Safeguarding & Consent

Question 1

When is a person recognised as an adult with full autonomy to make decisions about their health?

Answer 1

18

Question 2

Can children aged 16-18 make decisions about their health?

Answer 2

Yes, it is presumed patients are competent to give consent to treatment.

BUT if they refuse treatment, this can be overruled in certain situations by parents, people with parental responsibility or the court.

Question 3

Can children aged <16 make decisions about their health?

Answer 3

Can consent to treatment if they are deemed competent (Gillick competence).

CANNOT refuse treatment which may be deemed in their best interest.

Question 4

What is Gillick competence?

Answer 4

A judgement about whether the understanding and intelligence of the child is sufficient to consent to treatment.

Question 5

What is it important to consider when prescribing contraception to children under 16?

Answer 5

It is important to assess for coercion or pressure e.g. by an older partner

Question 6

What are the Frazer guidelines?

Answer 6

Specific guidelines for providing contraception to patients <16 y/o without having parental input and consent.

Question 7

To follow the Frazer guidlines, what 5 criteria must be met?

Answer 7

1) They are mature and intelligent enough to understand the treatment

2) They can’t be persuaded to discuss it with their parents or let the health professional discuss it

3) They are likely to have intercourse regardless of treatment

4) Their physical or mental health is likely to suffer without treatment

5) Treatment is in their best interest

Question 8

What are the rules regarding confidentiality in children aged <16 requesting contraception?

Answer 8

Children should be encouraged to inform their parents, but if they decline and meet the criteria for Gillick competence and the Frazer guidelines confidentiality can be kept.

Question 9

All intercourse in children under what age should be escalated as a safeguarding concern?

Answer 9

<13

Children under 13 cannot give consent for sexual activity.

Question 10

What is the legal framework for child safeguarding?

Answer 10

Children Act 1989

Question 11

What are the different types of abuse?

Answer 11

1) Physical
2) Emotional
3) Sexual
4) Neglect
5) Financial
6) Identity

Question 12

What are some risk factors for abuse?

Answer 12

• Domestic violence
• Previously abused parent
• Mental health problems
• Emotional volatility in the household
• Social, psychological or economic stress
• Disability in the child
• Learning disability in the parents
• Alcohol misuse
• Substance misuse
• Non-engagement with services

Question 13

What are some possible signs of abuse in children?

Answer 13

• Change in behaviour or extreme emotional states
• Dissociative disorders (feeling separated from their thoughts or identity)
• Bullying, self harm or suicidal behaviours
• Unusually sexualised behaviours
• Unusual behaviour during examination
• Poor hygiene
• Poor physical or emotional development
• Missing appointments or not complying with treatments