Even if confidentiality is maintained, the GMC advises that you should not refuse to listen to a patient's [] carers or others on the basis of confidentiality. She feels distressed at what happened and blames herself. 0
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Despite this, only 3% of parents said their general practitioner (GP) had discussed with them confidentiality in relation to their adolescent children (Reference Magnusson, Oakley and TownsendMagnusson 2007). The ethical and legal concerns of counseling the minors and completing custody evaluations are discussed. When a parent has lost or given up their parental rights. In There are some rights that every child is born with. For example, children are entitled to a safe environment free from child abuse. Confidentiality in child and adolescent mental health is a complex and often challenging matter. Pedro Weisleder 1 Affiliation 1 Division of Pediatric Neurology, Duke University Medical Center, Durham, NC 27710, USA. Frank's clinician should make a risk assessment, since other factors are also involved. Retrieved from https://www.hhs.gov/hipaa/for-professionals/faq/2094/does-parent-have-right-receive-copy-psychotherapy-notes-about-childs-mental-health-treatment.html. R (Axon) v Secretary of State for Health [2006] (subsequently referred to as Axon) (Table 1). The circumstances under which a therapist would disclose information the child shared in therapy. 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 beneficence and non-maleficence are applied to confidentiality issues, preserving confidentiality may benefit the young person by encouraging disclosure of all relevant clinical information, enabling the clinician to act effectively (Reference Ford, English and SigmanFord 2004). However, dilemmas arise when they refuse the sharing of information, even though breaching confidentiality could potentially protect or benefit that person or others. Which factor does not support the protection of confidentiality in a competent young person?
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However, decisions are often complex, and colleagues may well vary in their viewpoints. On the other hand, the lack of empathy associated with autism spectrum disorder may increase risk. Popular Psychology Counseling Minors and Confidentiality 14 May 2013 by Torey C. Richards, LMHC Confidentiality is a crucial part of counseling. 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). These exceptions are based on a minor's statusor the type of service requested. 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. Second, young people often prefer such information not to be shared with parents and/or other professionals. Furthermore, given the lack of suicidal intent, and considering that about 30% of adolescents report having had suicidal ideation (the overwhelming majority of whom do not attempt suicide) (Reference Evans, Hawton and RodhamEvans 2005), again the risk of serious harm here does not appear high.
Minors' Rights to Confidentiality, When Parents Want to Know An Ethical 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 Health Insurance Portability and Accountability Act (HIPAA) is the primary federal law governing medical privacy. One of a therapists most important ethical duties when treating minors is to discuss confidentiality concerns with the parent(s) and the child. (Informed Consent), A.2.d. r1Z^82R 4 One may need to think beyond the individual situation and consider principles more universally. Interestingly, there is some discrepancy between the GMC guidance relating to competent children as opposed to competent adults. TABLE 2 A summary of principles to consider when deciding whether to maintain or breach confidentiality of a competent young person. State Minor Consent Laws: A Summary, 3rd Edition Individual States: $35.00 (discounts available for more than one state) You will receive an electronic copy of . For under-16-year-olds, case law on consent generally derives from Likewise, a therapist must act to protect the child if they believe the child may engage in self-harm or hurt others. This paper examines all facets of this ethical dilemma by using Corey, Corey, and Callanan's (1998) decision-making model. A complicated web of federal and state laws, professional ethics, and statutory interpretations by various courts govern minors right to confidentiality in treatment. They must also be confident that their therapist will not share this information with third parties. f;`^&qA09DrEH R" DgY RDl/.F[0D=P $9r&*Hj5dOEe*DmlrL@__ $ !#N
The mean number of topics for individual-only sessions was 3.16, which, although not significantly different, implies that the split-session approach results in the best coverage of topics. Ultimately, clinicians want to do the right thing. 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). Mirza, Hassan (Inability to Give Consent), B.1.b.
