Welcome to the training on Teen Consent and Confidentiality provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Goal
The goal of this module is to equip Texas Health Steps medical and dental 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:
- 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 Texas law when youths engage in risky behaviors, request services that conflict with the provider’s personal values, or exhibit signs of abuse or neglect.
- Integrate culturally effective techniques into clinical encounters with adolescent patients.
Please note this module expires on 4/20/2023.
This module was released on 4/20/2020.
Accreditation Statement
Continuing Medical Education (Ethics Accredited)
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 1.25 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 1.25 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 accredited as a provider 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 1.25 contact hour(s) of Continuing Nursing Education.
Social Workers (Ethics Accredited)
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 1.25 contact hour(s) of Continuing Social Work Education.
This course has been designated by The Texas Department of State Health Services for 1.25 contact hours of education in professional ethics and social work values.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.25 hour(s) for attendance.
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 1.25 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
Disclosures
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).
Browser Requirements
Texas Health Steps courses are best viewed using a current browser. If you are using an out-of-date browser or a version of Internet Explorer less than 11, lesson progress and interactive features may not function properly.
- Relevant Laws and Policies and Professional Medical Society Recommendations
- Health-Care Providers
- Families
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U.S. Law |
Relation to Teen Consent and Confidentiality |
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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. |
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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. |
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U.S. Agencies Supporting U.S. Law |
Relation to Teen Consent and Confidentiality |
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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. |
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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.
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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. |
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Texas Law |
Relation to Teen Consent and Confidentiality |
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Texas Administrative Code Chapter 97. Communicable Diseases https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=25&pt=1&ch=97 |
Subchapter F: Sexually Transmitted Diseases |
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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 |
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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 |
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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 |
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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 |
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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 |
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Texas Penal Code, Indecency with a Child (scroll down to 21.11) https://statutes.capitol.texas.gov/SOTWDocs/PE/htm/PE.21.htm |
§ 21.11. Indecency with a Child
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Texas Agencies and Resources |
Relation to Teen Consent and Confidentiality |
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Adolescent Health—A Guide for Providers, Texas Health and Human Services Commission, 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. |
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Title 25, Part 1, Chapter 97, Subchapter F, Texas Administrative Code, Texas Health and Human Services Commission, Department of State Health Services |
The rules outline, among other things, reporting requirements for sexually transmitted diseases in Texas. |
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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. |
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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. |
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General Administrative Policy Manual: Medical Consent, 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. |
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Professional Medical Societies |
Relation to Teen Consent and Confidentiality |
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Informed Consent, Parental Permission, and Assent in Pediatric Practice, American Academy of Pediatrics
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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. |
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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
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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 and adolescent’s opinion in medical decision–making in clinical practice and research. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
- American Academy of Pediatrics. (2017). Sexual and Reproductive Health Care Services in the Pediatric Setting. Pediatrics, 140(5):e20172858.
- American Academy of Pediatrics. (2016).Policy Statement: Informed Consent in Decision-Making in Pediatric Practice.
- American Academy of Pediatrics. (2016). Technical Report: Informed Consent in Decision-Making in Pediatric Practice.
- American Academy of Pediatrics. (2011, affirmed 2015). Policy Statement: Consent for emergency medical services for children and adolescents.
- American Academy of Pediatrics. (2010, reaffirmed 2014). Child Abuse, Confidentiality, and the Health Insurance Portability and Accountability Act.
- American Academy of Pediatrics. (2014). Policy Statement: Contraception for Adolescents.
- American Academy of Pediatrics. (2014). The SSHADESS Screen from Reaching Teens: Strength-Based Communication Strategies to Build Resilience and Support Healthy Adolescent Development.
- American College of Physicians. (2019). ACP Ethics Manual, Seventh Edition.
- American Medical Association. (n.d.). Code of Medical Ethics Opinion 2.3.2, Professionalism in the Use of Social Media.
- Center for Adolescent Health and the Law.
- Centers for Disease Control and Prevention. (n.d.). A Guide to Taking a Sexual History.
- Contemporary Pediatrics. (2014). HEEADSSS 3.0: The psychosocial interview for adolescents updated for a new century fueled by media.
