ayesha kadir md gonca yilmaz md, phd. introduction what participation means, from the uncrc article...
TRANSCRIPT
![Page 1: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/1.jpg)
Ayesha Kadir MD Gonca Yilmaz MD, PhD
![Page 2: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/2.jpg)
IntroductionWhat participation means, from the UNCRCArticle 12 and linked articlesThe ladder of participationBarriers to child participationThe benefits of participationWhat can we do as an health care professional?
General discussion and questions
![Page 3: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/3.jpg)
Types Of Rights 54 Articles
Three types of rights Protection Provision Participation
21.04.23 3
![Page 4: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/4.jpg)
General Principles Underlying The UN Convention
Article 2 – all the rights in the Convention apply to all children without discrimination on any grounds
Article 3 – in all actions affecting children their best interests must be a primary consideration
Article 6 – all children have the right to life and optimal survival and development
Article 12 – all children, capable of expressing a view have the right to express that view freely and to have it taken seriously, including in judicial and administrative proceedings affecting the child, in accordance with their age and maturity
4
![Page 5: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/5.jpg)
Article12 CRC
![Page 6: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/6.jpg)
Where should participation take place?
At hom
e
In scho
ol
In hospita
ls
In courts
In culture and the
arts
In play and
recreation
In local governmen
t
In conferenc
es
In governmen
t policy
In international forums
In local communitie
s
In other words, at all levels of society and in all settings
![Page 7: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/7.jpg)
Child participation
![Page 8: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/8.jpg)
Why does participation matter?
![Page 9: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/9.jpg)
Article 5 implies that health care providers have both an obligation and an opportunity to:
21.04.23 9
![Page 10: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/10.jpg)
Participation and the realisation of rights
Participation
![Page 11: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/11.jpg)
21.04.23 11
![Page 12: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/12.jpg)
Participation in practice
![Page 13: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/13.jpg)
Alderson and Montgomery (1996) define four levels at which children can
participate;
1. Being informed 2. Expressing a view 3. Influencing a decision 4. Being the main decider
![Page 14: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/14.jpg)
What do you feel are the barriers to greater participation by children in their own health care?
21.04.23 14
![Page 15: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/15.jpg)
Arguments against medical child participationChildren lack the competence or experience to
participation.
Adult’s instincts to protect children from distressing information.
İt will infringe upon the rights of parents.
Children’s rights is a Western concept being imposed on other countries.
21.04.23 15
![Page 16: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/16.jpg)
What are the barriers facing children?
Attitudes and assumptions
Physical environment
Lack of training and skills
Lack of confidence
Lack of funding
Failure to commit time
Lack of accessible transport
![Page 17: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/17.jpg)
Right To Participation Frequently violated in
paediatric practice: Children often excluded Opinion/consent not
sought Good practice but rare
21.04.23 17
![Page 18: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/18.jpg)
At what age do you consider children to be competent to take responsibility for their own health care?
Why?
21.04.23 18
![Page 19: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/19.jpg)
Very young children taking decisions that affect their health, examples:Three-year-old Maisie was able to warn her mother
when she was feeling shaky from low blood sugar. Ruby at four years of age could be trusted not to
eat chocolates when her friend did and no adults were present, and by the age of five she was able to test her own blood sugar and decide how much cake she could eat.
Ahmet, a 8 year boy with acute lymphoblastic leukemia(ALL) was able to pay attention to his white blood cell count.
Jill, at 3 years of age, reminds her mother when it was time for her to take her HIV medicines
21.04.23 19
![Page 20: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/20.jpg)
What changes might be necessary in your practice or hospital to move toward a culture of greater respect for children’s participation in their own health care?
21.04.23 20
![Page 21: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/21.jpg)
Avoid talking over the child’s head: children get distressed when doctors talk directly to their parents without involving them.
21.04.23 21
![Page 22: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/22.jpg)
Give children the opportunity to ask questions and explore their concerns and deal with themhonestly and FULLY.
21.04.23 22
![Page 23: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/23.jpg)
A 10 year old boy is admitted to the hospital in the middle of the night and prescribed an intravenous infusion.
He refuses.
21.04.23 23
![Page 24: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/24.jpg)
A 20 month old boy is about to inhale medicine to expand the bronchi. The first inhalation goes fine, but the next he refuses.
What would you do as an health professional?
