Competency, consent and confidentiality

 

  • The law allows children of all ages to consent to treatment where the child can demonstrate that they fully understand the proposed treatment and any risks — Table 3.1
  • If a child under 16 years does attend clinic without carer, ensure their immediate safety, treat emergencies, and urgently contact carer.
    • Urgent medical consult if carer not available and young person is assessed as not competent to provide consent or if there is a potential risk in contacting carer
  • Ask about appropriate adult support or even a competent minor — may help identify responsible adult to talk with about their health — parent, other family or ATSIHP, trusted adult in community

Competency to consent to treatment

Table 3.1 Competency to consent to treatment 

Confidentiality

  • Offer confidential health care to all competent young people over 14 years
    • Builds trust between young person and care provider
    • Improves quality of health care
    • Confirm follow-up plans — who can be contacted about results (eg self or carer)
  • Let young person know confidentiality can be broken if they or others are in danger
  • Example confidentiality statement “everything we talk about will be confidential — that means it stays between you and me. But we will have to tell the right people if someone is hurting you, you are hurting yourself or you are hurting someone else. If I have to break confidentiality we will do it together”

Medicare card

  • Medicare wont give information about treatment to carers but carers may find out about appointment if family Medicare card is used
  • Over 15 years can get own Medicare card
  • Check if wants information uploaded to My Health Record

Protective behaviours

  • Protective behaviours is a personal safety framework that teaches children the tools they need to feel safe and get help if they are in dangerous or risky situations
  • In early childhood, teach carers about protective behaviours so that they 
    • Know where their child is, who they are with and what they are doing (including online)
    • Provide opportunities for children to build relationships with people they trust and feel safe with
    • Listen to children and keep them safe. Help them to feel comfortable to talk about worries
  • As children get older help to teach them about early warning signs of feeling unsafe and help them to identify safe people they can talk to
  • Talk to teens about 
    • Safe and unsafe places and times
    • Risky behaviours and consequences (eg alcohol and other drugs, driving)
    • Personal rights and consent (eg right to negotiate sex — right to say no)  — see STI checks for young people

Mandatory reporting