This form is an optional addendum to the “Informed Consent and Assumption of Risk for In-Person Services During COVID-19 Public Health Crisis” document. While we have made every reasonable effort to create a system where our services can be conducted completely across a glass partition, there may be situations in which the staff crossing over to the client’s space would be very helpful to support our work.
This document outlines a) the systems in place to prevent the staff from needing to cross over to the client’s space, b) the potential reasons why it would be very helpful for the staff to cross over to the client’s space, and c) the extra safety precautions our staff would take should this situation arise. Please read this carefully and let us know if you have any questions. When you sign this document, it will be an official agreement between us. If you choose not to sign this document, then the circumstances under which a staff member would cross over to the client’s side would be limited solely to life-threatening circumstances.
Systems in place to prevent staff from needing to cross over to the client’s space:
1) The staff sets up everything needed on the client side before they arrive for their session, including work and sanitation-related materials (e.g., tissues, hand sanitizer, trash can).
2) Each office space has been fitted with a high-quality sound system that allows ease of verbal communication across the glass partition. Conversation can be held at normal and natural volumes and tones.
3) The technology on the client’s side (i.e., the laptop and iPad) are remotely controlled by the staff from their side. The child’s tasks during an evaluation (e.g., pulling out a numbered envelope from a bin; inserting a USB key into their laptop) are designed to be feasible given their age and developmental level.
4) The WCP team has developed systems to support behavioral management across the glass partition, including incorporation of visuals (e.g., whiteboards, laptops, iPads), expertise in verbally managing the multiple demands placed on a client, and use of external rewards when appropriate. We also make sure to provide the right number of breaks for a child, including the option to go outside with staff (maintaining 6 feet social distancing).
5) The WCP team has agreed that one option is to invite the client’s parents into the client’s testing space should behavioral support be needed. The office has ample room on a couch behind the client so that the parent can be an unobtrusive as possible.
Potential reasons why it would be very helpful for the staff to cross over to the client’s space:
1) The client is having challenges staying on task despite the use of our normal repertoire of behavioral management strategies across the glass partition. Entering the client side, even briefly, could support the child’s ability to re-focus.
2) Technical problems can occur with the audio equipment, laptop, and/or iPad. The staff will first either try to talk the child through solving the problem, or have the child wait just outside the building on the front or rear porch while solving the problem directly. Should the child be unable to follow the instructions to solve the problem and be unable to wait outside on their own (e.g., due to age, behavioral challenges, weather, etc.), then it would be very helpful to have the staff enter the client’s side with them present to solve the problem directly.
Extra safety precautions taken by staff should they choose to enter the client’s side:
1) Wash or sanitize their hands.
2) Put on a face mask.
3) Make sure the client has their mask on.
4) Keep as much distance as possible from the client during the interaction, potentially asking the client to move to another area of their space.
5) Work as quickly as possible to minimize the amount of time on the client side.
6) Sanitize the surfaces on the client’s side before leaving.
7) Wash or sanitize their hands.
8) Return to the staff's side.
9) Document the reason for entering the client’s side, how much time they spent there and what they did, and inform the parents at the earliest reasonable time about the incident.
Informed Consent
This agreement serves as an addendum to the “Informed Consent and Assumption of Risk for In-Person Services During COVID-19 Public Health Crisis" document, as well as the general WCP informed consent agreement. You have read and understand this agreement, and you understand that, by signing it, you are releasing certain legal rights that you might otherwise have. Your signature below shows that you agree to these terms and conditions.