hear sufficiently to participate in the discussion. Provide accommodations as necessary, such as assistive listening devices (e.g., Pocketalker), supplementary written information, adequate lighting, access to professional interpreters, and a quiet environment.
• Provide visual supports throughout the discussion to support conversation and facilitate understanding of information, accommodating for any visual difficulties.
• Encourage the client to paraphrase the discussion to confirm comprehension.
• Provide the client with sufficient time to process the information and ask any questions. In some instances, it may be helpful to allow the client to contact you following the session to review any issues or ask about issues that did not come up during the initial session.
• Consider whether you need to verify that the client has demonstrated comprehension after each component has been presented, to minimize the effect of memory difficulties.
• Determine if any accompanying persons have specific support roles (e.g., communication assistance, informal decision supporter). Determine what, if any, information that the client wants shared with any support person(s). Ensure that the discussion is targeted to the client.
• Provide communicatively accessible handout information following the discussion to allow the client to review the material in their own environment and own time. This material should reflect a level of complexity that matches the client’s cognitive skills.
• Structure the dialogue to allow the client an opportunity to ask questions and add perspectives to the discussion. Techniques to facilitate this may include:
  • Numerous direct (“What do you think?”) and indirect (“I wonder what you are thinking”) invitations to participate in the discussion; and
  • Pausing frequently for sufficient durations to allow an unsure or reluctant client the opportunity to participate and ask questions.
• Use techniques to support communication, such as interactive drawing, pointing to relevant pictorial or symbolic representations, pointing to key words provided, gesturing, age-appropriate play activity or enactment, or the use of yes/no responses.
• Allow the client to express their understanding of the assessment and intervention alternatives at each stage of the discussion (e.g., present each option visually and allow the client to indicate what was understood using their preferred communication modality).

The clinical scenarios below are illustrative of common informed consent for service situations that SLPs and audiologists have encountered in their practice. While not exhaustive, they represent some of the more frequently encountered questions by ACSLPA regulated members.

Regulated members are advised to contact their ACSLPA Practice Advisor should they require practice guidance for informed consent situations not described below.

Please note that the recommendations provided within this appendix meet the minimum requirements expected of all ACSLPA regulated members. SLPs and audiologists practicing in Alberta are reminded that they also have a professional responsibility to be aware of employer and/or agency policies regarding informed consent, where they exist.

Informed Consent for Minors

Children in Foster or Kinship Care (through Children Services)

Q: I work for a school board. One of the children on my caseload is in foster care. Who do I need to obtain informed consent for speech and language services from? Can the foster parent provide consent in this situation? Do I need to contact the child’s caseworker for consent?

A: When making the determination about who to obtain informed consent for service from for a child in care, the service provider should find out from the child’s foster or kinship caregiver who the authorized decision maker is for the child.

Typically for children in foster or kinship care, a Director under the Child, Youth, and Family Enhancement Act will delegate responsibility to the child’s foster or kinship parent through a ‘Delegation of Powers and Duties to a Child Care Giver’. This written, legal documentation is executed by the child’s caseworker and allows the foster or kinship parent to make some daily decisions for the child and will include a checklist of duties for which the foster or kinship parent is responsible. This delegation typically includes decision-making authority to provide consent for ‘ordinary medical or dental care’, which would include SLP or audiology services.

However, depending on the type of custody agreement or order that is put into place for the child, the child’s biological parent may retain decision-making authority, and therefore must be consulted to obtain permission to proceed with service delivery.

Whenever the foster or kindship parent or the healthcare provider are unsure about who has legal authority to consent for service for the child, the provider should request a copy of the delegation order for the child’s file and ask the person who has the delegation of powers to inform of any future changes.

Disagreement Between Parents/Caregivers

Q: The parents of one of the children on my caseload are divorced. According to the custody arrangement provided, there is a joint custody agreement in place, whereby the parents share decision-making authority for the child. I obtained one parent’s informed consent for service, but since then, it has been disclosed to me that there has been some conflict around co-parenting between both parents, and that the other parent is beginning to indicate concerns about the child receiving services from an SLP. Am I ok to proceed with services with consent from one parent in this case? Or should I seek informed consent for services from the other parent?

