Staff Spark 3: Confidentiality and Minor Consent – Best Practices Adolescent Champion Project

“I. Am. The. Mom.”

Ms. Duffy said in her post, "Let's get one thing straight: no doctor or nurse is going to sequester my children in an exam room and talk to them privately. Period."

Recap: Michigan Law Patients ages 12 and up have a right to the following WITHOUT parental/guardian consent or knowledge: Pregnancy testing and prenatal care Birth control information and contraceptives Testing and treatment for sexually transmitted infections (STI's) Substance abuse treatment Patients ages 14 and up can access mental health counseling without parental/guardian consent/knowledge Up to 12 visits, or 4 months

Recap: Michigan Law Healthcare providers must breach the minor’s confidentiality and tell the parent if: There is suspicion of abuse by an adult The minor is a risk to themselves or someone else The minor is under age 12 and has been sexually active The provider may choose to tell the parents about any care provided to the minor patient for a compelling medical reason, in very rare situations Minors need a parent/guardian’s permission for: Vaccines (including HPV) Mental health medications Inpatient mental health treatment An abortion (unless a court-approved waiver is obtained)

Handout: Clarification on Laws, Policies, and Best Practices Reviewed on handout Policies Institution (UMHS, etc.), site Best practices Based on research (for example, studies show that when teens are assured of confidentiality, they seek healthcare more often and are more honest with their provider) Allows for the discretion of provider and/or staff

Lansing Situation Are there any laws that require the provider has time alone with the patient? Are there new confidentiality laws we should know about?

How do we talk to parents? A framework of understanding Parents/guardians are not the enemy. Parents/guardians are experiencing their own adjustment to their child’s adolescence. Providers have an opportunity to educate parents/guardians about the need for confidentiality in the provider-patient encounter. Providers should spend part of every visit (or at least yearly) with the teen alone. 

How do we talk to parents? Best Practice – Sample Script “As teens begin to develop into adults and take responsibility for their lives, we always ask parents/guardians to wait outside for part of the visit to encourage the teen to discuss his or her own view of their health.”

How do we talk to teens? Best Practice: Rights & Limitations Inform adolescent patients about their rights and limitations regarding confidentiality laws and procedures. Many teens don’t know that they have the right to access certain services without a parent/guardian’s consent.  Adolescents are more likely to disclose sensitive information if they have an assurance of confidentiality from their provider. Some populations of youth need extra assurances of confidentiality: 1) HIV positive youth, 2) LGBTQ youth, 3) Pregnant and parenting adolescents, and 4) sex workers.

How do we talk to teens? Best Practice: Insurance & Confidentiality Inform adolescent patients that if their insurance is billed for a service, that an Explanation of Benefits (EOB) may be mailed to their parent/guardian.  See UMHS Policy on Minors: Consent to Confidential Health Services on handout. Provide referral information for free or sliding scale clinics to adolescent patients who don’t want to use their parent/ guardian’s insurance. AHI’s “Find a Provider” map at umhs-adolescenthealth.org Or www.findcare.org

Mandatory Reporting Guidelines for Sexual Contact Reporting to Parents Mandatory if the child is under 12   Provider can consider reporting to the parents if the child is 12-15 but there is concern of coercion Reporting to Child Protective Services If the patient is under 16 they can’t legally consent to sex, and this can be reported.   It is rarely prosecuted – therefore, if the provider is not concerned with abuse or power differentials, then they should use their judgment, and is not required to report.   If the patient is under 13 then the degree of offense is higher and more likely to be prosecuted.   Providers can report to the police without telling the parents if needed.

The UMHS Child Protection Team is a great resource to discuss a particular situation.

Resources Confidentiality handout of laws for staff AHI Parent/Guardian Handout AHI Health Rights for Teens AHI Teen Patient Handout AHI “Find a Provider” Interactive Map umhs-adolescenthealth.org Findcare.org – identifies all sliding scale fee resources in a region

Sparklers – More case scenarios Questions?