A 14-year-old accompanied by her mother presents with complaints of nausea and vomiting for two weeks. After her mother leaves the room, she admits to being sexually active and tells you that she has had unprotected intercourse recently with her boyfriend. Her parents do not know she is sexually active, and she does not want her mother to know that a pregnancy test is being done or the result of that test. Pregnancy test comes back positive

• Do you disclose the test results to the patient’s mother? Why? Why not?
• Do you disclose the test results to the patient first? Why? Why not?
• How will you get the mother to leave the room to disclose results?
• What if the mother asks about test results?

A 16-year-old girl visits your office without her parents’ knowledge. She wants your assurance that everything will remain confidential and she is reassured by your response. She then discloses that she has been having a sexual affair with her stepfather. There has been no force or threat on his part. She believes she has been the provocative one. When you say they need family therapy and you are under legal obligation to report this to social services, the girl insists that you do neither and that she would not have told you anything had she known. Would it change anything if the boyfriend were a 21-year-old? 18- or 16-year-old?
What is your responsibility in this case? Explain.
What other issues does this case present for the adolescent? The family? The stepfather?
How will you manage the case after this initial visit?

You are caring for a 17-year-old male who is HIV-positive. He relates that he is having unprotected intercourse with his girlfriend who is unaware of his HIV status. As you continue to discuss this situation and the risk it poses to his girlfriend, he states that he has no intention of changing his behavior or revealing his HIV status to his girlfriend. Further discussion fails to result in changing his mind on this point. What would you do and why would this be your course of action?

The police bring in a 15-year-old street kid for an evaluation. During the course of your exam, you notice a foreign body in the ear canal that turns out to be foil-wrapped rock cocaine.
What would you do? Why?

1. Discuss the basis of the duty of confidentiality and its application to the adolescent client.
2. Identify situations in which breaking confidentiality is justified and the conditions that must be met to break confidentiality.
3. Discuss some implications to the (a) client/worker relationship, (b) the client (c) to the agency when confidentiality is violated.
4. Identify threats to the patient’s confidentiality (e.g., the bill that is to be sent to parents).
5. Discuss whether deception is justified to maintain confidentiality and any alternatives to the use of deception.
6. Distinction between violations of confidentiality and privacy.