Best Practices Discussion
Communication with the client regarding any follow up on mandated reporting is encouraged as a Best Practice. HERE is a fantastic resource regarding under-age consent and reporting. Although the site is geared towards the teenager, it’s loaded with hypotheticals that are very clarifying.
If you have an adult client who shares knowledge of abuse happening to someone else… The question of whether or not to report the abuse will come up. Use your best discretion. If you do decide to report it, we encourage that you communicate this to the client as a best practice. HERE is the mandated reporter resource guide to help you in your decision making.
Q: Dana is 17. She goes to her doctor to be treated for genital herpes. Does the doctor need to get Dana’s parents’ permission before treating her?
A: No. A minor has the legal right to consent to health care for sexually transmitted infections. So long as Dana has the capacity to consent, meaning that she understands the risks and benefits of the proposed and alternative treatments, parental consent is not required.
Q: Tom is six years old and needs a tetanus shot. His parents are out of town, and he is staying with his aunt and uncle. Can they consent to the vaccination for him?
A: Yes. Even though they are only caring for him temporarily, they can consent to his vaccination, unless they have reason to believe that his parents would object.
Q: In a counseling session with the school social worker, Jessi reveals that she is a lesbian. She asks the social worker not to tell anyone. Can the social worker “out” Jessi to her parents?
A: The professional obligation to maintain the confidences of clients would normally prevent the social worker from reaching out affirmatively to inform Jessi’s parents, but if the social worker makes notes of the information, which are then stored in the school’s permanent files, Jessi’s parents would probably have a right to view those records.
Q: Jose, who is 16, receives treatment for a sexually transmitted infection. Because of the type of treatment, he does not need parental consent and the care is confidential. He decides to pay for the treatment by using his parents’ insurance plan. Will information about his treatment be disclosed to his parents through the billing process?
A: Possibly. The health care provider cannot disclose the information to Jose’s parents. However, there is a risk of limited disclosure through the insurance process. By asking the insurance company about its notification procedures, both patient and provider can identify and respond to any risks.
Q: Jim and Toni, both minors, are considering a sexual relationship. Jim has been sexually active before and believes he may have been exposed to HIV. Toni has never been sexually active before and wants to prevent exposure to HIV. Can Toni consent to using pre-exposure prophylaxis (PrEP) to avoid infection?
A: Yes. A provider can prescribe PrEP based on Toni’s own informed consent.
Q: Qiao-ling is 15. She is severely depressed and wants mental health treatment. She does not want to tell her parents because she believes they will prevent her from seeking care. The physician believes that she needs to be treated. Can the doctor treat Qiao-ling?
A: Yes, if Qiao-ling gives her own informed consent to the treatment and the doctor determines that involving her parents would have a detrimental effect on her care. Qiao-ling cannot consent on her own to the use of antidepressants until she turns 16, however, and an independent psychiatrist must verify that she has capacity, the medication is in her best interests, and involving her parents would be detrimental to the course of treatment.
Q: Sisters Jayna and Delia have been removed from their parents based on a judicial finding of neglect and placed in foster care. Neither of the girls has ever had dental care, and both need cavities filled. Who can consent to this treatment?
A: Because a court has placed the children in foster care, the local social services commissioner or health commissioner can consent to dental care for Jayna and Delia.
Q: When James turns 13, his pediatrician, Dr. Song, has a talk with him and his mother, and they all agree that James will have a confidential relationship with Dr. Song going forward: James will be allowed to decide, in consultation with Dr. Song, when to involve his mother in health care decisions. When James is 16, he sees Dr. Song about a rash in his genital area that appeared after he started wearing a cup for hockey practice. Dr. Song recommends a prescription for an antifungal cream. James does not want to consult his mother about this. Must Dr. Song get consent from James’s mother before prescribing the cream?
A: No. Because James’ mother assented to the confidential relationship between James and Dr. Song, Dr. Song can rely on James’s informed consent and need not get prior consent from his mother.57
Q: Daniel, who is 16 years old, is planning to make an appointment with a clinic to check for STIs. He is sexually active with his boyfriend, who is 19. Should Daniel be concerned that the clinic might report his case to child protective services because he is technically a victim of the crime of sexual misconduct?
A: The law is on the side of Daniel’s care remaining confidential. Courts have determined that parents are not guilty of abuse merely for knowing that their adolescent son or daughter is having consensual sexual relations. In addition, Daniel’s boyfriend is not a proper subject of a child abuse report – only parents, custodians, or guardians are.
Q: Kim is 15. She is from Iowa but is staying in New York for the summer for a dance program. She has found out that she is pregnant and wants to terminate the pregnancy. Does she need parental consent?
A: No. While Kim is in New York, she will be treated according to New York law. She does not need parental consent.
