Treatment of Adolescents
with Substance Use Disorders
Endnotes
1 This chapter was written for the Revision Panel by Margaret K.
Brooks, Esq., Montclair, New Jersey.
2 An adult with "decisional capacity" is one who is able to understand an explanation of her diagnosis, prognosis, and choices of treatment, as well as their risks and benefits, and likely outcome should treatment be refused.
3 In States where parental consent is not required for treatment, the Federal confidentiality regulations permit a program to withhold services if the minor will not authorize a disclosure that the program needs in order to obtain financial reimbursement for that minor's treatment. The regulations add a warning, however, that such action might violate a State or local law (_2.14(b)).
4 Program staff may need training about what the State's child abuse and neglect laws require, including what conditions are considered reportable.
See the discussion of child abuse reporting.
5 Of course, a provider may turn an adolescent away for clinical reasons, that is, because it has determined that no treatment is needed or that the treatment it offers is inappropriate for the particular adolescent. In this case, the program might want to make a referral to another type of counseling service or to another substance use disorder treatment program. The procedure for making a referral is discussed in section 2.
6 Citations in the form "_2..." refer to specific sections of 42 Code of Federal Regulations (C.F.R.) Part 2.
7 Only adolescents who have "applied for or received" services from a program are protected. If an adolescent has not yet been evaluated or counseled by a program and has not himself sought help from the program, the program is free to discuss the adolescent's substance use disorders with others, although it would not be wise to do so. But, from the time the adolescent applies for services or the program first conducts an evaluation or begins to counsel the youth, the Federal regulations govern.
8 Note, however, that no information that is obtained from a program (even if the client consents) may be used in a criminal investigation or prosecution of a client unless a court order has been issued under the special circumstances set forth in _2.65. 42 U.S.C. _290dd-2(c); 42 C.F.R. _2.12(a),(d).
9 Although the rules concerning CJS consent probably apply to proceedings in juvenile court involving acts that, if committed by an adult, would be a crime, there appear to be no cases on point. It is less likely that the special CJS consent rules would apply when an adolescent is adjudicated (found to be) in need of special supervision (e.g., "persons in need of supervision"), but not guilty of a criminal act.
10 If an attorney is not immediately available, and someone wants information about child abuse and neglect rules within a particular State, contact the social service or child welfare agency for that area. Nationally, the Child Welfare League of America can also be called at 202-638-2952. Definitions of terms can also be accessed on the Internet.
11 For information about how to deal with communications with lawyers, law enforcement officials and subpoenas,
see TIP 24, A Guide to Substance Abuse Services for Primary Care Clinicians, (CSAT, 1997), pp. 111-112.
For information about dealing with search and arrest warrants,
see TIP 19, Detoxification from Alcohol and Other Drugs (CSAT, 1995c), pp. 83-84. Additional information about dealing with subpoenas appears in Confidentiality: A Guide to the Federal Laws and Regulations, (New York: Legal Action Center, 1995 ed.).
12 However, if the information is being sought to investigate or prosecute a client for a crime, only the program need be notified (_2.65); and if the information is sought to investigate or prosecute the program, no prior notice at all is required (_2.66).
13 Outcome evaluation that assesses clients' behavior at set times after completion of treatment (the importance of which is mentioned in Chapter 2) poses particular problems under the Federal regulations. For a discussion of this issue and a more complete explanation of the requirements of __2.52 and 2.53, see TIP 14, Developing State Outcomes Monitoring Systems for Alcohol and Other Drug Abuse Treatment (CSAT, 1995a), pp. 58-59.
14 Computerization of records greatly complicates efforts to ensure security. For a brief discussion of some of the issues computerization raises, see TIP 23, Treatment Drug Courts: Integrating Substance Abuse Treatment With Legal Case Processing (CSAT, 1996) pp. 52-53.
Source: The National Clearinghouse for Alcohol and Drug Information
DHHS Publication No. (SMA) 99-3283
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