minors' rights to confidentiality in counseling

She does not wish anyone to know; she feels embarrassed and does not want to cause trouble. Their views or the information they provide might be helpful in your care of the patient. The status of minority ends at the age of majority. 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. All of my clients know that everything they tell me stays between us except: He arrives in the clinic by himself. Consent to treatment of minors. Ahmed has read information online about medication with selective serotonin reuptake inhibitors and wants to give it a go. They may worry parents will intervene in a seemingly unhelpful way. Anecdotal experience of CAMHS services suggests that clinicians do hold disparate views on confidentiality, despite a general appreciation of its underlying principles, ethics and regulations. Confidentiality with adolescents in the medical setting: what do parents think? (Informed Consent), A.2.d. Popular Psychology Counseling Minors and Confidentiality 14 May 2013 by Torey C. Richards, LMHC Confidentiality is a crucial part of counseling. a a young person's belief that information will invariably be shared with parents does not affect the likelihood that they will disclose risky behaviours or attend healthcare services, b parents generally believe that they do not have a right to know about risks relating to their adolescent children, c aspects of confidentiality are rarely discussed with adolescent patients and their families in primary care, d when deciding whether to breach confidentiality, clinicians prioritise the risk of patient disengagement more than the seriousness, frequency, intensity and duration of the risky behavior. For example, some parents may abuse or disown a child for their sexual orientation or behavior. Therapists should ensure they understand state laws and their licensing boards ethics rules. Some parents may worry that secrets will undermine their relationship with their child. 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. The guidance Working Together to Safeguard Children explicitly states that: fears about sharing information cannot be allowed to stand in the way of the need to promote the welfare and protect the safety of children [] If a professional has concerns about a child's welfare and believes they are suffering or likely to suffer harm, then they should share the information with local authority children's social care (Department for Education 2015: p. 17). It protects minors from disclosures to third parties who are not their parents. Evidence supports such a model. A complicated web of federal and state laws, professional ethics, and statutory interpretations by various courts govern minors right to confidentiality in treatment. 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. Deontological ethics, such as that proposed by Kant, argues that the morality of an action is to be judged by whether the action is in itself right or wrong, based on a wider system of rules, rights or doing one's duty (Reference KantKant 1964). 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. 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). But when a child can openly discuss their feelings in therapy, their relationship with others, including their parents, may improve. 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. Counselors will encounter ethical dilemmas throughout their careers that may test their personal moral beliefs. .i\h9;T_ The steps the therapist takes to protect the childs privacy. Be found at the exact moment they are searching. C%61 TX[:b9m tXxdhA)d?ZHUS?L ~\pzXeO"g(y_#xtz7`5 %{:{+45vPE(#,x6x )|!t +oqPvH'kvcP[p_ g,k>|7A!a)hA#&Q$zzl|k >)7ed- .R,DC9-6Oi\5$w G?B'NVL7Nv riro#/'O>}v9= !V9cu ;h miW{&4*me;Zm]C}sT>;ny.j3%1[ETu:S>.8\Sc~!vN&4A*\Z@.o5u. police and children's services) to intervene and thus hopefully reduce the risk to both Katie and, potentially, others now and in the future. 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. In contrast, when the clinician learns of a significant risk, breaching confidentiality and sharing information with parents or other authorities may help them minimise the risk of harm. A balancing act in relation to the specific context needs to be considered, since consequentialist and legal arguments may vary depending on the case. Because I work with many high-conflict divorce families, many of the children and teens I see in therapy have their own minor's counsel. sM;VfF+$4X\&l)V f"L`Dp%v $ 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. 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. 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 Various studies have surveyed clinicians attitudes on what influences them to breach confidentiality when a child expresses risk to self. A Minor's Right to Confidentiality - FAMCare :9^Ht"F Q5 e?4ySs;31+Uw>>E}3-qXOKVRI,r:fV^3"od_UqcMsc[u Aiqj vo~tVskolhaM?~uof ?0M7W')>Wh,;X'2~OWe[Vg When considering Ahmed, we must also bear in mind the wider importance of trust between clinician and patient in society. However, some therapists ask parents to agree to the therapists confidentiality rules before they will treat the client. A parent who consents on the minor's behalf generally has the right to know the content of the child's treatment. 