The balance of ethical, legal and regulatory principles summarised in Table 2 is applicable in each of the case scenarios presented earlier (Box 1) depicting a young person wanting to keep information confidential. However, he is clear that he does not wish his family to know anything: they have other stresses and he does not wish to worry them further. However, the therapist would still be required to protect the confidentiality of other treatment details, such as the childs sexual orientation or history of abuse. Confidentiality involves keeping private the information disclosed by someone using services. When a state offers a child more privacy rights than the child has under federal law, a therapist must follow state law. On one hand, there is the consideration of preserving engagement and therapeutic rapport, particularly important given Katie's eating disorder and the associated risks. Therapists, parents, and others who have specific concerns about confidentiality may wish to talk to an attorney knowledgeable about the laws in their state. (Child emancipation is when a minor becomes legally responsible for their own care before the age of 18.). Clinical practice. a a young person's belief that information will invariably be shared with parents does not affect the likelihood that they will disclose risky behaviours or attend healthcare services, b parents generally believe that they do not have a right to know about risks relating to their adolescent children, c aspects of confidentiality are rarely discussed with adolescent patients and their families in primary care, d when deciding whether to breach confidentiality, clinicians prioritise the risk of patient disengagement more than the seriousness, frequency, intensity and duration of the risky behavior. On the other hand, it feels important to protect a young person from harm, and if breaching confidentiality is necessary for protection, then so be it. Disclosure may therefore result in distress or other negative feelings that actually lead to an exacerbation of risk. Although the argument to breach confidentiality is particularly strong here to ensure appropriate safeguarding, it is worth reflecting on the various principles listed in Table 2 in order to appreciate the process. Some therapists require parents to consent to a certain level of confidentiality, even when state or federal law affords the child fewer confidentiality rights. %PDF-1.7 % 0 e Adolescent health risk behaviour: when do pediatric psychologists break confidentiality? If parents do not need to know, but the GP does, consider writing the GP a separate letter or contacting them by phone. Confidentiality in Adolescent Health Care | ACOG The first scenario involves Ahmed, the 15-year-old with anxiety disorder who wants medication, but does not want his parents to know. The right of minors to confidentiality and informed consent The therapist should be clear about the law and their own confidentiality policies. The GMC defines public interest as when: the benefits which are likely to arise from the release of information outweigh both the child or young person's interest in keeping the information confidential and society's interest in maintaining trust between doctors and patients. For any given situation, some sort of ethical calculation is needed to determine the most appropriate course of action. Typically, the age range of consent is between 16 and 18. Published online by Cambridge University Press: This would reflect the risks to the child in question, the potential or actual risks to other children and the overall vulnerability of children, even if they happen to be competent. Although the original case related to accessing contraception, this case law now applies to any medical treatment. So even when a minor has no right to confidentiality from a parent, they still have a right to privacy from third parties. When you treat an adult, your legal and ethical obligations typically are to that client. However, who decides what is in their best interests the child, their parents or the State is perhaps ambiguous, as is what happens when rights to autonomy conflict with rights to protection (Reference IltisIltis 2010). Be found at the exact moment they are searching. other people's rights to be protected from the 19-year-old man, either victims currently being abused, or potential victims at risk in the future. The development of autonomy is also an important task of adolescent maturity, and the opportunity to engage with services in a confidential, supportive manner can be an empowering experience in its own right. This paper examines all facets of this ethical dilemma by using Corey, Corey, and Callanan's (1998) decision-making model. Protected time just for parents gives them the opportunity to share information or raise concerns that it would be inappropriate or distressing for their child to hear. On one hand, superficial cutting may arguably constitute a low risk of serious harm. In addition, many other static and dynamic factors may influence risk, for example history of suicide attempts, mental disorder, adverse childhood events, interpersonal difficulties, low educational achievement, and drug and alcohol use (Reference Hawton, Saunders and O'ConnorHawton 2012). When a parent has lost or given up their parental rights. Research has usefully shown the importance of confidentiality in helping young people access and engage with services. %PDF-1.7 % Minors - Rights and Obligations | Stimmel Law Even when a therapist must act to protect a child, the therapist must use a conservative