respond to at your colleague by recommending at least one additional way you would treat a child or adolescent client differently than you would an adult and at least one additional way you would address the legal and ethical issues involved.
When treating children and adults in a psychiatric crisis, there are some differences the practitioner should consider. For instance, informed consent, HIPAA, and other legal and privacy issues. Being in a crisis center, I have seen both situations and the differences in treatment.
A 22-year-old male was admitted to the crisis intervention unit for suicidal ideations, delusions, hallucinations, and acute psychosis. The patient had a previous diagnosis of bipolar 1 disorder. He had several psychiatric admissions in the past, including a 30-day rehabilitation program for drug abuse. When speaking with the patient, he admitted he has not been on any medications since late 2018 when he and his father decided it would be best for him to use a holistic approach to healing his mental illness. This patient was consenting to treatment and agreeable to inpatient psychiatric admission. This particular patient’s father was calling requesting info and requesting the right to make decisions on behalf of the patient.
According to HIPAA laws, if the patient is not a minor, and does not give another person the legal authority to make health decisions for them, no other person has the right to that patient’s information or decision making (U.S Department of Health and Human Services, 2015). If the patient were deemed incompetent or not able to make decisions for himself, it would then be possible for decisions to be made on his behalf (U.S Department of Health and Human Services, 2015).
Treating a Minor in Crisis
The laws and guidelines for treating minors for mental health issues vary from state to state. In New Jersey, minors can consent to their treatment for substance abuse, but their parent has to consent to treatment for mental health (Kerwin et al., 2015). In a crisis situation, we allow the parent to stay at the child’s bedside until an inpatient bed is found. The parent is involved in all of the child’s care and decision making. Parents also have the right to refuse psychiatric medications for their children. Individuals have the constitutional right to refuse medication, and this includes the rights of parents to refuse medication for their children unless they are a threat to themselves or others (Parris, 2018).
For providers, the rights of parents and children can cause both moral and ethical dilemmas. Although parents have the legal right to make decisions for their minor child, minors may have a preference and communicate their preference for treatment. This is called assent. Assent recognizes that a minor may not be thoroughly competent; however, there is importance in involving them in decisions about their treatment (American Academy of Child & Adolescent Psychiatry, n.d.). It is also essential to make the proper ethical decisions when treating a minor with medications. Medications may be a vital part of the minor’s treatment plan; however, at times, medications can be overly relied upon for children due to lack of other resources, and they end up on unnecessary medications (American Academy of Child & Adolescent Psychiatry, n.d.). It is the provider’s obligation to prescribe only medications in the child’s best interest, do no harm, and always obtain informed consent/assent when prescribing (American Academy of Child & Adolescent Psychiatry, n.d.).
American Academy of Child & Adolescent Psychiatry. (n.d.). Ethical issues in clinical practice. Retrieved from https://www.aacap.org/AACAP/Member_Resources/Ethics/Ethics_Committee/Ethical_Issues_in_Clinical_Practice.aspx
Kerwin, M. E., Kirby, K. C., Speziali, D., Duggan, M., Meliltz, C., Versek, B., & McNamara, A. (2015). What can parents do? A review of state laws regarding decision making for adolescent drug abuse and mental health treatment. Journal of Child & Adolescent Substance Abuse, 24(3), 166-176.
Parris, K. (2018). The problem with refusing (psychiatric) medications. Retrieved from https://parrislaw.org/psychiatric-medications/
U.S Department of Health and Human Services. (2015). When can I obtain treatment information about my loved one? Retrieved from https://www.hhs.gov/sites/default/files/families-hipaa-decision-tree-adult-patients.pdf?language=es
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