Bromberg / O'Donohue Toolkit for Working with Juvenile Sex Offenders

1. Auflage 2014
ISBN: 978-0-12-405925-2
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 592 Seiten

Reihe: Practical Resources for the Mental Health Professional

Juvenile sex offender therapy has changed markedly since it emerged in the 1980s. Toolkit for Working with Juvenile Sex Offenders provides therapists with a summary of evidence-based practice with this population, including working with comorbid conditions and developmental disabilities. It provides tools for use in assessment, case formulation, and treatment, and includes forms, checklists, and exercises. The intended audience is practitioners engaged in the assessment and treatment of juveniles whose sexual interests and/or behaviors are statistically non-normative and/or problematic. Readers will find a chapter on academic assessment and intervention, a domain frequently not covered by texts in this field. - Identifies evidence-based treatment practice specifically for juveniles - Provides tools for assessment, case formulation, and treatment - Covers treatment in comorbid conditions or developmental disabilities - Contains forms, checklists, and client exercises for use in practice

Autoren/Hrsg.

Bromberg, Daniel S.

O'Donohue, William T.

Leseproben

Chapter 1 Informed Consent or Assent for Assessment, Treatment and Releases of Information
Robert Kinscherff* and Craig Latham**,    *Massachusetts School of Professional Psychology, Newton, MA, USA,    **Latham Consulting Group, LLC, Northampton, MA, USA This chapter reviews informed consent/assent for assessment and treatment of youth with problematic sexual behaviors and adjudicated sexual offenses. Keywords
informed consent; informed assent; juvenile sexual offenders; problematic sexual offenders Informed Consent as an Ethical and Legal Obligation
Informed consent for professional services is an ethical and legal obligation in all North American jurisdictions. Informed consent for professional services is a fundamental right that is protected under international law, frameworks of ethical codes, as well as federal law (such as HIPAA) and state law (such as statutes and regulations). The elements of an adequate informed consent are described below, but it is critical to appreciate that genuine informed consent is a process rather than a moment. That is, while an informed consent form might be signed prior to initiating assessment or treatment, it may be necessary to revisit informed consent should the patient/client later become confused or unclear about the elements of informed consent. Revisiting informed consent is required should there be a substantive change in circumstances or the methods or goals of the professional services offered. There is nothing ethically or legally magic about a signature on a consent form. Courts have found that signatures on forms alone are insufficient to document an adequate informed consent. An adequate informed consent requires that: (1) the individual who is offering informed consent has been provided sufficient information to allow a reasonable person to make a considered decision about the professional services involved; (2) the individual demonstrates that they have a sufficient understanding of the information offered so that they can actually make considered decisions; and (3) the individual has been afforded a meaningful opportunity to ask questions or expressed concerns. Simply informing individuals about limits of confidentiality or testimonial privilege, the nature of professional services to be rendered, or other aspects of providing professional services is a necessary but insufficient step in obtaining adequate informed consent. In addition to providing information about the professional services to be rendered, the professional provider has an obligation to determine that the legal client offering informed consent has a sufficient understanding of the information to be able to make reasoned decisions when authorizing (or declining to authorize) professional services. The obligation to secure adequate and meaningful informed consent and “assent” (which we define below) is a particularly solemn professional duty since there is often at least some degree of implicit or explicit coercion involved in the provision of professional services to alleged or adjudicated juvenile sexual offenders or youth with problematic sexual behaviors. For example, being placed on probation by a juvenile court that is conditioned on participating in community-based assessment or treatment is a “voluntary” alternative to commitment to a juvenile justice authority. Discharge conditioned upon effective engagement in specialized juvenile sexual offender services in a residential treatment or a juvenile “secure treatment” or incarceration facility is “voluntary” in the sense that a youth can simply refuse to participate and accept the consequences of being “stuck” in institutional care for some period of time. A juvenile referred for a court-ordered evaluation can refuse to participate and accept whatever consequences may be imposed by the court which, in sexual offenses, may include longer-term confinement within the juvenile justice system. In addition to varying degrees of coercion involved in providing professional services to this population, assessments and treatment commonly involve intrusive inquiries regarding sexual perpetration and victimization, sexual behaviors and arousal, sexual interests, and masturbation practices. Effectiveness of assessment and treatment over time may be judged, at least in part, upon self-disclosures in these domains and others that are commonly outside of routine clinical inquiry or expectation when providing services to other clinical populations. As a result, it is particularly important to assure the adequacy of informed consent and assent and to appreciate that the process of obtaining them may be subject to particularly strict scrutiny if it is later challenged. Key Elements of Informed Consent
