Confidentiality in child and adolescent mental health is a complex and often challenging matter. 67 0 obj <> endobj Confidentiality should be one of the first issues raised when initially meeting a young person and their parents; this helps them understand the principles from the start (Reference Lehrer, Pantell and TebbLehrer 2007; Reference TebbTebb 2011). The notes are for personal use rather than official documentation. It protects minors from disclosures to third parties who are not their parents. Ultimately, clinicians want to do the right thing. Effect of mandatory parental notification on adolescent girls' use of sexual health care services, Concerned about confidentiality? In some cases, a parent may not have the right to information about their childs treatment. This paper examines all facets of this ethical dilemma by using Corey, Corey, and Callanan's (1998) decision-making model. "corePageComponentGetUserInfoFromSharedSession": true, Abstract. Roughly half of the adolescents in one online survey believed a parent's presence (or absence) had an effect on clinical conversations about their health (Reference Gilbert, Rickert and AalsmaGilbert 2014). For example, some parents may abuse or disown a child for their sexual orientation or behavior. Finally, practical suggestions on how to share information are explored. What are the Legal Rights of Children? - FindLaw The risk that young people will not disclose sensitive issues such as substance use, mental illness and sexual behaviours (Reference Hawton, Saunders and O'ConnorCarlisle 2006) and that they might disengage from services altogether (Reference Ford, Millstein and Halpern-FelsherFord 1997; Reference Thrall, McCloskey and EttnerThrall 2000) is significant if they feel that their confidentiality may be breached. One needs to decide whether Adele's cutting and suicidal ideation, without suicidal intent, would constitute a risk of serious harm. The ethical and legal concerns of counseling the minors and completing custody evaluations are discussed. 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. Doctors must also consider the impact that such a disclosure and its consequences could have on other young people and their trust in doctors (GMC 2015). Answer: When working with minors, confidentiality can be a tricky situation. B80~a6h Zao2@ s5 Finally, the clinician has weighed up the pros and cons, the rights and the consequences, and has determined that on balance, confidentiality should be breached to parents and/or other authorities. When it comes to children who do not have the maturity or understanding to make a decision, confidentiality can be breached if this is deemed to be in their best interests, reflecting the UNCRC. 2 The HIPAA privacy rule and adolescents: Legal questions and clinical challenges. In one survey of adolescent girls attending family planning clinics, 60% said that they would stop using sexual health services if parents were notified of contraceptive prescribing (Reference Reddy, Fleming and SwainReddy 2002). 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. This article explores various ethical, legal, regulatory and practical issues regarding confidentiality that can present in CAMHS, using four case scenarios (Box 1) to illustrate the application of principles in practice. In contrast, consequentialist or teleological ethics, such as utilitarianism proposed by Bentham and Mill, argues that the morality of an action is based solely on all the good and all the harm that consequentially arises (Reference MillMill 1863). It is useful to bear in mind deontological positions and individuals rights, as well as analysing the consequential benefits and harms of disclosure versus maintaining confidentiality. Adolescent health risk behaviour: when do pediatric psychologists break confidentiality? The treatment would need to be warranted in terms of its potential effectiveness (beneficence) significantly outweighing its potential for side-effects (non-maleficence). 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). 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. PDF Confidentiality/Minor Consent Laws - Adolescent Health Initiative However, in states like Washington, minors 13 or older do have comparable or even identical. e for this article. Maintaining Confidentiality with Minors: Dilemmas of School Counselors the police and/or children's services) may need consideration. So even when a minor has no. (Respect for Confidentiality), B.2.d. Minors' Right to Confidentiality: Addressing the Issue of Bullying and The need to ensure appropriate information-sharing between agencies involved in child protection has been highlighted by several high-profile cases and reports on child abuse. Confidentiality with adolescents in the medical setting: what do parents think? Another study (Reference Carlisle, Shickle and CorkCarlisle 2006) reported that parents unanimously wished to be informed about their adolescent children's health and risky behaviour, often citing their right to know. If the clinician decides to maintain confidentiality, they could still encourage and work with Adele to help her to continue reflecting on the sharing of information with her parents (GMC 2007). 