Can parents access their children's therapy notes?

Parents do not automatically have the right to access their children's therapy notes under HIPAA. This is due to the differentiation between information related to mental health treatment plans and psychotherapy notes.

Why does HIPAA restrict access to therapy notes?

The Privacy Rule differentiates between general mental health information in a child's medical record and specific psychotherapy notes. Psychotherapy notes, which are detailed notes taken by mental health professionals during therapy sessions, are considered protected and are generally not accessible to parents. They are intended for the personal use of the treating professional. They are separate from the rest of the medical record. However, while HIPAA does not grant parents a right to these notes, it does allow therapists discretion to share them if they believe it is appropriate, although this is not commonly practiced. These instances where therapists can exercise discretion to share psychotherapy notes include: 

• Client specifically requests access to their own psychotherapy notes.
• Legal obligations or court orders require the release of notes.
• Belief that not sharing information could harm the client or others.
• Client gives explicit consent for notes to be shared for a specific purpose.
• Professional consultations with other therapists or healthcare professionals, with client consent.
• Use in supervision or training of mental health professionals, ensuring confidentiality.
• Emergency situations where sharing information is vital to the client's well-being.

See also: Psychotherapy notes and HIPAA

HIPAA and medical records

Parents are generally considered the personal representatives of their minor children and, as such, typically have the right to access their children's health records. However, there are notable exceptions, especially in mental health treatment. For instance, if a child is legally deemed emancipated or has the right to consent to medical treatment under state law, the parent's right to access this information may be limited. HIPAA allows healthcare providers to exercise professional judgment in withholding information if they believe sharing it could harm the child. 

How does the concept of "mature minor" affect parental access to mental health information?

The concept of a "mature minor" refers to a legal principle recognizing that some minors possess the maturity to make their own decisions regarding medical treatment, including mental health care. Assessing a minor's maturity is based on their age, intelligence, maturity level, and understanding of treatment risks and benefits. The mature minor doctrine can limit parental access to mental health information. Suppose a minor is mature enough to make their own healthcare decisions. In that case, they can control access to their mental health information, setting a boundary on parental rights.

See also: Basics of HIPAA compliance for therapists

APA ethical principles and guidance on parental access

The American Psychological Association (APA) provides guidance on parental access to children's mental health records, balancing ethical considerations with legal requirements. Under the APA Ethics Code, psychologists are advised to maintain confidentiality and protect sensitive information obtained in therapy. However, the guidance recognizes that legal rights to access these records can vary, often depending on the child’s age, the nature of the parental consent for treatment, and state laws. Psychologists are encouraged to discuss the limits of confidentiality at the outset of therapy, including explaining to both parents and the child what information can be shared. In cases where there is a legal right for parents to access their child’s mental health records, psychologists must comply, unless doing so would cause harm to the child. 

See also: HIPAA Compliant Email: The Definitive Guide