(based on Ruebsaat, 2006, Records Management and other authors, as referenced)
Informed consent is needed for all key activities conducted when providing services and assistance, as it ensures women and girls’ participation in the shelter and related services is based on their full understanding of options available to them.
Consent may be provided verbally or in writing, although it is generally preferable to access written consent. The process of obtaining consent should consider what is reasonable for the individual, the circumstances surrounding information collection, the sensitivity of the information and whether it may be necessary to prove that the individual gave consent.
Written consent should be obtained before:
- Gathering and retaining personal information - women should be informed about why the information is needed and how it will be used.
- Using personal information – women should be provided an explanation regarding how the organization intends to use their information before offering written consent.
- Sharing information – in circumstances where information needs to be shared with other programme staff, a lawyer, health care professional or other service provider, information should be disclosed only for the purpose for which consent has been given.
- Accessing information from other sources – the woman should be the primary source of information about herself, but other sources may help identify risk factors and ways to minimize them (e.g. police or court services, health or mental health services).
- Conducting any assessment, including those related to risk, mental or physical health, and any other type of analysis.
- Providing various services, including counseling (therapeutic, legal, other), psychological analysis, medical/health testing, psycho-educational groups, advocacy with external groups, assisting trafficking victims with voluntary returns to their community of origin or reintegration.
- Conducting research activities, including programme monitoring and evaluation.
Provide women and girls with access to their personal information whenever requested and correct any inaccurate or incomplete information as requested.
Keep all personal information safe using specific information security practices to ensure it cannot be accessed by unauthorized individuals.
Steps for obtaining informed consent
Prior to requesting consent, provide the woman with relevant information, which may vary depending on the type of service being provided (e.g. counseling, medical interview/examination), but should consist of the following basic elements:
- Name, position and service role of the person requesting consent (if not already given).
- A detailed description of what consent is being requested for (i.e. collection and retention of information, assessment, service provision) including the time and place the activity is expected to take place, if applicable.
- The purpose of the activity.
- Risks or dangers associated with the activity (short or long term).
- Notice of any particularly sensitive or potentially upsetting topics, procedures or activities.
- Notice of when results of any assessment, examination or procedure will be available.
- Notice of the individuals’ rights to their records, medical file and personal documents.
- Reassurance that medical records will be kept confidential.
- Confirmation that she will have the opportunity to decide whether or not the organization can use it when referring her case to other service providers, law enforcement or other external actors supporting her case.
It is also important to:
- Reassure individuals that there are no right or wrong answers or reactions, and that questions regarding consent are standard and asked to everyone. Reassure women who have perceived that their survival or safety depends on giving a correct answer or response that they should only express their personal needs or interests.
- Adopt a neutral, professional and sympathetic tone and attitude. Do not pressure the individual to give consent nor imply what is best for her. Allow the woman to choose freely, knowing that her decision will be accepted without judgment or bias.
- Use plain language. By explaining activities and processes in simple terms and avoiding jargon, it is easier for the individual to understand and feel in control of her choices and related outcomes.
- Clarify and rephrase information that may be difficult to understand, watching for signs that the woman may not clearly understand the information provided. This helps to ensure that the content of the information is understood, particularly where language, social or cultural barriers exist.
- Encourage questions, which help ensure that the woman is informed about details/issues specifically important to her.
- Check that the woman comprehends the information provided. For example, formulate questions that are general (e.g. “Does anything I have told you seem unclear?”); and specific, to confirm consent for any details that might have been confusing (e.g. "Is there anything about how we intend to share information with your legal counsellor that seems unclear or confusing?").
- Assure the individual that there will be no negative consequences for refusing consent to any part of what is requested or offered.
- Use consent forms to document written consent. It is important to be flexible with such forms, adapting them as needed to the linguistic, operational and legal realities of a particular setting.
(International Organization for Migration, 2007)
Sample Consent and Confidentiality Clause for Intake Purposes (Canada)
I consent to receive the service(s) I have indicated above [list them above] which are provided by [insert agency name]. I understand that this application does not guarantee I will receive all the services I have indicated.
