Welcome to the training on Teen Consent and Confidentiality provided by Texas Health and Human Services (HHS) and the Texas Department of State Health Services (DSHS).
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.
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:
- Specify how and why to establish confidentiality and seek consent or assent when dealing with adolescent patients.
- Determine who can give consent for health care for minors in various situations, including identifying when teens may consent to their own treatment.
- 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.
- Integrate culturally effective techniques into clinical encounters with adolescent patients.
Please note this module expires on 9/13/2020.
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This course has been designated by The Texas Department of State Health Services, Continuing Education Service for 1.50 credit(s) of education in medical ethics and/or professional responsibility.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is an accredited provider (P0180) of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Nursing Education.
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Social Work Education.
This course has been designated by The Texas Department of State Health Services for 1.50 contact hours of education in professional ethics and social work values.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.50 contact hour/s of continuing education for Certified Community Health Workers.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.50 hour(s) for attendance.
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
- Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
- Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
- Appendix of Resources for Health-Care Providers
- Appendix of Resources for Families
- References Featured in Course
- Medical Definitions
|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.|
- Advocates for Youth white paper. Best Practices for Youth Friendly Clinical Services.
- American Academy of Pediatrics. Policy Statement: Informed Consent in Decision-Making in Pediatric Practice. (2016).
- American Academy of Pediatrics. Technical Report: Informed Consent in Decision-Making in Pediatric Practice, American Academy of Pediatrics. (2016).
- American Academy of Pediatrics. Policy Statement: Consent for emergency medical services for children and adolescents. Pediatrics (2011, affirmed 2015).
- American Academy of Pediatrics. Child Abuse, Confidentiality, and the Health Insurance Portability and Accountability Act. (2010, reaffirmed 2014).
- American Academy of Pediatrics. Policy Statement: Contraception for Adolescents. (2014).
- American College of Gynecologists and Obstetricians. Committee Opinion: Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices. (2012).
- American College of Physicians Ethics Manual, Sixth Edition (2012).
- Guttmacher Institute. Minors’ Access to Contraceptive Services, which compares Texas’s laws with those of the other states. (2017).
- HEADDSSS Psychosocial Interview Screen.
- Society for Adolescent Health and Medicine Clinical Care Resources web page, offers resources on billing for confidential adolescent health services.
- Society for Adolescent Health and Medicine and the American Academy of Pediatrics. Confidentiality Protections for Adolescents and Young Adults in the Health Care Billing and Insurance Claims Process. (2016).
- Society for Adolescent Health and Medicine. Confidential Health Care for Adolescents: Position Paper of the Society for Adolescent Medicine (2004).
- Texas Department of State Health Services, child abuse screening, documenting, and reporting policy for contractors and providers.
- Texas Department of State Health Services Disease Reporting web page.
- Texas Health Steps. Anticipatory Guidance-A Guide for Providers, which includes guidance topics for every age group birth through 20 years.
- Texas Health Steps Child Health Clinical Record Forms.
- Texas Juvenile Justice Department General Administrative Policy Manual: Medical Consent, 2015.
- Advocates for Youth. Adolescent Access to Confidential Health Services.
- Advocates for Youth. Your Guide to the Clinic.
- American Academy of Pediatrics. Confidentiality Laws Tip Sheet.
- American Academy of Pediatrics. Teenage Confidentiality: A Young Person’s Right to Privacy.
- Society for Adolescent Health and Medicine. Confidentiality Resources for Adolescents and Young Adults, list of online resources.
- Texas Health and Human Services. My Children’s Medicaid website, information for families about Medicaid benefits and pediatric health-care services.
- Texas Health Steps, information about finding a health-care provider and getting a ride to a checkup.
- American Academy of Pediatrics. (2016) Technical Report: Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 138 (2), e20161485
- American Academy of Pediatrics. (2011, affirmed 2015). Policy Statement: Consent for emergency medical services for children and adolescents. Pediatrics, 128 (2), 427-433.
- American Academy of Pediatrics. (2014). Policy Statement: Contraception for Adolescents. Pediatrics, 134(4):e1244-e1256.
- American Academy of Pediatrics. (1995; 2007 and 2011). Position Statement on Informed consent, parental permission, and assent in pediatric practice. Pediatrics, 116, 1238-1244.
