At what age can a teenager consent for healthcare? At what age is there a guarantee of confidentiality? In the USA, the answers depend on state law and the type of healthcare services.

In most states, parental consent is required for minors; and in most states, minor is defined as less than age 18. With this consent comes the right for the parent to have access to the healthcare information.

However, specific to sexual, mental health and substance use issues, most state laws grant the teenager confidentiality by age 14. This means that if the teen does not want information shared with the parents, health care providers have some discretion. For example, a provider may withhold from parents/guardians information that a teen has experimented with alcohol. If however, the teen had an alcohol use problem, the provider might decide that it was in the teen’s best interest for a parent to know.

Sometimes the diagnosis determines whether the care can remain confidential. For example, it is impossible for a provider to know beforehand whether the teenage female’s abdominal pain is due to pregnancy, pelvic inflammatory disease, appendicitis or psychiatric distress. As the reasons for the pain become more clear, the limits of confidentiality may change (i.e. if the reason falls into the category of sexual, mental health-related, or substance use).

Limits of confidentiality do not apply in circumstances involving abuse or the intention to harm oneself or another person. For example, a physician must report if a fourteen year old patient is having sex with a thirty year old, whether it is forced or not.

In most states, there are special categories of minors (under 18) who can consent for their own confidential care as if they were adults. These groups might include:

married teens
those on active duty in the military
emancipated youth (those given adult status by a judge)
self-sufficient youth who live without the support of their parents

The bottom line: it is imperative for the healthcare provider to know the laws of the state.

Emphasis on Health Promotion
Healthy People 2020 Objectives for Adolescents

Healthy People 2020 objectives for the adolescent period are listed below. The objectives include both the home and school environments.

Increase the number of adolescents who (whose):

have wellness checks yearly
participate in extracurricular and/or out-of-school activities
are connected to a parent of other positive adult caregiver
transition to self-sufficiency from foster care
parents consider them to be safe at school

Increase:

the number of middle and high schools that prohibit harassment based on a student’s sexual orientation or gender identity
educational achievement of adolescents and young adults
the number of schools with a school breakfast program

Decrease:

the proportion of adolescents who have been offered, sold, or given an illegal drug on school property
the proportion of public schools with a serious violent incident
adolescent and young adult perpetration of, as well as victimization by, crimes

Bright Futures Discussion Topics

The first priority is to listen to the concerns of the parents. Always observe the parent-child interaction during the entire visit. Reinforce positive interactions and discuss any concerns. If there are siblings in the room, how do they interact with the child? Is the parent positive about the child?

Bright Futures gives priority to these topics during the 11-21 year visits.