the statutes. Certain exceptions exist, such as in cases of certain medical emergencies to save the life of the patient or to avoid serious bodily injury, if an immediate threat to health or safety is involved, or in cases where child abuse or neglect is suspected, and records that are entirely de-identified and used for research purposes. "Minor consent laws" allow minors to consent for their own care in specific situations and for specific services. Only one parent . of Education), When Your Child, Teenager, or Young Adult has Mental Illness: What Parents Need to Know about HIPAA (HHS, Office for Civil Rights), HIPAA Privacy Rule and Sharing Information Related to Mental Health (HHS, Office for Civil Rights), Information for Teens: What You Need to Know About Privacy, A Matter of Law: Privacy Rights of Minor Patients, Health Insurance Portability and Accountability Act (HIPAA), Family Educational Rights and Privacy Act (FERPA), Confidentiality of Substance Use Disorder Records, Individuals with Disabilities Education Act (IDEA), Part B, Protection of Pupil Rights Amendment (PPRA), American Psychiatric Association Makes Key Changes in DSM-5-TR, DSM-5 Phobia Types, Diagnosis, and Treatment, Switching Antipsychotics When Treating Psychiatric Disorders, Ketamine Therapy for Bipolar Disorder Depression. Mental Health America. A parent generally has the right to request a childs medical record. A review of federal and state regulations for psychiatrists and behavioral health professionals trying to serve young patients while remaining compliant with the law. [Statutory Authority: RCW 18.83.050 (5) and chapter 18.83 RCW. Welcome to the updated visual design of HHS.gov that implements the U.S. Pediatricians, child and adolescent psychiatrists and childrens hospitals declare national emergency in childrens mental health. Not all parents have unconditional love for their child. The provision of mental health services is regulated and, to some extent, publicly . It requires health care providers, including therapists, to take reasonable steps to protect client privacy. Michael's first sexual experience occurred when, after a rave, he followed home a girl whom he had recently met and entered her bedroom through a window. . HEALTH CARE PROVIDERS MUST OVERRIDE THE MINOR'S CONFIDENTIALITY AND REPORT IF: There is suspicion of abuse by an adult Ideally, the adolescent would be part of such conversations. What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? The notes are for personal use rather than official documentation. Does the APA Ethics Code provide guidance? However, HIPAA, and not FERPA, applies to a health clinic on school property if it is operated by a third party independent of the school district. There is suspicion of physical abuse or neglect by an adult. Standard 4.03, "Couple and Family Relationships," states that psychologists "attempt to clarify at the outset (1) which of the individuals are patients or clients and (2) the relationship the psychologist will have to each person.". 4 0 obj HEALTH CARE PROVIDERS MUST OVERRIDE THE MINOR'S CONFIDENTIALITY AND REPORT IF: The minor is a risk to themselves or someone else. Confidentiality of Substance Use Disorder Records A federal regulation (42 CFR Part 2) protects the confidentiality of people receiving diagnosis, treatment, or referral for treatment for a substance use disorder at federally assisted SUD programs. Mental health and the law interact in numerous ways. Outpatient mental health services Emergency care if: o the proposed surgical or medical treatment is reasonably necessary . A lock (LockA locked padlock) or https:// means youve safely connected to the .gov website. Michael's therapist used these points as a guide. A: It is most helpful to consider this question from three perspectives: that of law, of clinical practice and of ethics. When Your Child, Teenager, or Young Adult has Mental Illness: What Parents Need to Know about HIPAA, HIPAA Privacy Rule and Sharing Information Related to Mental Health. (Child emancipation is when a minor becomes legally responsible for their own care before the age of 18.). Minors generally cannot consent to treatment; a parent or guardian consents on the minor's behalf. Encourage the minor patient to involve his or her parents and offer to facilitate conversation between the patient and the parents. 