- American Academy of Pediatrics, Committee on Child Abuse and Neglect. (2010, reaffirmed 2014). Child Abuse, Confidentiality, and the Health Insurance Portability and Accountability Act. Pediatrics, 125 (1), 197–201.
- American Academy of Pediatrics. (2002, reaffirmed 2008). Policy Statement: The Medical Home. Pediatrics, 110:184–186.
- American College of Physicians. (2012). Ethics Manual, Sixth Edition.
- American College of Obstetricians and Gynecologists. (2016). FAQ 184: Long-Acting Reversible Contraception (LARC): IUD and Implant.
- American College of Obstetricians and Gynecologists. (2012). Committee Opinion Number 539: Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices.
- American Medical Association. Patient Physician Relationship Topics: Patient Confidentiality.
- American Medical Association. (2012). The AMA Code of Medical Ethics' Opinions on Confidentiality of Patient Information: Opinion 5.055 - Confidential Care for Minors. AMA Journal of Ethics, Volume 14, Number 9: 705-707.
- Rome, E., Hicks, C. (2011) Is a teen entitled to confidentiality? Contemporary Pediatrics. Retrieved April 2017 from Modern Medicine.
- Anderson, S. L., Schaechter, J., & Brosco, J. (2005). Adolescent patients and their confidentiality: staying within legal bounds: what right does a teenager have to confidential health care? What influence does HIPAA exert on that right? How you apply the answers in your practice could determine whether an adolescent seeks health services--or forgoes necessary care. Contemporary Pediatrics, July 2005, p. 54
- Anderson, S. L., Schaechter, J., & Brosco, J. P. (2005). Adolescent patients and their confidentiality: staying within the legal limits. Contemporary Pediatrics. Retrieved September 2013 from Modern Medicine.
- Attorney General of Texas. What Can We Do About Child Abuse: The Responsibility to Report Child Abuse.
- Brei, A. (2007). Book review of Ethical Dilemmas in Pediatrics: Cases and Commentaries. Metapsychology Online Review, 11(5).
- Diaz, A., Neal, W. P., Nucci, A. T., Ludmer, P., Bitterman, J., & Edwards, S. (2004). Legal and ethical issues facing adolescent health care professionals. The Mount Sinai Journal of Medicine, 7(3), 181–185.
- English A, Ford, C. A., Santelli, J. S. (2009). Clinical preventive services for adolescents: position paper of the Society for Adolescent Medicine. American Journal of Law & Medicine, 35(2-3):351-364.
- Ford, C., English, A., & Sigman, G. (2004). Confidential Health Care for Adolescents: Position Paper of the Society for Adolescent Medicine. Society for Adolescent Health and Medicine.
- Fox, H. B., McManus, M. A., & Arnold, K. N. (2010). Significant multiple risk behaviors among U.S. high school students. The National Alliance to Advance Adolescent Health Fact Sheet No. 8.
- Franzini, L. Marks, E., Cromwell, P. F., Risser, J., McGill, L., Markham, C., Selwyn, B., & Shapiro, C. (2004). Projected economic costs due to health consequences of teenagers’ loss of confidentiality in obtaining reproductive health care services in Texas. Archives of Pediatrics & Adolescent Medicine, 158(12):1140-6.
- Gold, R. B. (2009). Unintended Consequences: How Insurance Processes Inadvertently Abrogate Patient Confidentiality. Guttmacher Policy Review, 12 (4).
- Grady, C., Wiener, L., Abdoler, E., Trauernicht, E., Zadeh, S., Diekema, D. S., … Wendler, D. (2014). Assent in research: the voices of adolescents. Journal of Adolescent Health, 54(5), 515–520.
- Guttmacher Institute. (2016). Fact Sheet: Unintended Pregnancy in the United States.
- Guttmacher Institute (2017). Minors’ Access to Contraceptive Services. State Policies in Brief publication.
- Hickey, K. (2007). Minors' rights in medical decision making. JONA's Healthcare Law, Ethics, and Regulation, 9, 100–104.
- Hobbs-Lopez, A. (n.d.). Texas Adolescents and Consent. Texas Department of State Health Services.
- Kuther, T. L. (2003). Medical decision-making and minors: issues of consent and assent. Adolescence.