The basic elements of an adequate informed consent include: 1. Identification of the legal client. The legal client is the individual or entity who has the legal authority to engage in the process of informed consent and then to authorize or decline to authorize professional services. An adequate informed consent can never be obtained from an individual who lacks the legal authority to offer it. Once the legal client has been identified, the practitioner should determine what other “ethical clients” (such as the youthful minor, third parties, others) are involved in the case. 2. Identification of the ethical client(s). Provision of professional services with adjudicated juvenile sexual offenders or youth with problematic sexual behaviors commonly involves ethical clients (and must always involve a legal client). The most obvious ethical client is the youth receiving assessment, treatment or other professional services. A youth under age 18 ordinarily cannot provide informed consent or authorize professional services, but the professional clearly has ethical obligations that include securing adequate informed consent from the appropriate legal client, clarifying one’s professional role and maintaining professional boundaries, provision of competent services, efforts to secure the youth’s “assent,” (discussed below), and termination of services that are ineffective or no longer necessary. There are commonly “third party” ethical clients as well. For example, a clinical professional working in a juvenile justice setting or residential treatment setting will have ethical obligations to the organization. Some professionals working with youth who have sexually victimized others consider “society” or “potential future victims” also to be ethical clients. This is understandable but cannot be used to justify deviating from the duties owed to the legal client or from research-based “best practices” with the youth receiving services. For example, identifying “society” or “potential future victims” as ethical clients cannot be used to justify professional practices that are punitive or shaming, overly restrictive, fall below accepted standards of care or practice, or are inattentive to legitimate boundaries of confidentiality or testimonial privilege. 3. Obtaining informed consent and “assent”. Informed consent can only be obtained from the legal client who has the capacity to authorize professional services following a sufficient informed consent process. Nonetheless, efforts are made to secure the “assent,” or willingness to participate, of the youth or other interested parties (such as the parent(s) or legal guardian) when it is a court-ordered evaluation. In that situation, the court is essentially authorizing the evaluation but steps are taken to secure the “assent” of the youth and parent(s) or legal guardian by describing the role of the professional, the nature and purpose of the evaluation process, any relevant limitations on confidentiality or testimonial privilege and the like in terms that are understandable and developmentally appropriate for the youth and sufficiently detailed to inform the parent(s)/legal guardian. Court-ordered evaluation may proceed without the assent of the youth or parent(s)/legal guardian, although a parent/legal guardian or attorney for the youth may advise the youth not to participate directly in the evaluation process. The goal of seeking assent is to communicate respect and regard for the position of the youth and others – and, ideally, to secure their engaged involvement with full appreciation of the circumstances in which they find themselves – but offering assent is not required to proceed with professional services. 4. The role of the professional(s) in providing professional services. The professionals providing services should identify their professional background at a level of detail sufficient to inform the legal client (and others) about their relevant training and experience. This is particularly important if the youth has special characteristics (such as an intellectual or developmental disability, unusual or complex clinical presentation, or is identified as posing particularly challenging cultural or linguistic competency issues). The scope and nature of services to be provided (such as assessment, treatment, other) should be described. If the identified legal client is not the parent or legal guardian of the youth, then the identified legal client and the role of the professional must be disclosed. For example, if the evaluation is court ordered, provided for an attorney, or...