American Academy of Pediatrics Releases Guidance on Maintaining Confidentiality in Care of Adolescents

Confidentiality can be affected by rapidly evolving technologies where information is shared, health care billing and legal requirements.
 
ITASCA, IL--As adolescents gain new skills in independence on the path to adulthood, they also assume rights and responsibilities concerning their personal health care, including the opportunity to have candid and confidential conversations with their doctor.
 
The American Academy of Pediatrics in a new   policy statement offers support to pediatricians on developing policies and practices that align with the needs of teenage patients and their families within a framework of federal and state laws.
 
The “Confidentiality in the Care of Adolescents: Policy Statement,” will be published in the May 2024 Pediatrics (published online April 22), along with an accompanying technical report, both of which were written by the AAP Committee on Adolescence and Committee on Practice and Ambulatory Medicine.
 
Policy statements and technical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.
 
“As a pediatrician and adolescent medicine specialist, when I’m working with adolescent patients, I want to help them develop responsibility for their health and well-being, so that they have the information they need to thrive as they enter adulthood. That includes the ability to have candid, confidential conversations with their doctor,” said Richard J. Chung, MD, FSAHM, FAAP, lead author of the policy statement.
 
“While we need to respect our teens’ need for privacy and confidentiality, we also recognize the important role of parents/caregivers and encourage teens to share information and lean on their parents/caregivers for guidance. It's important to work together as a team to provide the best care for our patients.”
 
The clinician also needs to be aware of how confidentiality can be impacted by rapidly evolving technologies where information is shared, as well as health care billing and legal requirements.
 
Some federal laws that may apply include the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule; the Title X Family Planning Program; the Family Educational Rights and Privacy Act (FERPA) and the 21st Century Cures Act. At the state level, as minor adolescents develop autonomy and the ability to participate in health care decision-making, they are typically granted the right to consent to care related to specific health issues. These may include reproductive health, substance use counseling and testing, and often mental health, although the ages at which this right is granted and other limits and stipulations vary from state to state.
 
The AAP offers recommendations for pediatricians when working with patients; practice management and operations; health care systems and technology; education; advocacy; and working with other healthcare team members.
 
When working with families, the AAP recommends that pediatricians:

• Respect the patient’s request for confidentiality when legally required or permitted.
• Prioritize the health and well-being of the patient, understanding that doing so may necessitate breaking confidentiality when legally required or permitted to safeguard the adolescent.
• Encourage the adolescent to share important health information with their parents/caregivers, to the extent that the adolescent deems acceptable, even though it may not always be legally or clinically required.
• Support adolescents and parents/caregivers in understanding the psychosocial development of the adolescent, recognizing normative changes in autonomy and decision making as youth transition from dependent childhood to independent adulthood. Discuss the need for confidential care, when appropriate.
• Include time alone with the adolescent during each clinical encounter. This is developmentally appropriate and may help in fostering independence skills. Promote alignment with parents/caregivers centered on the well-being of the adolescent, balancing the primary interests of the youth with parental needs and priorities.
• Explore relevant cultural perspectives, traditions, and religious beliefs held by the patient and family.

The policy statement observes that youth who have had limited access to health care due to system racism or marginalization might be particularly concerned about ensuring confidentiality. This includes youth involved in the justice system, youth in foster care, indigenous youth, refugee and immigrant youth, youth with intellectual disabilities, and LGBTQIA+ youth.
 
“A large part of the pediatrician’s job is listening,” Dr. Chung said. “We can help every young person by encouraging conversations and helping to create a safe space in our clinics.”

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.