A: Under joint custody agreements, both separated or divorced parents retain full guardianship rights, which includes decision-making authority for their child(ren) and the right to consent to treatment. Therefore, both parents can provide consent for and refuse treatment. Typically, either parent can consent to services. However, in situations where there is conflict or disagreement about services between parents, best practice would be to obtain informed consent for service from both parents where reasonably practical.

Q: The parents of a child on my caseload are divorced and share custody of the child. I obtained informed consent for service from one of the parents, but the other parent has indicated to me that they do not consent for their child to have speech and language or audiology services. What are the options for service provision in this situation?

A: This can be a very difficult situation to manage. Under joint custody agreements, both parents retain decision-making authority, including the right to consent to and refuse treatment for their child(ren). In situations where parents disagree regarding consent for service for a minor client, they should be encouraged to come to a consensus on the matter. In such circumstances, it would be appropriate to pause service provision until such time as a consensus is reached, or until direction through a Court Order is provided, which indicates that services can proceed.

Informed Consent in the Absence of a Custody Agreement

Q: The parents of a new child on my caseload recently separated, and there is no custody agreement in place yet. Do I need to obtain informed consent for service from both parents in this situation?

A: In situations where separated parents do not yet have a custody agreement in place, a reasonable assumption would be that both parents retain decision-making authority and the right to consent or refuse treatment for their child(ren). Therefore, either parent can consent to services.

In situations where there are indications of conflict or disagreement between separated parents about service provision, best practice would be to obtain informed consent for service from both parents where reasonably practical.

The service provider should also ask to be updated once an agreement is reached about custody of the child(ren), to find out if one parent will have sole decision-making authority or whether both parents will retain this right. Providers should be aware that this agreement may be informal (i.e., a verbal agreement between parents), or a formal contract in the form of a ‘Parenting Agreement’, or a ‘Parenting Order’, which is determined by the Courts.

Consent in the Absence of a Parent/Guardian

Q: At an intake assessment appointment for a minor client, the child was accompanied by an extended family member who reported that the child’s parents were not able to attend the appointment. What are the informed consent requirements in this situation? Can an SLP or audiologist complete an assessment in the absence of a parent/guardian?

A: Situations may arise where a parent or guardian is not able to attend a scheduled assessment appointment and will ask an alternate adult to take the child to their appointment. While consent for service may be implied in these situations, the SLP or audiologist is still required to obtain informed consent for service from a legally authorized representative for the child. In this case, the service provider should contact the parent by phone to obtain verbal consent for the assessment. If contact cannot be made, then the appointment will need to be rescheduled.

SLPs and audiologists may also want to consider having booking staff relay to the parent that they must be present at the appointment or send a parent/guardian who is legally authorized to make health care decisions for the child. If the person scheduling the appointment is notified that the parent/guardian will not be in attendance at the appointment, they may be able to provide the necessary information about the assessment such that the parent can provide verbal consent at the time of scheduling, and consent for the accompanying adult to attend the session with the client. This conversation would then be documented in the client chart.

In situations like those described above, any results, follow-up plans, or consent for further services should be discussed only with the child’s legally authorized representative.

Hard to Reach Families and Consent

Q: I work as a private-practice SLP and have been contracted by a school division to provide services to students in the classroom. I am having difficulties contacting the parents of one of the children on my caseload. I have tried to contact them on three separate occasions in order to obtain their consent to proceed with speech-language intervention, but I have been unable to reach them. Since the parents signed the school’s general consent for educational services form, the school is wanting me to “just get started”.  Can I proceed with SLP services since the general consent form has been signed?

A: These situations can be difficult since one can appreciate the school’s perspective in terms of wanting to get moving with programming that will benefit both the child and the teacher. ACSLPA Standards of Practice are clear, however, regarding the need to obtain informed consent for service for any personalized services. Although a family may have consented to “educational services” for their child at the beginning of the year, this is not the same as having obtained informed consent for the particular services of the SLP or audiologist. Sometimes having a conversation with school personnel and informing them regarding one’s responsibilities as a self-regulated professional may be all that is required to clarify this situation.