PDF Legal and Ethical Implications of Working with Minors in Alabama They may well consent to the sharing of information, for example with their family and/or other professionals. However, the parent does not have the right to view treatment notes unless a court orders otherwise. In contrast, research shows that parents value being told important information about their child. 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). :9^Ht"F Q5 e?4ySs;31+Uw>>E}3-qXOKVRI,r:fV^3"od_UqcMsc[u Aiqj
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State-by-State Variability in Adolescent Privacy Laws But what if the process of breaching confidentiality could exacerbate the risk? 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. In most cases, a therapist will provide the child and their parents with a HIPAA disclosure statement that offers details about how and when treatment information may be disclosed to others. Ethical judgements are significantly subjective processes, and such biases could influence us. A parent generally has the right to request a childs medical record. Confidentiality is a complex matter in clinical practice, and particularly so in child mental healthcare. Parents are well placed to support their children, and the Children Act 2004 endows them with an important role in both safeguarding and providing guidance to their children. (2004). 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. This in turn could have a negative impact on the adolescent's longer-term health and overall risk.
When Do Minors in Therapy Have a Right to Confidentiality? Some states extend additional privacy protections to minors that go beyond HIPAA. 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. Because a child cannot legally consent to treatment, the parent often acts as a personal representative for the child. Additionally, though minors do not have a legal right to privacy from their parents, their right to privacy from third parties (employers, advertisers, etc.) "coreDisableSocialShare": false,
Children and Consent: What You Need to Know - The Innocent Lives Foundation Various studies have surveyed clinicians attitudes on what influences them to breach confidentiality when a child expresses risk to self. Let us now consider Frank, the 16-year-old with autism spectrum disorder and repetitive thoughts of killing people, but no specific intent or target. The GMC guidance specifically notes that clinicians should consider the possible harms that may arise from disclosure (GMC 2007). In England and Wales, the Human Rights Act 1998 incorporates the European Convention for the Protection of Human Rights and Fundamental Freedoms (European Convention on Human Rights, ECHR), Article 8(1) of which specifies that everyone has the right to a private and family life. All of my clients know that everything they tell me stays between us except: The challenge of confidentiality is that it can frequently tear them in different directions when deciding what the right thing actually is. They may feel that the information itself is too sensitive and personal, particularly if it would cause them embarrassment. 58 0 obj
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2013. This article examined the attitudes of 195 school counselors in Israel regarding (a) the decision to maintain or breach confidentiality in a variety of ethical dilemmas, and (b) the reasons given for justifying their decisions. Adolescent health risk behaviour: when do pediatric psychologists break confidentiality? 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. All these judgements need to be made in terms of calculating beneficence and non-maleficence. is a counselor for two minor male children who are experiencing difficulties as a result of their parents' divorce. Eighteen ethical dilemmas in three domains were presented to respondents in a questionnaire. and The law regarding a minor's right to confidentiality in most states' rests on a simple foundation: Minors generally cannot consent to treatment, a parent or guardian consents on the minor's behalf. She is concerned that if they found out, they would just get angry. 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. 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. Therapeutic confidentiality is key to effective treatment for numerous reasons, including building and preserving a strong therapeutic alliance. R8u In contrast, another universal principle could be applied to supporting the need to breach confidentiality: societies where information is freely shared within families and between services may help deter those who might otherwise abuse. hbbd```b``^"A$._&fE0Y No eLetters have been published for this article. ')yUR-G5(l ?y;#z.>LSYwM$ rV\Vj$#FbY8);'m jAzha#V[lHNi5U91jVO>_dP9D>3 #G|_Vnj={/Yf~b0]/a5:;PE=>|%^j/R|J7x>
JV]5nFY)[+' >3KWj]i|.&b>#-hl -(3P4P|EP`{B!hS`/=P=o#L|7m!Q$)>UKJJc5:Iu}]NYHqThWpouEWo)VHN{q&*~4UaI,>_E!TEN'q#n&7HT71C1 With this argument, whether the choices ultimately prove good or bad is less important than the intrinsic freedom to make one's own choices. The first scenario involves Ahmed, the 15-year-old with anxiety disorder who wants medication, but does not want his parents to know. It also gives an opportunity to create a safe, supported space to encourage communication between the young person and the parents (Reference FordFord 2007). The importance of confidentiality in therapy. For example, California gives minors the right to control their own health care information when they otherwise have the right to consent to care. When initially considering whether to breach confidentiality, negotiation could be used. Two distinct strains of moral philosophy have historically dominated the ethical landscape. Legal Rights of Children: The Basics. Pricing. In fact, it is often through seemingly adverse outcomes that individuals learn from their mistakes and develop as human beings. The sensitive sharing of information could represent an opportunity to help support and develop family communication. Professionals take psychotherapy notes to analyze the contents of a conversation. Some therapists require parents to consent to a certain level of confidentiality, even when state or federal law affords the child fewer confidentiality rights. 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. Emergency care Care for independent minors Box 4 lists various practical aspects of disclosure. When you treat an adult, your legal and ethical obligations typically are to that client. hbbd```b``~"@$S(d6XM-&$X\ 40L6AxX/dV0D }]4|zz0?dY7?vHqW>_}E>N&5(z;xWMt[z$j| cN3pRb. Answer: When working with minors, confidentiality can be a tricky situation. 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. 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).
