CE Credit

Teen Consent and Confidentiality

Welcome to the training on Teen Consent and Confidentiality provided by the Texas Department of State Health Services (DSHS) and the Texas Health and Human Services Commission (HHSC).

Credit hours: 1.5 CE

Goal

The goal of this module is to equip Texas Health Steps providers and other interested health-care professionals to apply legal requirements, best practices, and ethical guidelines related to consent and confidentiality for adolescent patients.

Target Audience

Texas Health Steps providers and other interested health-care professionals.

Specific Learning Objectives

After completing the activities of this module, you will be able to:

  1. Specify how and why to establish confidentiality and seek consent or assent when dealing with adolescent patients.
  2. Determine who can give consent for health care for minors in various situations, including identifying when teens may consent to their own treatment.
  3. Apply ethical principles and comply with Texas law when youths engage in risky behaviors, request services the provider disapproves of, or exhibit signs of abuse or neglect.
  4. Integrate culturally effective techniques into clinical encounters with adolescent patients.

Please note this module expires on 9/13/2020.

Accreditation Statement

Disclosures

U.S. Law Relation to Teen Consent and Confidentiality
Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191 Federal legislation that, among other things, provides data privacy and security provisions for safeguarding medical information.
Title 42 Code of Federal Regulations § 59.5(a)(4) Federal legislation that states a family planning project receiving federal grant funding must provide services without regard to religion, race, color, national origin, handicapping condition, age, sex, number of pregnancies, or marital status.
U.S. Agencies Supporting U.S. Law Relation to Teen Consent and Confidentiality
U.S. Health and Human Services Department HIPAA included Administrative Simplification provisions that required the U.S. Health and Human Services Department (HHS) to adopt national standards for electronic health-care transactions and code sets, unique health identifiers, and security. Congress recognized that advances in electronic technology could erode the privacy of health information and incorporated into HIPAA provisions that mandated adoption of federal privacy protections for individually identifiable health information. HHS has published the following documents: Privacy Rule – Sets national standards for the protection of individually identifiable health information by health plans, health-care clearinghouses, and health-care providers who conduct standard health–care transactions electronically. Security Rule – Sets national standards for protecting the confidentiality, integrity, and availability of electronic protected health information. Enforcement Rule – Provides standards for enforcement of HIPAA. Administrative Simplification Rules Final Omnibus Rule – Implements a number of provisions of the HITECH Act to strengthen the privacy and security protections for health information.
U.S. Centers for Medicare & Medicaid Services HIPAA Administrative Simplification rules are also administered and enforced by the Centers for Medicare & Medicaid Services and include Transactions and Code Sets standards, Employer Identifier Standard, and National Provider Identifier Standard.
Medicaid or Title X Family Planning Under federal law, minors may give their own consent and receive confidential family planning services on request if the funding source is Medicaid or a federal Title X Family Planning Program.
Texas Law Relation to Teen Consent and Confidentiality
Texas Family Code Chapter 32. Consent to Treatment of Child by Non-Parent or Child Subchapter A: Consent to Medical, Dental, Psychological, and Surgical Treatment
§ 32.001 – Consent by Non-Parent
§ 32.002 – Consent Form
§ 32.003 – Consent to Treatment by Child
§ 32.004 – Consent to Counseling
§ 32.005 – Examination without Consent of Abuse or Neglect of Child Subchapter B: Immunization
§ 32.101 – Who May Consent to Immunization of a Child
§ 32.1011 – Consent to Immunization by Child
§ 32.102 – Informed Consent to Immunization
§ 32.103 – Limited Liability for Immunization Subchapter C: Miscellaneous Provisions
§ 32.201 – Emergency Shelter or Care for Minors
§ 32.202 – Consent to Emergency Shelter or Care by Minor
§ 32.203 – Consent by Minor to Housing or Care Provided Through Transitional Living Program
Texas Family Code Chapter 33. Notice of and Consent to Abortion § 33.001 – Definitions
§ 33.002 – Parental Notice
§ 33.0022 – Medical Emergency Notification; Affidavit for Medical Records
§ 33.003 – Judicial Approval
§ 33.004 – Appeal
§ 33.005 – Affidavit of Physician
§ 33.006 – Guardian Ad Litem Immunity
§ 33.0065 – Records
§ 33.007 – Costs Paid by State
