This paper was prepared with funding support awarded to Franco A. Carnevale by the Social Sciences and Humanities Research Council of Canada (SSHRC) and the Canadian Institutes of Health Research (CIHR). A 2016 study demonstrated that, when given the opportunity, adolescents use of EHRs afforded enhanced medical care and, although they accessed the portal less for laboratory results, appointments, or prescriptions, adolescents did engage in frequent confidential communications with their health care providers through patient portals 4. government site. 1 Generally, parents or guardians and adolescents should be informed, both separately and together, that the information each of them shares with the health care provider will be treated as confidential. The policy statement asserted that sexual minority youth (i.e., LGBTQ) can engage in higher risk behaviours and are at greater risk of being ostracized by their communities (10). It means that information about the child, or things that the child has talked about should not be disclosed to anyone else unless the child agrees. Obstetriciangynecologists should make clear to the patient what limitations, if any, exist in the EHR system. Working with children and youth can present significant challenges regarding respect for their confidentiality (1). Still, there are limitations to full autonomy and confidentiality throughout Canada depending on the severity of an illness and the risk of harm. Adolescents gain more ownership over their own health: We encourage adolescents to be active participants in their health care as a step toward becoming adults and to take on more responsibility. A 13-year-old girl presents to her local clinic for medical follow-up; she and her family are well-known here and live nearby. PDF California Minor Consent and Confidentiality Laws* Obstet Gynecol 2020;135:e4350. The authors thank Suzanne George, RN, MSc(A), for her research assistance in conducting the scoping review. HHS Vulnerability Disclosure, Help We developed a search strategy with the assistance of a McGill University health librarian to search Medline. Require a parent or guardian code word to access an adolescents patient portal. PDF Texas Health Steps Adolescent Health Guidance for Providers American College of Obstetricians and Gynecologists. details of any physical or mental health problems you have. FOIA On the basis of the ethical framework presented above, we propose the following recommendations for clinical practice with children. (Health care providers should be cognizant of potential coercion by parent or guardian to maintain access.). Confidentiality/Minor Consent Laws For Educational Purposes Only PARENT/GUARDIAN CONSENT EXCEPTIONS 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. Guidelines for health professionals recommend seeing young people alone to facilitate confidential care. It builds trust: Experimenting with a range of behavior is common among adolescents and young adults. Available at: Confidentiality in Adolescent Health Care, Addressing Patients and Parents or Guardians About Confidentiality, Provision of Health Care to Adolescent Patients, Suggestions for Protecting Adolescent Confidentiality Within Institutions, https://www.guttmacher.org/state-policy/explore/overview-minors-consent-law, https://www.aafp.org/about/policies/all/adolescent-confidentiality.html, https://www.nihcm.org/component/content/article/5-issue-brief/1287-protecting-confidential-health-services-for-adolescents-young-adults, https://www.opennotes.org/tools-resources/for-health-care-providers/implementation-toolkit/, https://www.cahl.org/state-minor-consent-laws-a-summary-third-edition, Alliance for Innovation on Women's Health, Postpartum Contraceptive Access Initiative. The National Adolescent and Young Adult Health National Resource Center (AYAH-NRC) - supported by the Maternal and Child Health Bureau - was established in September 2014 to help states improve receipt and quality of preventive services among adolescents and . In addition, given the importance of privacy in mental health, many parents may willingly consent to their child's . The American College of Obstetricians and Gynecologists encourages obstetriciangynecologists and other health care providers to ensure that their existing EHR systems protect the confidentiality of minor patients, including any OpenNotes features. Obstetriciangynecologists and other health care providers should be active in educating their staff and patients regarding the confidentiality of services. Research with children and adolescents often applies methodologies which aims at the disclosure of sensitive information about practices that impact on adolescent mental and physical health such as sexual activity, smoking, alcohol consumption, illegal drug use, self . This may mitigate the intimidation some patients may experience from parents or guardians. Given that consent for childrens treatment would be provided by the person with parental authority, this authority would need to have access to all relevant information to ensure that consent is informed. This initiative has been shown to potentially increase patient activation and engagement, as well as patient satisfaction, trust, and safety, and to improve the patientphysician relationship 20 21. Parent or guardian access to the patients visit notes through the electronic patient portal poses the potential that confidential and sensitive information may be accessed, resulting in a breach of confidentiality and potentially adverse outcomes for the adolescent patient. Limiting