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. Some important topics to discuss include: When a therapist believes a child is in danger, they typically have a legal duty to disclose certain information, even when the child otherwise has a right to confidentiality. There are exceptions. Myth: There is no hope for people with mental health issues. From a clinical perspective, the situation is more complex. By STEPHEN H. BEHNKE, JD, PHD, ELIZABETH WARNER, PSYD. Michael insisted that his mother not hear any of this. Inform the patient (and parent or guardian, if present) about circumstances in which the physician is obligated to inform the minors parent/guardian, including situations when: involving the patients parent/guardian is necessary to avert life- or health- threatening harm to the patient; involving the patients parent/guardian is necessary to avert serious harm to others; the threat to the patients health is significant and the physician has no reason to believe that parental involvement will be detrimental to the patients well- being. hb```y ea $BBhv|-9:WN tlwE\g{Z5So{:{jK~9!:2@6a L@IDX n>b H(?912v0 y1=ArpPe`JvSff`g:oA1& *[ However, only the fact and date of admission, and the date of discharge, the name and address of the treatment provider, if any, and the last known address must be disclosed upon request; (8) To law enforcement officers, public health officers, relatives, and other governmental law enforcement agencies, if a minor has escaped from custody, disappeared from an evaluation and treatment facility, violated conditions of a less restrictive treatment order, or failed to return from an authorized leave, and then only such information as may be necessary to provide for public safety or to assist in the apprehension of the minor. Likewise, a therapist must act to protect the child if they believe the child may engage in self-harm or hurt others. Provision of outpatient mental health treatment to minors without parental consent. The law is a blunt instrument, as the issue of minors and confidentiality well illustrates. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Additionally, though minors do not have a legal right to privacy from their parents, their right to privacy from third parties (employers, advertisers, etc.) WSR 93-07-036 (Order 337B), 246-924-363, filed 3/10/93, effective 4/10/93.] pQ :5QHOp@^\ j.Z@v Confidentiality. Family Educational Rights and Privacy Act (FERPA) FERPA protects the privacy of students in education records, and it applies to any public elementary, secondary, or post-secondary school, as well as any private school, state, or local education agency that receives funds from the US Department of Education. The law prohibits schools from disclosing a students personally identifiable information in education records without the written consent of the students parents, or the student themselves if they have reached the age of 18, with certain exceptions. Or, a psychologist may conclude that sharing certain information would be helpful; if so, the ethical standards from the section on "Privacy and Confidentiality" give the psychologist permission to do so. Toll Free Call Center: 1-877-696-6775, Content created by Office for Civil Rights (OCR), Information Related to Mental and Behavioral Health, Other Administrative Simplification Rules, Additional FAQs on Sharing Information Related to Treatment for Mental Health or Substance Use DisorderIncluding Opioid Abuse, These federal rules are administered by HHSs Substance Abuse and Mental Health Services Administration (SAMHSA). The term "competence" signifies a legal conclusion that an individual is capable of entering into a binding contract, transferring assets, or participating in a legal proceeding. Michael's therapist shared her concerns with Michael about these activities and about what she perceived to be his excessive fear that his mother "couldn't know anything about" these activities. endobj Can I make my own decisions about my mental health treatment? Physicians also have a responsibility to protect the confidentiality of minor patients, within certain limits. When Do Minors in Therapy Have a Right to Confidentiality? Laws authorizing minors to consent and laws protecting confidentiality are closely linked but they do not always match each other. For details, please see the National Center for Youth Law's California Minor Consent and Confidentiality Laws grid. State laws vary dramatically, so it is imperative for behavioral and mental health professionals to be fully aware and up to date on their own states requirements. However, there are numerous laws that apply to child and adolescent mental health and privacy, creating a complex legal landscape in which federal, state, and local laws overlap. Sessions include looking at different therapies to tackle anxiety, advice to support children, yoga flow and how nutrition can impact your mental health. 19a-285. An earlier version of this column was printed in the Massachusetts Psychological Association Quarterly. Title C. Developmental Disabilities Act. Accessed October 19, 2022. 