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Involving children in decision making and consent processes

by Ann Cox | Oct 23, 2023 | in Reducing inequalities in access, experience and outcomes

I undertook my doctoral research on how can we involve children aged 8-12 years in decison making and consent processes in outpatient CAMHS- however the concept is transferable to older children and those in inpatient services. We are really poor in involving children in decison making and consent processes and more often that not defaul to parental consent. We have an ethical and moral obligation to improve access for children in thier own care, by developing the competence of children. In developing thier decision making abilities we improve children's confidence, self agency, motivation, and positive outcomes of care. There is much more qualitative aspectsof care we could focus on to improve access for children from all cultures and backgrounds, but we rarely focus on improving this. The rights of children must be upheld and nurses/ clinicians feel safe in doing so by hvaing better understanding of the legal and practice frameworks and guidance. The ISUPPORTRights (isupportchildrensrights.com) is a helpful framework to start from. Nurses/ clinicians needs traning and skills on how to use the right legal framework, uphold children's rights, whilst balancing and involving parents/ caregivers at all levels. 

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James Dearden Oct 23, 2023

This is hugely important, not just to empower CYP and ensure that they are part of the healing process, but also to ensure that we are doing everything LEGALLY, which can become very tricky around the 16-18yr age group.
I really like this from Me First to try and understand your patients experiences:

https://www.mefirst.org.uk/wp-content/uploads...19-at-09.21.jpg

Will be checking out that website for sure.

GHarding Oct 24, 2023

I've just spent some time on the Me First website which I'd never heard of - there are some really good resources here. Thank for sharing!

Ann Cox Oct 24, 2023

The 16-18 year old group is far easier to navigate (IMO) as they come under the Mental Capacity Act, its involving Children under Gillick competence, under 16 years, that clinicians appear to struggle to know when this can be applied and when it cant.

Ian Lewis Oct 24, 2023

I think that we need to distinguish between legal consent, which depends upon capacity and Gillick competence, and consent that is not necessarily about the child's legal capacity but does help and ensure that they understand what the aim of any treatment or help is and consent to the degree that their capacity allows, given age and understanding. This includes the parent/ carer as where children do not have legal capacity to consent to treatment they will need to give such. I think that this also includes being clear about outcomes. What are we aiming to achieve together and how will we know/ measure whether we are achieving it. I use 'we' advisedly because this is about achieving a therapeutic alliance with children and understanding what it is that they are concerned about and how that can be improved. This seems particularly important for some children with protected characteristics where the power imbalance may be particularly acute and needs to be acknowledged. On Gillick competence, there is comprehensive guidance on this within the Mental Health Act Code of Practice , that can be applied in other circumstances. But lack of formal capacity does not mean that they do not have rights. https://www.gov.uk/government/publications/co...health-act-1983

GHarding Oct 24, 2023

Hi Ann, thank you for sharing, this is a really interesting piece of work. Do you think there need to be any adjustments to the standards for mental health or for community services?

Ann Cox Oct 24, 2023

Yes I do think that there needs to be adjustments for all children in mental health services, inpatient and community as we do not have a consitent approach to involving children in decision making and consent processes and ensuring we are involving children to thier fullest capacity as possible wihtout it being burdensome to them

James Dearden Oct 24, 2023

Slightly losing track of what’s been posted on here and what’s not but this also looked like a good resource:

https://www.isupportchildrensrights.com/

We have also developed a booklet locally to help CYP on the paediatric ward to understand some of the ways in which the hospital works which might be different to home (attached below - My Rules)