Q: Susan, 16, is brought into the emergency room by her very angry mother, who thinks that Susan is having sex with her 18-year-old boyfriend. The mother demands that the emergency room doctors or nurses perform a “rape kit” on her daughter to determine whether or not she is still a virgin. Must the providers perform the examination?
A: No. A minor who is capable of giving or withholding informed consent to reproductive health care cannot be forced to submit to such an examination. Medical ethics might also preclude the performance of a “virginity test” that has no medical purpose or benefit. Therefore, unless Susan voluntarily consents, the exam cannot take place.
Relevant Statutes to Consider for Best Practice
In New York, child abuse laws fall under the Family Court Act. Under Family Court Act, Section 1012. (e), an abused child is one whose parents or guardians are legally responsible for the child's care, inflicting physical abuse, mental abuse, sexual exploitation, or assault.
Relevant Statutes for Child Abuse in the state of NY HERE. Topics include but aren’t limited to: Financial Assistance, Providing Emotional Support to a Child Witness in a Grand Jury Proceeding, Uniform Child Custody Jurisdiction and Enforcement Act, Access to Clinical Mental Health Records, Social Services and School Responsibilities, and more.
Relevant Statutes for Elder Abuse in the state of NY HERE. Topics include but aren’t limited to: Social Services Law, Offenses Relating to Children, Disabled Persons and Vulnerable Elderly Persons, Scheme to defraud, Protective services, and more.
Relevant Statutes for Domestic Violence in the state of NY HERE. Topics include but aren’t limited to: Financial Assistance, Access to Justice, Orders of Protection for Family and Non-Family Offenses, Statewide Registry of Orders of Protection and Arrest Warrants, Safety Provisions, Emergency Shelter for Victims of Domestic Violence, Medical and Health Services, Workplace Provisions and more.
Relevant Statutes for Rape and Sexual Offenses in the state of NY HERE. Topics include but aren’t limited to: Financial Assistance, Access to Justice, Medical and Health Services, Health Services for Victims of Sexual Assault, HIV Testing, Safety Provisions and more.
Relevant Statutes for Stalking Offenses in the state of NY HERE. Topics include but aren’t limited to: Anti-Stalking Laws , Stalking by a Family Member, Unlawful Practice of Eavesdropping, and more.
Working with Children and Adolescents
Age of consent in NY: In New York, the legal age of consent is 17 years old. This means that anyone who engages in sexual activity with a person under 17 can be charged with statutory rape, even if the sexual activity was consensual. Please find a link to Sexual Assault Reporting in NY HERE. Victims of sexual violence should call 911 if they are in immediate danger; otherwise, they should call the NYPD Special Victims Division 24-hour hotline at 646-610-7272. Please find New York State Sexual Assault Victim Bill of Rights HERE as well as a Know Your Rights website with valuable guidance on what to expect HERE. New York State Hotline for Sexual Assault and Domestic Violence at 1-800-942-6906. Statutes for Rape and Sexual Offense in NY HERE. New York Civil Liberties Union (NYCLU) Handbook can be referred to as a complete guide to rights of adolescents.
CUSTODY
About Custody. Joint custody/sole custody/custody issues: If the Judge gives joint physical custody, the child lives with each parent for an equal amount of time. If the Judge gives sole physical custody, the child lives with this adult more than 50% of the time and this person is the custodial party and the noncustodial party will have visitation.
Custody Order NY state: A Custody Order gives responsibility for the child's care and how the child is brought up to one or both of the child's parents or to someone else. There are two parts of custody: (1) legal custody and (2) physical custody. A New York court can make orders about the child's custody only until the child is 18 years old. The Court gives custody based on what is best for the child, this is called the "best interest of the child." If there is no court order, then both parents have equal rights to physical and legal custody of the child.
RAINN
RAINN (Rape, Abuse & Incest National Network) is the nation's largest anti-sexual violence organization. RAINN created and operates the National Sexual Assault Hotline (800.656.HOPE, online.rainn.org or rainn.org/es) in partnership with more than 1,000 local sexual assault service providers across the country and operates the DoD Safe Helpline for the Department of Defense. RAINN also carries out programs to prevent sexual violence, help survivors, and ensure that perpetrators are brought to justice.
COLLATERAL SESSIONS
A collateral is usually a spouse, family member, or friend who participates in therapy to further the treatment interests of the patient. Since the collateral is not the subject of the treatment, the collateral is not considered a patient.
Any collateral contacts involved in treatment: If you are working with a child/adolescent, make sure to discuss what information will be shared with parents/guardians and how that sharing will happen. Discuss with parents/guardians as well what information they can expect to be shared with them and what information will not be shared. Make a plan for collateral sessions/calls (how often, who will be involved)
Get HIPAA forms signed for any collateral contacts beyond a parent/guardian of a client under 17 and discuss with client the purpose of these collateral contacts