approach, disclosing only that information which is absolutely necessary and disclosing only to the appropriate person or persons. Pricing. Various legal frameworks attempt to apply such ethical principles. The specificity of intent and threat is legally important. A young person's right to confidentiality lies in their right to autonomy; the freedom to make meaningful choices about one's own welfare is an important aspect of being human. hbbd```b``^"A$._&fE0Y Parents meanwhile vary in their attitudes towards adolescent rights to confidential consultations. They may feel that the information itself is too sensitive and personal, particularly if it would cause them embarrassment. The notes are for personal use rather than official documentation. If the child is competent to access treatment, Gillick also implies that they would be competent to access it confidentially, and this is consolidated further in case law through Axon. e parental rights to know information in order to help safeguard their child. Justice Silber's High Court judgment noted that the ECHR and the UNCRC: show why the duty of confidence owed by a medical professional to a competent young person is a high one and which therefore should not be overridden except for a very powerful reason. Different clinicians may well prioritise different factors, on the basis of their own wider ethical perspectives. The potential targets change frequently; they tend to be peers at college whom he perceives as bullies. sM;VfF+$4X\&l)V f"L`Dp%v $ (Primary Responsibility), A.2.a. However, both common law and Article 8(2) of the ECHR indicate that this duty is not absolute and disclosure can be justified when there is overriding public interest (Reference Robshaw and SmithRobshaw 2004). The first scenario involves a records request for a minor who consented to their own mental health treatment under one of the Minor Consent Laws. International Journal of Law and Psychiatry, Toward a coherent account of pediatric decision making, Confidentiality and treatment decisions of minor clients: a health professional's dilemma & policy makers challenge, As child grows, so does need for confidentiality, Managed care and school-based health centers: use of health services, Archives of Pediatrics & Adolescent Medicine, Adolescent girls' and boys' preferences for provider gender and confidentiality in their health care, Access to medical care for adolescents: results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, Forgone health care among U.S. adolescents: associations between risk characteristics and confidentiality concern, Parental identification of depression and mental health service use among depressed adolescents, Journal of American Academy of Child and Adolescent Psychiatry, Parents' views on confidentiality and health advice for adolescents in general practice, Primary Health Care Research & Development. This in turn could have a negative impact on the adolescent's longer-term health and overall risk. The therapist's disclosure policies. 58 0 obj <>/Filter/FlateDecode/ID[<65C330EAEC3575002CF1FADA970A6CC7>]/Index[7 127]/Info 6 0 R/Length 189/Prev 407228/Root 8 0 R/Size 134/Type/XRef/W[1 3 1]>>stream Article 8(1) of the European Convention on Human Rights specifies that: a everyone has the right to have their private and family life respected, b everyone has the right to freedom of thought, conscience and religion, c everyone has the right to liberty and security, d everyone has the right to freedom of expression. Some important topics to discuss include: When a therapist believes a child is in danger, they typically have a legal duty to disclose certain information, even when the child otherwise has a right to confidentiality. There are a number of ethical standards within the 2014 ACA Code of Ethics to consider, including A.1.a. This is a common scenario presenting to CAMHS services, and the principles illustrated in Table 2 apply. One qualitative survey found that adolescents generally wanted their doctor to ask them before telling a parent and to give them the opportunity to tell the parent themselves (Reference Carlisle, Shickle and CorkCarlisle 2006). Two distinct strains of moral philosophy have historically dominated the ethical landscape. 67 0 obj <> endobj The guidance Working Together to Safeguard Children explicitly states that: fears about sharing information cannot be allowed to stand in the way of the need to promote the welfare and protect the safety of children [] If a professional has concerns about a child's welfare and believes they are suffering or likely to suffer harm, then they should share the information with local authority children's social care (Department for Education 2015: p. 17). PDF Minors' Rights to Confidentiality, When Parents Want to Know: An Adult patients' confidentiality is subject to few restrictions. Anecdotal experience of CAMHS services suggests that clinicians do hold disparate views on confidentiality, despite a general appreciation of its underlying principles, ethics and regulations. Ultimately, there are various reasons why a child may wish for information to be kept confidential. Home Terms of Service Privacy Policy Sitemap Subscribe to The GoodTherapy Blog. An evidence-based tool such as the Structured Assessment of Violence Risk in Youth (SAVRY) could be particularly useful. The circumstances under which a therapist would disclose information the child shared in therapy. One model consists of breaking the session into distinct components: time with the young person alone, time with parents (or carers) alone and time with the family together. A parent generally has the right to request a childs medical record. She begs her doctor not to tell her family. 