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. When you treat an adult, your legal and ethical obligations typically are to that client. Tell the young person and/or family what you propose to disclose and why, unless that would significantly undermine the purpose or increase the risk of harm, Help them to understand the importance and benefits of sharing information, and reflect on the potential costs, so that ways to minimise them can be considered, Consider any views given by them on why you should not disclose the information, Appreciate that young people and families may understandably worry, particularly if they think they will be denied help, blamed or made to feel ashamed, or have had bad experiences or fear contact with the police or Social Services, Ask the young person for consent to the disclosure, if you judge them to be competent; even if not competent, ascertain their views on what information should be disclosed to whom, and how, and try to accommodate these views, Do not delay information-sharing if delay would increase the risk to the child or other children, Disclose the minimum information necessary to protect or benefit the child: information-sharing should be proportionate to the risk of harm, If in doubt whether to share information against the child's or family's wishes, seek advice from a senior colleague, a named doctor for child protection, or your organisation's Caldicott guardian; you could also discuss the case anonymously with children's services to get their initial opinion; bear in mind that a risk might become apparent only when a number of people with niggling concerns share them, Document any decisions made, including the reasons behind them, Generally encourage young people to share information, where appropriate, with their parents and to involve them in making important decisions, Ask whether they would like to disclose the information themselves or whether they would like you do it for them; if the latter, ask whether they would like to be present or not, Ask the child how they would like to frame the information; alternatively, explain what you are going to say and ask them to suggest how they might edit it, Have a moment with child and parents all present before the session ends in order to evaluate how everyone has responded. 20 & 21). Eighteen ethical dilemmas in three domains were presented to respondents in a questionnaire. Parents meanwhile vary in their attitudes towards adolescent rights to confidential consultations. The benefits of confidentiality include: A child or adolescent has little reason to disclose information they dont want shared with their parents if there is no guarantee of confidentiality. When a court order specifically prohibits the parent from accessing the child's information. The researchers also found that the topics most likely to be raised in individual time included mental health, stress, drugs and alcohol, and difficulties at school, problems frequently encountered in CAMHS. 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. Autonomy is arguably more deontological in character. The threshold issue surrounding minors' privacy rights is who gets to make decisions about the privacy and disclosure of the minor's mental health information. Counseling Minors and Confidentiality - Licensed Mental Health Counselor Children are entitled to a safe place to live and come of age. They are, theoretically, entitled to good nutrition, healthcare, and education. In contrast, sharing information with parents respects the parental right to a family life, so that they can fulfil their responsibilities as parents. Additionally, most legal jurisdictions Ethnic and religious factors may also influence parental attitudes (G Dur-Vil, personal communication, 2015). Adele is a 15-year-old girl attending CAMHS with depressive disorder. It requires health care providers, including therapists, to take reasonable steps to protect client privacy. Interestingly, there is some discrepancy between the GMC guidance relating to competent children as opposed to competent adults. One occasion on which information is sometimes unwittingly shared is when letters to GPs are copied to parents. PDF To tell or not to tell: The fine line between minors' privacy and There are also situations where confidentiality needs to be breached in accordance with legal or regulatory statutes (Box 2). Nevertheless, children in their preteen years and younger do not and cannot fully understand the nature of sexual activity. Most legislation relating to confidentiality arises from common law (i.e. A parent or legal guardian must provide consent on behalf of a minor (under age 18) before health care services are provided, with several important exceptions. This, and that Katie is under 16, indicates that the abuse is also criminal, while the sending of sexually elated messages suggests child exploitation and grooming. Various factors would indicate abuse (Box 3): the significant age difference, the use of alcohol, and Katie being an age where her maturity to consent is questionable. Because a child cannot legally consent to treatment, the parent often acts as a personal representative for the child. Even when a parent is pressuring me for information, I am able to refer them to the minor's counsel, who will work to protect the childs confidentiality, says Lois Nightingale, PhD, a marriage and family therapist from Yorba Linda, California. Autonomy involves respecting and supporting the right of patients to make their own healthcare choices. Retrieved from http://www.ncsl.org/research/health/mental-health-professionals-duty-to-warn.aspx. 