Sharon Levy, MD, MPH Children’s Hospital Boston

Slides:

Advertisements

Similar presentations

TUTORIAL MODULE 3 ASBIRT Alabama Screening, Brief Intervention, Referral, and Treatment Program.

Advertisements

Confidentiality quiz. (MPU). Death certification A 43 year old patient died of an infarct recently. You know that he had HIV and believe that it contributed.

1 SUBSTANCE ABUSE TREATMENT CONFIDENTIALITY National Center on Substance Abuse & Child Welfare February 17, 2004.

National Health Information Privacy and Security Week Understanding the HIPAA Privacy and Security Rule.

P E N N S Y L V A N I A C O A L I T I O N A G A I N S T D O M E S T I C V I O L E N C E P E N N S Y L V A N I A C O A L I T I O N A G A I N S T RAPE HIPAA.

Staff Spark 2: Confidentiality and Minor Consent – Laws Adolescent Champion Project.

Objectives  Review federal statutes (HIPAA, FERPA)  Discuss state guidelines  Review local procedures

Preoperative Management of Adolescents Undergoing Elective Surgery Nina L. Shapiro, MD Associate Professor Department of Head and Neck Surgery David Geffen.

Minor Consent Laws Kim Belasco – (619) Rachel Miller – (619)

1. 2 Objective To build capacity of staff and partners on safeguarding children and vulnerable young people in the implementation of the project. Outputs.

Consent and Confidentiality for Children in New Mexico Liz McGrath Executive Director Pegasus Legal Services for Children.

Ethics As of &July2008. Answers from APA’s The Principles of Medical Ethics with Annotation Especially Applicable to Psychiatry.

University of Hawai’i Integrated Pediatric Residency Program Continuity Care Program Medical Home Module Case 1.

Prevention with Positives HIV Clinician Training Legal concerns of providers integrating HIV prevention into clinical practice Carol Dawson Rose, PhD,

Secrets, Lies and Testing Dilemmas: Parents’ Requests for Adolescent Drug Testing, Sexual behavior Information Sharing and Ownership of Diagnostic Results.

Healthcare Transition: Getting on the Same Page Peter Scal, MD MPH Department of Pediatrics University of Minnesota July 21, 2012.

Patient Autonomy and Informed Consent. Begin reading at Law, p 82 (we covered the ethical issues in the Ethics text). Bottom of p 82 the book talks about.

Your Health and the Law A Guide for Teens Seventh Edition.

Michigan Medical Home.

University of Hawai’i Integrated Pediatric Residency Program Continuity Care Program Medical Home Module Case 3.

Comprehensive Children’s Mental Health Act

INTRODUCTION TO CLINICAL PSYCHOLOGY, THIRD CANADIAN EDITION by John Hunsley and Catherine M. Lee Chapter 5.

Legal Issues Concerning Minors For STD Workers ISDH STD Prevention Program 2014.

Principles of medical ethics Lecture (4) Dr. rawhia Dogham.

Using Teen Actors to Teach How to Communicate with Adolescents Anisha Abraham, MD, MPH Associate Professor, Department of Pediatrics Chief, Section of.

Responding to Students at Risk of Suicide – How Assertive is too Assertive? Gerard Hoffman Head of Counselling Service Victoria University of Wellington.

Minors and Mental Health Treatment: Who Gets to Decide? Center for Children’s Advocacy KidsCounsel Seminar September 29, 2009 Jay E. Sicklick, Esq. Deputy.

Confidentiality in Adolescent Health Care: Research, Ethics, Law, and Policy Abigail English, JD Director Center for Adolescent Health & the Law Treuman.

© 2007 McGraw-Hill Higher Education. All rights reserved. Lesson 2: Legal Liability.

Improving Adolescent Health: Addressing Depression and Substance Abuse in a Primary Care Setting For Primary Care Providers Caring for Adolescents in Oregon.

The identification and treatment of physical and sexual violence among adolescents in a healthcare setting: The Mount Sinai Adolescent Health Center By.

