Parents in particular are required to act in ways that protect and promote childrens best interests. Obstet Gynecol 2020;135:e4350. 8600 Rockville Pike These services do not require a parent or guardian to be present at the medical visit. 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. This would protect their privacy and may help prevent coercion, as entailed by the term free and informed consent. We may have to disclose private information to protect a patients safety. For products jointly developed with other organizations, conflict of interest disclosures by representatives of the other organizations are addressed by those organizations. That is, the law presumes that a minor patient's parent or guardian is their treatment representative. Confidentiality discussions and private time with a health-care provider for youth, United States, 2016. 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. 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. The maintenance of patient confidentiality may be affected by the widespread adoption and integration of EHRs in clinical care, which may necessitate a closer evaluation of the unique challenge this presents for providers of adolescent health care. The duty of confidentiality is based on four major arguments: The principle of respect for autonomy or respect for persons Respect for autonomy, or respect for persons, calls for us to allow others to decide who they want to know certain details about themselves. Obstetriciangynecologists and other health care providers should be active in educating their staff and patients regarding the confidentiality of services. These recommendations should be individually adapted to respect childrens confidentiality in clinical practice, such as in the two cases presented earlier (and the variations proposed immediately following). FOIA Family Code 6925). Clinical practice. Elk Grove Village (IL): American Academy of Pediatrics; 2017. 758, Promoting Healthy Relationships in Adolescents, for potential talking points when discussing confidentiality with parents, guardians, and patients 10. When feasible, obstetriciangynecologists and other health care providers should work with government agencies and legislative bodies to eliminate or mitigate the effect of laws that unduly restrict confidential health services for minor adolescents. If systems of EHRs have already been established, procedures to maintain adolescent confidentiality should be implemented where appropriate 17. 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. In the commentary, the authors stated that the decision making relationship is triangulated between physician, parent and child (9). Confidentiality refers to protection of privileged and private information shared during a health care encounter and in medical records that document the encounter 1. There are many occasions where confidential information may be disclosed and sometimes patient consent is not required. Once confidentiality is breeched, it is difficult to regain trust; so, obstetriciangynecologists should make efforts to avoid the violation of the trust between the health care provider and patient. It provides a safe space to ask questions: Talking to adolescents one-on-one also gives adolescents a chance to ask questions or give information they may feel self-conscious about. J Adolesc Health 2012;51:40914. Children who have decisional capacity (sometimes referred to as mature minors) are recognized as having some degree of decisional autonomy (1); that is, they are capable of deciding which medical treatments to undergo without requiring parental consent under specified conditions. ACOG Committee Opinion No. A parent who consents on the minor's behalf generally has the right to know the content of the child's treatment. However, when child abuse or neglect is . 4th ed. (Health care providers should be cognizant of potential coercion by parent or guardian to maintain access.). Until that time, the law will normally give the parent access to the child's treatment. In contrast, in Quebec law, there is an age threshold rather than a developmental one, where patients who are 14 years and over are entitled to consent and respect for their confidentiality, as per the civil code (NB: some exceptions exist, pertaining to safety and extended stays in hospital) (5). Under the age of majority, children in Canada are generally not considered fully autonomous with regard to consenting to medical treatment and confidentiality (NB: age of majority varies across Canada) (2). Confidentiality in adolescent health care. This article will help incite additional analyses and research that can further refine the normative and practice standards proposed here. 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. 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. However, some therapists . What is Confidentiality Confidentiality is the keeping of another person or entity's information private. Lazebnik: State laws govern adolescent medical confidentiality. 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. Obstet Gynecol 2020;135:e1717.This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. (14). Capacity refers to the ability to understand information that is relevant to making a decision about treatment, and the ability to appreciate the consequences of such decisions (17,18). This study examined the . Confidentiality is about keeping your information private. Numerous federal and state laws contain confidentiality protections for health information. Careful analysis of the relevant state and federal laws, informed by sound ethical principles, can clarify these Lehrer JA, Pantell R, Tebb K, Shafer MA. Since 2012, the German Federal Child Protection Act grants doctors an opportunity to circumvent their duty of confidentiality if they suspect CAN may be occurring, despite the reporting of CAN not being mandatory. OpenNotes. Legally speaking, people under the age of 18 do not typically have a right to confidentiality in therapy. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (. J Adolesc Health 2019;64:3118. 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. There is a paucity of published research and normative standards to guide health care providers in managing issues related to childrens confidentiality. If protection of adolescent confidentiality is not possible within their electronic system, the information technology support within individual institutions should be employed to restrict parental access per HIPAA compliance. Special requirements for electronic medical records in adolescent medicine. We therefore did not categorize the papers based on age. Second, we want to make sure that they have had the opportunity to learn to talk with a doctor by themselves so that when they are young adults, they are prepared to communicate and advocate for what they need. As a library, NLM provides access to scientific literature. 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. 