141 Table 16
Type 1 Standards for Information, Consent and Confidentiality (n=17)
# Unit Standards Stakeholder Not
Met
Partially Met
Fully Met
Mode Qualitative reasoning 5.2.1 Information, which is accessible and easy
to understand, is provided to young people and carers.
One 2 3 Currently, the TLC provides an information
pack to parents/carers with a designed section for children. Additional welcome packs are currently in the process of development. Two 3 Three 3 Four 3 Five 3 Six 3 Seven 3
5.2.2 The young person is given an age appropriate ‘welcome pack’ or
introductory information that contains the following: • A clear description of the aims of the ward/unit; • The current programme and modes of treatment; • The ward/unit team membership; • Personal safety on the ward/unit; • The code of conduct on the ward/unit; • Ward/unit facilities and the layout of the ward/unit; • What practical items can and cannot be brought in; • Resources to meet spiritual, cultural and gender needs
One 2 2 The information pack introduced covers
these purposes but does not contain all the information listed. Welcome packs are currently being produced.
Two 2 Three 3 Four 2 Five 2 Six 2 Seven 2
142 5.2.3 The welcome pack should include: The
complaints procedure; who else has access to information that the young person shares with the services;
circumstances under which information may be disclosed or shared.
One 2 2 Again, not all of this is covered in a welcome
pack specifically but the parents are able liaise with a family therapist and
psychologist as services to can provide them with the information.
Two 1 Three 3 Four 2 Five 2 Six 2 Seven 2
5.2.5 Young people are given verbal and written information on: • Their rights regarding consent to care and treatment; • How to access advocacy services; • How to access a second opinion; • How to access interpreting services; • How to raise concerns, complaints and
compliments; • How to access their own health records
One 1 2 The TLC distributes some of the
information. This is predominantly done verbally and not in a written format. New welcome packs will hope to cover this content more extensively.
Two 2 Three 3 Four 2 Five 2 Six 2 Seven 2
5.3.1 Each young person is allocated key worker(s) and the young person and their parents/carers are told who this is.
One 2 3 As standard practice, the children admitted
are assigned a special nurse and case
manager who satisfy the role of key workers. Not all children are aware of who they have been assigned in the early stages of
admission. Two 3 Three 3 Four 3 Five 3 Six 3 Seven 3
143 Table 16 Continued
Type 1 Standards for Information, Consent and Confidentiality (n=17)
# Unit Standards Stakeholder Not
Met
Partially Met
Fully Met
Mode Qualitative reasoning 5.5.1 Young people and their parents/carers are
informed verbally and in writing of their right to confidentiality and its limitations.
One 2 2 Their confidentiality and it limitations are
predominantly provided verbally relative to written documentation. This is particular the case where sensitive information is shared.
Two 3 Three 3 Four 2 Five 3 Six 2 Seven 2
5.5.2 Consent is sought prior to the disclosure of case material to parents/carers if the young person is assessed as able to make a decision. Guidance: In certain
circumstances this may be overruled if felt in the young person’s best interests. The young person should be informed when this happens.
One 2 3 Consent from the parents and children, to a
certain degree given their age and capacity, is sought by the TLC. Documentation is conducted but more may be required.
Two 3 Three 3 Four 2 Five 2 Six 3 Seven 3
5.5.3 The young person’s consent to the sharing of clinical information outside the clinical team is recorded. If this is not obtained the reasons for this are recorded.
One 1 2 Overall, where age appropriate and under
certain conditions their consent may be recorded by staff but more documentation recorded is needed. Two 2 Three 3 Four 2 Five 2 Six 1 Seven 2
144 5.6.1 Consent is sought and recorded by staff.
Guidance: Where the young person is assessed as not having competency to consent then this should also be
recorded. This applies to both medication and therapy and should be sought by staff members administering the treatment.
One 1 1 In the current context, due to the general age
of the children admitted and according the Children’s Act, this is usually completed through assent of the parents. It is unclear whether competency from the children is not sought. Two 2 Three 3 Four 2 Five 1 Six 1 Seven 2
5.6.2 All young people’s consent is recorded when a decision is required about their care. Where young people are not able to give consent, their views are ascertained as far as possible and taken into account. The legal basis for giving the proposed treatment or intervention is recorded.
One 1 1 Treatment, both therapeutic and medical, is
discussed and explained to the children, to a certain extent through assent and not consent from the children.
Two 2 Three 3 Four 1 Five 1 Six 1 Seven 2
5.6.3 Staff informs young people both verbally and in writing of their right to agree to or refuse treatment and the limits of this.
One 1 2 Overall, children admitted are informed
about their rights verbally but not in writing.
Two 2 Three 3 Four 1 Five 2 Six 2 Seven 2
145 Table 16 Continued
Type 1 Standards for Information, Consent and Confidentiality (n=17)
# Unit Standards Stakeholder Not
Met
Partially Met
Fully Met
Mode Qualitative reasoning 5.6.4 For all young people, the young person’s
capacity and/or competency is assessed and recorded when a decision is required about their care.
One 1 3 There is contention as to whether
competency as per its definition of the children is conducted. They are assessed as part of psychiatric and psychological assessment which may inform the level of the child’s participation in any decision making. Two 1 Three 3 Four 3 Five 1 Six 3 Seven 3
5.6.5 Where young people are not able to give consent, their views are ascertained as far as possible and taken into account, and the legal basis for giving the proposed treatment or intervention is recorded.
One 1 3 This has been illustrated according to
previous responses related to the children’s capacity to consent. Two 3 Three 3 Four 3 Five 1 Six 3 Seven 2
5.6.7 Parental responsibility is recorded in the young person’s notes.
One 3 3 This is routinely done as standard practice at
the TLC most notably from the social work department. Two 3 Three 3 Four 3 Five 3 Six 3 Seven 3
146
Met Met Met
5.6.8 Young people and carers are offered written and verbal information about the young person’s mental illness. Guidance: Verbal information could be provided in a 1:1 meeting with a staff member, a ward round or in a psycho-education group.
One 1 3 Overall, it is predominantly the
parents/carers who are informed both
verbally and on written documentation of the details of the child’s mental illness and diagnoses. More participation of the child is need appropriately. Two 3 Three 3 Four 2 Five 3 Six 2 Seven 3
5.6.9 Young people have an assessment of their capacity to consent to admission, care and treatment within 24 hours of admission.
One 1 1 Due to their age level of appropriateness,
children under 12 years of age in the TLC are made aware through parental assent and not consent. Two 3 Three 3 Four 1 Five 1 Six 2 Seven 3
5.6.10 The team follows a protocol for responding to carers when the young person does not consent to their involvement.
One 1 1 Currently, this protocol is discussed prior to
admission but no written policy is in place it seems. Two 2 Three 3 Four 1 Five 1 Six 2 Seven 3
147