- Guttmacher Institute. (2019). State Laws and Policies Minors’ Access to Contraceptive Services.
- One Key Question from Power to Decide.
- Society for Adolescent Health and Medicine Clinical Care Resources on billing for confidential adolescent health services.
- Society for Adolescent Health and Medicine and the American Academy of Pediatrics. (2016). Confidentiality Protections for Adolescents and Young Adults in the Health Care Billing and Insurance Claims Process.
- Society for Adolescent Health and Medicine. (2004). Confidential Health Care for Adolescents: Position Paper of the Society for Adolescent Medicine.
- Texas Department of Family and Protective Services. Texas Abuse Hotline. Report abuse, neglect, or exploitation.
- Texas Department of State Health Services, Disease Reporting.
- Texas Health Steps. (2016). Adolescent Health Guide.
- 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 Health Steps. Motivational Interviewing. Online course.
- Texas Health Steps Catalog. Child Health Clinical Record Forms.
- Texas Juvenile Justice Department General Administrative Policy Manual: Obtaining Medical Consent, 2017.
- Texas Medicaid & Healthcare Partnership. Basic Provider Search. Find a doctor, hospital or other participating provider.
- Advocates for Youth. Fact sheets on health issues, resources, and tools.
- American Academy of Pediatrics. Confidentiality Laws Tip Sheet.
- American Academy of Pediatrics. Information for Teens: What You Need to Know About Privacy.
- Society for Adolescent Health and Medicine. Confidentiality Resources for Adolescents and Young Adults, list of online resources.
- Texas Health and Human Services Commission. CHIP and Children’s Medicaid, information for families about Medicaid benefits and pediatric health-care services.
- Texas Health and Human Services Commission. Information about finding a health-care provider and other services.
- Texas Health and Human Services Commission. Healthy Texas Women. Information about finding health care providers and eligibility for free or affordable health services.
- Texas Health and Human Services Commission. Medical Transportation Program. Find out how to get a ride to the doctor, dentist, pharmacy, or other medically necessary appointment.
American Academy of Pediatrics. (2020). Adolescent Sexual Health: Stages of Adolescent Development.
American Academy of Pediatrics. (2018). Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics, 142(5):e20182587.
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, 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. (1995, 2007, and 2011). Position Statement on Informed consent, parental permission, and assent in pediatric practice. Pediatrics, 116:1238-1244.
American Academy of Pediatrics. (2002, reaffirmed 2008). Policy Statement: The Medical Home. Pediatrics, 110:184–186.
American College of Physicians. (2019). ACP Ethics Manual, Seventh Edition.
American College of Obstetricians and Gynecologists. (2012). Committee Opinion Number 539: Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices.
American Medical Association. Code of Medical Ethics Opinion 3.2.1 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, 14(9): 705-707.
Attorney General of Texas. Child Abuse. Your Legal Obligation.
Brei, A. (2007). Review: 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.
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, 38:343-358.
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.).
Pasternak, R. H., Gooding, H. C., Woodward, K, Hawkins, K., Sawyer, S., & Anoshiravani, A. (2014). Recommendations for Electronic Health Record Use for Delivery of Adolescent Health Care. Journal of Adolescent Health. 53(4): 487-490.
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.
Society for Adolescent Health and Medicine. (n.d.). Resources.
Texas Department of Family and Protective Services. (n.d.). Report Abuse, Neglect, or Exploitation.
Texas Department of State Health Services. (2016). Texas Health Steps.
Texas Health Steps. (2016). Adolescent Health: A Provider’s Guide.
Texas Juvenile Justice Department. (2017). TJJD/UTMB Correctional Managed Care Halfway House Health Services Manual: Medical Consent.
U.S. Department of Health and Human Services. (n.d.). Health Information Privacy.
U.S. Government Printing Office. Code of Federal Regulations. 45 CFR § 164.504.
Zimlich, R. (2019). Why confidential time with teen patients is necessary. Contemporary Pediatrics, 36(4).
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.
The medical definitions provided in this module were obtained or adapted from the federal Centers for Medicare & Medicaid, 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 & Dictionary of Medicine, Nursing, and Allied Health.
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