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. They may well consent to the sharing of information, for example with their family and/or other professionals. Even in cases of potential child abuse, the GMC still notes the relative value of confidentiality: although it may seem that parents would be the obvious people to disclose to in these circumstances, doctors should consider the potential adverse consequences. For example, the biological parent of an adopted child would not typically have a right to treatment information. 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 sM;VfF+$4X\&l)V f"L`Dp%v $ Some states extend additional privacy protections to minors that go beyond HIPAA. Protecting the child from third parties Confidential information can be used for a wide range of purposesbullying, marketing, even stealing a person's identity. Although the original case related to accessing contraception, this case law now applies to any medical treatment. In situations of child abuse, particularly given the difference in the power dynamic, the child may not be in a position to adequately protect themselves from the risk of further abuse by a coercive perpetrator. A Minor's Right to Confidentiality - FAMCare State-by-State Variability in Adolescent Privacy Laws The circumstances under which a therapist would disclose information the child shared in therapy. When Do Minors in Therapy Have a Right to Confidentiality? Various studies have surveyed clinicians attitudes on what influences them to breach confidentiality when a child expresses risk to self. Ultimately, in negotiating the minefield of confidentiality clinicians are significantly helped by reflecting thoughtfully on the various issues presented by a case and carefully documenting the reasons for their actions. The child protection jigsaw, Children's rights, confidentiality and the policing of children, International Journal of Children's Rights, Factors contributing to breaking confidentiality with adolescent clients: a survey of pediatric psychologists, Professional Psychology: Research and Practice, Factors influencing the decision to break confidentiality with adolescent students: a survey of school counselors, Reframing the confidentiality dilemma to work in children's best interests, Forging partnerships with parents while delivering adolescent confidential health services: a clinical paradox, Confidentiality and adolescents' use of providers for health information and for pelvic exams, Medical confidentiality and multidisciplinary work: child sexual abuse and mental handicap registers, Key examples of case law relating to children's rights to confidentiality, A summary of principles to consider when deciding whether to maintain or breach confidentiality of a competent young person. "corePageComponentUseShareaholicInsteadOfAddThis": true, Ahmed is a 15-year-old boy who presents with anxiety disorder. Article 8(1) could therefore be applied either way in a confidentiality dilemma, although many would generally prioritise a child's right to privacy over parental rights to know information about their child (Reference Applewhite and JosephApplewhite 1994). Confidentiality and treatment decisions of minor clients: a health Dilemmas arise when such ethical values conflict. Minors - Rights and Obligations | Stimmel Law endstream endobj 68 0 obj <>>> endobj 69 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/TrimBox[0 0 594 783]/Type/Page>> endobj 70 0 obj <>stream METHODS We summarized state laws and regulations on minor consent for the following: health services, substance abuse treatment, prenatal care, mental health care, contraceptive management, immunizations, sexually transmitted infection management, human immunodeficiency viruses testing and treatment, dental care, and sexual assault evaluation. For example, if a therapist fears a child may be planning a school shooting, the therapist may be required to notify police or school authorities. The murderous thoughts may represent a concrete black or white internal response to peer problems and consequent difficulty in emotional regulation, but little actual risk of carrying out violent acts. The prevalence of suicidal phenomena in adolescents: a systematic review of population-based studies, Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care, Confidential Health Care for Adolescents: position paper of the Society for Adolescent Medicine, More evidence supports the need to protect confidentiality in adolescent health care, GMC case