Treatment of Minors

Question 1

1. Consent to treatment by emancipated minors

Answer 1

1) emancipated minor shall be considered an adult for he purpose of consent to medical, dental or psychiatric care, without parental consent, knowledge or liability

Question 2

Emancipated minor

Answer 2

A minor is emancipated when he/she meets any of the following conditions:
1. minor has entered into a valid marriage, whether or not marriage has been dissolved
2. minor is on active duty with military
3. minor has received a declaration of emancipation from the courts (minor is at least 14, is living in separate and apart from parents/guardian with consent of parents, managing own finances, and does not obtain income from criminal activity.
Additionally to give consent for their own medical care, emancipated minors may live where they want, can apply for work, and can sign up for school. Does not change drinking/voting ages, In addition, statutory rape laws apply to emancipated minors except when the minor is legally married and the sexual activity was with spouse.

Question 3

Consent to Treatment by Unemancipated Minors

Answer 3

minor must be at least 12 y/o to consent to outpatient mh tx if the professional believes the minor is “mature enough to participate intelligently” in the tx.

Question 4

Parents involved in minors treatment

Answer 4

Tx “shall include the involvement of minor’s parent/guardians, unless the psych…after consulting with the minor…determines that the involvement would be inappropriate.

Question 5

Parent liable for minor’s MH tx

Answer 5

Minor’s parent/guardian are not liable for payment for MH tx provided pursuant to this section unless the parent participates in the MH tx, and then only for services rendered with the participation of the parent.
–this does NOT apply to minors who are receiving benefits under MediCal and it does NOT permit minors to consent to inpatient mh tx or receive psychotropic drugs, ECT or psychosurgery without parent consent.

Question 6

Minor consent cont

Answer 6

Minor who is at least 12 y.o can consent to outpatient MH tx provided by a professional person, a runaway house or crisis resolution center, or gov’t agency or contracting agency with the agency or receiving commented united funds.

• -This is more restrictive that H&S section and not only requires that the minor be able to participate intelligently but also that the minor “would present serious physical or MH harm to self or others without services…or is the alleged victim of incest or child abuse. Similarly this requires tx to involve minor’s parents when appropriate and does not permit minors to consent to inpatient tx, psychotropic drugs, ECT or psychosurgery without parental consent
• -Additional situation when minors can consent to tx; applices to counseling and may be applicable to psychs–minor who is 12 may consent to medical care and counseling related to the dx and tx of drug/alcohol related problem; does NOT authorize minors to receive replacement narcotics without parental consent.

Question 7

Consent

Minor’s biological/adoptive parents are married

Answer 7

Either parent alone may authorize tx; when parents disagree, provider to seek guidance from the court

Question 8

Consent

Minor’s biological/adoptive parents are divorced AND share legal custody

Answer 8

Either parent alone may consent unless the custody order says otherwise. However, even when only one parent can consent, it is often desirable to get consent from both parents; and if one parent refuses/withdraws consent, therapist should attempt to resolve the issue with them or suggest parents request the court to decide if tx is in the best interest of the child

Question 9

Consent

Minors’ biological/adoptive parents are divorced AND only one parent has sole legal custody

Answer 9

The parent with sole legal custody may unilaterally make MH care decisions; and if that parent withdraws consent, psych should not tx the minor

Question 10

Consent

The minor has unmarried parents

Answer 10

If paternity is not in dispute, either parent may give consent; but if biological parents disagree about tx, a court order may be necessary. If parenting has not been established, only the biological mother may give consent

Question 11

Consent

Minor has a legal guardian

Answer 11

A legal guardian has the same rights as a parent with legal custody to give consent.

Question 12

Consent

The minor has a stepparent

Answer 12

A stepparent does NOT have the authority to consent to tx unless he has legally adopted the stepchild, in which case the stepparent has the same authority as a biological parent with legal custody

Question 13

Consent

The minor is in the dependency system

Answer 13

The person authorized to give consent is determined by the court. In some cases, parent retains the right; in others, the court or it’s agent designated by the court must give consent.

Foster parents do not generally have the right to authorize tx except for ordinary medical and dental procedures.

Question 14

Consent

The minor has a caregiver

Answer 14

Caregivers who are realties, are 18 y/o, have completed and signed a Caregiver’s Authorization Affidavit may give consent for a minor’s tx.

Question 15

Minor’s confidentiality and access to records

Answer 15

minors are legally and ethically entitled to confidential relationships with providers.

• -Psych’s should protect the confidentiality of minors (even from parents when appropriate) and ensure minors understand limits of confidentiality
• -When psych is working with minor with parental knowledge and consent, psych should discuss confidentiality at the beginning of tx with the parent and child. Discussion should take into account needs of parents, best interest of child, impact of breaching the child’s conf on a therapeutic relationship, and it should end with an agreement of all parties about what info will be revealed by the child will and will not share with the parents. If an agreement cannot be reached, psych does not have to treat the minor and provide referrals

Question 16

1. Disclosure of Records of Minors to Parents/Guardians

Answer 16

Minors have right to inspect/get copy of there records when they have consented to tx. In this situation, the psych should not ordinarily share records with the minor’s parents/guardians without the minor’s authorization

–When records do not pertain to health care for which the minor has consented, the parent/guardians ordinarily have the right to access the records. However, an exception to this rule states that a health care provider “may refuse to provide parents/guardians access to a minor’s records when the provider determines the access to the patient records…would have detrimental effect on the provider’s professional relationship with the minor patient or the minor’s safety/psych well-being.”

–When parents are divorced, “notwithstanding any other provision of law, access to records and info pertaining to a minor child, including but not limited to, medical, dental and school records, shall not be denied to a parent b/c such a parent is not the child’s custodial parent.

Question 17

2. Disclosure of the Records of Minors to Third Parties

Answer 17

CA Confidentiality of Medical Info Act and HIPAA’s privacy rules, except in legally defined situations, a patient’s written authorization be obtained before disclosing confidential medical info.
–When auth is required, the minor must sign the authorization