Informed consent

Permission must come from the right person

The current BACB Ethics Code defines informed consent as permission from an individual with the legal right to consent. Applicable law determines who can decide and for what purpose. A parent, guardian, healthcare agent, involved caregiver, and emergency contact may have different authority.

Verify identity, source of authority, scope, restrictions, and expiration for the particular decision. A general relationship label should never substitute for that verification.

Information must be understandable

Signing a dense form does not demonstrate understanding. Explain the service in the person’s preferred language and communication form. Include the purpose, procedures, time commitment, expected benefits, possible risks or discomfort, alternatives, privacy limits, contact for questions, and how to decline or withdraw.

Offer interpreters, AAC, accessible formats, examples, and enough time. Ask the person to describe the choice in their own way or answer practical questions. Treat confusion as a signal to improve the explanation.

Voluntariness requires a real choice

Power differences can shape a decision. Families may worry that questions will affect scheduling, insurance, school relationships, or access to other services. Explain which consequences are required by law or service design and which choices remain open.

Avoid pressure, rushed signatures, hidden conditions, or presenting one option as inevitable. Withdrawal may require a safe transition or another lawful step, yet punishment for asking questions undermines meaningful consent.

Assent remains important

Legal consent and client assent answer different questions. A representative may have authority to consent while the person receiving services communicates willingness, discomfort, pause, or withdrawal. The Code requires assent when applicable.

Plan how the person communicates those responses through speech, AAC, gesture, movement, or another reliable form. Keep communication available. Respond to changing assent under the governing process rather than treating silence or compliance as agreement.

Consent should be renewed when the decision changes

The Code addresses explaining, obtaining, reobtaining, and documenting required consent. Common review triggers include a substantial intervention change, new risk, different setting or modality, changed information use, a new decision-maker, expired authority, or a material change in benefits or alternatives.

Set a clear version, effective date, decision scope, and review trigger. Continuing service without revisiting an outdated explanation weakens the process even when an old signature remains on file.

Treatment consent differs from privacy authorization

The HHS consent-versus-authorization FAQ explains that a HIPAA authorization is a detailed permission for a use or disclosure of PHI when required by the Privacy Rule. A service consent cannot automatically authorize every disclosure.

Keep treatment consent, financial agreement, privacy-notice acknowledgment, research consent, and release of information separate. A combined form must still satisfy every rule that applies to each component.

A fictional choice example

Mara is a fictional sixteen-year-old considering a new community travel program. The first explanation covers goals and schedule but omits the video-recording plan, alternative teaching location, and how Mara can pause. Staff score 3 of 6 predeclared consent-information elements as clearly explained.

The clinician revises the conversation, provides a visual summary, answers questions, and verifies the authorized decision-maker. Mara has AAC available and chooses a smaller first step. All six elements are addressed, or 6 of 6, and Mara’s assent process is documented separately. This measures completion of the explanation, not the validity of consent by itself.

Questions families can ask

Ask who has decision authority, which service or change the consent covers, how risks and alternatives were selected, and when the consent will be reviewed. Request a copy of every signed version. Ask how the person receiving services can accept, decline, pause, or correct the team.

Clarify what happens after withdrawal, which immediate safety duties remain, and whether a different form governs records, photos, video, research, testimonials, or communication with another provider.

Consent records should show the conversation

A strong record includes the decision, authorized person, information provided, accessible format, questions, answers, date, version, signature when required, assent process, and any limits. It also records a refusal or withdrawal without changing it into a missing-signature problem.

Practices should test whether current forms match actual services. A form can become inaccurate when a program adds telehealth, recording, new data uses, different settings, or another provider relationship.

Retire obsolete versions across every service route.