When parents are hard to reach, it may be helpful to ask the school how they have typically managed these situations. They may suggest a different phone number, an email address, connecting through a social worker who can facilitate communication (remember to follow employer’s policies re: use of these communication methods with clients and consider the parents’ privacy). It may also be possible to find out whether the parents typically visit the school at predictable times (e.g., drop-off or pickup) when one might be able to touch base.

Client Withdrawal from or Refusal of Service

Parental Refusal of Service for a Minor Client

Q: One of my clients is an eight-year-old with severe spastic cerebral palsy. The results of their feeding and swallowing assessment show that they are not safe with oral feeding. I have explained the assessment results to the child’s parents, taking time to outline with diagrams the process of swallowing and how a feeding tube or percutaneous endoscopic gastrostomy (PEG) would benefit the child. I also explained the risks associated with and without the tube (PEG). The client’s parents stated that they did not want a PEG for their child, as they felt that their child would be harmed by the surgery and that they had already been through enough medical procedures with little or no benefit. In my professional opinion, I think it’s important to explore this issue further with the family. How can I approach this?

A: The ACSLPA standard of practice on informed consent for service is clear that regulated members must respect the client’s (or their legally authorized representative’s) right to refuse interventions. Given that obtaining informed consent for service is a process, rather than an event, in situations such as this, respectful ongoing dialogue and engagement may give clients and/or their caregivers time to process the information shared and to engage the provider in more discussion that may help address their concerns about their child’s health and overall well-being. Ongoing dialogue may also reveal alternative interventions that the family would accept. However, regulated members must respect the client’s (or their legally authorized representative’s) right to choose whether they participate in ongoing dialogue.

Clinician Disagreement with Refusal of Service for a Minor Client

Q: One of the children on my caseload was diagnosed with a mild-moderate sensorineural hearing loss at four years of age. Their speech and language skills were subsequently evaluated, and they were found to present with mild receptive and moderate expressive language delays, coupled with some minor articulation errors. Although I have demonstrated and explained to his parents that their child is missing audibility of certain phonemes, which is likely contributing to their speech and language delays, their parents are reluctant to consider hearing aids for their child. They wish to proceed with speech-language intervention only at this time. What can I do?

A: Although an audiologist or SLP may have strong feelings about how intervention should proceed for a client, as per ACSLPA standards of practice, it is the parents’ decision as to whether they proceed with recommended intervention for their child, and their wishes must be respected.

Should the parents choose not to pursue amplification for their child, the audiologist should document the fact that a discussion took place, and what the parents’ choice was at that time. Ongoing dialogue, particularly regarding the benefits of amplification as well as the risks associated with not pursuing amplification, may assist the parents in making an informed decision later on. A trial period of amplification is always offered in Alberta and can be used as a tool to provide parents the opportunity to observe their child’s responses in aided and unaided situations.

Ensuring that the physician, SLP, and other professionals involved with the family are aware of discussions regarding amplification would also allow a discussion regarding approaches to speech-language intervention, including the potential effectiveness of particular interventions, dependent on the presence or absence of amplification.

In situations where a legally authorized representative’s withdrawal from or refusal to consent to services for a client in their care poses significant risk of harm, please refer to the information on page 4 of the Informed Consent for Service guideline.

Clinician Disagreement with Refusal of Service for a Geriatric Client

Q: I am an SLP in a feeding and swallowing program. One of my patients has been identified through assessment as a candidate for a feeding tube/PEG. In conjunction with the feeding and swallowing team and physician, I explained the assessment results, the recommendation for a PEG, and the risks and benefits associated with and without the PEG. The patient stated that they did not want a PEG, as they indicated that this intervention would violate their spiritual belief in bodily integrity.

