What is the most appropriate course of action when a mother asks a healthcare provider to inform the school about her child's social behavioral disorder?

Appropriate Action for School Communication About Child's Behavioral Disorder

The healthcare provider should obtain consent from the mother before communicating with the school about her child's social behavioral disorder. 1

Confidentiality and Consent Requirements

The fundamental principle in pediatric mental health care is maintaining patient confidentiality while establishing collaborative relationships that support the child's treatment. Healthcare providers must protect the child's confidential communications and obtain appropriate consent before sharing information with third parties, including schools. 1

• The child's specific communications and diagnostic information are confidential unless the parent (legal guardian) provides permission to share this information with external parties 1
• The therapist should use good clinical judgment in choosing if, when, how, and to whom to disclose protected health information 1
• Informed consent should consist of both the legal guardian and the patient (if older than the age of majority) 1

Why Direct Communication Without Consent Is Inappropriate

Simply informing the school without obtaining consent violates the core ethical principle of confidentiality in pediatric mental health care. 1

• Confidentiality is crucial for psychodynamic psychotherapy and all mental health treatment 1
• The clinician must skillfully communicate understanding to collaborating parties while protecting the child's confidential communications 1
• Documentation and records must be maintained in a private and secure location, and participating staff must be educated about protected health information 1

Why Telling the Mother to Handle It Alone Is Suboptimal

While the mother could technically inform the school herself, this approach misses important opportunities for optimal care coordination:

• The clinician should establish collaborative relationships with schools and define respective roles in assessment, treatment, and coordination of care 1
• Healthcare providers are positioned to facilitate appropriate communication that ensures the school receives clinically relevant information while maintaining confidentiality 1
• A designated hospital or practice liaison can partner with the child's school to ensure continuity of care and educational support 1

The Recommended Approach: Obtain Consent Then Collaborate

After obtaining written consent from the mother (and assent from the child if age-appropriate), the healthcare provider should facilitate communication with the school as part of a collaborative care model. 1

Steps to implement this approach:

• Discuss with the mother what specific information would be helpful for the school to know to support her child's needs 1
• Obtain written consent that specifies what information can be shared and with whom 1
• If the child is old enough, explain what information will be shared with the school and why 1
• Establish collaborative relationships with school personnel (counselors, nurses, teachers) and define respective roles 1
• Share only clinically relevant information that will help the school provide appropriate accommodations and support 1

Common Pitfalls to Avoid

• Misunderstanding privacy regulations (HIPAA): Pediatricians are allowed to exchange information with other professionals involved in a patient's care, but this still requires appropriate consent for school communications 1
• Sharing excessive detail: The school needs functional information about accommodations and support, not detailed clinical notes or therapy content 1
• Failing to involve the child: Depending on developmental stage, the child should understand what is being shared and why, which maintains the therapeutic alliance 1
• One-way communication: Establish ongoing collaboration rather than a single information transfer, as the child's needs may evolve 1