- Institute of Medicine and National Research Council Committee on the Science of Adolescence. (2011). The Science of Adolescent Risk-Taking: Workshop Report. National Academies Press, Washington (DC).
- National Research Council; Institute of Medicine; Board on Children, Youth, and Families; Committee on Adolescent Health Care Services and Models of Care for Treatment, Prevention, and Healthy Development. (2009). Adolescent Health Services: Missing Opportunities. National Academies Press (U.S.).
- Rae, W. A., Sullivan, J. R., Peña Razo, N., George, C., & Ramirez, E. (2002). Adolescent Health Risk Behavior: When Do Pediatric Psychologists Break Confidentiality? Journal of Pediatric Psychology, 27(6) 541-549.
- Rome, E., & Hicks, C. (2011). Is a teen entitled to confidentiality? Contemporary Pediatrics.
- Society for Adolescent Health and Medicine. (n.d.). Clinical care resources.
- Texas Department of Family and Protective Services. (n.d.). Report Abuse, Neglect, or Exploitation.
- Texas Department of State Health Services. (2016). Adolescent Health: A Provider’s Guide.
- Texas Department of State Health Services. (2016). Family and Community Health Division.
- Texas Department of State Health Services. (2016). Texas Health Steps.
- Texas Family Code.
- Texas Juvenile Justice Department. (2015). General Administrative Policy Manual: Medical Consent.
- Texas Penal Code.
- U.S. Department of Health and Human Services. (n.d.). The Health Insurance Portability and Accountability Act of 1996.
- U.S. Government Printing Office. Code of Federal Regulations. 45 CFR § 164.504.
- American Academy of Pediatrics, Committee on Pediatric AIDS. (2011). Policy Statement: Adolescents and HIV Infection: The Pediatrician’s Role in Promoting Routine Testing. Pediatrics, 128 (5), 1023–1029.
- Dailard, C. (2003). New Medical Records Privacy Rule: The Interface with Teen Access to Confidential Care. The Guttmacher Report on Public Policy, 6(1).
- English, A., & Ford, C. (2004). The HIPAA Privacy Rule and Adolescents: Legal Questions and Clinical Challenges. Guttmacher Institute.
- Goldenring, J. M., & Rosen, D. S. (2004). Getting into adolescent heads: an essential update. Contemporary Pediatrics.
- HEADDSSS Psychosocial Interview Screen.
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.
Promoting Adolescent HealthAdopt best practices for adolescent screening, including recommended schedules, effective communication, and enhanced clinical procedures. Includes video examples of effective screening techniques.
Motivational InterviewingGain communication skills that can be used in the primary care setting to motivate children, adolescents, and families to make positive health changes, improve self-care for chronic conditions, and avoid high-risk behaviors.
Identifying and Treating Young People with High-Risk BehaviorsLearn about the prevalence, signs, symptoms, and interventions for substance use and other risky adolescent behaviors.
Preconception and Prenatal Health: OverviewIntegrate best practices for preconception health care and counseling into preventive medical checkups.
Preconception and Prenatal Health: Managing Chronic Health Issues Before and During PregnancyLearn to assess the effects of chronic health issues on girls and women of reproductive age and on future pregnancies, and how to use motivational interviewing when discussing preconception/prenatal health with girls and women of reproductive age.
Preconception and Prenatal Health: Identifying and Intervening in High-Risk BehaviorsLearn how high-risk behaviors can affect the health and pregnancies of girls and women of reproductive age, and how to assess risky behaviors that may contribute to an unintended pregnancy.
Preconception and Prenatal Health: CytomegalovirusLearn how to offer preventive counseling about how pregnant girls and women can avoid cytomegalovirus infection and how to assess cytomegalovirus infection risks to newborns.
Texas Health Steps Guidance
Texas Health Steps Guidance
Anticipatory guidance—age-appropriate education and counseling—is a required component of every Texas Health Steps preventive medical and dental checkup. Texas Health Steps offers age-appropriate education and counseling topics so providers can assist patients, families, and caregivers to understand growth, development, and healthy practices. Texas Health Steps recommends that health-care providers personalize anticipatory guidance depending on the needs of their patients. Anticipatory guidance topics should be individualized and prioritized based on questions and concerns of the child or adolescent and their parent or guardian. Specific guidance should also be based on findings obtained during the health history and physical exam.