After follow-up discussions, the patient maintains that they do not want a PEG. My impression is that they do understand the risks and benefits of a PEG, and the physician has confirmed that this client has the capacity to make decisions regarding their treatment. I feel uncomfortable with the patient’s choice, and the risks that it presents to their health. What can I do?

A: Since it has been determined that this patient has the capacity to understand the risks and benefits of the proposed intervention, their decision to refuse a PEG tube must be respected. In situations like these, it is also recommended that regulated members ensure that the client has the member’s contact information and is aware that they can reach out to the member for future discussion.

The SLP should document the discussions they had with the patient in the patient’s chart, including his decisions regarding services. Further, the SLP may also find it helpful to discuss the situation and their own discomfort with a trusted colleague, supervisor, or counsellor.

Withdrawing Consent During Uncomfortable Procedures

Q: I recently saw a client for a hearing assessment. While they initially provided informed consent to proceed with the assessment, partway through the immittance assessment, they stated that the procedure was painful and that they did not want to proceed. What would be the most appropriate course of action in this situation?

A: Ultimately, according to ACSLPA standards of practice on informed consent, a client has the right to withdraw consent for service at any time. Although the client initially provided consent to proceed prior to the assessment, the audiologist must immediately and safely cease the assessment once the client has indicated that their consent to proceed is withdrawn.

For any procedure that results in discomfort or the possibility of injury, an extra procedural description can be helpful to promote client awareness and confidence. For example, sensitivity to pressure changes in the ear canal may vary across clients, in some cases resulting in physical discomfort. In these situations, although verbal consent to conduct the assessment may have been obtained at its outset, it may be necessary for the audiologist to provide additional explanation and possibly obtain consent to specifically proceed with the more invasive activity.

Informed Consent for Universal Classroom-based, Screening, and Educational Audiology Services

Universal Classroom-based Activities and Consent

Q: I am an SLP providing services to several elementary schools. One of the teachers has concerns about some students’ ability to follow directions during transitions and would like me to observe and provide some general strategies to them that may help facilitate their classroom’s transitions. As I will not be providing personalized services to any one child, what type of informed consent is required in this situation? Would the consent for general education services provided by parents/caregivers to the school at the beginning of the school year, which indicates that an SLP may be involved with classroom programming, be sufficient?

A: In this situation, since the SLP will be providing commonly used strategies that could be applied to any student, the information provided to the families at the beginning of the year indicating that an SLP may be present in the classroom from time to time during the year would suffice.

If, however, it appears that the general, classroom-wide strategies provided have not been particularly helpful and there are additional questions regarding a particular child’s comprehension or classroom performance, then personalized strategies, assessment, and follow-up may be warranted. In this case, the SLP is responsible for obtaining informed consent for service from the child’s parent/guardian.

Consent for Screening Services

Q: I am a school based SLP, and this year I am expected to conduct screenings of all students in the kindergarten classes on my caseload. Do I need to obtain informed consent prior to proceeding with the screenings? If consent is required, can I rely on the educational assistant to assist me with this process?

A: Speech, language, and hearing screening can take place in the form of a mass screening campaign, as mentioned above, or may target individual children or groups of children to determine which students require higher level services. Both mass screening and targeted individualized screening require the consent of a parent/guardian in order to proceed.

In terms of mass screenings, informed consent can be obtained by contacting families and obtaining verbal authorization to proceed or can involve the development of a health screening information sheet and consent form that is sent to families for their review and signature. The information sheet should outline the purpose of the procedure, scheduled dates, and who to call if there are questions. Parents/guardians should also be made aware that they will be contacted directly should individualized services be required for their child after screening. Although direct contact with families to obtain consent is arguably the most prudent, in the case of a mass screening, the minimal level of “intrusion” into the child’s or caregiver’s autonomy can justify a consent process involving an information sheet and consent form, as outlined above. The distribution of information regarding the screening campaign could certainly be handled by school staff or by support personnel; however, the SLP or audiologist responsible should be involved in developing the information about the process that is shared with families.

In these situations, it is also important to note that the absence of a response (i.e., the caregivers not returning a completed consent form) should not be interpreted as consent for a service.

