confidentiality in adolescent health care

Retrieved 2013 from http://www.guttmacher.org/statecenter/spibs/spib_MASS.pdf. Demographics are shown in Table 1 and quantitative survey data are shown in Table 2 and Table 3. Moreover, sensitive health issues that an adolescent is not ready to disclose to others may be documented and accessed all too easily by other health professionals without explicit consent being given. 117; quiz CE11-14. A study involving high school youth indicated that 25% of those surveyed would not seek health care for issues they wanted to keep private if they believed there was a possibility the information would not remain confidential (6). In addition, minors may give consent and receive family planning services if those services are funded by the federal Title X Family Planning Program or in some states the Medicaid program ( Ranji et al., 2016 ; U.S. Department of Health and Human Services, 2014 ). SNL 1995 Chapter A-4.1: An Act Respecting Advance Health Care Directives and the Appointment of Substitute Health Care Decision Makers: https://www.assembly.nl.ca/Legislation/sr/statutes/a04-1.htm. Adolescent consent and confidentiality is an area of concern in the delivery of health care to this patient population. American Academy of Pediatrics, Committee on Hospital Care and Institute for Patient- and Family-Centered Care. Archives of Pediatrics & Adolescent Medicine, 166(4), 331336. Elk Grove Ill: American Academy of Pediatrics. Administration for Children and Families, Administration on Children, Youth and Families, Childrens Bureau. Retrieved from http://www.guttmacher.org/pubs/confidentiality-review.pdf. 2020 Oct;136(4):e70-e80. In telemedicine visits, others may be present in-room but out of view, or sessions may be recorded without a patients knowledge or consent. Closed questions included queries regarding demographic data such as profession and years in practice. A legal and policy framework for adolescent health care: Past, present, and future. Abstract Confidential care for adolescents is important because it encourages access to care and increases discussions about sensitive topics and behaviors that may substantially affect their health and well-being. Riley M, Ahmed S, Reed BD, Quint EH. J Adolesc Health 2020;67(2):164-71. Obstetriciangynecologists and other health care providers who care for minors should be aware of federal and state laws that affect confidentiality. This document has been updated to include information on patient portals, guidance on the release of medical records, examples of ways to safeguard adolescent patients confidentiality, and talking points to use with parents and guardians. The present study was a voluntary, anonymous online survey. Barney A, Buckelew S, Mesheriakova V, Raymond-Flesch M. The COVID-19 pandemic and rapid implementation of adolescent and young adult telemedicine: Challenges and opportunities for innovation. Adolescents who use the emergency department as their usual source of care. Blythe MJ, Del Beccaro MA, American Academy of Pediatrics. (2011). The complex nature of the parent-child relationship in the context of a family-centred approach, along with the adolescents developing need for autonomy and continuing need for support, can pose significant ethical challenges for health care providers. In general, informed consent requires that a decision-maker has the capacity to make a decision, is given all relevant information, and is making a voluntary decision freely, without coercion [18]. State minor consent laws: A summary (3rd ed.). The need for parental consent in Adolescent health services: Missing opportunities. Centers for Disease Control and Prevention. Fostering health: Health care for children and adolescents in foster care (2nd ed.). Topics: adolescent health services, confidentiality, american college of obstetricians and gynecologists, nurses, neonatal, physicians, family This content is only available via PDF. (2002). Further research indicated that youth who forgo health care are those at highest risk and those who need health care services the most (7). Legal issues in the health care of children and adolescents (2nd ed.). Pediatrics, 130, 11701174. National Library of Medicine PubMed The nursing group consisted of both registered and licensed practical nurses; the physician group included both staff physicians and residents; the paramedical psychosocial support group included child life therapists, family support specialists, genetic counsellors, psychologists, social workers, spiritual care chaplains and psychosocial therapy aides; and the paramedical physical support group included dietitians, medical radiation technologists, occupational therapists, pharmacists, physiotherapists, psychometrists, respiratory therapists, speech language pathologists and physical therapy assistants. The Initial Reproductive Health Visit: ACOG Committee Opinion, Number 811. Do you provide opportunities for adolescents to meet with HCP without their parent/legal guardian present? Google Scholar, 2011 Demographics: Profile of the Military Community. Google Scholar. Any potential conflicts have been considered and managed in accordance with ACOGs Conflict of Interest Disclosure Policy. (1995). 