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 disclosure must be made by the professional person in charge of the public or private agency or his or her designee and must include the dates of admission, discharge, authorized or unauthorized absence from the agency's facility, and only any other information that is pertinent to the threat or harassment. What to do when an adolescent becomes sexually active, of course, is often a difficult issue. The issue seems especially pointed when adolescents talk about activities that, while not necessarily dangerous, are illegal, such as shoplifting, the recreational use of alcohol or experimenting with drugs. See G.L. State law addresses the age at which a minor child may consent to certain types of health care and may contain additional requirements related to disclosing a minors health information to parents (or withholding it). Under Illinois law, minors age 12 through 17 have the right toaccess and authorize release of theirown mental health and developmental disabilitiesrecords and information, and their parents havesuch rights only if the minor does not object orthe therapist does not feel there are compellingreasons to deny parental access. The agency or its employees are not civilly liable for the decision to disclose or not, so long as the decision was reached in good faith and without gross negligence; (12) To a minor's next of kin, attorney, guardian, or conservator, if any, the information that the minor is presently in the facility or that the minor is seriously physically ill and a statement evaluating the mental and physical condition of the minor as well as a statement of the probable duration of the minor's confinement; (13) Upon the death of a minor, to the minor's next of kin; (14) To a facility in which the minor resides or will reside; (15) To law enforcement officers and to prosecuting attorneys as are necessary to enforce RCW, (a) Only the fact, place, and date of involuntary commitment, an official copy of any order or orders of commitment, and an official copy of any written or oral notice of ineligibility to possess a firearm that was provided to the person pursuant to RCW, (b) The law enforcement and prosecuting attorneys may only release the information obtained to the person's attorney as required by court rule and to a jury or judge, if a jury is waived, that presides over any trial at which the person is charged with violating RCW. Telephone contact between mother and therapist continued while Michael was in middle school, but lessened as Michael began to feel he had more control over the nature and timing of visits. (c) Disclosure under this subsection is mandatory for the purposes of the federal health insurance portability and accountability act; (16) This section may not be construed to prohibit the compilation and publication of statistical data for use by government or researchers under standards, including standards to assure maintenance of confidentiality, set forth by the director of the health care authority or the secretary of the department of social and health services, where applicable. 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. HIPAA recognizes that some patients (including those with a mental illness or substance use disorder) may be unable to make their own health care decisions, including decisions related to health information privacy. McNary, A. <>>> HIPAA provides personal representatives of a patient with the same rights to request and obtain health information as the individual, including the right to obtain a complete medical record under the HIPAA right of access. When the child is emancipated. Authorization for disclosing data covered by HIPAA must generally be in writing by the patient, but in cases where the patient is not present or incapacitated, if in the best interest of the patient, a provider may share the patients information with family, friends, or others involved in the patients care or payment for care. In some jurisdictions, the law permits minors who are not emancipated to request and receive confidential services relating to contraception, or to pregnancy testing, prenatal care, and delivery services. OCR has organized certain FAQ's related to handling mental health information under HIPAA in two easy-to-access PDFs. 2021. Family Educational Rights and Privacy Act (FERPA). Make check out to Division of Mental Health and send to: DMH Communications & Training Section 3022 Mail Service Center Raleigh, NC 27699-3022 EFFECTIVE: January 1, 2005 SUPERSEDES: APSM 45-1 (7/1/03) (9/1/2000) The NC Department of Health and Human Services does not discriminate on There are exceptions. This page has been archived and is no longer being updated regularly. Beginning with this issue, and continuing every other month, the APA Monitor on Psychology will feature "Ethics Rounds," in which APA's Ethics Office will answer questions about the ethical issues psychologists most commonly face. Further, mental and behavioral health clinicians should discuss the limits of confidentiality with the adolescent and family, including the need to involve parents or legal authorities should the risk of harm to the adolescent or to others be imminent. 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. (a) Physical abuse, neglect, financial abuse, abandonment, isolation, abduction, or other treatment with resulting physical harm or pain or mental suffering; or (b) The deprivation by a care custodian of goods or services that are necessary to avoid physical harm or mental suffering.2 Send comments about this column to Ethics Office. (Formerly Sec. Clinical practice. If you are under 18, the ability to make decisions about your mental health treatment varies by state. However, it also creates a challenging area for clinicians to navigate as they work to do best by their patients and remain compliant with their legal obligations. 