Communicating with parents about their child’s drug use

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Issue of Patient Confidentiality

Your role as child or adolescent health care provider should be to advocate for the

best health possible for your patients and their families. As an advocate, you

will need to make decisions about when to involve parents in the care of your adolescent

and young adult patients. Adolescents have the legal right to receive

confidential services for substance abuse, mental health and reproductive health. Some

patients may be sufficiently involved in substance abuse or other risky behaviors that

involvement of their parents may be appropriate. Deciding when to involve parents

requires sensitivity to the specific behaviors and associated health problems, and his or

her willingness to work with the provider.

For those patients who are sufficiently involved in severe or health

threatening behavior and who express an unwillingness to work appropriately with the

provider at improving their behavior-related health status, parental involvement is

necessary. Before taking any action, however, the health provider should inform

the patient of his or her concerns and intention to involve the parents. Since drug users

at every age frequently deny that their functioning has been affected even when the

impairment is obvious, there is the distinct possibility that your position on disclosure

will class you with other adults as an adversary. This is a risk that must be

taken in the long-term interests of your patient’s well being and to fulfill your

professional role.

Parent/Patient

Sessions

Some physicians who provide primary care to children have found that scheduling

family sessions from time to time in which parents can discuss their child’s health

and any problems in child rearing they are experiencing can be important in

building a professional relationship with them and with their child. It also helps to

communicate your desire to encourage their child’s healthy development in any way you

can. Such conferences can be useful at 6 weeks after birth, about age 2, just before the

child enters school, before adolescence, during the high school years and possibly just

after high school graduation. They can provide an opportunity for an unhurried

discussion of child health issues, including the need to develop a firm parental stance

against the use of alcohol and other drugs. Knowing that you are available for a

longer conference on a regular basis (if one is needed) may also make the parent (and your

patient) more willing to bring up problems that cannot be adequately dealt with in a brief

routine visit.

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