12. Wadman R, Thul D, Elliott AS, Kennedy AP, Mitchell I, Pinzon JL. Acad Emerg Med 2013;20(11):1164-70. Full and truthful disclosure by individuals is essential to ensuring appropriate diagnostic testing and therapeutic management. Supporting the health care transition from adolescence to adulthood in the medical home. Visit our ABOG MOC II collection. Obstet Gynecol 2020;135:e1717. Internet addresses are current at time of publication. When clinicians encourage adolescents to communicate openly with their parents, it is essential to ask first about why they are reluctant to do so. (2009). American Journal of Public Health, 97(8), 13381341. Adolescent confidentiality is related to consent to treatment, but they are essentially different constructs and must be understood apart from one another. Materials to develop educational sessions Online Resources: Electronic health records (EHR) privacy controls cannot yet adequately address, let alone ensure, the confidentiality of adolescents. New York: Oxford University Press. Many health care providers wrongly assume a need to assess and document that an adolescent is a mature minor before providing confidential health care. (2001). To investigate the knowledge and practice of health care providers at Alberta Childrens Hospital (Calgary, Alberta), and to inform practice about the adolescents right to confidentiality. (2009). The survey consisted of 15 closed items and seven open comment items. Formal policy development is essential and we are working with appropriate health care and educational authorities. White PH, Cooley WC, Transitions Clinical Report Authoring Group; American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians. Child and adolescent recommendations. government site. Levenberg, P., & Elster, A. Canadian Medical Association. should be aware of federal and state laws that affect confidentiality. Family planning clinic clients: Their usual health care providers, insurance status, and implications for managed care. (1993). Berlan ED, Bravender T. Confidentiality, consent, and caring for the adolescent patient. Quantitative data were analyzed using descriptive statistics. Office of the Privacy Commissioner of Canada. 55(RR-14), pp. Should a physician feel uncomfortable about being alone with a patient or reviewing certain sensitive topics, it is appropriate to consider a chaperoned discussion with another HCP present [23]. There should be private conversation time between the health care provider and adolescent patient. Jones, R. K., Purcell, A., Singh, S., & Finer, L. B. Google Scholar]. When adolescents give you information in confidence, do you document this information in the health record? Please try after some time. Is there an age in Alberta when adolescents have the right to confidential health care. However, scarce literature regarding theoretical and practice-based knowledge of the adolescents right to confidential health care was identified. This combined approach might involve discussion with adolescents about how they perceive a specific disclosure to parents, helping them to weigh the potential advantages of more open communication, and offering to facilitate communication with parents in ways that help the patient. Teaching on confidentiality should extend to all clinicians and front-line staff. The sample was divided into four groups: nurses, physicians, paramedical psychosocial support and paramedical physical support. Committee on Adolescence Achieving quality health care for adolescents. (2007, October/November). doi: 10.1097/AOG.0000000000004094. While confidentiality is a basic principle for all health care encounters regardless of age, the unique considerations for capable adolescent patients are not always realized or appreciated. http://dx.doi.org/10.1097/AOG.0000000000003770. Pediatrics, AAP Council on Community Pediatrics. Zabin, L., Stark, H., & Emerson, M. (1991). Tax calculation will be finalised at checkout. PubMed 2014 May;123(5):1148-1150. doi: 10.1097/01.AOG.0000446825.08715.98. 