CONFIDENTIALITY
LEAH Lecture by Yolanda Evans MD MPH
Overview
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Why is confidentiality important?
Laws in Washington
Tips of how to start a visit
Example cases
Final Questions
Why is Confidentiality Important?
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Building trust is key
 This
can take time
 To build on trust, the
teen has to return to
see you
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Not all teens come
from supportive
environments
What Does Research Show?
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Having a confidential visit is important to teens
They are more likely to disclose risky behaviors if
it’s confidential
They’re also more likely to return for care
Ford, C., Millstein, S., Halpern-Felsher, B., & Irwin, C. (1997). Influence of physician confidentiality assurances on adolescents' willingness to disclose
information and seek future health care. A randomized controlled trial. JAMA , 1029-1034.
What are Barriers?
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Providers list ‘time constraints’ as a major barrier to
providing confidential care
Parents may also be unwilling to allow a confidential
visit (but this is not the norm!)
Helitzer, D. L., Sussman, A. L., Urquieta de Hernandez, B., & Kong, A. S. (2011). The "ins" and "outs" of provider-parent
communication: perspectives from adolescent primary care providers on challenges to forging alliances to reduce adolescent
risk. Journal of Adolescent Health , 404-409.
Age of Consent in WA
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In WA state youth of special ages can seek care for
certain things without a parent
 Mental
Health treatment: 13 years
 Alcohol and drug treatment: 13 years
 Sexually transmitted disease/HIV testing: 14 years
 Reproductive health: no age limit
Tips on Confidentiality
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Reassure the teen that the conversation is confidential unless
they tell you someone is hurting them or they want to hurt
someone (including self).
 WA
state law: 13+ for mental health, 14+ for
reproductive health
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Ask your questions confidently, without passing any judgment.
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Ask the same questions of everyone, regardless of gender!
 Example,
“Are you sexually active with boys, girls, or
both?”
 Don’t forget to ask about any unwanted intimate
contact
Cases
Sarah
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Sarah is a 17 y/o female coming in for a nutrition
visit because she is underweight
Her mom and dad are here with her
You tell them you’ll have a time during the visit to
meet with Sarah alone
 When
parents step out, you let her know you’ll have to
tell her parents if you’re worried about her safety
Sarah
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After learning a bit about her social life, she discloses
she’s been restricting her intake, binge eating and
purging
With more questioning, Sarah meets criteria for bulimia
She DOES NOT want to disclose to parents
What do you do with mom and dad?
Do you think she would have told you her eating habits if
you hadn’t asked for the time without family?
Ron
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Ron is a 15 y/o male who is brought in by his mom
for concerns about anger
You talk with them together, then ask mom to step
out for a few minutes
You tell Ron the visit can remain confidential unless
worried about his safety
Ron
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He is hesitant to talk with you, but let’s you know he
has a girlfriend
They have been sexually active but his parents don’t
know and he’d like to keep it that way
You counsel about safer sex practices and sexually
transmitted disease screening
What do you tell mom? Are you concerned about
ordering the screening tests?
DJ
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DJ is a 14 y/o male who comes in for concerns of
depression
He is here with his mom and stepfather
You talk with him alone and let him know the visit
will remain confidential unless you’re worried about
his safety
DJ
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DJ opens up about the bullying that is occurring at
school and online
He also tells you he is questioning his sexuality, but
has not told his parents
At the end of the visit, DJ discloses that a cousin in a
different state touched him inappropriately a few
years ago and he has never told anyone
DJ
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DJ gives you a lot of information including the name
of the cousin and location of the incident
He also tells you he has thought of suicide in the
past week
Now what do you do?
Maria
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Maria is a 15 y/o female comes to clinic for heavy
menstrual bleeding
She comes in with her entire family (mom, brothers,
dad) for each visit
You always offer to meet with her alone, but she
declines each time
Maria
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Maria ran out of her birth control pills about a
month ago, so she comes in for a refill
You offer to speak with her alone and she accepts
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She denies sexual activity, drug use, alcohol use
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Because she’s been out of pills for a month, a urine
HCG is obtained and it is positive
Maria
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Her family is waiting outside for her
She continues to deny sexual activity but you counsel
her on options for the pregnancy
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She leaves without making any decisions
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Do you have to notify her parents? What about her
PCP?
What Cases do you have?
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Does anyone in the audience have a case to discuss?
Summary
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Confidentiality laws vary by state!
In WA, minors can receive confidential care for
certain situations (mental health, substance use, STD
screening, reproductive health)
Assuring confidentiality is important to teens, but let
them know there are certain things you’ll have to
disclose
Questions?