(2004). English, A., & Ford, C. A. General Medical Council (2009) Confidentiality. To alleviate these fears, HCPs should consider communicating with parents early on around the developmental appropriatenessand the laws affectingconfidential health care for adolescents, and its demonstrable benefits. Washington, DC. Our study should be replicated and expanded in other institutions that provide health care to adolescents. ACOG Committee Opinion no. Society for Adolescent Health and Medicine; Gray SH, Pasternak RH, et al. Over the past few decades, the medical literature has extensively documented that effective care of adolescents requires that the interaction be confidential (4,5). Confidentiality refers to protection of privileged and private information shared during a health care encounter and in medical records that document the encounter 1. Confidentiality in Adolescent Health Care. the contents by NLM or the National Institutes of Health. The laws governing consent and confidentiality in adolescent health care vary from country to country . The complex nature of the parent-child relationship in the context of a family-centred approach, along with the adolescents developing need for autonomy and continuing need for support, can pose significant ethical challenges for health care providers. Juveniles in residential placement: 19972008 (Vol. Boekeloo, B., Schamus, L., Cheng, T., & Simmens, S. (1996). Before Cheng, T., Savageau, J., Sattler, A., & DeWitt, T. (1993). Moreover, sensitive health issues that an adolescent is not ready to disclose to others may be documented and accessed all too easily by other health professionals without explicit consent being given. Paediatr Child Health 2018;23(2):138-46: https://cps.ca/en/documents/position/medical-decision-making-in-paediatrics-infancy-to-adolescence. Coding frame categories matched the research questions regarding understanding and practice with open categories for further analysis of emerging themes. Obstetriciangynecologists are encouraged to know their individual systems and institutional policies regarding confidentiality, EHRs, patient portals, and the open access for visit notes. Access to reproductive healthcare specifically is a major tenet of confidential adolescent care. Confidentiality protection is an essential compo- nent of health care for adolescents because it is consistent with their development of maturity and autonomy and without it, some adolescents will forgo care. General Medical Council (2007) 0-18 Years: Guidance for all Doctors. Internet addresses are current at time of publication. Nowell, D., & Spruill, J. Confidentiality protections encourage adolescents to seek care and openly discuss issues related to sexuality, substance use, and mental health concernssometimes without parental consent or notificationallowing clinicians to fulfill their role in improving adolescent health. AIDS Patient Care and STDs, 23(5), 371376. Accessibility Both the adolescent and the parent, guardian, or caregiver should be made aware of these circumstances by the HCP involved. American College of Obstetricians and Gynecologists. 633: Alcohol Abuse and Other Substance Use Disorders: Ethical Issues in Obstetric and Gynecologic Practice, Practice Bulletin No. Google Scholar. Medical decision-making in paediatrics: Infancy to adolescence. Washington, DC: The National Academies Press. (2009). The various clinical roles were grouped into categories to generate meaningful sample sizes for analysis. Evaluation of the TRICARE Program: Fiscal Year 2012 Report to Congress. Ensuring the confidentiality and protection of health information is the standard of care for adolescents. Pediatrics, 131, 12061210. Clinicians should communicate to adolescents and their parents or caregivers the developmental importance of increasing autonomy and responsibility related to health care decision-making to facilitate better transition in navigating the adult health care system. Moreover, each Canadian province and territory has legislation regarding health record privacy protections, some of which takes precedence over PIPEDA. MMWR. A fast-evolving issue related to the provision of confidential care for adolescents is the emergence and proliferation of health information technologies. A comprehensive history and physical examination that includes sensitive personal information is often required for clinical decision-making involving adolescents. Guttmacher Institute, 2017 ). Some error has occurred while processing your request. Denny S, Farrant B, Cosgriff J, et al. English, A. JAMA, 282(23), 22272234. (2007, October/November). https://www.priv.gc.ca/en/privacy-topics/privacy-laws-in-canada/the-personal-information-protection-and-electronic-documents-act-pipeda/. Obstetrics