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Archive: Letter to Senator Kennedy on H.R. 1
June 4, 2001
The Honorable Edward Kennedy
428 Dirksen Senate Office Building
Washington, DC 20510
Dear Senator Kennedy:
The American Psychiatric Association is a medical specialty society comprised of
38,000 psychiatric physicians nationwide. The Council of Children, Adolescents
and their Families as the American Psychiatric Association would like to express
its concerns with language currently included in H.R. 1, the Elementary and
Secondary Education Act, referred to as the "Tiahrt amendment." Given
the shocking rate of suicide in the 15-19 age group, this provision jeopardizes
adolescent mental health and should not be enacted into law.
Adolescents are a relatively healthy subgroup of the U.S. population. Some of
their behavior, however, puts them at substantial risk for poor health,
including alcohol and substance abuse, sexually transmitted diseases (STDs),
human immunodeficiency virus (HIV), pregnancy, depression, injury, violence, and
suicide. Because these behaviors can jeopardize an adolescent’s development,
future opportunities, and even life, barriers to needed health care services
should not stand in the way of delivery of health care to adolescent patients.
A major obstacle to the delivery of health care to adolescents is concern about
confidentiality. Health professionals have an ethical obligation to provide the
best possible care and counseling to respond to the needs of adolescent
patients. This obligation includes every reasonable effort to encourage parental
involvement. However, the potential health risks to adolescents if they are
unable to obtain certain health services are so compelling that lack of
confidentiality can actually jeopardize adolescent health care. We encourage
family involvement, but forced parental involvement deters teens from seeking
timely medical advice and needed medical care.
The Tiahrt provision could have an unintended dilatory impact on the delivery of
health care to adolescents. The provision applies to all health service in a
school, including routine visits to the nurse’s office, appointments with a
school psychologist, sports physicals, and almost any service from a
school-based health center. A school would be denied all federal funding if it
"requires or otherwise causes" a student to obtain -- without prior,
written, parental consent -- medical or mental health examinations, testing,
treatment, or immunizations.
This provision could prevent any counseling, referral, or assistance by school
nurses, health professionals, guidance counselors, or even teachers from whom
minors often seek advice. A broad range of activities on the part of school
personnel might "otherwise cause" a minor to seek such care including
suggesting that a student seek counseling for alcohol or substance abuse,
providing a young person the phone number of a domestic violence or
suicide-prevention hotline. The Tiahrt provision would prevent a coach from
suggesting that an athlete with signs of anorexia seek medical help or
counseling.
While we support efforts to encourage family involvement in adolescent health
care, we believe that mandated parental consent in some situations could deter
teens from seeking needed care and may harm adolescents. Health professionals
and parents share a common goal – the health and well-being of their minor
patients. Family communication is the desired goal, and health care providers
are able to assist in that effort through their clinical medical judgement.
We urge you to remove the Tiahrt provision from H.R. 1, the Elementary and
Secondary Education Act reauthorization.
Sincerely,
David Fassler, M.D.Chair, Council on Children, Adolescents and their Families
Cc: Members of Senate Health, Education, Labor and Pensions Committee
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