8.1 Client Education and Informed Consent

Part II: Guidelines for Client Services and Clinic Management


  1. Client Education:
    1. Female Methods
    2. Male Methods
  2. Informed Consent and Method Specific Consent:

Client Education:

Delegate agencies must have written education plans for client education that include goals and content outlines to ensure the consistency and accuracy of the information provided. Education protocol should include detail on the educational focus for initial, annual, other revisits and supply visits.

A method to assess the client's educational needs should be performed at each visit. The education provided should be appropriate to the client's age, level of knowledge, language, and socio-cultural background and be presented in an unbiased manner. Clinic staff should use a client-centered approach to education, assessing each client's knowledge, circumstances and risks. A mechanism to determine that the information has been understood should be established. An example would be asking the client to repeat information in her/his own words.

Education services must provide clients with the information needed to:

  • Make informed decisions about family planning;
  • Use specific methods of contraception and identify adverse effects;
  • Perform breast self examination or testicular self examination;
  • Reduce the risk of transmission of sexually transmitted diseases and Human Immunodeficiency Virus (HIV), beginning with a risk assessment;
  • Understand the importance of recommended screening tests and other procedures involved in the family planning visit;
  • Understand the range of available services, the purpose and sequence of the clinic visit, and procedures and agency fees and financial arrangements.

Family planning education must include face-to-face instruction with the individual client. Additionally, film or videotape, pamphlets, and/or group discussion may be used. A variety of printed educational materials may be given to clients. Printed educational materials in languages prevalent in the community should also be available in the common areas or waiting areas of the clinic.

Initial clients should be offered information about basic female and male reproductive anatomy and physiology, and the value of fertility regulation in maintaining individual and family health. On subsequent visits, clients should be given information on reproductive health and health promotion/disease prevention, as appropriate.

Additional education should include information on preconception counseling, nutrition, exercise, smoking cessation, alcohol and drug abuse, partner and family violence, sexual abuse and sexual coercion.

Information on all contraceptive choices must be given to clients. Details on the safety, effectiveness, benefits, risks, potential side effects, complications and instructions on how to use the methods must be given for each contraceptive method prior to the client making an informed choice of method. See Appendix J for a Contraceptive Options Chart. The contraceptive education should be offered to clients on the following contraceptive choices:

Female Methods

Abstinence

Contraceptive Sponge

Contraceptive Transdermal Patch

Contraceptive Vaginal Ring

Diaphragm/Cervical Cap

Female Condoms

Female Sterilization

Fertility Awareness Method

Hormonal Implant

Hormonal Injectables

Intrauterine Device/System

Oral Contraceptives

Spermicides

Male Methods

Abstinence

Male Condoms

Male Sterilization

In providing contraceptive information to clients, staff should consider and discuss with the clients the methods for both their contraceptive effectiveness and their effectiveness in preventing STDs and HIV. Education on emergency contraception must be provided and emergency contraception must be available on site. See Appendix I for a Client Information Fact sheet on Emergency Contraceptive Pills.

Clinics must use any appropriate opportunity to provide all clients with information on the following high priority topics: emergency contraception and STD and HIV risk and prevention. This education must be done annually at a minimum.

Delegate agencies must develop procedures for evaluating the quality and effectiveness of the educational component. Evaluation of the client education services must occur annually.

All required client education must be documented in the client medical record. An education checklist will document coverage of all required education components. Topics on the checklist must be detailed in the education protocols.

Informed Consent and Method Specific Consent:

Informed consent is a process between the staff and client. The consent form exists to document the process.

The client's written voluntary informed consent must be obtained prior to the receipt of any clinical services. A written consent for general services must be executed at the initial visit. The consent form should inform the client of all routine clinic procedures that will be provided and should be reviewed and explained to the client.

Before signing the consent form the client must receive the appropriate education, and have the opportunity to ask and receive answers to any and all questions. This includes questions about the consent form or any services, supplies or procedures. Staff must make every effort to assure that clients understand all information presented verbally and/or in writing and be confident that clients understand the content of both the education and the consent form.

Staff signature as a witness on the form is not proof of client understanding, but attests the authenticity of the client's signature.

A method specific consent form must be executed if the client chooses a prescription method of contraception. To provide informed consent for contraception, the client must receive information on the benefits and risks, effectiveness, potential side effects, complications, discontinuation issues and danger signs of the contraceptive method chosen.

The method specific consent form must be updated and executed again when there is a change in the client's health status or a change to a different prescription contraceptive method. It should be routinely reviewed and updated at subsequent visits to reflect any changes in current information about that method.

Separate consent is also required for certain other procedures, including but not limited to, pregnancy testing and counseling visits and for sterilization. If the agency is a contracted IDHS sterilization provider, Federal sterilization regulations [42 CFR Part 50, Subpart B], which address informed consent requirements, must be complied with when a sterilization procedure is performed or arranged for through Title X.

All consent forms must contain statements acknowledging that consent is voluntarily given, that counseling and education were provided, that all of the client's questions have been satisfactorily answered and that the client has understood the content of all information given.

All consent forms must include the signature of the client, the signature of the person obtaining consent and the date. Consent forms must be written in a language that is understood by the client or translated and witnessed by an interpreter. In the case of clients with visual impairment or unable to read, the consent form should be read in its entirety to the client prior to obtaining the client's signature.

Parental or partner consent cannot be requested in order for the client to receive services; however, all clients should be encouraged to discuss their decisions with their partners, and in the case of teens, with their parents or an adult family member.

If staff believes that the client is unable to give informed consent (for example, because of a mental disability), then written informed consent must be given by the parent or legal guardian if the client is a minor, or by a legal guardian, if the client is an adult.

All consent forms must be kept in the client medical record.


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