module 12; providing psychological services to children and adolescents Flashcards
explain the aspects of the Code and The Guidelines that relate to psychological practice with children and adolescents
For the purposes of the APS Guidelines, the terms ‘young person’ or ‘young persons’ mean a child or children and adolescent or adolescents under the age of 18 years.
Parent
A person who has legal responsibility for a young person. Legal responsibility includes guardianship, adoption, custody, joint parental responsibility and equal shared parental responsibility. Where there are no court orders each of the parents, whether separated or not, continue to have parental responsibility. A parent’s parental responsibility for their child may be limited or diminished by a parenting order of the court. There are some limited circumstances when the court makes a parenting order that provides sole parental responsibility to one parent or other person.
The children’s court may use terms such as guardianship and custody, and other courts and tribunals may also use the terms ‘primary carer’, client-parent, or other parent.
Client-parent
The parent (or parents) who contracts or engages a psychologist to provide a psychological service for a young person is referred to in these Guidelines as the ‘client-parent’. In situations where a fee is to be paid for the psychological service, the client-parent is the parent who contracts or engages the psychologist and pays for that psychological service for a young person.
Other-parent
When only one parent (the client-parent) contracts or engages a psychological service for a young person and there exists a parent who has not been involved in the arrangement of the psychological service for the young person, for the purposes of these Guidelines, the latter parent is referred to as the ‘other parent’.
deliver a ‘confidentiality and informed consent’ statement to child and adolescent clients
Confidentiality applies to any disclosure of information. As with all clients, confidentiality is essential to providing psychological services to young people. Psychologists inform the young person and the client-parent about the legal and other limits to confidentiality before any decision is made to consent to the psychological service.
Psychologists are cognisant of and comply with any legal requirements to report child abuse and neglect. These requirements may differ in each state and territory of Australia. Psychologists communicate these legal requirements clearly and in language that can be understood by the young person and the client-parent(s). In those unusual circumstances where failure to disclose a young person’s information may result in clear risk to the young person or others, a psychologist may disclose information necessary to avert risk.
Matters to be considered by psychologists in discussing the limits to confidentiality include:
the context within which the psychological service is provided
the nature of the psychological service offered or proposed (e.g. assessment, counselling)
who is paying the fees for the psychological service
psychologists’ employment obligations or contractual obligations
any legal and other limits to confidentiality.
A young person who is not capable of giving informed consent is entitled to be informed of the limits to confidentiality. Psychologists use language that the young person can understand, which is determined by the young person’s age, maturity and capacity, and the context and purpose of the psychological service to be provided.
An example of confidentiality wording
Although most of what we talk about is private, there are three kinds of problems you might tell me about that we would have to talk about with other people:
If I found out that someone has been seriously hurting or abusing you, I would have to tell someone about it.
If you tell me you have made a plan to seriously hurt yourself, I would have to tell your parents.
If you tell me you have made a plan to seriously hurt someone else, I would have to tell someone.
I would not be able to keep these problems just between you and me because the law says I can’t.
Do you understand that it’s okay to talk about most things here but that there are three things we must talk about with other people?
When making a judgement on whether to disclose a young person’s information, psychologists consider the young person’s best interests as paramount. Psychologists clarify with the young person and the client-parent at the outset of the psychological service:
what, if any, information that the young person tells the psychologist may be disclosed by the psychologist to the client-parent
what, if any, information that the young person tells the psychologist may be disclosed by the psychologist to the other parent
what, if any, information that the young person tells the psychologist may be disclosed by the psychologist to any other third parties.
When a young person has the capacity to give informed consent, the consent of the young person is required for any disclosure of the young person’s information by the psychologist to the client-parent, the other parent (if any) and third parties. The psychologist has a duty to maintain the young person’s confidentiality and to limit any disclosure in accordance with the express wishes of the young person unless there is a clear risk to the young person or to others.
If a young person does not wish their communications to be disclosed to the client-parent, the other parent (if any) or third parties, and this is in conflict with the wishes of the client-parent, the psychologist discusses and attempts to resolve this conflict with the young person and the client-parent prior to proceeding with the psychological service.
If a psychologist considers that a young person lacks the capacity to give informed consent, then only the client-parent’s consent is required for a disclosure of the young person’s information by the psychologist. Nevertheless, the young person’s wishes about disclosure of their communications by the psychologist to the client-parent, other parent (if any) and to third parties is sought and respected if possible. The age, maturity and capacity of the young person and the context and purpose of the psychological service to be provided are taken into account.