Staff Spark 3: Confidentiality and Minor Consent – Best Practices

Navigating Managed Care1 PARTNERING WITH PROVIDERS Work to build strong, trusting relationships so providers really stand behind you, your child, and your.

1 Privacy Issues in a Pediatric Healthcare Setting HIPAA Summit September 9, 2005, Session IV Kathleen Street, JD, LLM Children’s Health System Birmingham,

1 HEALTH CARE NEEDS OF CHILDREN AND YOUTH IN THE CHILD WELFARE SYSTEM California Common Core Curricula for Child Welfare Workers.

Intimate Partner Violence: Effects on Children Why Do We Need to Screen? Heidi M. Sallee, MD University Pediatrics Saint Louis University Saint Louis,

 Collaboration › A non-hierarchical partnership › Focus on mutual understanding  Evocation › Supporting client in discovering own motivation for change.

The Tension Between Confidentiality and Accessibility Edward B. Goldman, J.D. Deputy General Counsel University of Michigan October 10, 2007.

For Pain or Not for Pain: Methadone Madness

CONFIDENTIALITY LEAH Lecture by Yolanda Evans MD MPH.

Resources to Improve Private-Sector Providers Chlamydia Screening Practices Gale R Burstein, MD, MPH, FAAP Erie County Department of Health Buffalo, NY.

Patient’s Bill of Rights. The pt. has the right to considerate and respectful care. The pt. has the right to considerate and respectful care. The pt.

Abuse & Violence Why What How When. Just by looking, can you tell who has been abused? Nearly five children die every day in America from abuse and neglect.

SCREENING BRIEF INTERVENTION AND REFERRAL TO TREATMENT (SBIRT) 1.

+ Case 1: Linda 45y/o Female with Bipolar disorder Divorced Researcher at Tufts Medical Center Seen the same therapist for 20 years Weekly Appointments.

Use of Opioids fro Chronic Pain in Primary Care Norman Wetterau MD

How Do I Access PREP or Refer Someone? Jackie Yanofsky, MSW Treatment Coordinator PART and PREP Programs UCSF, Psychiatry Department.

Florida Mental Health Summit August 2015 Elise Fallucco, MD Child and Adolescent Psychiatrist, Nemours Children’s Specialty Care Physician Scientist, Nemours.

Abortion in Australia Abortion is not uncommon for young women in Australia; about 30% of women become pregnant in their teenage years (usually their.

 We are a student-focused department.  Our goal is to partner with you in achieving optimal health.  We hope to see you for your health needs and look.

Unit 4 Seminar. Key Terms  Confidentiality  Privileged communication  Privacy.

Elizabeth Garnsey  Minors(children) are not little adults.  There are unique ethical concerns that arise when clients are minors.

KITS V JUNE , 2014 BREAKING DOWN AND UNDERSTANDING THE PSYCHOLOGICAL : WHAT YOU DON’T KNOW CAN HURT YOU M. Connie Almeida, PhD, LSSP, Licensed Psychologist.

Can Providers Assure Commercially Insured Adolescents Confidentiality for STI Screening and Treatment? C onflicting Laws and Innovative Approaches Abigail.

Primary Care Models for Chronic Pain Treatment Melissa Weimer, DO, MCR.

Protecting abortion access for teens: Defeating parental notification in Oregon Alison Edelman, MD, MPH Assistant Professor Department of OB/GYN ARSM 2007.

HIPAA and Transitions Protected Health Information PHI.

Bridget Burnett, PsyD Kathryn Jantz, MSW, MPH Sue Williamson, JD

Counseling and Legal Issues

Kids' legal rights in medical care, your obligations and risk minimisation 27 April 2017.

