Adolescent Health

With one in five (20%) U.S. teen girls reporting ever experiencing physical and/or sexual violence from someone they were dating, adolescent relationship abuse is highly prevalent and has major health consequences. Health care providers can help by providing prevention messages about healthy relationships, and helping those exposed to abuse. In response, Futures Without Violence has developed Hanging Out or Hooking Up: Clinical Guidelines on Responding to Adolescent Relationship Abuse: An Integrated Approach to Prevention and Intervention, focusing on the transformative role of the adolescent health care provider in preventing, identifying and addressing adolescent relationship abuse (ARA). These guidelines are applicable to providers working in a range of settings serving adolescents, including adolescent health, pediatrics, family planning clinics, and school-based health. Use these guidelines in combination with the Hanging Out or Hooking up safety cards and other resources below.

Disclosing limits of confidentiality

Navigating the balance between confidentiality and abuse reporting requirements is the fundamental challenge when addressing IPV. Laws requiring mandatory reporting of child abuse perpetrated by a parent or caregiver are often clear. However, laws vary widely from state to state for adolescents when it comes to sexual or physical abuse by a partner. As a provider, it is critical to understand the state’s minor consent and confidentiality, physical and sexual abuse laws (and in some state, statutory rape laws), and that you are able to clearly articulate them to your patients.

Make sure that you have accurate, up-to-date information about reporting laws for your state, and disclose limits of confidentiality prior to screening.

Because simply providing anticipatory guidance about healthy relationships can trigger a positive disclosure of abuse or other situation that requires a report to law enforcement or child welfare, it is essential that the limits of confidentiality are reviewed with all patients prior to any anticipatory guidance about healthy relationships or direct assessment for ARA.

Provider tips for discussing conditional confidentiality

  • Be direct: Discuss confidentiality and the conditions under which it might be breached at the beginning of the visit.
  • Keep it simple: Tailor your discussion to the youth’s age and context.
  • Communicate care and concern: Frame your need to breach confidentiality in the context of “getting them the help that they might need,” rather than using the law, policy or phrase “I am a mandated child abuse reporter,” as a reason to breach confidentiality.
  • Assure two-way communication: Let your patient know if you are going to share information that they told you in confidence.
  • Know the law.
  • Check for understanding: Ask the patient to explain what they understand about conditional confidentiality.
  • Document your communications, understanding and actions in the medical record.

Adapted from Second edition: Duplessis V, Goldstein S and Newlan S, (2010) Understanding Confidentiality and Minor Consent in California: A Module of Adolescent Provider Toolkit. Adolescent Health Working Group, California Adolescent Health Collaborative.

This video depicts an interaction between a healthcare provider and an adolescent patient about addressing technology and harassment.

In this video, a clinician provides anticipatory guidance during a pregnancy test visit.