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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Overview
Appendix/Resources

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:

Specify how and why to establish confidentiality and seek consent or assent when caring for adolescent patients.
Determine who can give consent for health care for minors, including identifying when teens may consent on their own.
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 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

References Featured in Course

American Academy of Pediatrics. (Reaffirmed 2023). Policy Statement: Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 138(2):e20161484.
American Academy of Pediatrics. (Reaffirmed 2023). Technical Report: Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 138(2):e20161485.
American Academy of Pediatrics. (2023). Council on Child Abuse and Neglect (COCAN).
American Academy of Pediatrics. (2023). National Resource Center for Patient/Family-Centered Medical Home.
American Academy of Pediatrics. (2022). Adolescent Sexual Health.
American Academy of Pediatrics. (2022). Adolescent Sexual Health AAP Policy Statements.
American Academy of Pediatrics. (2021). Contraception for Adolescents. Pediatrics, 134(4): e1244–e1256.
American Academy of Pediatrics. (2021). A declaration of a mental health emergency from the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association.
American Academy of Pediatrics. (2018). Clinical Report: Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics, 142(5):e20182587.
American College of Emergency Physicians (ACEP). (2021). Evaluation and Treatment of Minors.
American College of Emergency Physicians. (2021). Evaluation and Treatment of Minors
Policy Resource and Education Document (PREP).
American College of Obstetricians and Gynecologists. (2021). Long-Acting Reversible Contraception: Intrauterine Device and Implant.
Psycom Pro. (2022). Confidentiality and Consent in Child and Adolescent Mental Health Care.
Society for Adolescent Health and Medicine. (n.d.). Resources.
Texas Department of Family and Protective Services. (n.d.). Report Abuse, Neglect, or Exploitation.
Texas Health Steps. (2016). Adolescent Health: A Provider’s Guide.
Texas Tribune. (2022). Federal court ruling may prevent Texas teens from getting birth control without parental permission.
U.S. Department of Health and Human Services, youth.gov. (n.d.) Risks and Protective Factors.
U.S. Department of Health and Human Services. (n.d.). Health Information Privacy.

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.

Accreditation Statements

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

General Disclosure

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).

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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