14. Les chercheurs ont analys les questions fermes au moyen de statistiques descriptives, et les questions ouvertes au moyen dun code thmatique manifeste. What are the core concepts of patient and family-centered care? Clinicians need to become familiar with federal and state laws that influence practice and policies in their specific setting, and how to provide health care within this context to adolescent patients during routine and acute care. Evaluation of the TRICARE Program: Fiscal Year 2012 Report to Congress. (2000). Confidential care for adolescents is important because it encourages access to care and increases discussions about sensitive topics and behaviors that may substantially affect their health and well-being. Paediatr Child Health 2018;23(2):138-46: https://cps.ca/en/documents/position/medical-decision-making-in-paediatrics-infancy-to-adolescence. Les chercheurs ont reu un total de 389 rponses, reprsentant des dispensateurs de soins de diverses disciplines. . poverty, such as educational shortcomings or poor health, neighbourhood-based statistics need to be gathered as the basis for local fine-tuning. doi:10.1001/archpediatrics.2011.1131. Obstetriciangynecologists are encouraged to know their individual systems and institutional policies regarding confidentiality, EHRs, patient portals, and the open access for visit notes. Blythe, M. J., & Del Beccaro, M. A. At times, the best strategy may be to encourage the adolescent to find a secure location outside of the home (e.g., an office at school) to speak from. Because one of the four core concepts in family-centred care is information sharing, some health care providers believe all information must be shared with parents/legal guardians. Our study should be replicated and expanded in other institutions that provide health care to adolescents. Wibbelsman CJ, American Academy of Pediatrics. All rights reserved. Truth telling. Washington, DC: Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice. The ACOG policies can be found on acog.org. While most parents and caregivers appear to acknowledge and recognize the benefits of adolescent confidentiality [25], they also report having concerns that confidentiality may promote risky behaviours or undermine their own protective role [22]. Principles of biomedical ethics (4th ed.). 200 Summary: Early Pregnancy Loss, ACOG Committee Opinion No. Health care for youth in the juvenile justice system. Curr Opin Pediatr. While health care providers regard confidentiality as paramount, the present survey reveals a wide variation of understanding and practice regarding confidential care for adolescents. Juvenile Arrests 2008. Gans, J. Task Force on Health Care for Children in Foster Care, AAP., District II, New York State. Chicago, IL: American Medical Association. No part of this publication may be reproduced, stored in a retrieval system, posted on the internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. Institutional knowledge gaps included lack of evidence-based resources, and guidelines or policies regarding the practice of adolescent confidentiality. Journal of Adolescent Health, 35(1), 160167. Developing emergency department-based education about emergency contraception: Adolescent preferences. Teens and mobile phones. In order to establish such environments, nurses should be well-versed in laws and institutional policies related to adolescent confidentiality. Advance Health Care Directives Act. (2012). CAS Sigman, G., & OConner, C. (1991). CrossRef Key tenets when providing confidential care for adolescents include time alone with a health care provider, maintaining privacy of health information, and securing informed consent for services without permission from a parent, guardian, or caregiver. Department of the Navy. Education on rights to privacy and confidential health care delivered through school-based or community health promotive programs could further alleviate concerns that might prevent adolescents from seeking health care. Denny S, Farrant B, Cosgriff J, et al. When an adolescent is deemed a mature minor (i.e., is found to have the capacity and maturity to make health care decisions alone) and no risk to self is apparent, they may then consent to having their health records kept private [15]. ACOG Committee Opinion No. Policy compendium on confidential health services for adolescents. These include health issues related to sexual behaviors, substance use, and mental health. 633: Alcohol Abuse and Other Substance Use Disorders: Ethical Issues in Obstetric and Gynecologic Practice, Practice Bulletin No. Effects of reporting and enforcement on access to care for adolescents. 