Issues of care for hospitalized youth

Question 1

What percentage of hospital admissions in Canada are of teens?

Answer 1

~4.5%

Question 2

What percentage of admissions for patients 5-24yo are for mental health conditions?

Answer 2

18%

Question 3

What is normal adolescent development?

Answer 3

Cognitive development to progress to adult decision-making and judgment
Social changes to become increasingly independent from parents for financial and emotional support and guidance

Question 4

What is adolescent development like in teenagers with chronic illness?

Answer 4

May have delayed or precocious puberty
Typically have delayed psychological and social changed
Delayed separation from family as require additional care and financial support

Question 5

What is the impact of hospitalization on teens?

Answer 5

Loss of control can cause conflicts

Question 6

What is the mature minor doctrine?

Answer 6

capacity for decision-making is not strictly tied to age. Rather, issues such as maturity, an individual’s ability to understand and appreciate necessary information, and the seriousness of the decision being made must be weighed.

Question 7

In which provinces does the mature minor doctrine apply?

Answer 7

Alberta, Nfld, Labrador, NWT, NS, Nunavut, Saskatchewan, BC, Ontario, PEI, Yukon

Question 8

What is the age of consent in other provinces?

Answer 8

Manitoba minors <16yo cannot give consent
NB capacity determined by legally qualified medical practitioner if <16yo
Quebec fixed age of consent at 14yo

Question 9

What are exceptions to confidentiality?

Answer 9

1. Suicidal ideation
2. Homicidal ideation
3. Abuse or neglect
4. Reportable infections

Question 10

What are the CPS recommendations regarding location?

Answer 10

1. Admit to wards that routinely admit teens, or dedicated adolescent units if available
2. Arbitrary age cut-offs should be avoided
3. Youth-dedicated spaces for rec activities and socialization w/ visitors or other patients
4. Teens should be roomates with other teens

Question 11

What are the CPS recommendations regarding privacy?

Answer 11

1. Privacy curtains
2. Private areas for confidential interviewing and physical examinations
3. Offer a chaperone for physical exams esp. if sensitive exam

Question 12

What are the CPS recommendations regarding education?

Answer 12

1. Access to educational programs to continue normal school activities
2. Educate clinicians providing care to teens about issues relevant to this population

Question 13

What are the CPS recommendations regarding socialization?

Answer 13

1. Accommodate opportunities for teens to socialize with peers
2. Recreational group activities for teens in hospital should be arranged

Question 14

What are the CPS recommendations regarding cultural issues?

Answer 14

1. Provide appropriate training in cultural and diversity training to staff
2. Provide interpreters and do not require teen to translate

Question 15

What are the CPS recommendations regarding ethical and legal issues?

Answer 15

1. Teenagers are capable of consenting to treatment unless caregivers have reason to believe otherwise
2. Confidentiality is a right
3. MD should encourage open collaboration with parents and other caregivers in decision making
4. Teens should be allowed to meet alone with care providers
5. Hospitals should ensure policies related to access to medical records are in line with preserving adolescent confidentiality

Question 16

What are the CPS recommendations regarding access to staff with adolescent health expertise?

Answer 16

1. All staff working with teens should be knowledgeable about normal adolescent growth and development
2. All staff working with teens should be familiar with psychological impact of hospitalization on teens
3. If complex needs than should have access to trained adolescent health experts