American Academy of Pediatrics. (Reaffirmed 2023). Policy Statement: Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 138(2):e20161484.
American Academy of Pediatrics. (Reaffirmed 2023). Technical Report: Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 138(2):e20161485.
American Academy of Family Physicians. (2019). The EveryONE Project: Social Determinants of Health: Guide to Social Needs Screening.
American Academy of Pediatrics. (2022). Protecting Children From Sexual Abuse by Health Care Professionals and in the Health Care Setting. Pediatrics, 150(3): e2022058879.
American Academy of Pediatrics. (2022). Commentary: Adolescent Consent and Confidentiality: Complexities in Context of the 21st Century Cures Act. Pediatrics, 149(6): e2022056414.
American Academy of Pediatrics. (2017). Sexual and Reproductive Health Care Services in the Pediatric Setting. Pediatrics, 140(5):e20172858.
American Academy of Pediatrics. (Reaffirmed 2014). Child Abuse, Confidentiality, and the Health Insurance Portability and Accountability Act. Pediatrics, 125(1): 197–201.
American Academy of Pediatrics. (n.d.). The SSHADESS Screening: A Strength-Based Psychosocial Assessment.
American College of Emergency Physicians. (2021). Evaluation and Treatment of Minors Policy Resource and Education Document (PREP).
American College of Obstetricians and Gynecologists. (2022). Committee Statement No. 3: Ethical Approach for Managing Patient–Physician Conflict and Ending the Patient–Physician Relationship.
American College of Obstetricians and Gynecologists. (2020). Committee Opinion No. 803: Confidentiality in Adolescent Health Care.
American College of Obstetricians and Gynecologists. (Reaffirmed 2022). Committee Opinion No. 735: Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices.
American Medical Association. (2022). Code of Medical Ethics Opinion 2.3.2, Professionalism in the Use of Social Media.
Center for Adolescent Behavioral Health Research, Boston Children’s Hospital. (2020). CRAFFT+N Questionnaire. Contains questions on substance use, including tobacco and nicotine use.
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.
Got Transition. (2023). A federally funded program to improve the transition from adolescent health care to adult care.
Guttmacher Institute. (2023). State Laws and Policies, Minors’ Access to Contraceptive Services.
Massachusetts General Hospital Institute of Health Professions. (2022). Culturally Competent and Effective Healthcare, a collection of library resources.
National Institute on Drug Abuse. (n.d.). Screening to Brief Intervention (S2BI).
North American Society for Pediatric and Adolescent Gynecology & Society for Adolescent Health and Medicine. (2020). Joint Statement: The 21st Century Cures Act & Adolescent Confidentiality.
One Key Question Online, from Power to Decide.
Psychology Today. (2022). Motivational Interviewing.
Sawyer, K. & Rosenberg, A. (2020). How Should Adolescent Health Decision-Making Authority Be Shared? AMA Journal of Ethics.
Society for Adolescent Health and Medicine & the American Academy of Pediatrics. (2016). Confidentiality Protections for Adolescents and Young Adults in the Health Care Billing and Insurance Claims Process.
Texas Department of Family and Protective Services. Texas Abuse Hotline. Report abuse, neglect or exploitation.
Texas Department of Family and Protective Services. Recognize the Signs of Child Abuse.
Texas Department of State Health Services. (2023). Texas Notifiable Conditions, which includes instructions about how to report a notifiable condition to DSHS.
Texas Department of State Health Services. HIV and Texas Law. (2022).
Texas Department of State Health Services. (2021). Confidential Report of Sexually Transmitted Infections (STI) form.
Texas Health and Human Services Commission. (2021). Healthy Texas Women, Section 1115 Demonstration Waiver Evaluation Design.
Texas Health and Human Services Commission. (n.d.). Person-centered Planning for Waiver Program Providers.
Texas Health Steps. (2016). Adolescent Health: A Guide for Providers.
Texas Health Steps. (2017). Anticipatory Guidance Provider Guide, including guidance topics for every age group birth through 20 years.
Texas Health Steps. (n.d.). Texas Health Steps Child Health Record Forms.
Texas Health Steps Catalog. (n.d.).
Texas Juvenile Justice Department/UTMB Correctional Managed Care. (2017). Halfway House Health Services Manual. Obtaining Medical Consent.
Texas Medicaid & Healthcare Partnership. (2023). Texas Medicaid Provider Procedures Manual.
Texas Medicaid & Healthcare Partnership. Search Providers. Use online tool to find a doctor, hospital or other participating provider.
Loma Linda University, Children’s Health. Whole Child Assessment (WCA). (n.d.).

Appendix of Resources for Families

Advocates for Youth. (n.d.). Fact sheets on reproductive and sexual health issues, resources and tools.
American Academy of Pediatrics. (n.d.). Healthy Foster Care America, Confidentiality Laws Tip Sheet.
American Academy of Pediatrics, healthychildren.org. (2010). Information for Teens: What You Need to Know About Privacy.
Society for Adolescent Health and Medicine. (n.d.). Confidentiality Resources for Adolescents, Young Adults, and Parents.
Texas Health and Human Services Commission. (n.d.). Medicaid & CHIP Programs & Services. Information for families about Medicaid benefits and pediatric health-care services.
Texas Health and Human Services Commission. (n.d.). Healthy Texas Women. Information about finding health-care providers and eligibility for free or affordable health services.
Texas Health and Human Services Commission. (2021). Medical Transportation Program. Find out how to get a ride to the doctor, dentist, pharmacy or other nonemergency but medically necessary appointment.
Texas Medicaid & Healthcare Partnership. (n.d.). Medicaid Provider Search.