Continuing Education: Unit II

Addressing Barriers to Learning
New Directions for Mental Health in Schools

Section C Continued

Privacy and Confidentiality

There are numerous reasons why it is important to maintain confidentiality in the delivery of health care services to adolescents. Possibly the most important is to encourage adolescents to seek necessary care, but additional reasons include supporting adolescents' growing sense of privacy and autonomy and protecting them from the humiliation and discrimination that could result from disclosure of confidential information.

The confidentiality obligation has numerous sources in law and policy. They include: the federal and state constitutions; federal statues and regulations (such as those which pertain to Medicaid, Title X family planning programs, federal drug and alcohol programs, Title V maternal and child health programs, or community and migrant health centers); state statutes and regulations (such as medical confidentiality statutes, medical records statutes. privilege statutes, professional licensing statutes, or funding statutes); court decisions; and professional ethical standards.

Because these varied provisions sometimes conflict, or are less than clear in their application to minors, it is important that practitioners have some general guidelines to follow -- or questions to ask -- in developing their understanding how to handle confidential information. Confidentiality protections are rarely, if ever, absolute, so it is important for practitioners to understand what may be disclosed (based on their discretion and professional judgement), what must be disclosed, and what may not be disclosed. In reaching this understanding, a few of the most relevant questions include: What information is confidential (since it is confidential information that is protected against disclosure)? What information is not confidential (since such information is not protected)? What exceptions are there in the confidentiality requirements? What information can be released with consent? What other mechanisms allow for discretionary disclosure? What mandates exist for reporting or disclosing confidential information?

In general, even confidential information may be disclosed as long as authorization is obtained from the patient or another appropriate person. Often, when minors have the legal right to consent to their own care, they also have the right to control disclosure of confidential information about that care. This is not always the case, however, since there are a number circumstances in which disclosure over the objection of the minor might be required: for example, if a specific legal provision requires disclosure to parents; a mandatory reporting obligation applies, as in the case of suspected physical or sexual abuse; or the minor poses a severe danger to himself or others.

When the minor does not have the legal right to consent to care, or to control disclosure, the release of confidential information must generally be authorized by the minor's parent or the person (or entity) with legal custody or guardianship. Even when this is necessary, however, it is still advisable -- from an ethical perspective -- for the practitioner to seek the agreement of the minor to disclose confidential information and certainly, at minimum, to advise the minor at the outset of treatment of any limits to confidentiality. Fortunately, in many circumstances, issues of confidentiality and disclosure can be resolved by discussion and information agreement between a physician, the adolescent patient, and the parents without reference to legal requirements.

Excerpted from "The Legal Framework for Minor Consent" by Abigail English written as the introduction to State Minor Consent Statutes: A Summary (April, 1995) prepared by the National Center for Youth Law (authored by M. Mathews, K. Extavour, C. Palamountain, & J. Yang).

Finally, it should be noted that the sharing of confidential information within and across agencies can be facilitated through developing a Consent to Exchange Confidential Information. The forms on the following pages illustrate those that are being developed around the country to overcome the barriers to the type of sharing that is essential in coordinating services.

Note that the form is designed to meet the varying demands of federal and state laws and education codes.

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Child's Name______________________ Birth Date__________
Mother's Maiden Name______________ Father's Name__________
Social Security No__________________ Record No.__________

I authorize_____________________ to exchange information with (Agency/Person/Organization)________________________ (Address)_________________________ about information obtained during the course of my/my child's treatment/case/service plan for_______________________________.

The exchange of records authorized here is required for the following purpose:___________________________________.

Restriction: Release or transfer of the specified information to any person or agency not named herein prohibited unless indicated below:

Such exchange shall be limited to the following specific types of information:_____________________________________________

This consent is subject to revocation by the undersigned at any time. It shall terminate, without express revocation on:_______________________.(Date, Event, or Condition)

I understand I am entitled to receive a copy of this consent. _____copy(ies) requested and received.
I have read this consent carefully and have had all my questions answered.

Date_____________ Witness___________________

Signed (Parent, Guardian, Conservator)____________________________

Signed (Case Manager/County Representative)__________________________


Confidential Client Information



The following records and/or information was released to:


____Summary of Record ____Psychiatric Evaluation ____Results of Psychological /
Vocational Testing
____Diagnosis / Assessment ____Medical Assessment,
Lab, Test, etc.
other (specify)
____Social History ____History of Drug/
Alcohol Abuse
____Treatment Plan ____Other Evaluation/
Assessment (specify)
____Financial Information

Released by:

TITLE________________________________________ DATE______________________.

Case Name:

Citiaion Examples:

Case Record No.:

Health and Safety Code 5
W&I Code 10850 and 5328
Ed. Code 49075
Civil Code 56 and 1796
42 CFR Part 2
Date of Birth:

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Test Questions -- Unit II: Section C

(1) Which of the following are major aspects of the legal concept of consent?

___(a) a person must have the capacity to consent
___(b) a person must have appropriate and sufficient information before being asked to consent
___(c) a person's consent must be given voluntarily
___(d) a and b
___(e) a and c
___(f) b and c
___(d) all of the above

(2) It is important to maintain a client's confidentiality to protect embarrassing information from disclosure.

___True ___False

(3) It is important to maintain a client's confidentiality to minimize the likelihood of discrimination against the person.

___True ___False

(4) It is important to be able to offer confidentiality to encourage individuals to use services.

___True ___False

(5) Identify two major exceptions to client confidentiality in a psychosocial counseling situation.

This is the end of Unit II Section C.

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Unit II Coda

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