and Gynecology Clinics of North America, 27(1), 195211. Divisions of HIV/AIDS Prevention. (2012, November). Full-text document published online on March 26, 2020. CANADIAN PAEDIATRIC SOCIETY ADOLESCENT HEALTH COMMITTEE (2021-2022), Members: Holly Agostino MD, Marian Coret MD (Resident Member), Megan Harrison MD, Ayaz Ramji MD (Board Representative), Alene Toulany MD, Ashley Vandermorris MD, Ellie Vyver MD (Chair), Liaisons: Amy Robinson MD (CPS Adolescent Health Section), Principal authors: Holly Agostino MD, Alene Toulany MD. As a library, NLM provides access to scientific literature. In: Elster AB, editor. Journal of Adolescent Health, 46(4), 307308. Retrieved from http://nahic.ucsf.edu/download/health-care-for-homeless-youth-policy-options-for-improving-access/. Keep in mind that statutes relating to the confidentiality of an adolescent's health care vary from state to state and also according to the issue involved. The selected Green Journal articles are free through the end of the calendar year. Consent and confidentiality for adolescents in health care are too often neglected topics. Guidelines for Adolescent Preventive Services (GAPS). A legal and policy framework for adolescent health care: Past, present, and future. . We will use the information from the present study to develop educational interventions in our institution (17). Special requirements for electronic medical records in adolescent medicine. Office of the Privacy Commissioner of Canada. Teens and mobile phones. Les chercheurs ont reu un total de 389 rponses, reprsentant des dispensateurs de soins de diverses disciplines. The Old Town Center is well worth visiting. PubMed Hosp Pediatr 2015;5(2):67-73. Confidentiality in adolescent health care. (2003). The authors recommended strategies to improve the understanding and practice of adolescent confidentiality include: encouraging individuals examination of beliefs; postsecondary instruction; knowledge-translation strategies within programs; and institution-directed guidelines and policy. Paediatr Child Health 2012;17(6):305-06. Other analyses of respondent comments revealed individual and team knowledge gaps regarding adolescent and parent/guardian rights, and the difference between the constructs of consent to treatment and the provision of confidential health care for adolescents. Canadian Medical Association. ACOG Committee Opinion No. A hallmark of delivering quality adolescent health care services is the provision of confidential care. PubMed Wadman R, Thul D, Elliott AS, Kennedy AP, Mitchell I, Pinzon JL. Justified paternalism in adolescent health care. CrossRef Some potential respondents may have had a different understanding and interpretation of self-selecting and, with surveys based on self-reporting, there is always the possibility for discrepancy between what is reported and reality. 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. poverty, such as educational shortcomings or poor health, neighbourhood-based statistics need to be gathered as the basis for local fine-tuning. HIV among youth in the US. 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. Disclaimer. While confidentiality is a basic principle for all health care encounters regardless of age, the unique considerations for capable adolescent patients are not always realized or appreciated. Despite clear advantages, the delivery of confidential services remains suboptimal for adolescents in Canada [3]. Holly Agostino MD, Alene Toulany MD; Canadian Paediatric Society, Adolescent Health Committee Adolescent Health Committee. Recommendations and Rationale. Centers for Disease Control and Prevention. Others believe that as long as the adolescent is younger than 18 years of age, and the parent or legal guardian is signing the consent for treatment, the parent or legal guardian should be present at all medical appointments and have access to all information shared with health care providers. In both provinces, parents continue to have access to their adolescents medical information before the ages specified by law. The ACOG policies can be found on acog.org. Staff may have been on more than one electronic mailing list, staff may not have checked their e-mail during the time the survey was available and it was not feasible to determining how many of the 1800 staff receiving the survey had the potential to engage in caregiving interactions with adolescents. Archives of Pediatrics & Adolescent Medicine, 166(4), 331336. Time alone with HCPs fosters adolescent independence and the development of skills to better navigate both paediatric and adult health care systems [12]. Archives of Pediatrics and Adolescent Medicine, 155(9), 10721073. There is no universally accepted, legally defined age of consent