Consent for minors in therapy?

[FreudianSlippers]

I've recently got some referrals for teen clients for my private practice. When I saw teens in the past, it's always been through organizations that take care of consent and paperwork. My question is...do teens legally need to sign a consent form? or is it enough if the parents sign? Obviously I would discuss consent with them...but do I need to have the paperwork completed by the teens? I'm in CA and scoured the Board of Psych's rule and regulations....all I could find was that teens 12+ "may" sign consent forms themselves under some circumstances. It doesn't say whether or not they don't have to if their parents/legal guardians sign it. If I were seeing clients in person I'd have them sign consents to be safe....but it seems like a lot to expect a 13 year old to read through a long and dry legal document without me there to explain or answer questions. Would love to hear thoughts!

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[PhDenial]

Minors don’t sign or give consent. Their parents/legal guardians do. What you should gather is assent, typically verbally. One example of how you can gather assent is: “We’ll be working together on ____. Does that sound good to you?”

 

[MAClinician]

Agree with the assent to service. The program I work for is monitored by the State Medicaid (all similar programs are) and they randomly choose 2 families to interview. Teens 13+ in my state sign an assent form but parents/guardians sign consent for the interview.

If you are doing telehealth you could probably google examples of assent forms and highlight key points (confidentiality, purpose of treatment, how tx goals are decided, any specific info related to substance use etc) and email or mail to the client and/or parent. Make it teen friendly so they are more likely to review the important things but don’t need to know CFR42 blah blah blah means.... because teens won’t care.

 

[WisNeuro]

Been a while since I saw anyone under 18, but we had then sign an assent/consent form. We also thoroughly explained the issues surrounding their minor status and parents access to info.

 

[BuckeyeLove]

Curious; have any of you ever had a teen come to you without parents knowing? I don't do outpatient therapy, but I've always wondered how folks handle this situation. I know that states differ in how this is handled/how many sessions can be offered before parents need to know.

 

[WisNeuro]

Curious; have any of you ever had a teen come to you without parents knowing? I don't do outpatient therapy, but I've always wondered how folks handle this situation. I know that states differ in how this is handled/how many sessions can be offered before parents need to know.

I would imagine it would depend on if they were in crisis or not. If not, I don't imagine I'd want to begin anything unless I had a parental consent form or saw some legal emancipation papers. But, I'm not really up in the child laws at this point in my career.

 

[FreudianSlippers]

Minors don’t sign or give consent. Their parents/legal guardians do. What you should gather is assent, typically verbally. One example of how you can gather assent is: “We’ll be working together on ____. Does that sound good to you?”

That's what I was thinking/hoping. Thanks!

Agree with the assent to service. The program I work for is monitored by the State Medicaid (all similar programs are) and they randomly choose 2 families to interview. Teens 13+ in my state sign an assent form but parents/guardians sign consent for the interview.

If you are doing telehealth you could probably google examples of assent forms and highlight key points (confidentiality, purpose of treatment, how tx goals are decided, any specific info related to substance use etc) and email or mail to the client and/or parent. Make it teen friendly so they are more likely to review the important things but don’t need to know CFR42 blah blah blah means.... because teens won’t care.

Thanks! I think i'll actually do this. Give parent's the legal/jargon consent and make a simpler version for the teens. Simple and pragmatic

 

[FreudianSlippers]

Curious; have any of you ever had a teen come to you without parents knowing? I don't do outpatient therapy, but I've always wondered how folks handle this situation. I know that states differ in how this is handled/how many sessions can be offered before parents need to know.

Yes you can. In CA if they are 12+ and you have reason to belief they can maturely participate in their own Tx, they can consent for themselves. But there are stipulations, like you have to try to contact the parents unless you believe there is reason you shouldn't, and document that process.

 

[borne_before]

I LOVE the assent/consent discussion with parents/patients. It's a great way to begin building an alliance with minor patient and distance the psychologist from the parent/authoritarian role.

I usually say something along the lines of:

1. Legally, you're a minor and that means your parents can legally pry into what we discuss. Legally, you have no right to confidentiality. However, therapy works best if there is an agreement of confidentiality from parents. I explain the difference between consent and assent.
2. I get agreement from the parent to not pry too much and respect their child's privacy. Most parents are exceedingly cool with this. I explain how it's important that we build a trusting and private space so we can talk about difficult things and vulnerabilities.
3. Then I discuss the things that we might share with parents. That I have a legal and ethical, and personal duty to keep my patients safe (e.g., mandated reporting, the suicide talk, dangerous behaviors, etc). I frame it as genuine concern that I want the best for you and sometimes that means sharing things that might cause real harm, whether the child wants to or not.
4. Next we discuss including parents, how I can facilitate communication between child and parent, how I'll always ask permission before including a parent, etc. I'll see how they feel with me speaking to their parents about them...
5. I talk about communication, how I need feedback from the minor patient to ensure that I'm doing a good job.
6. I often introduce therapy with the two mountain metaphor.

 

[futureapppsy2]

Please, please, please explain mandated reporting up front and make sure that your clients actually understand it (have them paraphrase it back to you). When people don’t do this and have to make a mandated report, it can a) be really dangerous for the client and b) completely destroy their trust in therapy, period.