Case of a Girl with a Secret


The assurance of confidentiality in sexual, reproductive, and mental health is an essential element of the therapeutic relationship between adolescents and their health-care providers. Research has shown that adolescents may forgo needed health care for these sensitive concerns if they believe this information will be shared with their parents. To address this issue, laws have been enacted to protect confidentiality when an adolescent seeks care in areas such as sexually transmitted infection testing, contraception, and outpatient mental health services. Confidentiality laws can vary by state and may depend on a practitioner’s assessment of the minor’s ability to make informed decisions regarding his or her health. In some circumstances, however, confidentiality cannot be assured, such as when the adolescent’s safety is at stake. There are also other challenges to preserving confidentiality such as billing for services, the electronic medical record, and patient portals. For this reason, providers should familiarize themselves with the laws regarding adolescent confidentiality in their state and include discussions of confidentiality in each adolescent patient encounter.


Confidentiality Informed consent Emancipated or mature minor Explanation of benefits Patient portal 


  1. 1.
    Feierman J, Lieberman D, Schissel A, et al. Teenagers, health care and the law. New York Civil Liberties Union; 2009. Accessed 12 Sept 2016.
  2. 2.
    Berlan E, Bravender T. Confidentiality, consent, and caring for the adolescent patient. Curr Opin Pediatr. 2009;21:450–6.CrossRefGoogle Scholar
  3. 3.
    American Civil Liberties Union. Timeline of important reproductive freedom cases decided by the Supreme Court; 2015. Accessed 12 Sept 2016.
  4. 4.
    Health and Human Services. Title X: the national family planning program; 2014. Accessed 12 Sept 2016.
  5. 5.
    American College of Gynecologists. Committee opinion: adolescent confidentiality and electronic health records; 2014. Accessed 12 Sept 2016.
  6. 6.
    English A, Ford C. The HIPAA privacy rule and adolescents. Perspect Sex Reprod Health. 2004;36(2):80–6.CrossRefGoogle Scholar
  7. 7.
    Guttmacher Institute. 2016. Accessed 12 Sept 2016.Google Scholar
  8. 8.
    Ford C, Millstein S, et al. Influence of physician confidentiality assurances on adolescents’ willingness to disclose information and seek future health care. JAMA. 1997;278(12):1029–34.CrossRefGoogle Scholar
  9. 9.
    Reddy D, Fleming R, Swain C. Effect of mandatory parental notification on adolescent girls’ use of sexual health care services. JAMA. 2002;288(6):710–4.CrossRefGoogle Scholar
  10. 10.
    Bravender T, Lyna P, et al. Physicians’ assurances of confidentiality and time spent alone with adolescents during primary care visits. Clin Pediatr. 2014;53(11):1094–7.CrossRefGoogle Scholar
  11. 11.
    Akimbami L, Gandhi H, Cheng T. Availability of adolescent health services and confidentiality in primary care practices. Pediatrics. 2003;111(2):394–401.CrossRefGoogle Scholar
  12. 12.
    Frerich E, Garcia C, Long S, et al. Health care reform and young adults’ access to sexual health care: an exploration of potential confidentiality implications of the affordable care act. Am J Public Health. 2012;102(10):1818–21.CrossRefGoogle Scholar
  13. 13.
    Burstein G, Blythe M, Santelli J, et al. Confidentiality protections for adolescents and young adults in the health care billing and insurance claims process. J Adolesc Health. 2016;58(3):374–7.CrossRefGoogle Scholar
  14. 14.
    Anoshiravani A, Gaskin GL, Groshek MR, et al. Special requirements for electronic medical records in adolescent medicine. J Adolesc Health. 2012;51(5):409–14.CrossRefGoogle Scholar
  15. 15.
    American Academy of Pediatrics, Committee on Adolescence and Council on Clinical and Information Technology. Standards for health information technology to ensure adolescent privacy. Pediatrics. 2012;130(5):987–90.Google Scholar
  16. 16.
    Bayer R, Santelli J, Klitzman R. New challenges for electronic health records; confidentiality and access to sensitive health information about parents and adolescents. JAMA. 2015;313(1):29–30.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of Adolescent Medicine, Department of PediatricsThe Children’s Hospital at MontefioreBronxUSA
  2. 2.Division of Adolescent Medicine, Pediatric Residency ProgramThe Children’s Hospital at Montefiore, The Pediatric Hospital for Albert Einstein College of MedicineBronxUSA

Personalised recommendations