for health care decision-making in Canada. Adolescents perception of factors affecting their decisions to seek health care. All rights reserved. Government of Canada. Adolescents interpretations of conditional confidentiality assurances. Published 1991. Feelings of uneasiness around discussing sensitive information, and concern about subsequent questions from parents or caregivers have been reported. Some clinicians believe that to offer adolescents confidential health care, they must assess and document that person as a mature minor in the health record. Pediatrics, AAP Council on Community Pediatrics. (2000). . Confidential health care for adolescents: Position paper of the Society for Adolescent Medicine. 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. HCPs can encourage adolescents to sweep the room with their cameras to establish who is present, to use headphones, or to utilize chat functions to limit the ability of others to overhear medical conversations. Office staff should also be trained to welcome adolescents who present or call for an appointment on their own, and to safely relay test or other results. (2011). Your message has been successfully sent to your colleague. official website and that any information you provide is encrypted An official website of the United States government. The Society for Adolescent Health and Medicine (SAHM) and the American Academy of Pediatrics (AAP) encourage adolescents to discuss health issues with their parents while also supporting their right to privacy [5] [26]. (1995). While survey items did not include inquiry related to beliefs, respondents revealed related information in the open-ended and response questions, indicating that values and beliefs create a basis for how adolescent confidentiality is ultimately understood and practiced. Ginsburg, K., Slap, G., Cnaan, A., Forke, C., Balsley, C., & Rouselle, D. (1995). (2012). HIPAA: A military perspective. While confidentiality is a basic principle of all health care, it may not be clear to practitioners that the practice of confidentiality applies to adolescents. Sugerman, S., Halfon, N., Fink, A., Anerson, M., Valle, L., & Brook, R. (2000). Therefore, just as with right to confidentiality, the capacity of adolescent patients to consent to a proposed treatment varies with age and circumstances and must be determined on a case-by-case basis. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. Our findings are unlikely to be unique. J Adolesc Health 2016;58(2):134-40. This review examines confidentiality, consent to health care and research involving adolescents in regard to legal and ethical aspects. Involving children in medical decisions. Confidentiality in health care: A survey of knowledge, perceptions, and attitudes among high school students. Accessibility related to adolescent health care that address confidentiality for particular health care settings, special populations, and specific services preventive health care, testing & treatment for STDs & HIV, contraception, pregnancy-related care, and other reproductive health services. Journal of Adolescent Health, 29(3), 156159. In particular, adolescents are less likely to openly communicate with HCPs around issues related to substance use, mental health, and sexuality when confidentiality cannot be guaranteed [10]. Les dispensateurs de soins considrent la confidentialit comme fondamentale, mais le sondage a rvl une vaste variation de la comprhension et des pratiques quant la confidentialit des soins des adolescents, tant dans les donnes qualitatives que quantitatives. (2005). The Calvin house dates back over 700 years to the 14th century. The present voluntary, anonymous online survey was available for data collection over 14 days in March 2012 at the Alberta Childrens Hospital in Calgary (Alberta). The grouping of these specific roles did not change the overall findings. Levenberg, P., & Elster, A. evidence-based practice in adolescent health care. While confidentiality is a basic principle for all health care encounters regardless of age, the unique considerations for capable adolescent patients are not always realized or appreciated. Telemedicine can improve health care access and is likely to be an increasingly common option for medical interactions because it allows flexible scheduling. http://ktclearinghouse.ca/knowledgebase/knowledgetoaction. Correspondence to McKee MD, Rubin SE, Campos G, OSullivan LF. Do you provide this information to the adolescent: Everything we discuss with you today is confidential with three exceptions: if you are at risk of immediate harm; if you are putting someone else at risk of immediate harm; if someone else is putting you in immediate harm? 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.