notes: protecting children from abuse and neglect . The Health Insurance Portability and Accountability Act (HIPAA) is the primary federal law governing medical privacy. Not all parents have unconditional love for their child. W%smY:B "!3A(d1a{jJFiM8t8Tl dVD9LT~FTkh Q 59m ~UvtG>vj:qc6 nrX 9q;8p&PD3SRxFt-X2 ] The first scenario involves Ahmed, the 15-year-old with anxiety disorder who wants medication, but does not want his parents to know. endstream endobj startxref Please don't tell Confidentiality in child https://doi.org/10.1192/apt.bp.114.013854, Reference Ford, Millstein and Halpern-Felsher, Medical confidentiality versus disclosure: ethical and legal dilemmas, Confidentiality: issues in working with self-harming adolescents, Concerns over confidentiality may deter adolescents from consulting their doctors: a qualitative exploration, Adolescent consent and confidentiality in the UK, Confidentiality in health care: a survey of knowledge, perceptions, and attitudes among high school students, The Victoria Climbi Inquiry: Report of an Inquiry by Lord Laming (Cm5730), Working together to Safeguard Children: A Guide to Inter-Agency Working to Safeguard and Promote the Welfare of Children. When parents understand that confidentiality is key to effective treatment, they may be more willing to respect their childs need for privacy. "coreDisableEcommerce": false, These legal frameworks, however, more explicitly focus on children's rights to consent to treatment as opposed to their rights to confidentiality (Reference CaveCave 2009). 0 We have explored how ethical, legal and regulatory principles can be applied to dilemmas relating to confidentiality that present to CAMHS services. PDF Minor Students' Rights - Wisconsin Department of Public Instruction Youth under the age of 18 can consent to all medical care if they are emancipated or living separately and without support from their parents, are/were legally married, or a member of the Armed Forces. (2017, September 12). Al-Kindi, Qutouf 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). The therapist's disclosure policies. Confidentiality is the idea that the personal and health information a patient reveals to a clinician is private and that there are limits on how and when the information can be disclosed to a third party [5]. Hostname: page-component-7ff947fb49-944cw Furthermore, the mean number of topics discussed was significantly higher when a young person was seen both individually and with family (4.11 topics), as opposed to only being seen with family (2.76 topics). Confidentiality and Consent in Adolescent Substance Abuse: An Update Their views or the information they provide might be helpful in your care of the patient. Feature Flags: { A consequentialist position would instead place the ethical onus on the specific situation, calculating a harm/benefit ratio of consequences. However, even if the legal argument justifies Ahmed's rights to confidentiality, the clinician also needs to make clinical and ethical judgements. The importance of confidentiality in therapy. However, 77% of the parents also acknowledged the value of adolescent confidentiality, which, as Reference TebbTebb (2011) notes, reflects some discordance in attitudes. A balancing act in relation to the specific context needs to be considered, since consequentialist and legal arguments may vary depending on the case. Typically, the age range of consent is between 16 and 18. His school counsellor remains concerned despite a package of cognitivebehavioural therapy; Ahmed's anxiety is significantly affecting his work. A study conducted by Isaacs and Stone (2001) reviewed situations in which counselors would breach confidentiality of their minor clients to their parents. There is no forensic history or history of aggression. 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. View all Google Scholar citations 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. The clinician needs to evaluate whether breaching confidentiality would ultimately reduce or increase risk. Emergency care Care for independent minors Connecticut Law About Rights of Minors - Connecticut Judicial Branch Which factor does not support the protection of confidentiality in a competent young person? PDF The Case of Liam: Ethical Counseling of Minors Third, the child's level of competency may need to be taken into consideration. GMC guidance advises that information can be disclosed if there is an overriding public interest in the disclosure in order to protect the child from risk of death or serious harm, including through self-harm (GMC 2007). Published online by Cambridge University Press: When a state offers a child more privacy rights than the child has under federal law, a therapist must follow state law. Different clinicians may well prioritise different factors, on the basis of their own wider ethical perspectives. Therapists should ensure they understand state laws and their licensing boards ethics rules. Pedro Weisleder 1 Affiliation 1 Division of Pediatric Neurology, Duke University Medical Center, Durham, NC 27710, USA.
What Zodiac Sign Is Dream Smp, Articles M