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. Society for Adolescent Health and Medicine; Gray SH, Pasternak RH, et al. The State Government and the Landessportbund umbrella organisation have created a network for sport, with the shared aim to strengthen volunteer work and community activities, to Ford CA, Millstein SG, Halpern-Felsher BL, Irwin CE. Consent, competence, and confidentiality related to psychiatric conditions in adolescent medicine practice. Obstet Gynecol. As one of the most important energy and industrial Perspectives on Sexual and Reproductive Health, 36(2), 8086. Disclaimer. Qualitative Research Methods for the Social Sciences. FOIA Patient portals available on most EHR platforms allow patients or caregivers to access to health information, including test results, diagnoses or problem lists, medications, and upcoming appointments. joc90755 [pii]. Retrieved from http://www.med.navy.mil/directives/Pages/NAVMEDP-MANMED.aspx, MARADMIN 308/11. Do you get permission from adolescents to share the information they have given to you in confidence with other health care providers? Psychiatry, American Academy of Child and Adolescent Psychiatry. Moreover, without confidential care, adolescents may decline routine services, such as sexually transmitted infection (STI) testing, or not engage in follow-up care [11]. Additionally, they should be informed of any restrictions to the confidential nature of the relationship. Chapel Hill, NC: Center for Adolescent Health & the Law and National Adolescent and Young Adult Health Information Center. Journal of the American Medical Association, 293(3), 340348. sharing sensitive information, make sure youre on a federal The https:// ensures that you are connecting to the 1 Multiple studies have found associations between confidentiality practices and receipt of recommended services. Le respect de la confidentialit des adolescents peut prsenter des problmes dans le cadre de la pratique des dispensateurs de soins auprs de la famille et des processus mdicaux, thiques, juridiques, sociaux et bureaucratiques. Washington, DC. FOIA Journal of Adolescent Health Care, 10, 449453. Journal of Adolescent Health, 29(2), 8193. Similarly, Newfoundland and Labrador accord the right to privacy of medical information at age 16 [17]. Provision of adolescent confidentiality becomes confused by misunderstandings about family-centred care, capacity, legal responsibility, and authority to consent to medical care and treatment. 8600 Rockville Pike JAMA, 278(12), 10291034. Klein, J., Wilson, K., McNulty, M., Kapphahn, C., & Collins, K. (1999). Ginsburg KR, Slap GB, Cnaan A, Forke CM, Balsley CM, Rouselle DM. Access to private and confidential health care among secondary school students in New Zealand. Confidentiality is a critical component of adolescent medical care. Being aware of alternate health care referral centers for free or substantially decreased costs may be of benefit for the adolescent if there is a risk of billing disclosure. Weinstein RS, Krupinski EA, Doarn CR. Data is temporarily unavailable. Pediatr Rev 2009;30 (11):457-9. Reproductive health services for adolescents: Critical legal issues. DISCLOSURES: This work originated at Alberta Childrens Hospital, Calgary, Alberta. Obstet Gynecol. Clinical preventive services for adolescents: Position paper of the Society for Adolescent Medicine. . 803. Confidentiality in health care: A survey of knowledge, perceptions, and attitudes among high school students. Preliminary estimates for 2011 as of July 2012 (Vol. Obstet Gynecol. Washington, DC: Office of Juvenile Justice and Delinquency Prevention. Ford, C., Thomsen, S. L., & Compton, B. Perspectives on confidential care for adolescent girls. You may be trying to access this site from a secured browser on the server. Our findings are unlikely to be unique. Today it is a popular place to live and work with its excellent recreational facilities and many cultural events. Our initial focus will be with one multidisciplinary group to refine techniques before broadening our approach with other groups, specific professions and new recruits. However, a lack of confidential care does not delay or dissuade . Do you provide this information to the parent/legal guardian: Everything we discuss with your child today is confidential with three exceptions: if they are at risk of immediate harm; if they are putting someone else at risk of immediate harm; if someone else is putting them in immediate harm? Wolters Kluwer Health Adolescent Health Care, Confidentiality Concerns about confidentiality may create barriers to open communication between patient and physician and may thus discourage adolescents from. