Question: “A dilemma has come up in our high school. We have three positions called Therapeutic Counselors. Our first year was 2009-2010 and we learned a lot. We operated on the school law basis of not requiring any teen that came in for counseling to get their parents consent. This year, however, one of our counselors is demanding that we now get parental consent for every student that comes in for counseling. If this happens, I know for a fact that we will miss many students who do not want their parents knowing that they are receiving these services. Do you have any insights about this dilemma? I would sure appreciate any advice or direction that you may have.”

Response: Good to hear about the good work you have been doing. Sorry to hear there is a snag in the process. There are guidelines and rationales for both positions (proceeding with and without parent consent) These look at the legal issues that may be regulated by the state/district; the ethical issues related to the parents rights and responsibilities; the clinical issues related to confidentiality. It is essential to clarify when students can be seen without consent.

As important as the decision is the process by which colleagues talk through the issues to come to an agreement with which everyone feels works. Hopefully, there is a "supervisor" who can facilitate a good discussion of all the issues. We do have a Quick Find on confidentiality/consent that has a number of resources to aid the discussion –
http://smhp.psych.ucla.edu/qf/confid.htm

(1) “I would say that a majority of the schools I have worked with have required parental consent for students to receive mental health services in the school (even though it was not required for guidance counselors, etc.). While sometimes challenging, schools and mental health providers have found that obtaining parental consent provides an important opportunity to engage with parents and families/guardians, and assess the child’s home environment. Also, depending on the background and licensure of the person providing the mental health service (e.g., psychologist, social worker, etc.), Codes of Ethics for the profession might obligate practitioners to obtain consent. For example, in the Code of Ethics for social workers, there is important information on consent processes with clients. One thought is that perhaps this person might get in touch with a local child welfare agency to find out how they pursue consent processes (as I am sure they come across this issue in their practice with children and families). Or this person might connect with other school districts in their area to see what practices they follow? Hope these thoughts might at least spark ideas for the individual below. It does sound like they are in a “gray” area.”

(2) “Got to be honest, I've never heard of someone with a Clinical License not obtaining parental consent, even if they do work in a school, and the services are required under an IEP. I'm sure that's a HIPPA violation, as well as a State Law, but I only know our state. That being said, our state law does provide for minors 14 and older to receive outpatient counseling without the consent of their parents, for up to five visits of no more than 45 minutes each. However, if the clinician believes services will need to continue past those 5 sessions, then part of the work conducted during them it to obtain consent for ongoing treatment. I do know that our state School Social Workers and Counselors, use this as a way to assist students during a crisis situation. Working towards obtaining parental consent as part of their work. Some school district do include a consent form as part of school registration paperwork, that will allow a student to seek services from the School Counselor or Social Worker during a given school year without further parental consent. However, this is very rare and I know the documents were approved by the school districts lawyers. The situation you are addressing is outside providers working within the school environment and not school staff. Then the clinicians are bound by the consent rules of their organization and state law. The following website has resources for school personnel related to Special Ed. Law and Mental Health. Once you get to this link, you will have to scroll down to Mental Health.
http://www.wct-law.com/CM/Custom/TOCPublications.asp

(3) “These questions are always tough. Unfortunately I have more questions than answers...... here are my thoughts: What are the parameters of the law for these therapeutic counselors? She implies that the law allows for providing counseling in the school setting. If that is the case, has she educated the counselors about the parameters (and rationale) for the law? If she is not a credible source, is there someone else (e.g. administrator or attorney) who can speak to the counselors and let them know that they are practicing within the confines of the law. If the law does appear to suggest parent consent is required for counseling, are there exceptions (i.e. substance abuse services, victims of abuse) that might apply to these students? If the counselors decide they want to get parental consent, I would suggest that they do so in such a way that minimizes drop off for this program (e.g. meeting with parents face-to-face, informing them what the services entail, giving them an opportunity to ask questions).”

(4) “We have school based mental health provided by our community mental health partner. The students are clients and they do third party billing and we do not have funds to cover students who do not have insurance but their parents can do a sliding scale fee. We also have a school social worker at the middle school who meets with students but she is in regular contact with the parents but we do not have a permission form that parents sign for them to meet. One idea may be that the school put out in a school newsletter that there are now these services at school and that students can self refer, be referred by staff or by parents to access these services which are free of charge. The services are offered as part of a grant and are being offered by licensed mental health clinicians. Parental permission is not required for a student to attend. - This kind of statement would need to be approved by the administration.”

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UCLA Center for Mental Health in Schools
Dept. of Psychology, P.O.Box 951563, Los Angeles, CA 90095.
tel: (310)825-3634
email: Linda Taylor ~ web: https://smhp.psych.ucla.edu