Browsing by Subject "Confidentiality"

Now showing 1 - 10 of 14
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    Adolescent Access to Federally Funded Clinics Providing Confidential Family Planning Following Changes to Title X Funding Regulations
    (American Medical Association, 2022-06-01) Krass, Polina; Tam, Vicky; Min, Jungwon; Joslin, Isabella; Khabie, Lily; Wilkinson, Tracey A.; Wood, Sarah M.; Pediatrics, School of Medicine
    Importance: In May 2019, new federal regulations regarding Title X funding were introduced. There has been no formal evaluation of the impact of this regulatory shift as it pertains to minors' access to services. Objective: To explore the geography of federally funded clinics providing confidential reproductive care to adolescents following changes to Title X funding regulations. Design, setting, and participants: This retrospective cross-sectional study used a population-based sample of US Census tracts. All clinics participating in the Title X program in August 2018 and August 2020 were included in the analysis. Data were analyzed from January to December 2021. Exposures: Period, defined as before and after the 2019 Title X rule change (August 2018 and August 2020, respectively). Main outcomes and measures: US Census tracts were evaluated for the availability of confidential family planning care within a 30-minute drive, according to the presence of a Title X clinic or a permissive state law. Census tracts in which minors lost access to confidential care after the rule change were characterized in terms of demographic characteristics. Univariate logistic regression evaluated associations between Census tract characteristics and the odds of losing vs maintaining access to legally protected confidential minor services. Results: The study included 72 620 Census tracts, accounting for approximately 324 697 728 US residents (99.96% of the population). After the Title X rule change, 1743 clinics in the Title X program left (39.0%) and minors living in 6299 Census tracts (8.7%) lost access to confidential family planning care, corresponding to an estimated 933 649 youth aged 15 to 17 years. Minors living in rural Census tracts (odds ratio [OR], 1.27; 95% CI, 1.18-1.36) and those in the Midwest (OR, 2.41; 95% CI, 2.24-2.60) had higher odds of losing access to care. Minors living in Census tracts with a higher Social Vulnerability Index (OR, 0.51; 95% CI, 0.47-0.55), a larger proportion of Black individuals (OR, 0.34; 95% CI, 0.31-0.37), and/or a larger proportion of Hispanic individuals (OR, 0.45; 95% CI, 0.42-0.49) were less likely to lose access to care. Conclusions and relevance: These findings suggest that there were losses in access to legally protected confidential reproductive health services for youth after the 2019 Title X rule change. Although evidence-based Title X guidelines have since been reinstated, state laws that ensure adolescent confidentiality in obtaining family planning services may protect youth from future alterations to the Title X program.
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    Adolescent Interview With a Medical Interpreter: A Standardized Patient Encounter for Pediatric Residents
    (Springer Nature, 2023-10-18) Hudson, Tristin; Hecht, Shaina M.; Robbins, Cynthia; McHenry, Megan S.; Byrne, Bobbi; Pediatrics, School of Medicine
    Background: Pediatricians can cultivate a more trusting relationship with their non-English speaking patients by emphasizing the importance of upholding patient confidentiality in the presence of an interpreter. We designed a case for pediatric residents to increase comfort when conducting an adolescent interview using a medical interpreter, emphasizing the importance of upholding patient confidentiality, specifically when discussing sensitive health topics. Methods: We developed a standardized patient encounter (SPE) for pediatric residents at a large academic institution that focused on exploring sensitive health topics with an adolescent, non-English speaking female patient using an interpreter. A validated survey was administered upon completion of the case, prompting participants to reflect on their comfort and skills with specific activities before and after the case, and was analyzed using paired t-tests. Results: Eighty-nine residents participated; 66 were interns and 23 were in their second year of residency. The mean scores of all paired survey items significantly increased after the case (p<0.01), indicating perceived personal growth in all educational objective categories. The majority of the participants (97%, N=86) agreed that they built skills in understanding cultural humility and caring for future patients (mean Likert scores: 4.91 and 5.10, respectively). Conclusions: Upon completion of the case, residents reported increased comfort and skills using a medical interpreter for non-English speaking patients within the context of patient-centered care, discussing various sensitive health topics, emphasizing the importance of upholding patient confidentiality, and demonstrating skills in adolescent interviewing. Both medical confidentiality and cultural humility education can be integrated into simulation-based medical education to improve the quality of care for diverse patient populations.