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. HCPs can encourage adolescents to sweep the room with their cameras to establish who is present, to use headphones, or to utilize chat functions to limit the ability of others to overhear medical conversations. HCPs should routinely counsel the adolescents they see regarding their right to confidential health care, along with any limits that may apply. To ensure study rigor, manual coding was verified through triangulation of researchers, with adherence to trustworthiness criteria (10). Confidential care for adolescents is important because it encourages access to care and increases discussions about sensitive topics and behaviors that may substantially affect their health and well-being. Professional Psychology: Research and Practice, 24(3), 367369. Confidentiality and adolescents use of providers for health information and for pelvic examinations. In particular, adolescents are less likely to openly communicate with HCPs around issues related to substance use, mental health, and sexuality when confidentiality cannot be guaranteed [10]. Please enable it to take advantage of the complete set of features! Additionally, they . Cheng, T., Savageau, J., Sattler, A., & DeWitt, T. (1993). Studies have shown that adolescent patients are interested in being screened and receiving information on safe sexual practices and other risky behaviours in both ED [36] [37]and inpatient wards [38], regardless of gender, sexual experience, or relationship with primary care providers [39]. This was revealed in both the qualitative and quantitative data. Nursing Clinics of North America, 37(3), 393404. This is a preview of subscription content, access via your institution. Most EHR systems have not been designed to provide item-specific control over parental access and release of adolescent health care information. Provided by the Springer Nature SharedIt content-sharing initiative, Health Promotion for Children and Adolescents, https://doi.org/10.1007/978-1-4899-7711-3_17, http://www.cdc.gov/hiv/resources/factsheets/PDF/youth.pdf, http://www.cdc.gov/vitalsigns/hivamongyouth/, http://www.militaryonesource.mil/12038/MOS/Reports/2011_Demographics_Report.pdf, http://www.dtic.mil/whs/directives/corres/pdf/602518r.pdf, http://www.guttmacher.org/pubs/confidentiality-review.pdf, http://tricare.mil/tma/dhcape/program/evaluation.aspx, http://www.uspreventiveservicestaskforce.org/tfchildcat.htm, http://www.guttmacher.org/statecenter/spibs/spib_MASS.pdf, http://nahic.ucsf.edu/download/health-care-for-homeless-youth-policy-options-for-improving-access/, http://b.3cdn.net/naeh/1c46153d87d15eaaff9zm6i2af5.pdf, http://www.med.navy.mil/directives/Pages/NAVMEDP-MANMED.aspx, http://www.doncio.navy.mil/uploads/0601CZD27871.pdf, http://www.huduser.org/publications/pdf/p6.pdf, http://www.aclu.org/FilesPDFs/med_privacy_guide.pdf. Adolescents have a right to confidential care and private time with their HCPs, and clinicians are legally and ethically obligated to provide routine, private, confidential care to adolescent patients. HHS Vulnerability Disclosure, Help Careers, Unable to load your collection due to an error. Data were password protected with access controlled by the studys principal investigator. Lehrer JA, Pantell R, Tebb K, Shafer MA. 2-4 Additionally, ensuring young people have access to . Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. (2011). doi:10.1089/apc.2008.0256. Adolescent patients cite confidentiality as one of the key determinants of their use of health care. 14 At the federal level, the Health Insurance Portability and Accountability Act Privacy Rule includes specific protections for adolescent minors in . GMC.Google Scholar. Adolescence, AAP Committee on Adolescence. McKee MD, O'Sullivan LF, Weber CM. Confidentiality and consent are closely related but distinct concepts. (2013, July 1). (2010a). There should be private conversation time between the health care provider and adolescent patient. Edman, J. C., Adams, S. H., Park, M. J., & Irwin, C. E., Jr. (2010). Clear, routine discussions with adolescentsanda parent or caregiver about the protections (and limits) of confidentiality before the medical encounter is initiated can help mitigate these concerns. English, A. Access to medical care for adolescents: Results from the 1997 Commonwealth Fund Survey of the health of adolescent girls. Increasing education around privacy laws while reinforcing awareness of confidentiality concerns can improve knowledge gaps. PDF Google Scholar, English, A., Gold, R. B., Nash, E., & Levine, J. Confidentiality in adolescent health care. Google Scholar. Air Force Instruction 41-210. Qualitative analysis revealed three main thematic categories: beliefs, knowledge and practice. Whose personal control? Pediatrics 2016;138(2):e20161347. Journal of Adolescent Health, 27(1), 2533. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). HHS Vulnerability Disclosure, Help Access to medical care for adolescents: Results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls. Obstetrics & Gynecology135(4):989-990, April 2020. Forgone health care among U.S. adolescents: Association between risk characteristics and confidentiality concerns. Examiner les connaissances et les pratiques des dispensateurs de soins de lAlberta Childrens Hospital de Calgary, en Alberta, et tayer les pratiques au sujet du droit des adolescents la confidentialit. Springer, Boston, MA. Nursing practice and statutory rape. (2010b). Justified paternalism in adolescent health care. Equally, adolescents with chronic health conditions engage in risk behaviours at similar or even greater rates than healthier peers [35], making tertiary care encounters another option for screening and risk prevention in this population. Young adolescents comfort with discussions about sexual problems with their physician. Health care confidentiality is the "privileged and private nature of information provided during the health care transaction." 