Adolescence is a time of rapid change in both physically and emotionally. Young people may be overwhelmed with conflicting and confusing feelings regarding changes in their bodies, sexuality, as well as their place in family, friends and society. Most adolescents have few serious medical problems, however it can be a dangerous time of experimentation with high-risk behaviors, while lacking the maturity to make sound, safe decisions. To work toward a healthier adolescent population, health care providers must address sensitive issues that impact the physical and emotional health of modern youth. It is important for health care providers to be comfortable discussing sensitive issues with adolescents. Issues pertinent to facilitating such discussions are confidentiality and consent.

Confidentiality

Adolescents are a group that is very concerned about privacy and the judgment of others. Lack of confidentiality in adolescent health care can create barriers to care. It is first important that the parent and adolescent be separated so that the provider can privately discuss issues with the patient. Both the patient and the parent should be informed of the adolescent’s right to confidentiality when seeking information and services on sexuality, contraception, mental health services, and substance abuse (laws may vary by state). The provider should make it clear that patient confidentiality is necessary to provide optimal medical care. On the other hand, it is important for the patient to understand that the established confidentiality is not absolute or unqualified. In circumstances where there is imminent harm to the patient or others, confidentiality may be forsaken to obtain help for the patient. In these circumstances, the patient should be informed of what information needs to be disclosed and to whom. The patient should also be given the opportunity to make disclosure to their parents or others on their own. Specific instances include:

• Suicidal ideation
• Homicidal ideation
• Physical abuse
• Sexual abuse
• Behaviors that put one at risk of physical harm

Consent

Historically, a basic rule in providing medical treatment to minor children, including adolescents, has been that the consent of the parent is required. Nevertheless, a substantial body of the law allows adolescents; generally persons aged less than 18 years, to give consent for their own care in a wide variety of circumstances. Categories of minors most commonly authorized to give their own consent for a broad range of services are:

• Mature minors
• Legally emancipated minors
• Married minors
• Minors in the armed forces
• Minors living apart from their parents
• Minors over a certain age
• High school graduates
• Pregnant minors
• Minor parents

• Emergency care
• Pregnancy related care (sometimes including abortion)
• Contraceptive services
• Diagnosis and treatment of STDs
• Diagnosis and treatment of reportable, infectious, contagious or communicable diseases
• HIV/AIDS testing and/or treatment
• Treatment or counseling for drug or alcohol problems
• Collection of medical evidence or treatment for sexual assault
• Inpatient mental health services
• Outpatient mental health services

Although the controversy surrounding abortion is long-standing and not limited to the questions related to the minor’s access to abortion. Some states have enacted a parental consent law.
 
 

Confidentiality Laws

Generally, if a minor has the right to consent to care, then information may not be disclosed to parents without the patient’s consent.
 
 

Some approaches to working with adolescent patients

• Time MUST be spend alone talking to the adolescent
• It is often useful to talk to the patient individually, then speak to the parent individually, and then both together
• On issues that are confidential, encourage adolescents to discuss the issue with parents, or disclose the issue
• Follow the HEADSS interview format: Home, Education/Employment, Activities, Drugs, Sexuality, Suicide
• It can be useful to ask patients about their friend’s involvements in risky behavior: ex. Do your any of your friends smoke or drink alcohol?;
• Encourage adolescents to share their knowledge with you before giving them information: ex: Have you thought of what kind of birth control method you might want to use?" Allow them to tell you if they have been thinking about the pill versus Depo, then explain the various methods.
• Open-ended questions are helpful in directing further questioning.