I also consent to having staff from the [insert agency name] collect personal information about me necessary for the purpose of delivering those services.
I understand that the personal information I provide is confidential. The release of any information regarding my involvement with the [insert agency name] may occur only with my written and signed consent subject to certain limited exceptions. These are:
- " If agency staff have reason to believe that a child needs protection under section 13 of the Child, Family and Community Service Act they are obligated (as are the general public) to inform the Ministry of Children and Family Development;
- " If agency staff have reason to believe that I am likely to cause serious physical harm to myself or another, they are obligated to inform the appropriate authorities (family doctor etc.);
- " If agency staff are required by court order to disclose specific records or to attend court and give evidence.
This agreement is in effect from [insert start date] until [insert end date].
Agency staff signature
I understand that my records will be kept for [insert agency retention period here] and that they will be destroyed after that time.
See Appendix II for additional sample consent forms on:
- Basic Contact Information for Intake Purposes (Generic);
- Risk Management (Generic);
- Consent to Release Information to Third Parties; and
- Consent to Collect Information from Third Parties.
Excerpt from Ruebsaat. 1998. Records Management Guidelines: Protecting Privacy for Survivors of Violence. BC Association of Specialized Victim Assistance and Counselling Programs. Vancouver.
Barriers to consent and engaging specific groups
It is important to identify and seek to address potential barriers to informed consent from women escaping situations of violence and find ways to reduce or eliminate them. This is important to promote a woman's understanding of her options, and ensure her engagement with service providers is based on her full knowledge and agreement with the process.
Barriers to obtaining informed consent may relate to language differences between the service provider and woman seeking assistance; age, where a girl is a minor or is not capable of giving her consent; challenges associated with physical or cognitive abilities, where providers are unable to effectively engage with the woman; or fear and perceptions about the shelter and its services.
For language barriers, where information cannot be understood in either verbal or written formats:
- Engage an interpreter specifically trained in safety and confidentiality of survivors.
- Receive verbal consent and document the reason for not obtaining consent in writing.
- Translate intake forms into languages reflecting the community being served.
In cases where the the girl is a minor or due to her age, is not capable of giving consent:
- Consent should be obtained from a safe parent or guardian, where possible.
- Where it is unsafe or otherwise not possible to gain parental or legal guardian consent, the reasons for not gaining consent should be documented and legal counsel should be sought for the girl.
- In addition to gaining legal consent to provide services to girls, informed consent should be sought from the girl specific to the services and supports to be provided. Service providers will need to take extra precautions to ensure the girl is able to understand the information provided, including the nature, consequences, benefits and risks of a particular activity and the overall plan to support her (Reubsaat, 2006).
- Assess the young person's capacity to understand the information being provided, and the subsequent ability to give informed consent, by considering her developmental level and the nature, complexity and duration of the plan for support and intervention (i.e. if the service or intervention is long-term or complex, more maturity may be required for a young person to understand the associated risks and benefits).
- Indicators which may be used to determine whether a girl is able to understand and give consent include exploring whether she is able to:
- interpret information accurately and logically
- suggest alternatives if asked to
- follow-through on an agreed-upon course of action
- appreciate benefits and risks of particular activities (e.g. the case plan)
- assess the credibility of information provided regarding alternatives
- If a girl gives consent on her own behalf and is assessed as being capable of understanding the information, the standard steps in obtaining informed consent should be followed.
If there are capacity issues, "individuals who are mentally disabled, psychologically disabled or individuals who are otherwise unable to fully participate in the informed consent procedure require special assistance, often in the form of a legal guardian or legal counsel. The legal guardian is a person with full power of attorney granted by the individual, or the individual’s legal counsel holding such written power of attorney. Organizations should consult an attorney regarding consent by minors or individuals who, due to a mental or physical condition, are not in a position to give legally valid consent" (IOM, 2007). Caution should also be taken in cases where the legal guardian is the accused perpetrator.
Barriers related to fears or negative perceptions about the shelter or low-levels of trust with service providers may be reduced through careful attention to the approach and process employed in gathering informed consent
(International Organization for Migration, 2007. IOM Handbook on Direct Assistance for Victims of Trafficking)