State Minor Consent Laws: A Summary, Third Edition It protects minors from disclosures to third parties who are not their parents. 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 . 'Shhh! According to Mitchell, Disque, and Robertson (2002) "Research indicates that counselors struggle when faced with issues surrounding confidentiality rights of minors and rights of parents" (p. 156). The risk of such negative consequences is implicated in research. Abstract. Although these arguments have further evolved in contemporary moral philosophy, both perspectives still remain relevant when considering confidentiality issues. (2014). Yet, research also indicates that self-harm is a risk factor for more significant suicide attempts, albeit in the longer term, so this would also need to be factored in. When parents understand that confidentiality is key to effective treatment, they may be more willing to respect their childs need for privacy. First, young people frequently present to child and adolescent mental health services (CAMHS) with sensitive and risk-related situations, including self-harm, suicidality, sexual behaviour, and alcohol and substance use. Developing autonomy and individuation from one's parents is particularly critical in adolescence (Reference Erikson and NortonErikson 1968). 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. e endstream
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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.
The right of minors to confidentiality and informed consent Katie is a 14-year-old girl attending CAMHS with an eating disorder. She also has occasional suicidal ideation, although has never had any firm intent or plan. For example, a teenager whose weight is dropping and who confides early signs of an eating disorder may agree to gain weight on a prescribed schedule and attend regular visits until you are assured that he or she has the problem under control.
(PDF) Minors-rights-to-confidentiality-when-parents-want-to-know-an Effect of mandatory parental notification on adolescent girls' use of sexual health care services, Concerned about confidentiality? 5 Close this message to accept cookies or find out how to manage your cookie settings. 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.
There seems to be much confusion among school counselors dealing with confidentiality issues. 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. 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. 2021. This is a common scenario presenting to CAMHS services, and the principles illustrated in Table 2 apply. The following factors concerning possible sexual abuse would indicate the need for reporting: the young person is too immature to understand or consent, children under 13 years old are legally considered to be unable to consent to sexual activity, significant differences in age, maturity or power between the young person and the sexual partner, the young person's sexual partner having a position of trust or having a history of abusive relationships with children, the use of force or the threat of force, pressure, bribery or payment, the use of drugs or alcohol to influence a young person. Who Gets to Decide? Children are entitled to a safe place to live and come of age. Counselors will encounter ethical dilemmas throughout their careers that may test their personal moral beliefs. sM;VfF+$4X\&l)V
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Difficulties in balancing parental and This paper explores the ethical scenario related to confidentiality rights of a minor when his/her parents seek information from the counseling session, in this case related to exploration of sexuality. Even when a parent is pressuring me for information, I am able to refer them to the minor's counsel, who will work to protect the childs confidentiality, says Lois Nightingale, PhD, a marriage and family therapist from Yorba Linda, California. It consists of the following: A therapist who works for a non-profit counseling center is treating a mature and intelligent 15-year-old minor. Confidentiality brings these tensions to the forefront: Reference TebbTebb (2011) notes the important role that clinicians can play both in helping young people in the transition to adulthood, encouraging them to take greater responsibility for making decisions about their own health, and in supporting parents accept the increasing independence of their children. PZjDz1]\\N?6u6 thEGX8qy>1z&P.Th3dQB7AejDkD(:GND'e"tTr='tRD.`0FP9nfR2f,p68 ]^JNa>rPo_|/-F__~Cy:Cu*,bt#E>^jO'U+~{=,B,g{{g~{`{t^z4)I'q>|UA\9=Vy]P'G0e[SssV[TJcOfEu:MO(\75a0
S-qll?4LqaZ=%${SxyK^]{73%/j\\?./. Now what? Be found at the exact moment they are searching. Time-Management Hacks to Be More Efficient and Procrastinate Less. Minor Consent : Based on Status A minor can consent to health care services without a parent or guardian if On the other hand, it could be argued that the short-term risk is low, and that breaching confidentiality might have a negative impact on his rights, his healthcare engagement and perhaps his social situation, any of which could exacerbate risk. Ultimately, there are various reasons why a child may wish for information to be kept confidential. There are also situations where confidentiality needs to be breached in accordance with legal or regulatory statutes (Box 2). 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.
