2024 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and self-determination as possible given their assessed capacity and individual rights may not be abridged unless superseded by legal mandate or court order.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. 

2024 Edition

Client Rights (PA-CR) 1: Client Rights and Responsibilities

The agency protects the legal and ethical rights of persons served by:

  1. informing people of their rights and responsibilities;
  2. providing ethical and equitable treatment; and
  3. providing people with sufficient information for them to make an informed choice about using the agency and its services.

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.
 
Fundamental Practice

PA-CR 1.01

All persons served receive, and are helped to understand, information about their rights and responsibilities that is:
  1. provided in writing;
  2. distributed during their initial contact;
  3. available in the major languages of the defined service population; 
  4. effectively and appropriately communicated to persons with special needs; and
  5. posted in the reception or common area of each service delivery site or residential facility.
Interpretation: If an agency provides services remotely using technology, client rights and responsibilities should be made available on the agency’s public website and the agency must implement a system for assuring and documenting that clients receive and understand their rights and responsibilities.

Interpretation: If a client is disoriented, suffering from impaired cognition, or in immediate crisis at initial contact, the summary of client rights and responsibilities should be provided at an appropriate time.

EAP Interpretation: Affiliates who deliver services on behalf of an EAP are not required to post client rights and responsibilities in the reception area of their service delivery location, but information regarding client rights must be made available upon service initiation. 

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

 
Fundamental Practice

PA-CR 1.02

Written rights and responsibilities include, but are not limited to:
  1. basic expectations for use of the agency’s services including the responsibility to provide information needed to receive services;
  2. hours in which services are available;
  3. rules, behavioral expectations, and other factors that could result in discharge or termination;
  4. the right of the person served to receive service in a manner that is non-coercive and that protects the person’s right to self-determination;
  5. the right of the person served, families, and/or legal guardians to participate in decisions regarding the services provided; and
  6. basic information about how to lodge complaints, grievances, or appeals.
Related Standards:
Interpretation: The agency's explanation of how to lodge complaints, grievances, or appeals should include informing clients about their right to file a complaint with the appropriate public authority or regulatory body.
 
Fundamental Practice

PA-CR 1.03

People have the right to ethical and equitable treatment including:

  1. the right to receive services in a non-discriminatory manner; 
  2. the consistent enforcement of program rules and expectations; and
  3. the right to receive inclusive services that are respectful of, and responsive to, cultural and linguistic diversity. 
Related Standards:

Examples: Fair and equitable treatment may include the provision of effective, equitable, understandable, and respectful services that are responsive to: diverse cultural beliefs and practices, such as the freedom to express and practice religious and spiritual beliefs; preferred languages; and other communication needs.

Other categories that should be protected from discrimination and disrespect include, but are not limited to: race and ethnicity, military status, age, sexual orientation, gender identity, and developmental level.

One way agencies can be responsive to the unique, culturally-defined needs of persons and families being served is by ensuring that program information, signs, posters, printed material, electronic and multimedia communications, and trainings are available and presented: 
  1. in the language(s) of the major population groups served; and 
  2. in a manner that is non-discriminatory and non-stigmatizing.

Note: Refer to COA’s glossary for definitions of equity, diversity, and inclusion.
 
Fundamental Practice

PA-CR 1.04

Individuals provide consent prior to receiving services and have the right to:

  1. participate in all service decisions;
  2. be informed of the benefits, risks, side effects, and alternatives to planned services;
  3. be offered the most appropriate and least restrictive or intrusive service alternative to meet their needs;
  4. receive service in a manner that is free from harassment or coercion and that protects the person’s right to self-determination;
  5. refuse any service, treatment, or medication, unless mandated by law or court order; and
  6. be informed about the consequences of such refusal, which can include discharge.
Related Standards:

Interpretation: When the client is a minor, or an adult under the care of a guardian, the agency follows applicable laws or regulations governing the right of the parent or legal guardian to refuse service, treatment, or medication unless mandated by law or court order.

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

 
Fundamental Practice

PA-CR 1.05

The agency maintains a formal mechanism through which applicants, clients, and other stakeholders can express and resolve grievances, including denial of service, which includes:
  1. the right to file a grievance without interference or retaliation;
  2. timely written notification of the resolution and an explanation of any further appeal, rights, or recourse; and
  3. at least one level of review that does not involve the person about whom the complaint has been made or the person who reached the decision under review.
Related Standards:
AG Interpretation: Agencies providing Adult Guardianship should ensure that an advocate is appointed to assist the individual in navigating the grievance process.
 
Fundamental Practice

PA-CR 1.06

The agency states in writing circumstances under which it will serve minors without consent from a parent or legal guardian, and provides this information upon request.
NA The agency does not serve minors without consent from a parent or legal guardian.
2024 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.
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.
 
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 2.02

Prior to the disclosure of confidential or private information, the agency informs the client about circumstances when it may be legally or ethically permitted or required to release such information without his or her consent, and notifies the client of such a release when it occurs.

Examples: When permitted or required by law, regulation, or court order, confidential information may be released without the authorization of the client and legal guardian. The agency may wish to seek legal counsel, as necessary, when others seek identifying information about an individual or family, or when the release of confidential information is necessary for the provision of services.
 
Fundamental Practice

PA-CR 2.03

The agency obtains informed, written consent from the individual or a legal guardian prior to recording, photographing, or filming, or the agency has a clear policy prohibiting recording, photographing, or filming.

Interpretation: For Early Childhood Education (PA-ECE) or Out-of-School Time Services (PA-OST), it is not necessary to obtain consent each time children or youth may be recorded, photographed, or filmed; consent may be provided at enrollment and maintained in program records or files. Consents should be reviewed and updated annually. 

Juvenile Justice Interpretation: In juvenile justice programs, when recording, photographing, or filming is required by law, consent may not be necessary. However, it is still expected that the agency inform clients prior to recording, photographing, or filming.
 

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.
2024 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.
 
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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