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Minors, Confidentiality, and Consent
It may seem like common sense to involve parents or other family members in all aspects of treating a minor individually, but this must be weighed against issues of privacy. (Gudeman, 2006) Fortunately, the law and clinical judgement are usually in harmony when it comes to confidentiality for minors’ clinical records.
The therapist should discuss privacy with parents and the minor in the beginning of treatment. Typically, the understanding is that the child will have a high level of privacy, but the therapist will discuss with the parents the child’s overall status and progress in general terms only. However, when there is a threat to the child’s welfare, or the therapist feels there should be a significant change in treatment, then the discussion will be more specific as needed to provide good care.
When the parents are married, the therapist can get permission from one parent to treat the child so long as the parent states that the parents are in agreement. The therapist should take care to document any discussions concerning marital status, custody, and parental agreement.
Where the parents are not married, the custodial parent (in the case of sole legal custody) can provide authorization for the child to receive treatment. Where there is shared custody, both parents should give permission for treatment. If the therapist cannot communicate with one of the parents, a review of the court order concerning custody may clarify who can provide permissions for treatment. It is important not to interfere with the rights of a custodial parent. (Leslie, 2007)
Once treatment has commenced, one of the custodial parents may wish to withdraw permission to treat. In that case, the ethical and legal mandate not to abandon a client, and the treatment needs of the child can trump the desire of the parent to stop treatment. The therapist can say that both parents must agree to terminating treatment, just as they had to agree on starting it. (Leslie, 2005b)
States have laws addressing the medical needs of minors, and needs pertaining to sexual assault. State law may indicate at what age a minor can provide their own consent for treatment for sexual assault. This includes medical and psychotherapeutic treatment. In California, this begins at age 12, although parents cannot be held responsible for payment.
States generally have laws allowing minors to consent to their own treatment when there is a threat of harm should they not receive treatment. There may be specific rules on when to notify parents.