If a third party (e.g. school, court, government agency, funding body or insurance company) requests or directs the client-parent to seek a psychological service for the young person, and then seeks a report based upon the psychological service provided to the young person, the psychologist ensures that the client-parent and young person are fully aware of the nature, purpose and consequence of the report being sought. This would include, but is not limited to:
the purpose of the service
the reasonably anticipated use that will be made of the report and/or information collected or disclosed
the legal and other limits to confidentiality.
explain the role of the child-parent relationship in the provision of psychological services to children and adolescents.
As part of their usual practice, psychologists work towards respecting and nurturing the child-parent relationship when working with young people. However, psychologists remain aware of the possibilities of conflicting views between the parents and the young person about the young person’s developing right to autonomy and also of the possibility of the risk of harm or neglect by parents. In balancing these concerns, psychologists consider the best interests of the young person as paramount.
When providing a psychological service to a young person whose parents are separated or divorced, psychologists are aware of the potential for increased complexity of the circumstances in which the psychological service is sought. A significant proportion of separating couples experience high levels of conflict, and psychologists are particularly mindful of the need for safety for the clients, relevant others and themselves. Alternatively, when psychologists are aware that the client-parent has not separated from the other parent, they may assume that the client-parent has the legal authority necessary to engage in psychological services on behalf of the young person.
While considering the rights of parents and minors:
schedule an initial family meeting with the parents, child and psychologist to discuss confidentiality
provide a written professional services agreement (all participating parties sign this, including the psychologist, parents, and child)
parents may be involved in the treatment, yet the minor’s communications remain confidential
parents should be able to initiate future family meetings
children should be involved in treatment as much as possible
psychologists should know the legal position.
Psychological services and informed consent
Psychological services may be sought for children and adolescents by someone other than the client themselves. The following parties may seek psychological services:
A parent with legal responsibility for a young person may contract or engage psychological services for that young person.
A young person who has the capacity to give informed consent is entitled to engage psychological services for themselves, subject to the young person’s capacity to pay the fees of the psychological service in those circumstances where fees are charged.
When a young person is capable of giving informed consent and is accompanied by the client-parent, psychologists may only provide the psychological service with the young person’s consent unless the psychologist provides a psychological service in an emergency.
When a young person is not capable of giving informed consent, psychologists may only provide psychological services with the consent of the client-parent unless the psychologist provides a psychological service in an emergency.
In Australia, young people are considered capable of giving informed consent when they ‘achieve a sufficient understanding and intelligence to enable them to fully understand what is proposed’.
The law in Australia was stated by the High Court in Re: Marion (1992). As part of the process of obtaining informed consent, a psychologist determines whether the young person:
can understand the nature of the proposed psychological service
can understand the benefits and risks of the proposed psychological service
can understand the consequences of receiving or not receiving the proposed psychological service
has the capacity to make an informed choice
can understand the limits to confidentiality.
AUSTRALIA;
Marion’s case—Australia
Marion’s case involves a 14-year-old girl in the Northern Territory with severe intellectual disabilities, deafness and other disorders whose parents sought an order for her to undergo a hysterectomy and oophorectomy. The effect would be sterilisation and preventing Marion from being able to have children and many of the hormonal effects of adulthood.
The High Court of Australia recognised everyone’s right to bodily integrity under national and international law. It distinguished between therapeutic and non-therapeutic surgical procedures, as well as the duty of surrogates to act in the best interests of the incompetent patient. In the case, the High Court ruled that while parents may consent to medical treatment for their children, the authority does not extend to treatment not in the child’s best interests. Also, the Court held that if medical treatment has sterilisation as its principal objective, parents do not have the authority to consent on behalf of their child.
ENGLAND;
The Gillick v. West Norfolk and Wisbech Area Health Authority and AnrLinks to an external site. (Global Health Rights, 2018) case is an example of medical consent used to determine ‘competence’.
In this case, the court heard that ‘parental rights’ did not exist other than to safeguard the best interests of a minor. The majority held that in some circumstances, a minor could consent to treatment and that a parent had no power to veto treatment in these circumstances.
A child who is deemed ‘Gillick competent’ is able to prevent their parents from viewing their medical records. As such, medical staff will not disclose a child’s medical records deemed ‘Gillick competent’ unless consent is manifest.
You should consider the following principles when working with minors:
Competence: Consider the child’s age, cognitive capacity and the context.
Information: In treatment, children can often participate in goal-setting and discuss treatment alternatives. This autonomy and personal control may facilitate therapeutic change. Consult or inform the child even if you have to do something against their wishes—as you would with an adult.
Lack of coercion: Coercion should be avoided.