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    Case 27-2021: A 16-Year-Old Boy Seeking Human Immunodeficiency Virus Prophylaxis
    (NEJM Group, 2021-09) Neilan, Anne M.; Salvant Valentine, Sheila; Knopf, Amelia S.; School of Nursing
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    Case Delays and Insufficient Client Communications
    (2015) Hook, Sara Anne; Faklaris, Cori
    Real-life legal practice doesn't fit neatly into the bounds of legal ethics that we all learned in law school. There are always questions and pitfalls that you'll need to figure out to make certain you're in compliance today. This seminar compiles the toughest current challenges attorneys face in protecting their professional reputations. Our experienced attorney faculty will help you get the tools you need to do the right thing without fear of disciplinary action or litigation. •Clarify allowable and prohibited conduct in social media. •Discover and avoid hidden conflicts of interest. •Find out how to properly handle case delays. •Prepare for the ethical challenges a virtual law office presents. •Protect client confidentiality in online communications and in data storage.
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    Chapter 13: Intellectual Property Issues Raised by Email
    (2014) Smith, Michael B.; Hook, Sara Anne; Dossa, Aly
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    Characteristics Associated with Confidential Consultation for Adolescents in Primary Care
    (Elsevier, 2018-08) Gilbert, Amy Lewis; McCord, Allison L.; Ouyang, Fangqian; Etter, Dillon J.; Williams, Rebekah L.; Hall, James A.; Tu, Wanzhu; Downs, Stephen M.; Aalsma, Matthew C.; Pediatrics, School of Medicine
    OBJECTIVE: To examine how provider report of confidential consultation in the electronic health record is associated with adolescent characteristics, health risk factors, and provider training. STUDY DESIGN: This prospective cohort study was conducted as part of a larger study implementing computerized clinical decision support in 2 urban primary care clinics. Adolescents used tablets to complete screening questions for specified risk factors in the waiting room. Adolescent-reported risk factors included sexual activity, substance use, and depressive symptoms. Providers were prompted on encounter forms to address identified risk factors and indicate whether confidential consultation was provided. Provider types included adolescent medicine board certified pediatrics and general pediatrics. Differences in proportions of adolescents reporting risk factors by provider type were assessed using χ2 tests. Associations between adolescent characteristics, risk factors, and provider-reported confidential consultation were examined using logistic regression analyses. RESULTS: The sample included 1233 English and Spanish-speaking adolescents 12-20 years of age (52% female; 60% black; 50% early adolescent). Patients seen by adolescent medicine board certified providers reported sexual activity, depressive symptoms, and substance use significantly more often than those seen by general pediatric providers. Among patients seen by board certified adolescent medicine providers, confidential consultation was provided to 90%. For those seen by general pediatric providers, confidential consultation was provided to 53%. Results of multiple logistic regression demonstrated that female sex, later adolescence, and clinic location were significantly associated with confidential consultation. CONCLUSIONS: Provider training is needed to reinforce the importance of confidential consultation for all adolescents.
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    Duties to Prospective Clients
    (2015) Hook, Sara Anne
    Real-life legal practice doesn't fit neatly into the bounds of legal ethics that we all learned in law school. There are always questions and pitfalls that you'll need to figure out to make certain you're in compliance today. This seminar compiles the toughest current challenges attorneys face in protecting their professional reputations. Our experienced attorney faculty will help you get the tools you need to do the right thing without fear of disciplinary action or litigation. •Clarify allowable and prohibited conduct in social media. •Discover and avoid hidden conflicts of interest. •Find out how to properly handle case delays. •Prepare for the ethical challenges a virtual law office presents. •Protect client confidentiality in online communications and in data storage.
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    Ethical Practices for Civil Litigation
    (2016-06-23) Hook, Sara Anne
    Do you know the most effective way to apply the Rules of Civil Procedure to get the best outcome for your client? Are you up to date with the latest changes? This practical course uses the experience of veteran civil litigation attorneys to build your own skills. From commencing an action to enforcing a judgment, you'll learn which procedural rules can be your best friend or your worst enemy. Stay a step ahead of your opponent with detailed knowledge of service of process, discovery and motions. Get insights into the rules judges enforce to the letter and which they let slide. No matter which side of the claim your client is on, our faculty will prepare you to master civil procedure.
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    Legal and Ethical Implications of Social Media
    (2016-05-03) Hook, Sara Anne
    Social media technologies continue to evolve at an increasingly rapid rate and have now replaced email as the preferred method of communication for many. Because of the Rules of Professional Conduct and other doctrines, lawyers need to be especially careful in using social media for client communication, marketing and other law firm functions, as well as handling social media as evidence. And it doesn't stop there: not only might incorrect use of social media end up as a breach of ethical rules, but it also has the potential to communicate a lack of professionalism to the community and damage a case or a client.