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Parental Boundaries: Can Professionals Keep Secrets

Parental Boundaries: Can Professionals Keep Secrets?

This project is a requirement of the GOA Abnormal Psychology Course. Using the process of design thinking, a challenge in the world of mental health was identified, interviews and research were undertaken, and a solution prototype was developed. Below you will find information about the identified area of concern and my proposed solution. Please feel free to provide feedback on this prototype, using questions such as “How might we…”, “What if….?”, “I wonder….”, “I like…”, and “I wish.” Keep the comments positive, please. For more information on the process of Design Thinking, click here.

BACKGROUND:

Confidentiality is an important aspect to professional relationships in the mental health world. Trust is built over time and experience with a client. If that trust is broken it can seriously impact a patient’s path to recovery in the rehabilitation setting. I am very close friends with an individual who spent one year in a rehab facility and his experience was dramatically impacted because of the lack of confidentiality with the staff there. While conducting some research on information surrounding this topic I found that the American Academy of Family Physicians advised while caring for an adolescent patient “Privacy should be respected by physicians and their staff. The adolescent should be offered an opportunity for examination and counseling separate from parents/guardians.The physician should make a reasonable effort to encourage the adolescent to involve parents or guardians in healthcare decisions. Every effort should be made to maintain confidentiality and patients should be made aware that certain situations and circumstances create limitations on guaranteed confidentiality” (AAFP).


THE CHALLENGE:

Parents are not only paying for the rehab services but are intrested in being regularly updated with their child’s progress. The challenge is keeping these parents involved and well informed while maintaining the patient’s trust without revealing personal information. I researched studies that had been conducted regarding this this challenge. In a 1997 article titled “Influence of Physician Confidentiality Assurances on Adolescents’ Willingness to Disclose Information and Seek Future Health Care: A Randomized Controlled Trial” I found that the results found proved that “assurances of confidentiality increased the number of adolescents willing to disclose sensitive information about sexuality, substance use, and mental health from 39% (68/175) to 46.5% (178/383) (β=.10, P=.02) and increased the number willing to seek future health care from 53% (93/175) to 67% (259/386) (β=.17, P<.001). When comparing the unconditional with the conditional groups, assurances of unconditional confidentiality increased the number of adolescents willing to return for a future visit by 10 percentage points, from 62% (122/196) to 72% (137/190) (β=.14, P=.001).”

While talking to my friend about his experience in rehab, he revealed that he did not come out of rehab very changed because of this very problem. Case managers and therapists did not ever quite establish a trust with him that allowed him to reveal how he was really feeling and in effect, they were unable to properly treat him. 

Confidentiality is not only important to the patient for peace of mind, it is very important to the health care provider as well. To deliver accurate and helpful diagnoses as well as proposing efficient treatment plans the patient cannot fear for their privacy because they will be less likely to share important information– this is particularly the case with adolescents. I saw a real challenge here because teens are at such an important and critical stage in development. Rehab programs are important in this stage to prevent developing a lifetime health risk. There is a challenge in factoring in the interests of parents and guardians with young individuals who need privacy. This is a challenge because parents are they are financially and legally responsible for a child’s well-being.

Surveys show that most adolescents will seek routine medical care with their parents’ knowledge. Making parental involvement or notification mandatory, however, drastically affects adolescent decision-making, and reduces the likelihood that teens will seek timely treatment. In a regional survey of suburban adolescents: – Only 45 percent of adolescents surveyed would seek care for depression if parental notification was required” (Advocates for Youth).


THE SOLUTION:

The solution that I have developed is a signed disclosure agreement for teenagers whose parents are paying for treatment to allow teens to feel comfortable opening up and sharing more personal and relevant information with their therapists. Of course there are limits to this including harm to self, others, and abuse.


WHAT’S NEXT?

What if all patients entering into these rehab programs trusted their confidential information with clinicians. Perhaps client/ professional relationships would last and their would not be a barrier to hinder patients willingness to divulge information which would slow and even stop progress.

A follow up idea for these adolescent patients would be providing access to confidential health care services beyond the rehabilitation programs they are in. The two individuals I spoke to who spent time in a rehab facility agreed that they would have liked an outlet or resource who they could speak to, turn to. How else could this challenge be addressed and faced? How might we make these adolescent patients feel safer while talking to health care professionals so they are not afraid of repercussions from parents. I would love to hear any feedback you may have for me. This feedback could be question you may have about my proposed solution or ideas of your own to expand upon what is found here.

The next step for me is to talk more with my school guidance counselor to gather some information on how often she proposes for students to tell their parents about information. I could collect more information on how often students decide to involve their parents and go from there.  


SOURCES CITED:

 

“Adolescent Health Care, Confidentiality.” AAFP Policies. N.p., 13 June 2013. Web. 23 Apr. 2017.

Ford, C. A., S. G. Millstein, B. L. Halpern-Felsher, and J. R. Irwin. “Influence of Physician Confidentiality Assurances on Adolescents’ Willingness to Disclose Information and Seek Future Health Care. A Randomized Controlled Trial.” JAMA. U.S. National Library of Medicine, 24 Sept. 1997. Web. 23 Apr. 2017.

“Adolescent Access to Confidential Health Services.” Advocatesforyouth.org. Advocates for Youth, n.d. Web. 24 Apr. 2017.

 

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COMMENTS: 2
  1. April 27, 2017 by Jen Weeks

    I am not sure about the nature of treatment at rehabilitation clinics, but perhaps empowering the patient with a self-advocacy workshop to help them communicate about their medical condition with family and friends could be a component if it wasn’t already. It might also be interesting to have some sort of reflective exit ticket before leaving rehab where the patient identifies their greatest challenges in terms of being healthy and feeling supported.

  2. April 29, 2017 by Shreyas Gupta

    I really like your project! I think this is an interesting area of discussion as privacy and confidentiality become more and more important with the amount of information easily accessible on the information for example. I definitely think it is important to have teens feeling a sense of privacy in sharing information with a therapist but also you have to consider that maybe people at that age aren’t fully able/ready to make such important decisions about their health and that’s why parents are allowed access to their files until 18 years of age. Definitely really interesting though!

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