5. Strategies to facilitate the ability to provide confidential adolescent healthcare include explaining its importance to parents and adolescents, routinely spending part of each adolescent visit alone with the patient, discussing confidentiality, and addressing issues that increase risk of unintentional disclosure of protected information related to billing, Explanations of Benefits (EOBs), release of health records, and electronic health records. doi: 10.1097/AOG.0000000000002945. However, several barriers to privacy protection exist when telemedicine is compared with in-person visits. Do you provide this information to the adolescent: Everything we discuss with you today is confidential with three exceptions: if you are at risk of immediate harm; if you are putting someone else at risk of immediate harm; if someone else is putting you in immediate harm? Marks, A., Malizio, J., Hoch, J., Brody, R., & Fisher, M. (1983). US Department of Justice, Office of Juvenile Justice and Delinquency Prevention. Confidentiality is defined as an agreement between the patient and provider whereby information discussed during or after the encounter will not be shared with other parties without the explicit permission of the patient (13). Survey responses revealed the importance of addressing the following concerns: Survey responses indicated confusion regarding how to reconcile the concept of family-centred care with the provision of confidential health care for adolescents. Recommendations and Rationale. North Rhine-Westphalia, the Sporting State NRW is leading the pack in many respects, especially when it comes to sport. (1994). A total of 389 responses were received, representing health care providers in many disciplines. Also, the understanding of how family-centred care may apply to adolescents must be explored, as well as similar studies performed involving health care providers regarding their understanding and practice on the related issue of capacity to consent. doi: 10.1542/peds.2022 . Holder, A. Google Scholar. J Adolesc Health 1997;21(6):408-15. Ils ont constat diverses pratiques lies au respect de la confidentialit des adolescents et une incomprhension gnralise de la question. U.S. Preventive Services Task Force. https://doi.org/10.1007/978-1-4899-7711-3_17, DOI: https://doi.org/10.1007/978-1-4899-7711-3_17. HCPs are discouraged from asking in the presence of a parent or caregiver whether an adolescent would like time in private, because the adolescent may feel uncomfortable or reluctant to, agree. Correspondence: Ms Ruth Wadman, Alberta Childrens Hospital, Department of Adolescent Medicine, 2888 Shaganappi Trail Northwest, Calgary, Alberta T3B 6A8. Preventative health screening may be best addressed at routine health visits, but it is essential that HCPs create other opportunities to address confidential issues in various practice settings. To alleviate these fears, HCPs should consider communicating with parents early on around the developmental appropriatenessand the laws affectingconfidential health care for adolescents, and its demonstrable benefits. HIV among youth in the US. Confidential health care for adolescents: Position paper of the Society for Adolescent Medicine. English, A., & Ford, C. A. Guidelines for Adolescent Preventive Services (GAPS)Implementation and resource manual. Sharing adolescents information with parents/legal guardians; Opportunities for adolescents to meet with health care providers without parents/legal guardians present; Informing adolescents and parents/legal guardians about adolescents right to confidential health care and its limits; Sharing adolescents confidential information with other health care providers; Documentation of adolescents confidential information in the health record; and. However, the data gathered from the 389 respondents are important and worth sharing, even if the percentage of returns was low. Adolescent consent and confidentiality. The present study aimed to explore the knowledge and practices of staff at a large Canadian paediatric facility related to confidentiality in adolescent health care.
How To Get A Caregiver For Autistic Child, How Long Does The Eviction Process Take In Florida, Section 232 Tariffs News, Ben's Cookies Chatfood, Let And Const In Javascript, Articles C