11 During the 1970s, many states established laws that allowed minors to consent to treatment for sexually transmitted diseases, 12 after it became clear that adolesc. Deontological arguments generally support the young person's right to confidentiality in terms of their rights to autonomy and privacy, and this is further supported by case law such as Gillick and Axon. Total loading time: 0 Confidentiality with adolescents in the medical setting: what do parents think? For example, if young people have little faith in the confidentiality of health services, this may lead them to keep sensitive but important information hidden or may even prevent them from attending at all. Lehrer et al's survey found that 10.5% of boys and 14.3% of girls who reported not accessing healthcare services gave concern about confidentiality as their reason, particularly if they had high depressive symptoms and suicidal ideation (Reference Lehrer, Pantell and TebbLehrer 2007). Therapeutic confidentiality is key to effective treatment for numerous reasons, including building and preserving a strong therapeutic alliance. For example, California gives minors the right to control their own health care information when they otherwise have the right to consent to care. hb``0d``d``` In fact, research has convincingly shown that protecting confidentiality can improve, and restricting confidentiality can diminish, the likelihood that adolescents access healthcare (Reference Cheng, Savageau and SattlerCheng 1993; Reference Ford, Millstein and Halpern-FelsherFord 1997, Reference Ford, Bearman and Moody1999; Reference Kapphahn, Wilson and KleinKlein 1999; Reference Carlisle, Shickle and CorkCarlisle 2006). Al-Maamari, Almoatasem case law that becomes accepted as legal). If a child cannot safely disclose whatever they want, the therapist may not have enough information to know what kind of help the child needs. These principles can also be viewed from both deontological and consequentialist positions. PDF Confidentiality/Minor Consent Laws - Adolescent Health Initiative More moderate importance was attached to the negative effects of breaching on the family and on service attendance. Box 4 lists various practical aspects of disclosure. Because I work with many high-conflict divorce families, many of the children and teens I see in therapy have their own minor's counsel. Some states extend additional privacy protections to minors that go beyond HIPAA. endstream endobj startxref In fact, it is often through seemingly adverse outcomes that individuals learn from their mistakes and develop as human beings. One could argue that the potential outcome is so serious, one should have a low threshold, so that confidentiality should be breached even if the likelihood of him acting on his thoughts is low. The common law duty of confidentiality mandates that information shared between a client and a professional (such as in the patientdoctor relationship) is generally confidential. The status of minority ends at the age of majority. r1Z^82R 4 Minors' Rights to Confidentiality, When Parents Want to Know An Ethical However, dilemmas arise when they refuse the sharing of information, even though breaching confidentiality could potentially protect or benefit that person or others. When Do Minors in Therapy Have a Right to Confidentiality? Autonomy is arguably more deontological in character. You must inform an appropriate person or authority promptly of any reasonable concern that children or young people are at risk of abuse (GMC 2007: p. 25); if a child or young person is involved in abusive or seriously harmful sexual activity, you must protect them by sharing relevant information with appropriate people or agencies, such as the police or social services (GMC 2007: p. 27). Furthermore, there are also the rights of others to consider: first, those of her parents, who have an important role in safeguarding; second, there is the issue of public interest, i.e. The intrinsic duty of a clinician acting out of good will, striving to do good and avoid harm for the patient, could be seen deontologically as a good in itself, represented archetypically by the Hippocratic Oath. However, it does beg the question as to what constitutes a very powerful reason to override a competent young person's right to confidentiality. PDF Confidentiality concerns with minors - American Counseling Association Minor Consent : Based on Status A minor can consent to health care services without a parent or guardian if They may worry about how their parents will react, particularly if they are already worried about their parents mental health or that disclosure would lead to family conflict. This chart addresses the rules that apply when minors live with their parents or guardians. PDF Legal and Ethical Implications of Working with Minors in Alabama PDF Confidentiality/Minor Consent Laws - Adolescent Health Initiative Clients have to believe that they can tell me practically anything and it won't be repeated to anyone, including their parents. State Minor Consent Laws: A Summary, Third Edition This paper explores the ethical scenario related to confidentiality rights of a minor when his/her parents seek information from the counseling session, in this case related to exploration of sexuality. Finally, practical suggestions on how to share information are explored. For under-16-year-olds, case law on consent generally derives from
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