● have been sexually, physically, or emotionally abused. The subchapter also requires information concerning any legal or disciplinary actions against a mental health care professional that must be disclosed. Failure to report this information may result in added sanctions or license revocation. for their own health care and counseling also allow the health care provider to inform the parents, with or without the consent of the minor for them to do so. The Texas laws that require mental health and substance abuse communications and records to be confidential also provide for disclosure based on consent of the patient, consent of the parent of a minor, or if the patient presents a threat of imminent danger to self or others. This subsection reminds the counselor that they must follow all state and federal laws. TAC rules defer to the HIPAA Privacy Act and FERPA that governs information disclosure in an educational setting which is reviewed in the ASCA section on confidentiality. One part of the Privacy Act, the Minimum Necessary Rule, is summarized as follows (HHS, 2013): The minimum necessary standard, a key protection of the HIPAA Privacy Rule, is derived from confidentiality codes and practices in common use today. It is based on sound current practice that protected health information should not be used or disclosed when it is not necessary to satisfy a particular purpose or carry out a function. The minimum necessary standard requires covered entities to evaluate their practices and enhance safeguards as needed to limit unnecessary or inappropriate access to and disclosure of protected health information. The Privacy Rule’s requirements for minimum necessary are designed to be sufficiently flexible to accommodate the various circumstances of any covered entity. The Privacy Rule generally requires covered entities to take reasonable steps to limit the use or disclosure of, and requests for, protected health information to the minimum necessary to accomplish the intended purpose. The minimum necessary standard does not apply to the following: ● Disclosures to or requests by a health care provider for treatment purposes. ● Disclosures to the individual who is the subject of the information. ● Uses or disclosures made pursuant to an individual’s authorization. ● Uses or disclosures required for compliance with the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Rules. ● Disclosures to the Department of Health and Human Services (HHS) when disclosure of information is required under the Privacy Rule for enforcement purposes. The subchapter details the mandate of required reporting in cases of abuse or neglect. When mental healthcare providers, including licensed counselors, believe neglect or physical, mental, emotional, or sexual abuse or exploitation has occurred, they are required to make a report to the state agency of license or the Council. The subchapter lists the time frames, types of information to be gathered, and the format for reporting. Additional permitted disclosures of protected health information (PHI) will be covered in subsequent sections. The 500-page HIPAA document includes sections that apply to disclosure of protected information and the transmission of information that may be shared among agencies. Health providers should receive additional training on HIPPA regulations that apply to their practice.
2. Texas Family Code Section 32.004 allow persons under 18 to consent to counseling if they: ● are considering suicide. ● have drug or alcohol addiction or other chemical dependency issues. Discussion The Texas Administrative Code 681.45, Subchapter B (Tex.reg, 2020b) references six different sections of the TAC related to confidentiality and required reporting. This section combines two important components, confidentiality and duty to report, into one subchapter, and it includes references from the Texas Family Code, Texas Occupational Code, Texas Health and Safety Code, Texas Behavioral Executive Council, Texas Civil Practice and Remedies Code, and Texas Human Resource code. The TAC sections are interrelated, and one informs the other as they outline what information is to be held confidential and define exceptions for disclosure when necessary for the administration of justice. Remember that the Texas statutes in the TAC are compiled by the TBHEC and presented in consolidated rulebooks for professional counseling and marriage and family therapy available for download in PDF format (TBHEC, 2023). The summaries in the previous section are provided for all the regulations mentioned in the TAC Rule 681.41 subchapter B (Tex.reg, 2021), but each chapter and referenced sections should be reviewed in their entirety. The practice of counseling is as diverse as the clients it serves, so some sections referenced in this TAC chapter apply to specialized practice. For example, certain sections contain specific regulations applicable to children, clients with physical or mental challenges, clients in hospital settings, those with competency issues requiring personal representatives, or counselling of couples or groups. Confidentiality and required reporting regulations are necessary for ethical practice regardless of the specialty area, but it is critical to revisit specific sections for in-depth study as applicable. Consent for treatment by a minor is discussed in Texas law that allows minors to receive counseling services in cases of chemical dependency or addiction, suicide prevention, and physical, emotional, or sexual abuse without parental consent. At the age of 16, a child may request inpatient or outpatient services without the consent of a parent or guardian and may provide a written form of consent for services. Children in foster care over the age of 16 may be allowed to give consent for healthcare services if they have been deemed to have the capacity to give consent by the court. In all cases, a child 16 or older is not allowed to consent to an abortion. Abigail English, JD, of the Center for Adolescent Health & the Law, provides the following information. According to English (2019): Health care professionals are allowed to rely on a minor’s written statement that they are authorized to consent. Texas minor consent laws also relieve health care professionals of liability for non-negligent care for which a minor has consented. Even though minors can give consent in certain situations, their health information may still be accessed by parents, as English explains: Texas laws contain provisions that are specific to the confidentiality of minors’ health information, particularly with respect to parents’ access to that information. Confidentiality protections and consent requirements are closely linked but not perfectly matched. Generally, when minors may consent for their own health care they can expect confidentiality protection, but there are exceptions. The Texas laws that allow minors to consent
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