21.04.23 24
![Page 25: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/25.jpg)
Article 16 – the right to privacy and respect for confidentiality
25
![Page 26: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/26.jpg)
Develop policies on confidentiality.
21.04.23 26
![Page 27: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/27.jpg)
What about seeing a child on his- her own?
21.04.23 27
![Page 28: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/28.jpg)
Develop policies on consent to treatment.
21.04.23 28
![Page 29: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/29.jpg)
Medical consent to treatmentSome countries have introduced a fixed age
Age threshold
Combine system
Some countries adopt an approach that gives the parents a gradually decreasing role
No age treshhold21.04.23 29
![Page 30: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/30.jpg)
Consultation Plan
21.04.23 30
Child -young person
Waiting room
Communication with the child
Informing children about therapy
Provision of information
Informed consent
Advocacy
![Page 31: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/31.jpg)
Resources Goldhagen, J., Waterston, T. Child Rights Training Programme – available
from ESSOP www.essop.org or: CHILD data set is available at http://www.europa.eu.int/comm/health/ph/programmes/monitor/fp_monitoring_20 00_frep_08_en.pdf .
Simonelli F and Guerreiro AIF (eds); Self-evaluation Model and Tool on the Respect of Children’s Rights in Hospital (2009) an d The respect of children’s rights in hospital: an initiative of the International Network on Health Promoting Hospitals and Health Services . Final Report on the implementation process of the Self-evaluation Model and Tool on the respect of children’s rights in hospital. January 2010, both available:
http://www.hphnet.org/index.php?option=com_content&view=article&id=1551% 3Ahp-for-children-a-adolescents-in-a-by-hospitals-&catid=20&Itemid=95
(last accessed on 23 November 2011) United Nations Children’s Fund. Convention on the rights of the child.
Available at: www.unicef.org/crc
21.04.23 31
![Page 32: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/32.jpg)
Cases1 Fatma is an 8- year old girl of an Egyptian family that
lives in Turkey. She is healthy and visited you for a child care visit. Family makes plans for their 8-year old girl to undergo female genital mutilation.
2 A 12 year old girl, Sue, with terminal acute lymphoblastic leukemia(ALL) refuses therapy and wants to go home.
3 A 14-year-old girl, Merry, visits your outpatient clinic. She is anorexic and looks exhausted. Family doesn’t want her hospitalization. When you are talking with her, you learn that she was inseminated by her uncle and became pregnant
4 A 10-year-old boy, Tim, develops enuresis nocturna. You performed all laboratory tests and diagnosed ‘depression’. You sent him with antidepressive drug to home.
21.04.23 32
![Page 33: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/33.jpg)
Case 1.Fatma is an 8- year old Egyptian girl, living in
Turkey. She is healthy and visited you for a pre-travel health care visit. While her vital signs were taken, the clinic nurse overheard Fatma’s older sister speaking about plans for Fatma to undergo female genital mutilation.
Which rights are at stake for the child and parent?
What would you do in this situation?21.04.23 33
![Page 34: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/34.jpg)
Case 2.A 12 year old girl, Sue, with terminal acute
lymphoblastic leukemia(ALL) refuses therapy and wants to go home.
Which rights are at stake for the child and parent? What would you do in this stiuation?Who would you go for guidance?
21.04.23 34
![Page 35: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/35.jpg)
Case 3.A 14-year-old girl, Merry, visits your outpatient
clinic. She is very thin and tired appearing. And you are concerned about anorexia. You ask to her speak her alone and learn that she has been brought in by her father for medical care because she is pregnant. She tells you that her uncle is father.
Which rights are at stake for the child and parent? Which rights would you prioritize? Why? How would you resolve the potential conflict?
21.04.23 35
![Page 36: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/36.jpg)
Case 4.A 10-year-old boy, Tim, develops nocturnal
enuresis. After full evaluation, you diagnose him with ‘depression’ and prescribe antidepressant medication.
Which rights are at stake for the child and parent?
Which rights would you prioritize? Why? How would you resolve the potential conflict?
21.04.23 36
![Page 37: Ayesha Kadir MD Gonca Yilmaz MD, PhD. Introduction What participation means, from the UNCRC Article 12 and linked articles The ladder of participation](https://reader036.vdocuments.net/reader036/viewer/2022062518/56649e225503460f94b0e853/html5/thumbnails/37.jpg)
Thank you!
21.04.23 37