What are the Legal Rights of Children? - FindLaw Police and children's services might even offer support, which could attenuate risk. On one hand, there is the consideration of preserving engagement and therapeutic rapport, particularly important given Katie's eating disorder and the associated risks. 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. However, the scenario is less clear-cut since Frank is currently not making any specific threats nor is there intent. However, the Courts have never declared this to be part of the . This article explores confidentiality in the context of child and adolescent mental health services (CAMHS), particularly when the clinician is having to make decisions on whether to maintain or to breach it. When a minor has their own attorney, this lawyer holds the privilege for the child's therapy, and they often work with me to help keep emotional safety a priority for the child's counseling. Meanwhile the Family Law Reform Act 1969 mandates that 16- to 17-year-olds can consent to medical treatment. (Respect for Confidentiality), B.2.d. Behnke, S. H., & Warner, E. (2002). A survey of clinical child psychologists found a significant lack of consensus in attitudes but the authors reflected that ethical codes and guidelines allow for (and result in) individual differences in decision making (Reference Rae, Sullivan and Pena RazoRae 2002). However, even if the legal argument justifies Ahmed's rights to confidentiality, the clinician also needs to make clinical and ethical judgements. 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. Preserving confidentiality respects the young person's right to a private life. _4/5M=>^~9TIOU}p0vPLO~iEPunK7^w/&7_8GEz|8VJz^_] More moderate importance was attached to the negative effects of breaching on the family and on service attendance. I would like to thank Dr Adrian Raby (Clinical Lecturer in Medical Ethics, Imperial College London) and Dr Shereen Haffejee (Consultant Child and Adolescent Psychiatrist and Named Doctor for Safeguarding Children, Surrey and Borders Partnership NHS Foundation Trust) for their advice. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. However, the clinician should remain vigilant in case the level of intent or threat changes.
A Minor's Right to Confidentiality - FAMCare 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. During the 1960s and 1970s, the Supreme Court established that minors have certain constitutional rights, including the right to privacy with respect to contraception and abortion. Third, the child's level of competency may need to be taken into consideration. When a parent has signed an agreement to respect the confidentiality between the health care provider and the minor. 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).
Responding to Parental - JSTOR What if a child instead wanted to keep confidential information that would indicate that they, or others, were in danger: would it still be in the public interest to keep this type of information confidential? 2013. Most children do not have a legal right to privacy from their parents, as a parent may need certain information in order to consent to treatment. ABA Center on Children and the Law Child Welfare League of America National Council of Juvenile and Family Court Judges National Runaway Safeline Office of Juvenile Justice and Delinquency Prevention (OJJDP) OJJDP Office of Justice Programs Office of Legislative Research: 2022 Acts Affecting Children (Office of Legislative Research)
GoodTherapy | Client Confidentiality Depending on the jurisdiction and application, this age may vary, but is usually marked at either 14, 16, 18, 20, or 21. Salo and Shumate (1993) state that courts have generally ruled that the privacy rights of minors are an extension of parental privacy rights and therefore counselors have legal obligations to the parent or guardian.
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