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. 371 0 obj <>/Filter/FlateDecode/ID[<3E5CC4AC34EBB54085F8E3250EEB73E0>]/Index[348 41]/Info 347 0 R/Length 105/Prev 166715/Root 349 0 R/Size 389/Type/XRef/W[1 2 1]>>stream 50-State Survey of Health Care Information Privacy Laws. 348 0 obj <> endobj Michael's mother wanted help in deciding whether Michael should go for each scheduled visit. (2) In the course of guardianship or dependency proceedings; (3) To the minor, the minor's parent, including those acting as a parent as defined in RCW, (4) To the courts as necessary to administer chapter. Second, clinical judgment will indicate to what extent maintaining an adolescent's privacy is central to the treatment. Similarly, jurisdictions may permit unemancipated minors to request and receive confidential care to prevent, diagnose, or treat sexually transmitted disease, substance use disorders, or mental illness. Clinical Takeaway: Do not disclose information related to past, present, or future mental health status, provision of healthcare, and payment for care without authorization from the patient, unless the patient is incapacitated. Sessions take place 16-19 May, free of charge during lunchtimes. October 19, 2021. A psychologist may conclude that an adolescent's wish not to have information shared reflects an appropriate separation and so should be honored. 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. When a court order specifically prohibits the parent from accessing the child's information. endstream endobj startxref A complicated web of federal and state laws, professional ethics, and statutory interpretations by various courts govern minors right to confidentiality in treatment. The mental health service agency or its employees are not civilly liable for the decision to disclose or not, so long as the decision was reached in good faith and without gross negligence; (11) To appropriate law enforcement agencies and to a person, when the identity of the person is known to the public or private agency, whose health and safety has been threatened, or who is known to have been repeatedly harassed, by the patient. Adolescent minors who consent for their own care are entitled to many confidentiality By law, the attorney-client relationship is a confidential one. 3 0 obj These ethical standards again recommend several points. Elizabeth Warner practices in Brookline, Mass., and is a member of the Massachusetts Psychological Association Ethics Committee. Confidential information under this section may be disclosed only: (1) In communications between mental health professionals to meet the requirements of chapter 71.34 RCW, in the provision of services to the minor, or in making appropriate referrals; (2) In the course of guardianship or dependency proceedings; It may be, for example, that an adolescent has conflicting wishes about keeping information private. Physicians who treat minors have an ethical duty to promote the developing autonomy of minor patients by involving children in making decisions about their health care to a degree commensurate with the childs abilities. This page is intended to be a one-stop resource for guidance and other materials on how HIPAA applies to mental health and substance use disorder information. "Minor consent laws" allow minors to consent for their own care in specific situations and for specific services. Seyfarth. The law. This applies whether the patient is an adult or a minor child. Below are a few notable highlights. Depending on the case, the state, and the courts order, that lawyer may get to determine whether and when parents can view information about mental health treatment. The law is a blunt instrument, as the issue of minors and confidentiality well illustrates. <> Confidentiality protections allow adolescents and young adults to seek the health care they need and protect their privacy for these services. The extent to which the psychologist explains the limitations on confidentiality will depend on the child's age and maturity. %PDF-1.5 themselves to a mental health facility. As the therapy progressed, contact between Michael's mother and his therapist occurred only as needed. First, early in the relationship the psychologist should make clear what relationship she will have to each of the parties. When parents understand that confidentiality is key to effective treatment, they may be more willing to respect their childs need for privacy. A psychologist in this position should seek both legal counsel and consultation from colleagues. When an unemancipated minor requests confidential care and the law does not grant the minor decision-making authority for that care, physicians should: In many jurisdictions, unemancipated minors are not permitted to request or receive abortion services without their parents (or guardians) knowledge and consent. There is suspicion of sexual