Texas Health Steps offers Anticipatory Guidance-A Guide for Providers, which includes guidance topics for every age group birth through 20 years. It mirrors anticipatory guidance topics included on the Texas Health Steps Child Health Clinical Record Forms.
Families and caregivers of children with chronic medical conditions face complex challenges and extended stress. Providing long-term care for a child with a disability or chronic illness can take a physical, emotional, and financial toll. It also requires a time commitment that can be difficult to achieve.
As a pediatric health-care provider, you “have a responsibility to recognize caregiver burden (Adelman, Tmanova, Delgado, Dion & Lachs, 2014). Research has shown that caregivers are at increased risk for depression, anxiety, and other negative health effects of what can be a crushing responsibility. At each pediatric checkup, make it part of your routine to inquire whether family or caregivers have questions or concerns about their roles, their own health, or navigating the health-care system.
The health of your young patients and the health of their caregivers are interwoven.
Caregivers who feel overwhelmed may not be able to provide appropriate care for a child in need. You must be alert to outcries for help or signs of health problems related to caregiving, including loss of sleep and diet imbalance. Open communication allows you to be a sounding board for caregivers who are struggling with their duties. At the same time, be on the watch for signs of fatigue or stress in caregivers who try to project an “all’s well” attitude even when they are having problems.
Your role includes providing practical counseling about stress and offering resources designed to help families and caregivers cope.
Top 10 Caregiver Coping Skills
Sharing this Top Ten list of coping skills can help caregivers learn strategies that may reduce stress:
- Understand your feelings.
- Express your emotions.
- Educate yourself about your child’s illness or condition.
- Keep communications open.
- Talk to other parents.
- Focus on the strengths and goals that are achievable.
- Believe in your child.
- Establish routines.
- Maintain your sense of humor! There is no co-pay for laughter!!
- Remember that taking care of yourself is caring for your family.
Source: Parent to Parent of New York State
Resources to share with families and caregivers
Aging and Disability Resource Centers (ADRCs) operated by Texas Health and Human Services (Texas HHS). The centers are welcoming and offer information about state and federal health benefits as well as local programs and services. The trained staff can connect caregivers with services such as home care, meals, transportation, legal help, attendant care, respite support, and housing. Visit the ADRC website for a list of resource center locations in Texas.
Family Support Services, a program to help families care for children with special health-care needs at home. Services are provided by the Children with Special Health Care Needs (CSHCN) Services Program, a branch of the Texas Department of State Health Services.
Navigate Life Texas, a multilingual website created by parents for parents of children with disabilities and special health-care needs. This unique site offers comprehensive, relevant, and reliable information for families, professionals, advocates, and anyone working with children who have disabilities and their families. Sponsored by the Texas Interagency Task Force on Children with Special Needs.
Take Time Texas, a website offered by Texas HHS that includes a state inventory of respite services.
Texas Parent to Parent offers peer support for parents of children with special health-care needs.
All Medicaid managed care organizations (MCOs) provide case management services (called service management for STAR members with special health-care needs). In the other Medicaid managed care programs, everyone gets some level of case management. Patients should first be referred to the plan’s service coordinator and then referred to Case Management for Children and Pregnant Women if patient needs cannot be met by the plan’s services. Health plans are also required to make appropriate referrals to case management services.
For patients enrolled in STAR Medicaid, STAR Health, or Fee-For-Service (FFS) Medicaid, providers can make a referral by one of these methods:
- Calling 877-847-8377 (877-THSteps).
- Contacting a case manager (“Find a Case Manager” web page accessed from the Resources for this module).
- Submitting the Case Management Referral Form (the form is also accessed from Resources).
For patients enrolled in STAR Kids:
- Health Plan service coordinators and others can refer by submitting the STAR Kids Case Management Request Form (the form is also accessed from Resources).
Early Childhood Intervention (ECI) is a statewide program for families with children birth through 35 months who have disabilities and developmental delays. All health-care providers are required by federal and state regulations to refer children 35 months and younger to the local ECI program as soon as possible but no later than seven days after the suspicion or identification of a developmental delay.