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. Potential for disclosure of laboratory results, prescriptions, and diagnoses may occur with itemized explanation of benefits statements. Forgone health care among U.S. adolescents: associations between risk characteristics and confidentiality concern. Osborn P, Berg CA, Hughes AE, Pham P, Wiebe DJ. 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. Require a parent or guardian code word to access an adolescents patient portal. Obstetriciangynecologists should not misinterpret consent required to provide health care services with consent required to provide education and counseling; that is, even when consent is required by a parent or guardian for provision of contraception, an obstetriciangynecologist may still provide counseling about contraceptive options. 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. American College of Obstetricians and Gynecologists While a child is a minor - in most states and for most purposes, that means under the age of 18 - parents are responsible for their care, and when it comes to health privacy, the general rule is that parents are entitled to know their minor child's protected health information (PHI). 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. This right is recognized throughout civil law norms and in professional codes of ethics. We present an ethical framework and practice recommendations for: (a) respecting confidentiality for children who have decision-making capacity (as legally defined in different jurisdictions) and (b) recognizing some degree of respect for confidentiality among children who do not have decision-making capacity. The authors reported on: (a) how parents can help adolescents understand and manage their health problems; (b) the difference between adolescents and parents in their perceptions of care received and (c) why there were differences and what that could mean for the provision of health care (7,8). 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 Engaging patients through open notes: an evaluation using mixed methods. Bethesda, MD 20894, Web Policies However, there are important exceptions where a minor can consent to their own care, without a parent's permission. We conducted a scoping review of the literature to map existing knowledge on the practice of confidentiality in paediatric health care. 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. Based on our inclusion criteria of articles pertaining to confidentiality in clinical communication, child or children, in English or French, and pertaining to studies in North America, Australia and English Europe (i.e., settings with normative standards similar to those in Canada, the authors practice location) from 2005 to 2015, we narrowed the search down to a final set of seven articles. Federal government websites often end in .gov or .mil. The OpenNotes toolkit 22 offers resources for institutions that choose to provide patient access to health care providers notes. Confidentiality refers to protection of privileged and private information shared during a health care encounter and in medical records that document the encounter 1. It is important for obstetriciangynecologists to be aware of their individual state and local laws. Some degree of confidentiality is . Our interest in preparing this article emerged when we developed a confidentiality policy regarding children, which has since been implemented at the Montreal Childrens Hospital. This may mitigate the intimidation some patients may experience from parents or guardians. Obstetriciangynecologists should work with their health care organizations to be able to provide confidential billing. There should be private conversation time between the health care provider and adolescent patient. J Adolesc Health 2007;40:21826. J Adolesc Health 2016;58:3747. Consult experts when the patients decision-making capacity is uncertain. Most articles did not specify an age group and only identified populations as children or adolescents. Review individual cases and provide proxy access for parents of adolescent patients with disabilities when appropriate. 803. Implementation toolkit. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. The provider can only share the minor's medical information with them with a 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. ACOG Committee Opinion No. In this section, we articulate how dominant standards regarding respect for confidentiality can (and arguably should) be adapted to clinical practice with children. Additionally, they should be informed of any restrictions to the confidential nature of the relationship. 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. Optimally, obstetriciangynecologists should ensure that medical record information, including EHR information, for care provided under minor consent or mature minor provisions is considered confidential and should not be disclosed to parents or guardians without adolescent consent. Furthermore, the childs confidentiality should be respected in relation to all persons other than those directly involved in making treatment decisions or offering care. 758. J Adolesc Health 2014;54:48790. OpenNotes is a national initiative that encourages patient access to visit notes written by their health care providers 19. Confidential Health Care for Minors Download PDF 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 child's abilities. 796. maternal and child health clinics; allied health services, such as optometrists and physiotherapists; naturopaths, chiropractors, massage therapists and other complementary . Obstetriciangynecologists are encouraged to know their individual systems and institutional policies regarding confidentiality, EHRs, patient portals, and the open access for visit notes. Bulk pricing was not found for item. Children may be granted confidentiality and should be actively involved in discussions and decision-making regarding their care. The Health Insurance Portability and Accountability Act (HIPAA) privacy rule, however, defers to state and other federal applicable laws about disclosure of protected health information for unemancipated minors that may allow health care providers discretion regarding parental or guardian access to a minors protected health information 15. There should be private conversation time between the health care provider and adolescent patient. Obstetriciangynecologists are encouraged to ensure conversation time alone with adolescents to clarify the adolescents privileges regarding the release of information and to obtain appropriate and preferred contact method. 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. Any concern for a HIPAA violation should be addressed by individual health care systems. 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 . Numerous federal and state laws contain confidentiality protections for health information. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The AMA was founded in part to establish the first national code of medical ethics. Some exceptional circumstances were highlighted where confidentiality cannot be guaranteed when there is a risk of serious harm to self or others, serious criminal activity, psychosis and where there has been sexual or physical abuse. 