The Tiahrt/Graham amendment, adopted by voice vote to H.R. 1, the Elementary and Secondary Education Act, would require written prior parental consent before a minor could receive any non-emergency health or mental health service in a school setting. In doing so, the Tiahrt/Graham amendment isolates young people from the essential health-care services they need.

• Tiahrt/Graham is an unconstitutional restriction on all funds, including non-federal dollars. The Tiahrt/Graham amendment would deny all federal funds to schools that fail to comply with the amendment, even if they use other non-federal sources of funding to provide health-care services to minors. This is an unconstitutional federal condition on local and private funds because it penalizes schools that provide constitutionally protected, confidential health services for minors by withdrawing all federal funding. It is also a disproportionate sanction, one that could result in a cutoff of federal funds to an entire school district – or even a state educational agency – if even one staff member fails to comply with the amendment.

• Addressing young people’s health needs in a timely fashion should be our first priority. Today’s youth are at particularly high risk for health problems and unhealthy behaviors such as alcohol and substance abuse, sexually transmitted diseases (STDs), human immunodeficiency virus (HIV), pregnancy, mental illness, injury, and self induced and interpersonal violence. Every day young people suffer depression, fear, extreme anxiety and anger, and even contemplate suicide. Regrettably, many do not take the initiative to seek help from caring adults, yet these health threats can jeopardize an adolescent’s development, future opportunities, and even life. As a result, our common goal should be one of reducing, not erecting, barriers to needed health care services. We must not inhibit school-based personnel from immediately addressing what may be signs of physical illness, emotional or behavioral trouble.

• Tiahrt/Graham applies to all health services in school settings. The Tiahrt/Graham amendment would require prior written consent before a minor can access virtually any health service in any school setting. This includes routine visits to the nurse’s office, appointments with a school psychologist or school counselor, sports physicals, and almost any service offered by school-based health or mental-health service providers. These services include both preventive-health and primary health-care services and range from basic screenings for height, weight, vision, hearing, and scoliosis, other developmental health checks, to counseling services to address why a student might be having difficulties at school (the causes of which could be poor vision, malnutrition, depression, substance abuse, or a variety of other conditions or illnesses).

• The amendment is so broadly worded that it could discourage school officials from offering routine, responsible guidance to young people. The Tiahrt/Graham amendment denies funds to any educational agency or institution that provides or "otherwise causes" a young person to receive a health service. The meaning of "otherwise causes" is so vague as to present serious constitutional concerns. Moreover, it is so broad that it could discourage any counseling, referral, assistance by school nurses or other health professionals, mental-health providers, counselors, teachers, or even principals from whom minors routinely seek advice.

School personnel regularly perform a broad range of activities that might "cause" a minor to seek health care, including providing critical referral information; offering an uninsured young person the name of a nearby community health center; suggesting that a minor obtain substance abuse or mental health counseling, a vision or hearing exam, or an HIV test; or providing a young person with the phone number of a domestic-violence or suicide-prevention hotline. A principal who calls a student who has been disruptive in class into his/her office may violate the Tiahrt/Graham amendment if, as a result, the conversation "causes" the young person to seek mental-health counseling for anger management. A school physical-education teacher may not want to risk violating Tiahrt/Graham by talking to a visibly too-thin young woman about eating disorders – because this might "cause" the student to seek care for her illness. These two examples illustrate the startlingly broad sweep of the Tiahrt/Graham amendment, and hint at its potential to place individuals’ and the public health at risk.

• The Tiahrt/Graham amendment removes control and flexibility from local communities. Although the Tiahrt/Graham amendment applies to all school-based health care, it would particularly affect school-based health centers, which comprise a critical link in our nation’s public-health system for young people. Young people are the population most likely to be uninsured and to lack access to traditional health-care providers. The nation’s 1300 school-based health centers were founded to address this gap. While such centers vary in size, form, and in the services they provide, they all have advisory boards comprised of community representatives, parents, youth, and family organizations that participate in the planning and oversight of the center. Decisions about how services should be provided in school settings should be left to local decision-makers who can assess the needs of their own communities.

• Tiarht/Graham is contrary to the recommendations of major medical, mental health, and public health organizations, which support young people’s access to confidential health care. Leading medical groups, including the American Medical Association, American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Public Health Association, the National Medical Association, the National Association of School Psychologists, and the American Psychological Association oppose mandatory parental consent requirements for young people to access certain sensitive health-care services. Health professionals have an ethical obligation to provide the best possible care and counseling to respond to the needs of adolescents. 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 their health.

• The Tiahrt/Graham amendment will not improve family communication; it will only isolate young people from health services. While most teens seek their parents’ advice and counsel when making decisions about their health care, in some cases, open family communication is not possible. This is particularly true of sensitive services such as mental health, substance abuse, and reproductive-health care. School-based health centers and other school-based services personnel provide a confidential, safe place for young people to receive essential services and accurate health-care information that may otherwise be inaccessible or appear less convenient. Requiring parental consent before a minor could access any health service or obtain health care in a school setting will mean that minors may not receive the information they need to make informed decisions about their health or be able to obtain necessary services. Furthermore, it is highly probable that many parents and students would fail to complete or return the necessary paperwork to consent for the services – not because they intend to decline them, but because such communications often fall through the cracks. These young people may be most at-risk for health problems.

• Tiahrt/Graham supplants minors’ rights in numerous states. Although the Tiahrt/Graham amendment does not preempt explicit state laws that allow minors to consent to health-care services without involving a parent, state laws vary widely in express grants of authority to minors. For example, while every state has a statute that expressly allows minors to consent for STD testing and treatment, only 20 states and the District of Columbia have statutes that explicitly permit minors to consent for outpatient mental health services, and only 22 explicitly permit minors to consent for general medical services. However, even in states without such statutes, minors are permitted to consent to medical treatment under the state and federal Constitutions or as a result of state common law. The Tiahrt/Graham amendment would supplant the legal regimes in all the states in which there is no express statute on point, but where minors are nevertheless permitted to consent for sensitive services.