§ 33.008 – Physician’s Duty to Report Abuse of a Minor; Investigation and Assistance
§ 33.0085 – Duty of Judge or Justice to Report Abuse of Minor
§ 33.009 – Other Reports of Sexual Abuse of a Minor
§ 33.010 – Confidentiality
§ 33.011 – Information Relating to Judicial Bypass
§ 33.012 – Civil Penalty
§ 33.013 – Capacity to Consent
§ 33.014 – Attorney General to Enforce
Texas Family Code Chapter 151. Rights and Duties in Parent-Child Relationship § 151.001 – Rights and Duties of Parent
§ 151.002 – Rights of a Living Child After an Abortion or Premature Birth
§ 151.003 Limitation on State Agency Action
Texas Family Code Chapter 261. Investigation of Report of Child Abuse or Neglect Subchapter A: General Provisions
§ 261.001 – Definitions
§ 261.002 – Central Registry
§ 261.003 – Application to Students in School for Deaf or School for Blind and Visually Impaired Subchapter B: Report of Abuse or Neglect; Immunities
§ 261.101 – Persons Required to Report; Time to Report
§ 261.102 – Matters to be Reported
§ 261.103 – Report made to Appropriate Agency
§ 261.104 – Contents of Report
§ 261.105 – Referral of Report by Department or Law Enforcement
§ 261.1055 – Notification of District Attorneys
§ 261.106 – Immunities
§ 261.107 – False report; Criminal Penalty; Civil Penalty
§ 261.108 – Frivolous Claims Against Person Reporting
§ 261.109 – Failure to Report; Penalty
§ 261.110 – Employer Retaliation Prohibited
§ 261.111 – Refusal of Psychiatric or Psychological Treatment of Child Subchapter C: Confidentiality and Privileged Communication
§ 261.201 – Confidentiality and Disclosure of Information
§ 261.202 – Privileged Communication
§ 261.203 – Information Relating to Child Fatality
§ 261.204 – Annual Child Fatality Report Subchapter D: Investigations
§ 261.301 – Investigation of Report
§ 261.3011 – Joint Investigation Guidelines and Training
§ 261.3013 – Case Closure Agreements Prohibited
§ 261.3015 – Alternative Response System
§ 261.3016 – Training of Personnel Receiving Reports of Abuse and Neglect
§ 261.302 – Conduct of Investigation
§ 261.3021 – Casework Documentation and Management
§ 261.3022 – Child Safety Check Alert List
§ 261.3023 – Law Enforcement Response to Child Safety Check Alert
§ 261.3025 – Child Safety Check Alert List Progress Report
§ 261.303 – Interference with Investigation; Court Order
§ 261.3031 – Failure to Cooperate with Investigation; Department Response
§ 261.3032 – Interference with Investigation; Criminal Penalty
§ 261.304 – Investigation of Anonymous Report
§ 261.305 – Access to Mental Health Records
§ 261.306 – Removal of Child from State
§ 261.307 – Information Relating to Investigation Procedure
§ 261.3071 – Informational manuals
§ 261.308 – Submission of Investigation Report
§ 261.309 – Review of Department Investigations
§ 261.310 – Investigation Standards
§ 261.311 – Notice of Report
§ 261.312 – Review Teams; Offense
§ 261.3125 – Child Safety Specialists
§ 261.3126 – Co-location of Investigators
§ 261.314 – Testing
§ 261.315 – Removal of Certain Investigation Information from Records
§ 261.316 – Exemption from Fees for Medical Records Subchapter E: Investigations of Abuse, Neglect, or Exploitation in Certain Facilities
§ 261.401 – Agency Investigation
§ 261.402 – Investigative Reports
§ 261.403 – Complaints
§ 261.404 – Investigations Regarding Certain Children Receiving Services from Certain Providers
§ 261.405 – Investigations in Juvenile Justice Programs and Facilities
§ 261.406 – Investigations in Schools
§ 261.407 – Minimum Standards
§ 261.408 – Information Collection
§ 261.409 – Investigations in Facilities Under Texas Juvenile Justice Department Jurisdiction
§ 261.410 – Report of Abuse by Other Children
Texas Health and Safety Code Chapter 572. Voluntary Mental Health Services § 572.001 – Request for Admission
§ 572.002 – Admission
§ 572.0022 – Information on Medications
§ 572.0025 – Intake, Assessment, and Admission
§ 572.003 – Rights of Patients
§ 572.004 – Discharge
§ 572.005 – Application for Court-Ordered Treatment
§ 572.0051 – Transportation of Patient to Another State
Texas Penal Code, Abuse and Neglect § 12.21. Abuse and Neglect
Texas Penal Code, Indecency with a Child § 21.11. Indecency with a Child
Texas Agencies and Resources Relation to Teen Consent and Confidentiality
Adolescent Health—A Guide for Providers, Texas Health and Human Services, Texas Department of State Health Services An easy-to-use guide detailing health-related legal issues in Texas pertinent to the treatment of adolescents by health-care providers and other professionals who provide services, information, and support to young people.
Title 25, Part 1, Chapter 97, Subchapter F, Texas Administrative Code, Texas Health and Human Services, Department of State Health Services The rules outlining, among other things, reporting requirements for sexually transmitted diseases in Texas.
