Understanding the concept of confidentiality
If you work in healthcare, then I’m sure you are aware of how important confidentiality is. Confidentiality is all about keeping information private. In healthcare, there are legal requirements surrounding what information that practitioners must keep private, and how this data should be stored. Confidentiality helps to protect the privacy of patients, and when done right, it facilitates a trusting environment that enables open communication. Fortunately, most adults are at least somewhat aware of how confidentiality in the healthcare space works, and they will typically feel comfortable opening up to practitioners. However, this is not always the case for children. If you are a practitioner who treats children, it’s important that you figure out the best way to inform them of their rights regarding confidentiality. This can be a difficult and complicated conversation to raise, but it’s a critical aspect of developing a trusting relationship. Regardless of whether your child patient is learning anger management, emotional regulation, or any other intervention skill, teaching them about confidentiality should always be a priority.
Confidentiality in a medical health setting
Within the healthcare environment, confidentiality has specific legal regulations that dictate what information can and cannot be shared. This is to ensure that the privacy of patients is protected at all times, enabling them to be honest without fearing that information will be passed on to unauthorized individuals. There is a very strict code of ethics that is taught to all practicing healthcare physicians, including confidentiality. If practitioners are found to be in breach of these ethics, there are serious consequences, including fines and, if the breach is deemed severe enough, even a loss of license. If you think your patient isn’t aware of these confidentiality rules, then it is a good idea to inform them early into treatment. This will help show your patient that you have their best interests at heart and are bound by ethics to maintain their privacy.
It is also important to understand variations in confidentiality rules. For example, confidentiality and privacy becomes slightly more complicated depending on the age of your patient. There is a certain age where adolescents are allowed to consent to mental or medical healthcare without informing their parents, but this age differs between states. As a licensed practitioner, it is your responsibility to be aware of this age and inform your patient of their rights. Regardless of whether you specialize in therapeutic activities for teens and kids, working with autistic children, or are in a medical health field, understanding these regulations is an essential component of treating young patients.
Additionally, there are certain situations where mandatory reporting is a requirement. These include if the practitioner suspects child abuse, or if they are genuinely concerned for the health and safety of the patient or others.
Importance of confidentiality during therapy
As a therapist, you may find that confidentiality impacts your work in a more significant way than with other healthcare fields. Often, therapeutic work requires patients to be extremely open about their emotions and thoughts, which can be very challenging, particularly for children. As such, it is your responsibility to ensure your patients know they are in a safe and confidential environment, where the things they say won’t be reported back to their parents. If you are a therapist that specializes in treating children, then you will likely be aware of how important it is to treat trust as a process. Instead of assuming that your patients immediately trust you, you need to demonstrate to them that you are trustworthy and have their best interests at heart. One of the best ways to do this is to explain how confidentiality works in your first session with a new patient.
As we mentioned, there are certain situations where confidentiality is revoked and mandatory reporting takes its place – this is most likely relevant to a situation where you believe a child is experiencing abuse. However, this is a very serious, and hopefully uncommon, scenario. In every other instance, maintaining the privacy of your patients should be your absolute highest priority.
Tips to explain confidentiality to children
As we mentioned, sometimes it can be difficult explaining how confidentiality works. You want to make sure your explanations are coherent and simple enough to be understood, but at the same time its essential that your patients have a comprehensive understanding of how confidentiality applies to their sessions with you. To help you navigate this difficult process, we have a few tips and strategies that you can easily employ:
Understand the laws and regulations of your state: Specific regulations regarding confidentiality differ between states. Any breach of confidentiality laws will have legal repercussions for the practicing therapist, so it is extremely important that you have a sound understanding of what laws apply to your work. Further, explaining confidentiality to children will be ineffective if you don’t properly understand how it works, so make sure you get a grasp on this as soon as possible.
Involve the patient: Although in most situations minors aren’t able to give informed consent for medical treatment, they should still be involved in clinical decision-making processes. Research has shown that children as young as 12 have an understanding of how decisions lead to consequences in regards to their health. To help develop a child’s coping skills in terms of monitoring their health, you should keep them involved in the care delivery process. Giving children the opportunity to participate in the decision-making process is therefore both reasonable and ethical. As your patient gets older, you will likely find their ability to participate in these discussions increases significantly, and you should adjust your treatment method to suit their intellectual and emotional capabilties.
Inform your patient of the limitations of confidentiality: After you explain what confidentiality is to your patient, you should inform them of the limitations to these laws. This will ensure that your patients are informed and aware of what information may be shared with other parties: including healthcare practitioners and family members.
Remember that informed consent is a process: Obtaining informed consent for a child patient will be a process that involves the child’s parents or guardian. You should keep in mind that consent should be an ever-occurring conversation that involves the minor as well. This means everytime there is a reasonably significant change to the treatment plan or intervention for the patient, then you should have another conversation with the relevant parties, and obtain informed consent.
Take home message
Navigating professional therapeutic relationships with young patients can be difficult: situations including working on anger management, developing a safe environment, encouraging questions, and informing them of their confidentiality rights aren’t always as easy as you want them to be. However, the key to any good relationship is communication and provided you consistently inform your patients of the rights afforded to them, there’s no reason why these conversations wouldn’t go smoothly. We recommend developing your own understanding of how confidentiality works, and then applying your knowledge to yur conversations with patients. Therapy should be an environment where patients feel safe and comfortable, and fostering a positive relationship begins with you.
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