Academic journal article Journal of School Health

Passive versus Active Parental Permission: Implications for the Ability of School-Based Depression Screening to Reach Youth at Risk *

Academic journal article Journal of School Health

Passive versus Active Parental Permission: Implications for the Ability of School-Based Depression Screening to Reach Youth at Risk *

Article excerpt

Although ages vary by state, minors in most states may give permission for reproductive care (related to sexual assault, rape, pregnancy, and sexually transmitted diseases services), human immunodeficiency virus testing and counseling, mental health care, and drug--or alcohol-related services without parental notification. (1) Boonstra et al have emphasized the importance of providing these types of confidential services to adolescents, as minors tend not to seek services for such sensitive health concerns, if they must notify their parents. (2)

At present, permission for students to participate in school-based health screening is obtained using different approaches and is dictated by the school district in which the program is being implemented. (3-10) The choice of approach is generally based on a district's interpretation of the Protection of Pupil Rights Act (PPRA) put into effect by the federal government in the 1970s. The PPRA states that "No student shall be required ... to submit to a survey, analysis or evaluation that reveals information concerning ... mental or psychological problems of the student or the student's family." (11) The Act states that these stipulations "do not apply to any physical examination or screening that is permitted or required by an applicable State law, including physical examinations or screening that are permitted without parental notification." Whether a screening questionnaire that does not directly ask about mental or emotional problems, but rather if a child has been feeling unhappy, grumpy, or cross with her/his parents, might be considered one of the "limited number of situations" where a minor, of his/her own accord, can consent for specific health services is open to interpretation of the PPRA and varies by state and by school districts within each state.

Further issues are raised when school-based health screening is carried out within a research context. The notion of "passive consent," in which consent to participate is assumed from a lack of active refusal of participation, is often rejected by members of the research ethics community who feel that it is contrary to notions of informed consent found in the Belmont report and to the specific requirements found in the U.S. federal regulations on research. (12) Likewise, the term "parental consent" is widely used but specifically rejected by many in research ethics because parents do not bear the risks and benefits of participation. Parents can provide "permission" because children (or at least younger children) are not considered competent, and parents are generally best able to represent the interests of the child. For these reasons, in this article, we use the terms "passive parental permission" to mean information provided to parents with parents having the option to actively decline their child's participation and "active parental permission" to mean information provided to parents requiring written permission of a parent/legal guardian for their child's participation. Under the condition of passive parental permission, parental non-response is interpreted as permission, whereas under the condition of active parental permission, non-response is interpreted as decline.

Studies that compare child and adolescent participation rates under differing conditions of parental permission have shown that requiring active parental permission lowers student participation (13,14) and systematically excludes specific demographic and high-risk groups.(15-17) For example, in a trial of a gang prevention program delivered to middle school students recruited from 18 schools across the Unites States, active parental permission protocols affected student participation differentially with respect to race, parental education, family structure, and parental level of school commitment. (15) Another study found that use of active parental permission for participation in a survey of adolescent alcohol use led to differential under-representation of target groups of adolescents at high risk for drinking. …

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