Informed Consent and Agreement for Virtual Advocacy
WOMEN’S RESOURCES CENTER
INFORMED CONSENT AND AGREEMENT FOR VIRTUAL ADVOCACY
Women’s Resources Center and Virtual Advocacy Information
Virtual advocacy involves the use of electronic communications to enable Confidential Advisors (CAs) to connect with individuals using live interactive video and audio communications. CAs within the Women’s Resource Center (WRC) offer a variety of services to student and employee survivors of sexual misconduct, and their support persons, including but not limited to, advocacy, case management, meeting accompaniment, resources, referrals, and crisis intervention. We do not provide counseling, treatment, or diagnosis for mental health.
Virtual Platform Certificate of Consent
Virtual advocacy services can present certain risks including but not limited to technical difficulties, potential risks to my privacy, interruptions, unauthorized access to data and/or the platform, and reduction of the CA’s ability to directly intervene in crises or emergencies. I understand that my CA will take all reasonable and required precautions to ensure privacy and confidentiality. The WRC takes the following security measures with the use of virtual technologies: usage of the HIPAA compliant Zoom platform (Zoom PHI), with password protected and unrecorded meetings. Zoom encrypts the data on the platform, and I understand the WRC ensures that no WRC staff member other than the CA will be able to hear/view my session unless otherwise permitted by me. HIPAA, FERPA, and related privacy protections consistent with governing federal and State law, apply to virtual advocacy in the same manner that in-person services are protected.
- I understand that participation in virtual advocacy is completely voluntary, and that my decision to participate or not participate in no way impacts my access to other programs, phone advocacy services, or in-person advocacy services offered by the WRC.
- I understand I can change my mind and withdraw my consent to virtual advocacy at any time.
- I understand there are potential risks to this technology, including but not limited to interruptions, unauthorized access to data and/or the platform, and technical difficulties.
- I understand I am responsible for maintaining my own security and privacy when booking sessions, communicating with the WRC, and participating in virtual advocacy. I understand that I can speak with my CA about how to maintain my own security and privacy.
- I understand that my CA is unable to provide the same kind of emergency assistance using the virtual platform as in an in-person session.
- I have been provided the opportunity to ask questions about virtual advocacy. My questions have been answered and the risks, benefits, and any practical alternatives have been discussed with me in a language I understand.
- To maintain confidentiality, I will not share my virtual appointment link with anyone unauthorized to attend the appointment.
By entering into this Zoom session, I certify:
That I have read or had this form read and/or had this form explained to me. That I fully understand its contents including the risks and benefits. That I have been given ample opportunity to ask questions and that any questions have been answered to my satisfaction. That I agree to the items contained in this document.