2023 Edition

Client Rights Introduction

Purpose

The rights and dignity of clients are respected throughout the agency.

Introduction

COA’s Client Rights (PA-CR) standards are founded on the principle that practices should reflect a profound respect for personal dignity, confidentiality, and privacy. In addition to addressing legally protected client rights, the standards in this section also center on the professional ethics of service delivery. This section promotes privacy, transparency, and mutual respect.

Interpretation

 COA recognizes that mandated clients and individuals receiving Adult Guardianship (PA-AG) services may have a reduced level of rights. In addition, information provided to individuals who have been deemed incapacitated by the court, court order, and state law may vary based on an individual’s assessed capacity to understand such information. Individuals should retain as much personal responsibility and self-determination as possible given their assessed capacity and individual rights may not be abridged unless superseded by legal mandate or court order.

Note: Please see PA-CR Reference List for the research that informed the development of these standards.


Note: For information about changes made in the 2020 edition, please see the CR Crosswalk. 

2023 Edition

Client Rights (PA-CR) 2: Confidentiality and Privacy Protections

The agency protects the confidentiality of information about clients and assumes a protective role regarding the disclosure of confidential information.

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VIEW THE STANDARDS

Related Standards:

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed administration and management infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study Evidence On-Site Evidence On-Site Activities
County/Municipality Administered Agency, State Administered Agency (Central Office), or other Public Entity
  • Confidentiality policy
  • Confidentiality procedures
  • Sample release form for disclosure of confidential information
State Administered Agency (Regional Office)
  • No Self-Study Evidence
 County/Municipality Administered Agency, State Administered Agency (Central Office), or other Public Entity
  • No On-Site Evidence

State Administered Agency (Regional Office)
  • Communications with staff regarding completing releases of information (memo, in-service training documentation, staff meeting minutes)
 All Agencies
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records
 
Fundamental Practice

PA-CR 2.01

When the agency receives a request for confidential information about a client, or when the release of confidential information is necessary for the provision of services, prior to releasing such information, the agency:
  1. determines if the reason to release information is valid;
  2. obtains informed, written authorization to release the information from the client and/or parent or legal guardian, as appropriate; and
  3. maintains each authorization of consent in the case record and provides a copy to the client and/or parent or legal guardian.
Related Standards:

Note: Please see the Case Record Checklist for additional guidance on this standard.

 
Fundamental Practice

PA-CR 2.04

The release form for disclosure of confidential information includes the following elements:
  1. the name of the person whose information will be released;
  2. the signature of the person whose information will be released, or the parent or legal guardian of a person who is unable to provide authorization;
  3. the specific information to be released;
  4. the purpose for which the information is to be used;
  5. the date the release takes effect;
  6. the date, event, or condition upon which the consent expires in relation to the individual purpose for disclosure, not to exceed one year from when the release takes effect;
  7. the name of the person(s) or agency/agencies that will receive the disclosed information;
  8. the name of the person or agency that is disclosing the confidential information; and
  9. a statement that the person or family may withdraw their authorization at any time except to the extent that action has already been taken.
Interpretation: When a release form is used to authorize the exchange of information between multiple parties, the form must comply with all elements of the standard. All relevant parties must be authorized to disclose and receive the information specified, for the purpose indicated, in the consent.

Interpretation: Elements (b) and (i) will not apply when law, regulation, or court order permits confidential information to be released without the authorization of the person or legal guardian.

Interpretation: Blanket release forms signed by clients when service is initiated do not meet the requirements of this standard except as put forth by federal regulation, for example, when making application to FEMA/DHS in a declared disaster.

Examples: Examples of information that may also be included on release forms include a statement regarding the impact, if any, of refusing to sign the authorization, and rules regarding re-disclosure of information.
2023 Edition

Client Rights (PA-CR) 3: Research Protections

An agency that participates in or permits research involving service recipients establishes the right of individuals to refuse to participate without penalty and guarantees participants’ confidentiality.
Interpretation: All research involving service recipients is conducted in accordance with applicable legal requirements. For purposes of PA-CR 3, research includes all forms of internal or external research involving service recipients except internal program evaluation and outcomes research, and educational projects carried out by students and interns as part of their professional training. 

Agencies serving children and youth who are wards of the state are advised to consult Code of Federal Regulations 45 CFR § 46.4.09 and 21 CFR § 50.56. These regulations specify who can participate in research and require that an advocate must be appointed for each participating child. 
 
NA The agency does not permit research involving service recipients.

NA State Administered Agency Regional Office

1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed administration and management infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study Evidence On-Site Evidence On-Site Activities
County/Municipality Administered Agency, State Administered Agency (Central Office), or other Public Entity
  • Human subject research policy
  • Human subject research procedures
  • Informed consent form template
State Administered Agency (Regional Office):
  • Evaluated in the Central Office only
 County/Municipality Administered Agency, State Administered Agency (Central Office), or other Public Entity
  • Signed consent forms for research activities
  • Minutes from research proposal meetings for the previous six months
State Administered Agency (Regional Office)
  • Evaluated in the Central Office only
 County/Municipality Administered Agency, State Administered Agency (Central Office), or other Public Entity
  • Interviews may include:
    1. Agency head
    2. Relevant personnel
    3. Persons served
State Administered Agency (Regional Office)
  • Evaluated in the Central Office only
 
Fundamental Practice

PA-CR 3.01

The identity and privacy of participants is safeguarded in all phases of research conducted by, or with the cooperation of, the agency including, but not limited to, masking the individual identify of research participants in all statistical analyses, reports, summaries, and case examples. 
 
 

PA-CR 3.02

The agency has a mechanism to review research proposals involving service recipients, such as a human subjects committee or an internal review board that reports to the agency head or senior management.
 
Fundamental Practice

PA-CR 3.03

Research participants, or a parent or legal guardian, sign a consent form that includes:
  1. a statement that he or she voluntarily agrees to participate;
  2. a statement that the agency will continue to provide services whether or not he or she agrees to participate;
  3. an explanation of the nature and purpose of the research;
  4. a clear description of possible risks or discomfort, as applicable; and
  5. a guarantee of confidentiality.
Interpretation: The consent form should be presented to the participant in an accessible format, which takes into account language barriers as well as intellectual and developmental disabilities that could impact the participant’s understanding.

Note: Please see the Case Record Checklist for additional guidance on this standard.

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