Medication-Assisted Therapy at Coleman Profession Services

Working with Adolescents: Additional Considerations

Screening, Brief Intervention and Referral to Treatment

Jay Sicklick, Esq. Center for Children’s Advocacy August 6, 2018

Professional Associations & Position Statements Training UPDATE

Intimate Partner Violence Reporting Training UPDATE

Conflicting Laws and Innovative Approaches

Case 1 – 17 yo white female 2 year history of using opioids – prescription post minor surgery, continued use post prescription (non-medical sources) –

Confidentiality and Consent Issues Involving Minors in Rhode Island

ETHICAL CHALLENGES AND MANAGING RISK IN SOCIAL WORK PRACTICE

Presentation transcript:

Sharon Levy, MD, MPH Children’s Hospital Boston Confidentiality: Parents and Teens Sharon Levy, MD, MPH Children’s Hospital Boston

Teen Seeking Treatment Anna is a 15 yo girl who presents for evaluation and treatment of opioid dependence. She would like to try Suboxone. She does not want her parents to know about her treatment.

*Weddle M, et al. Pediatr Clin North Am. 49(2):301-315 Legal Issues Governed by state rules In 42/50 states minors can consent to outpatient counseling for substance abuse without parent consent* States differ in the types of services included *Weddle M, et al. Pediatr Clin North Am. 49(2):301-315

Williams RJ, et al. A Clin Psychol 2000;7:138-66. Practical Issues Insurance carrier may notify parent if insurance is under their name. May be difficult for teen to manage treatment requirements without parent knowledge. Teens respond better to treatment when parents are involved* Williams RJ, et al. A Clin Psychol 2000;7:138-66.

Clinical Pearls Engage patient in treatment. Screen for potential domestic violence. Make informing parent(s) a treatment goal.

Teen Identified by Screening Brian is a 16 year old boy who presented for an annual physical. After you discussed confidentiality you do a routine SBIRT screen. He tells you that he smokes marijuana daily. You would like him to see a psychologist for further evaluation.

Practical Issues Use of marijuana is usually not considered an “acute risk” in the context of confidentiality. Sharing information with parents could threaten therapeutic relationship and ability to follow him further. But, teens who are referred for evaluation or treatment of substance use disorders are unlikely to follow through on their own.

Clinical Pearls Ask if parents are aware of drug use. If so, inviting parents into conversation may be easy. Ask permission to share information with parents. Teen who discloses heavy drug use may be trying to get help. Side with the teen when presenting information “Brian has been very honest with me and told me that he uses marijuana. He has agreed to see a psychologist to talk about this further; I will give you the referral information so that you can help coordinate.”

Parent requests to see medical record Sara is a 17 year old healthy girl who you follow for primary care. She recently had a “panic attack” which was associated with one time use of cocaine. Her mother asks to review her medical records.

American Academy of Pediatrics Confidentiality Laws Tip Sheet Legal Issues HIPAA rules allow parents access to the medical records for their minor children except: When parental consent for treatment is not required. When a minor obtains care at the direction of a court. When a parent agrees that a health care provider and minor may have a confidential relationship. American Academy of Pediatrics Confidentiality Laws Tip Sheet

Clinical Pearls Review your confidentiality policy with parents. Assure parents that their daughter has been screened and no further assessment is recommended at this time. Discuss the benefits of maintaining confidentiality versus the risks of breaking confidentiality.

Parent confidentiality Mrs. Smith accompanies her 15 yo son to an appointment. She speaks to you alone and requests a drug test. She saw something about him using marijuana on Facebook. She asks you to keep everything confidential.

Policy Issues The American Academy of Pediatrics recommends that physicians refrain from ordering urine testing on competent adolescents without their knowledge and consent. AAP policy statement. Pediatrics Vol. 98 No. 2 August 1996, pp. 305-307

Practical Issues Drug testing has significant limitations. A negative drug test would not rule out drug use. A positive drug test supports a history of drug use, but does not discern between single time and chronic or heavy use. Drug testing without consent may damage the relationship between child and parent.

Clinical Pearls Encourage parents to discuss what they saw on Facebook. Interview the teenager alone to take a substance use history. If recent substance use is denied, consider suggesting a drug test to “prove it” to parents.