Educational Audiology Services and Consent

Q: I am an educational audiologist providing services to multiple schools. Typically, the children on my caseload are managed by an audiologist in the community, and my role in their care is to manage the classroom acoustics and FM systems, and to educate teaching staff on proper use of equipment and accommodations for hearing loss. Since I am not directly involved in assessment and intervention for the student (i.e., I am not assessing their hearing loss, prescribing their hearing aids, nor providing aural rehabilitation to the student), would the consent for general classroom services provided by parents/caregivers at the beginning of the school year allow me to proceed with services? Or would I need to obtain informed consent for services myself for each student?

A: Generally, there is a lesser degree of risk around professional services that are provided to support educators in their provision of educational services. In this situation, it would be ACSLPA’s expectation that regulated members still give consideration to informed consent, but the level of rigor may be matched to the risk to clients. In this case, the pre-existing, more general consent obtained through the school would be considered sufficient. However, regulated members should be aware of the consent and the process by which it was obtained to ensure its suitability for the intended service. When necessary, members should provide input into planning and executing the informed consent for services process to ensure that they are able to rely on the consent obtained.

Alberta College of Speech-Language Pathologists and Audiologists (ACSLPA). (2022). Standards of Practice. 2.3 Informed Consent. https://www.acslpa.ca/members/standards-of-practice/#area2

Alberta College of Social Workers. (n.d.). Guidelines on the management of consent and confidentiality when working with minors. https://acsw.ab.ca/resource/guidelines-on-the-management-of-consent-and-confidentialitywhen-working-with-minors/?_rt=MXwxfGNvbnNlbnQgd2l0aCBtaW5vcnN8MTc3MDc1OTk2Nw&_rt_nonce=a1427530a6

Alberta Health Services. (2020). Consent to treatment/procedure(s): Minors / mature minors [Procedure]. https://extranet.ahsnet.ca/teams/policydocuments/1/clp-consent-to-treatment-prr-01-03-procedure.pdf

Alberta Health Services (AHS). (2010). Mature Minor Algorithm. https://www.albertahealthservices.ca/assets/info/hp/phys/if-hp-phys-consent-mature-minors-algorithm.pdf

Alberta Government. (2021). The foster care handbook: A guide for caregivers. https://open.alberta.ca/dataset/a20eba02-08fc-451a-bae9-32c14036943a/resource/a5f0ef12-2862-45a3-8c57-bcb4eaddbcfb/download/cs-foster-care-handbook-guide-caregivers-2021.pdf

Alberta Government Resolution Services. (2017). Guardianship, parenting, custody, access and contact. https://www.alberta.ca/assets/documents/rcas-general-information-guardianship-parenting-custody-access-and-contact.pdf

College of Alberta Psychologists. (2019). Practice guideline: Informed consent for services. https://www.cap.ab.ca/Portals/0/pdfs/New%20Guidelines/Practice%20Guideline-%20Informed%20Consent.pdf?ver=2019-08-20-102058-527

College of Physicians and Surgeons of Alberta. (2015). Advice to the profession: Informed consent for minors. https://cpsa.ca/wp-content/uploads/2020/06/AP_Informed-Consent-for-Minors.pdf

College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO). (2006). Obtaining consent for services: A guide for audiologists and speech-language pathologists. https://www.caslpo.com/sites/default/uploads/files/GU_EN_Obtaining_Consent_for_Services.pdf

Communication Disabilities Access Canada (2020). Communication supports for people who have speech, language and communication disabilities: Guiding questions for service providers. https://www.cdacanada.com/wp-content/uploads/2020/09/CDAC-Guiding-Questions-for-Service-Providers-EN-Fillable-Tagge-1.pdf

Government of Alberta. (2000). Child, Youth and Family Enhancement Act. Edmonton: Alberta King’s Printer.

Government of Alberta. (2000). Health Professions Act. Edmonton: Alberta King’s Printer.

Government of Alberta. (2000). Mental Health Act. Edmonton: Alberta King’s Printer.