CE/CME

Teen Consent and Confidentiality

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).

Credit Hours: 1.25 CE

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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 on 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 caring for adolescent patients.
  2. Determine who can give consent for health care for minors, including identifying when teens may consent on their own.
  3. 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.
  4. Integrate culturally effective techniques into clinical encounters with adolescents.

Defining terms used in this module: The terms teen, young person, youth and adolescent are used interchangeably to refer to a person in the transition years between childhood and adulthood. Child refers to a person ages 1 through 10 years. According to the American Academy of Pediatrics (AAP), youth ages 11 through 14 years are in early adolescence, ages 15 through 17 years are in middle adolescence, and ages 18 through 21 are in late adolescence even though youth ages 18 years and older are legally adults. Under Texas law, a minor is a person 17 years or younger who has never been married or declared an adult by a court (emancipated). The term parent includes legal guardians. Consult this module’s Appendix of Resources for links to federal and state laws and policies referenced in the module.

Please note this module expires on 5/18/2026.

This module was released on 5/18/2023.

References Featured in Course

Medical Definitions

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

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.

General Disclosure

One of the requirements of continuing education is disclosure of the following information to the learner:

  1. 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.
  2. Commercial Support.
    The THSTEPS Web-based Continuing Education Series has received no commercial support.
  3. Disclosure of Relevant Financial Relationships.
    The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
  4. 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.
  5. 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).

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Appendix of Relevant Federal and State Laws and Policies and Professional Medical Society Recommendations

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 a broad range of family planning services, excluding abortion, 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 for Professionals. 2021 update

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. This provision was under litigation at the time the module was developed.

Texas Law

Relation to Teen Consent and Confidentiality

Texas Administrative Code Chapter 97. Communicable Diseases

Subchapter F: Sexually Transmitted Diseases

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 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

§ 261.3017 - Consultation with Physician Networks and Systems Re: Certain Medical Conditions

§ 261.30175 – Mitigation of Provider Conflicts

§ 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

§ 261.3024 – Removal from Child Safety Check Alert List

§ 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, Indecency with a Child (scroll down to 21.11)

§ 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 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.

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.

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, 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

   

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, reaffirmed in 2023, 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.

   
 

This joint statement recommends that providers advocate for information access and record release policies that incorporate adolescent confidentiality protections. These may include separate account access for the adolescent minor and proxy and other processes to allow for segmented access to the EHR.

Adolescent Consent and Confidentiality: Complexities in Context of the 21st Century Cures Act. AAP, Pediatrics.

This commentary recommends two strategies for maintaining adolescent privacy at a time when complexities and challenges are mounting to adolescent consent and confidentiality.

   

American College of Emergency Physicians. Evaluation and Treatment of Minors Policy Resource and Education Document (PREP).

This is an explication of ACEP’s 2021 Policy Statement that says, “The medical screening, examination and treatment of an emergency medical condition of a minor in the emergency department should not be delayed because of consent issues. When clinically, legally, and ethically appropriate, adolescents independently treated in the emergency department should have their confidentiality honored.”

Appendix of Resources for Health-Care Providers

Appendix of Resources for Families