abuse, meaning any of the following: o The minor has had any involuntary sexual contact or intercourse Some adolescents are minorsunder age 18and some are young adultsage 18 or older. Some therapists require parents to consent to a certain level of confidentiality, even when state or federal law affords the child fewer confidentiality rights. Today the Code is widely recognized as authoritative ethics guidance for physicians through its Principles of Medical Ethics interpreted in Opinions of AMAs Council on Ethical and Judicial Affairs that address the evolving challenges of contemporary practice. Consent to treatment of minors. I work with adolescents, and am not clear about my ethical obligations concerning confidentiality. For minors, however, the right to privacy in therapy is limited. The American Academy of Pediatrics has included substantial related guidance in its Guidelines for Adolescent Depression in Primary Care. Understanding the barriers to care that exist due to fear and stigmatization, the guidelines make it clear that despite the importance of including family in treatment when possible adolescents value their sense of privacy and individuality and should be interviewed alone about depressive symptoms, suicidality, and psychological risk factors. A minor who is "fifteen years of age or older, whether with or without the consent of a parent or legal guardian, may consent to receive mental health services" (C.R.S., 27-65-103). These laws tend to fall into two categories - confidentiality laws, which impose an affirmative duty on the provider to maintain the confidentiality of protected information, and privilege laws, which establish an evidentiary privilege for such information that may be exercised by the patient. vPU x3 For example, supposing a minor forbearing daily their parent's insurance plant, this parent would see the claim in an explained of benefits (EOB), take it hard till unreal stop treatment private in non-school settings. -- A health care provider shall: The mental health guidance addresses three core areas: Guidance on Responding to an Opioid Overdose. The AMA was founded in part to establish the first national code of medical ethics. For example, some parents may abuse or disown a child for their sexual orientation or behavior. Myth: Therapy and self-help are a waste of time. AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health. Help-seeking behaviour and adolescent self-harm: a systematic review. Adolescent minors who consent for their own care are entitled to many confidentiality Minnesota has state laws that allow minors to consent to certain types of services without parent or guardian permission (Minnesota Statutes Sections 144.341 - 144.344). State law addresses the age at which a minor child may consent to certain types of health care and may contain additional requirements related to disclosing a minor's health information to parents (or withholding it). (7) To law enforcement officers or public health officers as necessary to carry out the responsibilities of their office. Over time, Michael and his therapist agreed that Michael himself would begin to speak to his mother about these issues, and that the therapist could follow up with a phone call. Pharmacy records may now be confidential . Third, as the child develops, the structure of the therapy may change for clinical reasons. Consider the following vignette (identifying information has been changed): Michael, age 8, developed headaches and other signs of anxiety around visits to his father, who divorced his mother several years earlier. When Michael reached high school and expressed a wish that the therapist not speak with his mother, the therapist revisited the issue of confidentiality. The ability to be vulnerable in therapy can support a strong therapeutic alliance and can help a person recover more quickly. Thus, the changing clinical picture will have ethical implications. Michael's mother, to support Michael's relationship with his father, adhered to the visitation plan strictly, but her son's anxiety and physical complaints worried her. English, A., & Ford, C. A. Confidentiality and disclosure generally (a) In general. 36 Addiction and mental health services and supports. BMC Psychiatry. 0 Available at: https://phii.org/wp-content/uploads/2020/08/Summary-of-Laws-Related-to-CAMH.pdf Accessed October 19, 2022. *A minor who is at least 16 years of age can consent to services related to pregnancy, delivery, and postpartum care only after the provider has made a reasonable effort to contact the minor's parents or guardian. Under PPRA, parents and students 18 and over shall be notified and given the right to opt-out of collection and disclosure of personal information, as well as certain physical examinations and screenings. 19a-216. Individuals with Disabilities Education Act (IDEA), Part B IDEA protects the rights of children with disabilities and applies to public education from state educational agencies, preschool special education programs, and special education programs for older students.