What is the appropriate principle of confidentiality with adolescents in terms of safety and legal obligations?

• A. Privacy is maintained by default; information is shared with parents only.
• B. Privacy should be maintained at all times, with no disclosures.
• C. Privacy should be ignored if the adolescent asks for transparency.
• D. Privacy is maintained unless there is a safety concern or legal obligation; disclosures occur with consent or as required by law; safety exceptions apply.

Answer: (D)

The principle being tested is that confidentiality for adolescents is maintained as a default, but it is not absolute. Privacy should be protected, but there are two main over-riding factors that can require sharing information: safety concerns and legal obligations. In practice, that means information is shared with the adolescent’s consent whenever possible, or as required by law when a legal duty to disclose exists. Safety exceptions come into play when there is risk of harm to the adolescent or others, or when abuse or neglect is suspected; in those cases, you disclose the minimum information needed to ensure safety and to comply with mandatory reporting requirements, working with supervisors and following organizational policies. It’s also important to discuss limits of confidentiality with the adolescent from the start, document decisions and steps taken, and involve parents or guardians in a manner appropriate to the situation and legal guidelines.