There’s exactly one rule in our program, and I tell every family this before they ever join. We treat each other with kindness. No bullying, no racism, no transphobia. No cursing at someone. No intentionally breaking someone’s build or hurting someone in the group. That’s it. Everything else we teach, taking turns, reading a room, handling disagreement, sits inside that one rule.
I stand by that rule firmly with the kids. Lately I’ve been thinking about why I even have to ask for the same thing from their families. It’s one rule, inside the program and out. We treat each other with kindness. That’s the whole expectation, and it doesn’t stop at the edge of a session.
The Instinct to Reach Out
As a teacher, reaching out was never complicated. Two kids get into it at recess, I call both sets of parents, and I can say exactly what happened. There’s no confidentiality standing in the way. The facts belong to everyone involved.
Running a therapeutic social skills program is different. When one child is unkind to another in session, my instinct as a clinician is still to reach out. But now HIPAA is part of the equation, and it changes how I reach out, what I’m allowed to say, and sometimes whether I can say anything at all. Pennsylvania sets the age at 14. Once a child turns 14, state law lets them consent to their own outpatient mental health treatment, and I legally can’t share details with a parent the way I could when they were 8. Pennsylvania is one of several states that land on 14, alongside Alabama, Delaware, Hawaii, Idaho, Kansas, Michigan, New Mexico, Ohio, Oregon, Utah, Vermont, and West Virginia. A couple of states set the bar even earlier: Florida and Virginia allow a minor to consent at 13, and Arkansas, California, Maryland, and Nevada set it at 12. The exact age varies depending on where a family lives, but the underlying principle is the same almost everywhere. At some point, a teenager’s own confidentiality rights kick in, whether or not their parent is ready for that. Sometimes the right move isn’t to reach out at all. It’s to protect the child’s privacy and let the group work through it together, the way we’re teaching them to work through things with each other.
That gets a lot harder when a parent isn’t willing to respect that HIPAA exists in the first place.
When a Parent Won’t Accept the Line
A parent demands a phone call. They want more information than I’m legally allowed to give. Their child isn’t eight years old, they’re old enough under my state’s mental health consent laws that I can’t simply hand over what was said in session, no matter how firmly it’s demanded. I can explain that. I can explain it kindly, more than once. Some parents hear it and adjust. Others don’t, and that’s where it gets complicated in a way no one warns you about when you start this work.
Social media adds another layer. A child goes home and tells their own version of what happened in session, and a parent posts about it, sometimes accurately, sometimes not, and either way I can’t respond publicly with the actual details, because that information isn’t mine to share even in my own defense. A parent posts about my unwillingness to get on a call, without mentioning that the reason is a law protecting their own child. I’m left holding a boundary I can’t fully explain in public, while someone else gets to say whatever they want about it.
So the questions I keep coming back to are less about any one family and more about the shape of the work itself. Do I change the program itself. Do I move toward a cash pay model instead of accepting insurance, so the relationship is a direct educational service instead of a clinical one bound by HIPAA. Do I stop taking insurance altogether and shift fully into a coaching and education model, where the rules around confidentiality and consent look different because the service itself is different.
I don’t have a clean answer yet. But I know the current tension, trying to hold both a clinician’s confidentiality obligations and a teacher’s instinct to just explain what happened, isn’t sustainable long term.
Walking Away Is a Coping Skill Too
I’m not going to call someone who’s rude to me. Not that day, not the next day. And I want to be honest about why, because it connects directly to what I teach in session.
A lot of the kids in my program experience rejection sensitive dysphoria, that intense, physical reaction to criticism or conflict that comes up so often with ADHD. In the moment, the instinct is almost always to fix it immediately. Apologize even when you didn’t do anything wrong. Reach out right away. Smooth it over so the discomfort stops. I spend a lot of session time helping kids notice that instinct and choose something different, because people pleasing isn’t a coping skill. It just moves the discomfort onto you and teaches everyone else that pushing hard enough works.
I’d be a hypocrite to teach that and not live it myself.
When someone is disrespectful toward me, I don’t have to set fire to their village back. I don’t have to be rude in return, and I don’t have to prove anything by staying calm on a call I never should have agreed to in the first place. I can just let them be. Quietly, without a rebuttal, without an explanation owed. Walking away isn’t cold and it isn’t avoidance. It’s a boundary, the same one I’d want any of these kids to feel allowed to set for themselves.
Kids Come First, Even When That’s Inconvenient
The rule in our program exists to protect the group’s emotional safety. When a parent is disrespectful toward me, posts negatively, or refuses to even hear what actually happened, and I still bend over backward to accommodate them, I’m quietly telling the rest of the group that kindness is optional if you push hard enough. That’s not the environment I promised the other families.
So here’s where I’ve landed on the line.
I reach out when there’s a genuine misunderstanding and the person on the other end is open to hearing my side of it too. I reach out when a family is confused, hurt, or just needs information. That’s most of my emails, honestly, and I’m glad to send them.
I hold the line when someone is disrespectful and shows no interest in accountability. I hold the line when a parent is more focused on managing their own image, whether that’s a Facebook post or the threat of a bad review, than on what actually happened to the other kids in the room. A negative review is uncomfortable. It is not more important than the ten other families trusting that I’ll protect their kid’s experience in the group.
Billing Isn’t Separate From This
The same rule applies to payment, and I used to feel guilty saying that out loud. A card bounces, no one updates it, the bill goes unpaid, and the child shows up to the next session anyway because it feels harsh to turn a kid away over something that’s not their fault.
Here’s what I’ve had to accept. Repeatedly attending without paying isn’t neutral. It’s a boundary being crossed, just a quieter one than a rude email. I can hold compassion for a family’s financial situation and still require that they communicate with me about it directly, the same way I’d ask any of the kids in the program to communicate instead of just taking what they want and hoping no one notices.
Holding the Line Is Part of the Teaching
I used to think professional boundaries and clinical warmth were in tension with each other. I don’t think that anymore. The kids in my program watch me. They watch how I handle conflict, how I respond when someone treats me poorly, whether I actually mean it when I say kindness is the one rule or whether that rule bends the moment an adult pushes back hard enough.
Holding the line isn’t the opposite of care. It’s what makes the care in this program mean something.
0 Comments