parental or guardian access to information about certain personal issues such as sexuality, substance abuse, and mental health concerns allows adolescent patients to be more comfortable talking with their health care providers about these issues. The American College of Obstetricians and Gynecologists has neither solicited nor accepted any commercial involvement in the development of the content of this published product. We may have to disclose private information to protect a patients safety. In this article, we examine challenges regarding the respect for confidentiality with children and youth in health care and offer guiding principles for clinical practice. However, these children generally do not have the complete autonomy that is legally accorded to adults; they are minors and are therefore entitled to protection of their best interests (NB: there are some jurisdictional variations in Canada on whether best interests protection is applicable for minors with decision-making capacity) (2). Providing alone time, apart from a parent or guardian, for discussion between the adolescent patient and health care provider is an important aspect of the health care visit 5. Committee Opinion No. Most EHRs have the capability for patients to view any combination of appointments, medication lists, allergies, most recent vital signs, laboratory values, health care provider notes, and communication between patient and health care provider. These challenge procedures would allow HCPs to breach confidentiality, but only to the extent needed to serve the youths best interests (e.g., when there is a perceived danger or risk of danger to a childs safety and/or development). When considering consent and confidentiality outside of legal standards, the age at which a child is considered capable can be thought of on a continuum that depends on many social, developmental, educational and cultural factors. We are hopeful that this article will incite additional analyses and research, that can help further refine the normative and practice standards proposed here. Available at: National Institute for Health Care Management. Special requirements for electronic medical records in adolescent medicine. This compromises trust in the providerpatient relationship. OpenNotes. Inform the patient that despite the physicians respect for confidentiality the minor patients parents/guardians may learn about the request for treatment or testing through other means (e.g., insurance statements). However, there are important exceptions where a minor can consent to their own care, without a parent's permission. National Library of Medicine Lazebnik: State laws govern adolescent medical confidentiality. Despite the legal issues involved, we posit here that there is ethical value to including children of all ages (i.e., who are capable of participating) in discussions about their medical concerns, and to (a) seek their consent or assent for treatment and (b) respect their confidentiality, in a manner that is adapted to their capabilities. Definitions Personal information that we will treat as confidential includes, but is not limited to: Identification and demographic information including names, address, phone numbers, email addresses, birth dates, social security numbers, and photographs/videos Available at: Anoshiravani A, Gaskin GL, Groshek MR, Kuelbs C, Longhurst CA. Explore the minor patients reasons for not involving his or her parents (or guardian) and try to correct misconceptions that may be motivating the patients reluctance to involve parents. J Pediatr Adolesc Gynecol 2017;30:17683. Frontiers | Identifying Risk and Resilience Factors in the Case Discussion: Confidentiality and Adolescents - Seattle Children's Careers, Unable to load your collection due to an error. Mature minor: An adolescent younger than the age of majority who, even if living at home as a dependent, demonstrates the cognitive maturity to give informed consent. Any updates to this document can be found on acog.org or by calling the ACOG Resource Center. Obstetriciangynecologists are encouraged to know their individual systems and institutional policies regarding confidentiality, EHRs, patient portals, and the open access for visit notes. Mental health, minors and the muddy waters between a parent's right to Physicians should be aware that states provide mechanisms for unemancipated minors to receive care without parental involvement under conditions that vary from state to state. Engaging patients through open notes: an evaluation using mixed methods. If, after counseling, the patient refuses the chaperone, this decision should be respected and documented in the medical record 11. An initial set of 376 results was identified. Statutes on the rights of minors to consent to health care services vary by state, and obstetriciangynecologists and other health care providers should be familiar with the regulations that apply to their practice. Legally speaking, people under the age of 18 do not typically have a right to confidentiality in therapy. All rights reserved. Confidentiality Toolkit U.S. Department of Health and Human Services, Administration for Children and Families, Office of Planning, Research, and Evaluation (2021) Discusses how responsibly sharing records between agencies can enhance service-delivery and record-sharing processes and confidentiality considerations. Any potential conflicts have been considered and managed in accordance with ACOGs Conflict of Interest Disclosure Policy. Available at: https://www.guttmacher.org/state-policy/explore/overview-minors-consent-law. In