Texas Department of State Health Services HIV-STD Program Home of the HIV/STD Program that maintains Texas HIV/STD incidence rates and provides resources for patients and health-care providers. This is also where health-care providers report five STDs: HIV and AIDS, syphilis, chlamydia, gonorrhea, and chancroid.
Texas Child Protective Services, Texas Department of Family and Protective Services (DFPS) Among other things, this agency is responsible for investigating reports of abuse and neglect of children and helping youth in foster care successfully transition to adulthood.
General Administrative Policy Manual: Medical Consent, 2015, Texas Juvenile Justice Department The rule that establishes a procedure for the Texas Juvenile Justice Department (TJJD) to consent to certain medical services for youth in TJJD jurisdiction in accordance with the Texas Family Code 32.001.
Professional Medical Societies Relation to Teen Consent and Confidentiality
Informed Consent, Parental Permission, and Assent in Pediatric Practice, American Academy of Pediatrics A policy statement developed in 1995 and reaffirmed in 2007 and 2011 that asserts that in most cases, physicians have an ethical (and legal) obligation to obtain parental permission to undertake recommended medical interventions. In many circumstances, physicians should also solicit a patient assent when developmentally appropriate. In cases involving emancipated or mature minors with adequate decision-making capacity, or when otherwise permitted by law, physicians should seek informed consent directly from patients
Policy Statement: Informed Consent in Decision-Making in Pediatric Practice, American Academy of Pediatrics Technical Report: Informed Consent in Decision-Making in Pediatric Practice, American Academy of Pediatrics A 2016 policy statement and accompanying technical report addressing informed consent as an essential part of health-care practice and noting that parental permission and childhood assent is an active process that engages patients, both adults and children, in health care. Pediatric practice is unique in that developmental maturation allows, over time, for increasing inclusion of the child’s and adolescent’s opinion in medical decision–making in clinical practice and research.
The Adolescent’s Right to Confidential Care When Considering Abortion, American Academy of Pediatrics A 2017 policy statement that reaffirms the AAP’s position that the rights of adolescents to confidential care when considering abortion should be protected.
Standards for Health Information Technology to Ensure Adolescent Privacy, American Academy of Pediatrics This 2012 policy statement reviews the challenges to adolescent privacy posed by commercial health information technology systems and recommends basic principles for ideal electronic health record systems. This policy statement has been endorsed by the Society for Adolescent Health and Medicine.
Confidential Health Care for Adolescents: Position Paper of the Society for Adolescent Medicine, Society for Adolescent Medicine A 2004 position paper addressing confidential health care for adolescents based on standards of clinical practice, research findings, principles of ethics, and law.
Confidentiality Protections for Adolescents and Young Adults in the Health Care Billing and Insurance Claims Process, Society for Adolescent Health and Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists A 2016 endorsement by three medical societies to establish policies and procedures so health-care billing and insurance claims processes do not impede the ability of providers to deliver essential health-care services on a confidential basis to adolescents and young adults covered as dependents on a family's health insurance plan.
Supporting the Health Care transition from Adolescence to Adulthood in the Medical Home, American Academy of Pediatrics A policy statement developed in 2011 and reaffirmed in 2015 detailing practice-based implementation of transition to adult health-care services for all youth beginning in early adolescence. This policy statement has been endorsed by the American Academy of Family Physicians, and the American College of Physicians.
Consent for Emergency Medical Services for Children and Adolescents, American Academy of Pediatrics A policy statement developed in 2003 and reaffirmed in 2011 and 2015 detailing evaluation and treatment of children and adolescents in emergency medical conditions in which a parent or legal guardian is not available to provide consent or conditions under which an adolescent patient might possess the legal authority to provide consent.

The medical definitions provided in this module were obtained from Children and the Law in Texas: What Parents Should Know by Ramona Freeman John (University of Texas Press, 1999); Medscape; and the Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health.