6 states allow individuals insured as dependents to request confidential communications from their insurance provider via a written request. Bright futures: guidelines for health supervision of infants, children, and adolescents . Take steps to facilitate a minor patients decision about health care services when the patient remains unwilling to involve parents or guardians, so long as the patient has appropriate decision-making capacity in the specific circumstances and the physician believes the decision is in the patients best interest. Similar caution should be assumed when releasing information to other health care providers. Pediatrics 2012;130:98790. However, there may be substantial cost to these safeguards, and constant reevaluation of protection is imperative. 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. Patients should be informed that there are laws protecting their confidentiality in the health care setting. Any patient treatment-related information . In addition, given the importance of privacy in mental health, many parents may willingly consent to their child's . Potential for disclosure of laboratory results, prescriptions, and diagnoses may occur with itemized explanation of benefits statements. At the initial visit, the obstetriciangynecologist should discuss the following issues with the parent or guardian and the patient: 1) the meaning and importance of confidentiality; 2) the scope of confidentiality protection; and 3) the limitations of confidentiality. 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. When a minor has the right to consent, a provider generally may not disclose the minor's health care information to anyone, including the minor's parents or guardians, without the minor's consent, unless there is an explicit exception in the law that permits or requires the disclosure. Inform or refer the patient to alternative confidential services when available if the physician is unwilling to provide services without parental involvement. Security measures and enhanced EHR standards should be adopted at the systems level to prevent breaches of patient confidentiality. details of any physical or mental health problems you have. . Please try reloading page. Obstetriciangynecologists should emphasize to the parent or guardian that confidentiality is important to foster a safe and trusting environment for adolescents to discuss their concerns and health care. Most EHRs were not designed to provide item-specific control over parental or guardian access and release of adolescent health care information. 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. In one review article, the authors examined the conditions under which social agencies should be notified of suspected child abuse when the disclosure goes against a childs wishes (12). 14 states have provisions that serve to protect the confidentiality of individuals insured as dependents. J Adolesc Health 2004;35:1607. Obstetriciangynecologists should make clear to the patient what limitations, if any, exist in the EHR system. Committee on Adolescence, Council on Clinical and Information Technology. 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). There is a paucity of published research and normative standards to guide health care providers in managing issues related to childrens confidentiality. 4 states have confidentiality protections specific to EOBs. By reading this page you agree to ACOG's Terms and Conditions. Careers, Unable to load your collection due to an error. Beth Israel Deaconess Medical Center, Harvard Medical School. For the purposes of this article, children are divided into two groups: those who are recognized as having decisional capacity and those who are not. Provision of adolescent confidentiality becomes confused by misunderstandings about family-centred care, capacity, legal responsibility, and authority to consent to medical care and treatment. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. Guttmacher Institute. At the initial visit, the obstetriciangynecologist should discuss the following issues with the parent or guardian and the patient: 1) the meaning and importance of confidentiality; 2) the scope of confidentiality protection; and 3) the limitations of confidentiality 1. Children, Confidentiality, Health care, Privacy, Youth, Putting Childrens Interest First - Federal-ProvincialTerritorial Consultations on Custody and Access and Child Support, Treatment decisions regarding infants, children and adolescents, Listening authentically to youthful voices: A conception of the moral agency of children, Toward a moral horizon: Nursing ethics for leadership and practice, Scoping studies: Towards a methodological framework, Family experiences with outpatient care: Do adolescents and parents have the same perceptions. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The minor can consent to medical, dental, or psychiatric care. Grilo SA, Catallozzi M, Santelli JS, Yan H, Song X, Heitel J, et al. Aiden is not seeking any specific intervention at this point, but begs the psychologist not to tell the parents because they wouldnt understand and would be very upset. Obstet Gynecol 2018;132:e21320. The authors argued that physicians have professional obligations to parents and children that may sometimes be in conflict. The American College of Obstetricians and Gynecologists offers the following recommendations and conclusions: 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. 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. 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). Available at: Anoshiravani A, Gaskin GL, Groshek MR, Kuelbs C, Longhurst CA. Obstetriciangynecologists and other health care providers should be active in educating their staff and patients regarding the confidentiality of services. Available at: National Institute for Health Care Management. Many associations of health professionals caring for minors, including the American College of Obstetricians and Gynecologists, the Society for Adolescent Health and Medicine, the American Academy of Pediatrics, the American Academy of Family Physicians, and the North American Society for Pediatric and Adolescent Gynecology, recognize the importance of confidentiality in providing health care for adolescents 7 8 9. Authors of an opinion piece on pelvic pain in adolescents did not explicitly address whether HCPs should reveal the diagnosis to parents, stating that adolescents should be involved in deciding which aspects of the consultation would be discussed with parents (14). 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. There are times when a parental or guardian proxy to the adolescents patient portal may be appropriate, such as when an adolescent lacks the capacity for decision making, including those adolescents with severe intellectual or development disabilities. Statutes and regulations regarding medical record information should be updated to ensure this standard is achieved. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary.
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