general, adolescents have the right to confidentiality concerning reproductive health services. Ethics and Confidentiality in Child Welfare 803. During her follow-up, the girl asks for contraception but adamantly states that she does not want her parents involved in this discussion. She is confident and well-informed about engaging in a sexual relationship, and plans to do so soon, with what appears to be an age-appropriate partner. Confidentiality and Consent - Stanford Medicine Children's Health Principles of confidentiality - ethical guidance - GMC New York, NY: Guttmacher Institute; 2019. Although there are multiple benefits of EHRs, these benefits may conflict with the protection of confidentiality. Confidentiality refers to protection of privileged and private information shared during a health care encounter and in medical records that document the encounter 1. Confidentiality protections for adolescents and young adults in the health care billing and insurance claims process. PDF Confidentiality/Minor Consent Laws - Adolescent Health Initiative Nonetheless, mental health confidentiality laws for minors generally mirror those of physical medical treatment. Adolescents often have questions or concerns that they may feel embarrassed to talk about in front of their parents or guardians. When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship. Adolescents should be aware that certain insurance carriers itemize explanation of benefits statements 7. Some degree of confidentiality is . Substance abuse treatment. Family Code 6925). if the first patient described high risk sexual behaviour? 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. Obstetriciangynecologists and other health care providers who care for minors should be aware of federal and state laws that affect confidentiality. The maintenance of patient confidentiality may be affected by the widespread adoption and integration of electronic health records (EHRs) in clinical care, which may necessitate a closer evaluation of the unique challenge this presents for providers of adolescent health care. The ACOG policies can be found on acog.org. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement While ACOG makes every effort to present accurate and reliable information, this publication is provided as is without any warranty of accuracy, reliability, or otherwise, either express or implied. Consider the following two cases, adapted from our clinical practice. Confidentiality covers any statements or communications between a patient and other professional staff at the doctor's office. Physicians also have a responsibility to protect the confidentiality of minor patients, within certain limits. For patients ages 18 and older, require a signed release of information for a parent or guardian to ask health questions about the adolescent by telephone. LATE ADOLESCENCE Physically adult form Set sense of identity More mature relationships Transition to living away from family In the transition from childhood to adulthood, adolescents develop new health care needs and concerns at the same time they are gaining autonomy from their parents. ET). Obstetriciangynecologists who treat adolescent patients should provide resources for parents and caregivers and encourage continued parental involvement 10. Obstetriciangynecologists and other health care providers and institutions that establish an electronic health record (EHR) system should consider systems with adolescent-specific modules that can be customized to accommodate the confidentiality needs related to minor adolescents and comply with the requirements of state and federal laws. With this population, HCPs establish goals of care and obtain consent for interventions from parents, however we suggest that particular care be taken to directly involve the child, to understand her priorities and concerns, to offer, with parents agreement, leeway for partial or complete privacy once the risk/benefits of doing so are analysed, and in a manner that is adapted to her capacity and situation. 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 4. How would your approach change if these children had mild intellectual delays? Other states have consent laws that include substance misuse treatment, pregnancy prevention and care, and, sometimes, abortion services, mental health care, and emergency care. 587. While gaining the adolescents trust, we still encourage them to discuss issues with their parents or guardians. There is a paucity of published research and normative standards to guide health care providers in managing issues related to children's confidentiality. We propose that this framework illuminates the moral complexity of confidentiality in working with children and families. These services do not require a parent or guardian to be present at the medical visit. Standards for health information technology to ensure adolescent privacy. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 Doctor Patient Confidentiality Law | What Is Covered There should be private conversation time between the health care provider and adolescent patient. 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. or "consent" - before their minor child can receive a medical service. The threshold for this decisional capacity is defined differently across jurisdictions and practice settings but the division is typically centred on dominant legal norms, which we believe inadequately address a number of complex ethical concerns.
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