Confidentiality with Children and Adolescents

Secret Club or Safety Net? Confidentiality with Children and Adolescents
Imagine a child whispering secrets into a trusted adult’s ear. This scenario highlights the importance of confidentiality in healthcare settings, especially when working with children and adolescents. Confidentiality creates a safe space for young people to express themselves freely, fostering trust and promoting their well-being [1]. But is it ever okay to break this promise? Let’s explore the complexities of confidentiality with this unique patient population.
Confidentiality builds trust between a healthcare professional and a child or adolescent [2]. Knowing their disclosures will be kept confidential, young people feel more comfortable opening up about sensitive topics like bullying, anxiety, or even substance abuse. This open communication allows for early intervention and support, leading to better health outcomes.
However, maintaining confidentiality isn’t always straightforward. In certain situations, healthcare professionals may need to disclose information to ensure a child’s safety [3]. If a child reveals suicidal ideation, plans to harm themselves or others, or experiences abuse, healthcare professionals have a legal and ethical obligation to intervene. Additionally, in cases of suspected child neglect, reporting may become necessary to protect the child’s well-being.
The key lies in striking a balance between building trust and ensuring safety [4]. Healthcare professionals should explain the limitations of confidentiality upfront, using age-appropriate language. For instance, they can explain that they need to tell someone if a child is planning to hurt themselves or someone else. This transparency fosters trust while setting clear boundaries.
Open communication and collaboration with parents or guardians are also crucial [5]. While maintaining confidentiality for the child, healthcare professionals can involve parents in a way that protects the child’s privacy. For instance, they can discuss general concerns without revealing specific details shared by the child.
Confidentiality in pediatric care is a complex yet essential concept. By creating a safe space for open communication while prioritizing safety, healthcare professionals can empower children and adolescents to navigate the challenges of growing up, fostering a foundation for healthy development.
[1] The Association for Play Therapy. (n.d.). Confidentiality and ethics. Association for Play Therapy. [confidentiality in play therapy ON Association for Play Therapy]
[2] American Academy of Child and Adolescent Psychiatry. (2022, December). Confidentiality and adolescents. American Academy of Child and Adolescent Psychiatry. [informed consent example for adolescents ON American Academy of Child and Adolescent Psychiatry]
[3] The National Center for PTSD. (2023, May 12). Confidentiality and disclosure of mental health information. Veterans Affairs (.gov). [confidentiality in mental health ON Veterans Affairs (.gov)]
[4] The Trevor Project. (2023, May 19). Confidentiality and privacy for LGBTQ youth. The Trevor Project. [youth confidentiality and privacy ON]
[5] American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. [apa ethical principles of psychologists and code of conduct 2017 ON American Psychological Association]

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