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). Published online by Cambridge University Press: 2013. Had Frank actually made specific threats against a person, with some intent to kill, then confidentiality should be breached, and police and children's services informed, in accordance with GMC guidelines and ethical principles (since safety and protection would generally supersede rights to autonomy). Informed Consent and Assent Except in situations consistent with certain exceptions allowed under the laws in one's jurisdiction (e.g., when the minor is married or in the military, an emancipated minor) minors are not typically allowed to consent to their own treatment. However, dilemmas arise when they refuse the sharing of information, even though breaching confidentiality could potentially protect or benefit that person or others. The therapist's disclosure policies. For example, mandated reporters must disclose suspected child abuse to child protectiveservices. 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. Cama, Shireen F. 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. Depending on the jurisdiction and application, this age may vary, but is usually marked at either 14, 16, 18, 20, or 21. Confidentiality represents an opportunity to engage a young person in developing a trustful engagement with services, with long-term positive consequences for their mental health. Select the single best option for each question stem. 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). Feature Flags: { 2 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]. 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. When Do Minors in Therapy Have a Right to Confidentiality? 2013. Typically, the age range of consent is between 16 and 18. 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. There seems to be much confusion among school counselors dealing with confidentiality issues. Finally, practical suggestions on how to share information are explored. 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. "corePageComponentUseShareaholicInsteadOfAddThis": true, Deontological ethical philosophy argues that: a the consequences of an action are what defines whether it is ethical or not, b we can never know exactly the subjective experience of other beings, c the morality of an action relates to the action itself and not its consequences. _4/5M=>^~9TIOU}p0vPLO~iEPunK7^w/&7_8GEz|8VJz^_] The risk of such negative consequences is implicated in research. Ethical principles (both deontological and consequentialist) and legal and regulatory frameworks (relating to human rights, case law and General Medical Council guidance) are outlined. 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. Confidentiality and treatment decisions of minor clients: a health However, the GMC would generally advise the clinician still to encourage Ahmed to involve his parents, even if ultimately his confidentiality is respected (GMC 2007). (2004). More moderate importance was attached to the negative effects of breaching on the family and on service attendance. 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). However, Reference Kapphahn, Wilson and KleinKapphahn et al (1999) found that 34% of boys and 43% of girls with high depressive symptom scores, and 2541% of youth reporting substance use, high stress levels, physical abuse or sexual abuse, were not given an opportunity to speak privately with their doctor. 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. Two distinct strains of moral philosophy have historically dominated the ethical landscape. 02 January 2018. State Minor Consent Laws: A Summary, Third Edition A parent who consents on the minor's behalf generally has the right to know the content of the child's treatment. Minor Consent : Based on Status A minor can consent to health care services without a parent or guardian if She begs her doctor not to tell her family. Hanson, K. (2018, October 12). is similar to that of adults. 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. Different clinicians may well prioritise different factors, on the basis of their own wider ethical perspectives. 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. Finally, clinicians must always be mindful of their own ethical values, built up from their experiences and their cultural background (Reference Applewhite and JosephApplewhite 1994). Maintaining Confidentiality with Minors: Dilemmas of School Counselors She remembers little, although reports that the man, who was vaguely connected to her wider peer group, had been sending her sexually related messages online. In my view, although family factors are significant and cogent, they should not override the duty of confidentiality owed to the child.. PDF Legal and Ethical Implications of Working with Minors in Alabama And what about parents rights should they not be given information to enable them to protect their child? to mental health review tribunals) for statutory purposes under the Mental Health Act 1983. is a counselor for two minor male children who are experiencing difficulties as a result of their parents' divorce.

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