Informed Consent, Confidentiality, and Practitioner Disclosure in Therapeutic Work with Youth: A Systematic Review of Practitioners’ Perspectives

Abstract

Mental health practitioners provide therapeutic interventions to youth on a daily basis, yet sparse research exists to inform ethical decision-making. It is commonly understood that therapeutic work with youth is ethically complex especially when considering informed consent and confidentiality, both of which have practical limitations. This review synthesized literature which reported practitioners’ perspectives (e.g., psychologists, social workers) on ethical decision-making about informed consent and confidentiality in therapeutic work with youth. Specifically, this review aimed to amalgamate relevant professional perspectives on work with youth who may be considered “Mature Minors” or “Gillick Competent,” indications of capacity to consent to intervention. Included studies (n = 25) largely originated in North America (40%), suggesting an underrepresentation of culturally diverse practitioners and help-seeking youth in available literature. Most studies concentrated on confidentiality (72%) and few considered decision-making related to informed consent. Adolescent risk-behavior and related potential for harm were prevalent factors in practitioners’ decision-making. This review demonstrates that practitioners endorse disparate decision-making factors and are limited in consensus to breach confidentiality. As such, practitioners demonstrate variance in approach to working with this developmentally vulnerable population.