To qualify for ECI services, a child must have:
- A qualifying medically diagnosed condition that has a high probability of resulting in a developmental delay. For more information, visit the ECI Qualifying Diagnosis Search web page.
- An auditory or visual impairment as defined by the Texas Education Agency (TEA) rule at 10 TAC Section 89.1040.
- A documented delay of at least 25 percent in one or more of the following areas of skills and development: gross motor, communication, cognition, fine motor, social, emotional, or self-help. Or, a documented delay of at least 33 percent when the delay occurs only in expressive language.
- A qualitative determination of delay, as indicated by responses or patterns that are disordered or qualitatively different from what is expected for the child’s age.
To refer a child, providers should use the ECI Provider Referral and Feedback form. The form, which requires a parent or guardian signature, helps ensure that ECI’s evaluation results and service plan are shared with the referring provider.
To refer families for services, providers can call the local ECI program.
Texas Health Steps requires that all federal- and state-mandated checkup components be documented in the medical record in order for the checkup to be considered complete and to qualify for provider reimbursement. Any checkup component that is not completed must be noted in the medical record, along with the reason it was not completed and a plan to complete it. The medical record must also contain documentation of all screening tools used, screening results, and referrals. Texas Health Steps child health clinical record forms are optional but are recommended to assist providers with documentation of all required checkup components. Providers should be aware that Texas Health Steps checkups are subject to retrospective review and recoupment if the medical record does not include all required documentation.
A medical home is the patient’s primary point of contact when accessing health care. The medical home concept was developed by the American Academy of Pediatrics (AAP) and is promoted by Texas Health Steps. A medical home is defined as one in which care is accessible, family-centered, continuous, comprehensive, compassionate, coordinated, and culturally effective. It is a partnership between a child, the family or caregiver, and the child’s primary health-care setting. The primary health-care setting can be a physician’s office, a hospital outpatient clinic, a school health center, a community health center, or a health department clinic.
Providers who need assistance finding a specialist or subspecialist who accepts patients enrolled in Medicaid can find a specialist or subspecialist by using the Texas Medicaid & Healthcare Partnership (TMHP) Online Provider Lookup or by calling the Texas Health Steps toll-free help line for providers at 800-964-2777 Monday through Friday from 8 a.m. to 6 p.m. Central Time. Select option 3 to speak with a representative.
Providers can access a set of child health clinical record forms to document Texas Health Steps preventive medical checkups. The set includes a form for each checkup under the Texas Health Steps Periodicity Schedule, for patients from up to 5 days old through 20 years. Providers can save or print the forms.
Each form includes the required components for that age’s checkup, along with space for documenting routine, non-required components of a medical checkup. The backside of the form includes a helpful list of suggested anticipatory guidance topics and checklists such as the Hearing Checklist for Parents and Lead Risk Factors.
Texas Health Steps is the preventive care services program for children birth through 20 years who are enrolled in Medicaid. Texas Health Steps provides regular checkups and screenings as part of the Early and Periodic Screening, Diagnosis, and Treatment program, also known as EPSDT.
In Texas, EPSDT is known as Texas Health Steps, which includes the preventive care components—or Early and Periodic Screening (EPS)—of the total EPSDT service. Required medical checkups and preventive care services are provided in accordance with the latest Texas Health Steps Periodicity Schedule, which is modeled after the one developed by the American Academy of Pediatrics (AAP). Additional checkup components are required in Texas to meet federal and state guidelines, and checkups are encouraged as part of the medical home. The Periodicity Schedule specifies when each of the checkup components is due. Providers should always refer to the latest schedule available. To download a PDF of the Periodicity Schedule online, visit the Texas Health Steps Provider Information web page.
The Texas Medicaid & Healthcare Partnership (TMHP) updates the TMPPM monthly. The policy updates are published on the TMHP website and in banner messages, which appear weekly on a provider’s Remittance and Status Report as well as on the website. Providers can find updates on the web page in two ways:
Release Notes—Changes to the TMPPM arranged by date, with most recent at the top of the list.
Change History—Changes to the TMPPM arranged by chapter. (If a chapter has not changed, it will not appear on the list).
NOTE: Providers should always check the TMHP website for the current TMPPM, banner messages, and policy and procedures updates. Archived versions of the TMPPM will remain online for reference purposes.