Gillick competency awareness for interpreters Policy v0.3 200921

Sign Solutions (SLIA) Ltd Gillick Competency awareness for Interpreters Policy Policy Statement Gillick Competency is a term originating in England and is used in medical law to decide whether a child (under 16 years of age) is able to consent to his or her own medical treatment, without the need for parental permission or knowledge. Background A young person who is Gillick Competent does not require parental consent for such treatment as counselling. \"....whether or not a child is capable of giving the necessary consent will depend on the child's maturity and understanding and the nature of the consent required. The child must be capable of making a reasonable assessment of the advantages and disadvantages of the treatment proposed, so that consent, if given, can be properly and fairly described as true consent.\" When deciding whether a child is mature enough to make decisions for themselves, people often talk about whether a child is 'Gillick competent' or whether they meet the 'Fraser guidelines' What do 'Gillick competency' and 'Fraser guidelines' refer to? Gillick competency and Fraser guidelines refer to a legal case, which looked specifically at whether doctors should be able to give contraceptive advice to under 16-year-olds without parental consent. But since then, they have been more widely used to help assess whether a child/young person has the maturity to make their own decisions/choices and to understand the implications of those decisions/choices about medical treatment in general. Counselling forms part of what is defined as “treatment”. The Gillick principle is therefore central to the legal and ethical basis of providing counselling/therapy for children and young people under the age of 16 and allows young people under 16 years of age and of ‘sufficient understanding and intelligence’ who understand the implications of medical treatment to consent to such treatment without their parent(s) / carer(s) consent or knowledge. The Guidance and Regulations of the Children Act 1989 brought a new beginning to philosophy and practice in the childcare system and provides guidelines on consent and entitlement to confidentiality of children and young people in medical and psychiatric examination and assessments. The Guidance specifically states that children should have sufficient understanding to make informed decisions about their care and treatment. The Children Act itself gives no guidance on how to determine a child's capacity for under- standing and it is accepted that the principles used in ascertaining Gillick Competence will apply. The Gillick Principle originated in the House of Lords in 1985 and concerns the rights of children under 16. The courts agreed that once a child has a sufficient level of under- standing and intelligence, they are deemed capable of making up their own minds on matters requiring a decision. A young person meeting these criteria is referred to as a 'Gillick competent child'. Scope V0.3 20/09/21

Sign Solutions (SLIA) Ltd The aim of this policy is to ensure that throughout the work of Sign Solutions our staff and freelance staff has an awareness of Gillick competency and the role of the interpreter. Sign Solutions will offer learning opportunities and make provision for appropriate Gillick competency awareness training ensure this policy is available to all staff and freelance staff. Guidelines for interpreters • On arrival introduce yourself and your role as the interpreting professional and then interpret for the young Deaf patient. • Interpret to the best of your skills and abilities and point out any linguistic issues or if you do not understand the patient or being understood by the patient. • If there are any issues you have a duty under the NRCPD code of conduct to alert the healthcare professional, who would most likely involve a professional to diagnose if there are any learning difficulties or capacity issues. This may be a Deaf psychologist or psychotherapist. • You will at all times abide by the NRCPD code of conduct especially around competency, to ensure that the interpretation provides the young person with the opportunity to be fully expressed and therefore effectively assessed. • Competency in young people can be impaired by circumstances like extreme stress, drug misuse or special needs, so that there may be times when someone up to the age of 18 years will only be accepted for medical treatment such as counselling, with the parents’ consent. • Therefore the healthcare professionals that you will be interpreting for will be aiming to ascertain whether the Deaf patient is Gillick competent or not. It will be up to the healthcare professional to ask key questions to assess this competency and your role is to interpret the proposed treatment and questions and ensure that the patient’s responses are fully communicated to the healthcare professional to enable them to make a fair competency judgement. • Gillick Competency status gives the young person certain rights to make decisions and be granted confidentiality without parental consent. • Your role will be to interpret and ensure that the proposed treatment plan is fully understood by the deaf patient for careful consideration. As always within any appointment, confidentiality of the patient is of paramount importance so you will keep all information that they have been privy to, confidential in line with the NRCPD code of conduct surrounding confidentiality. • The healthcare professional will always seek the young person’s signed permission before any information is passed to anyone else, even in situations such as requests from court/police. Extracts from 2. Competency – NRCPD code of conduct. • 2.2 You should strive to ensure that complete and effective communication takes place; you should not add nor take anything away from the intended meaning and should keep to the spirit of what is said or signed. V0.3 20/09/21

Sign Solutions (SLIA) Ltd • 2.3 You should, in advance where practicable, seek to ensure that the necessary conditions for effective communication are provided (e.g. being seated where you can see/be seen/be heard clearly; provision for adequate breaks, etc). Where this is not the case you should make it known to the parties concerned and, if the deficiency is likely to be a serious impediment to effective performance, you should indicate to the organiser your inability to continue with the assignment. • 2.4 If there are communication problems during an assignment, you should look to solve these using your professional skills. If the problem persists, you should indicate to the organiser your inability to continue with the assignment. • It is vitally important that Gillick competency assessments are not carried out without an interpreter as if a Deaf patient used BSL as their first or preferred language or they would potentially not fully understand the information about the treatment, consequences or outcome and therefore they cannot make an informed decision about consent. • Deaf people are commonly at an increased risk of what has been termed a “low fund of information”; this refers to the knowledge individuals accumulate from picking up facts and common-sense understanding through casual conversation and access to media. Coupled with low levels of literacy, this often leads to knowledge deficits about illnesses, their symptoms and causes, treatment options and risks, medication and preventive care. • Although printed materials about health topics or procedures may be available to d/Deaf patients the information may not be written at a level appropriate for them and as BSL is a completely different syntax and grammar, communicating or providing information in any other method/language than their preferred method is putting them at a considerable disadvantage. This has serious implications for the process of obtaining informed consent and the consequent safety of d/Deaf patients. Health professional’s guidance and role in determining Gillick Competency The following is used by a Healthcare professional as guidance in determining and recording a decision as to whether a young person is able to undertake treatment without the knowledge, involvement or support of their parent(s) / carer(s). NOTE: Non-disclosure to parents is considered appropriate in circumstances of alleged parental abuse. V0.3 20/09/21

Sign Solutions (SLIA) Ltd • The Interpreter will interpret questions and answers between the healthcare professional and the young deaf patient to ensure they are able to make the following considerations; • Can the young person understand the advice/information they have been given and have sufficient maturity to understand what is involved in the treatment and the outcome? • Can they communicate their decision and reasons for wanting the treatment? • Is this a rational decision based on their own values and beliefs? • Is the young person making the decision based on a perception of reality? (E.g. this would not be the case with a chronic substance misuser) • Are they confident that the young person is making the decision for themselves and not being coerced or influenced by another person? • Are they confident that I am safeguarding and promoting the welfare or the young person? • Has the young person explicitly requested that they do no tell their parents/carers about the treatment even though you have asked them to? • If the answers are YES – usually the outcome if that the young patient is Gillick competent and the healthcare professional record the details of the decision-making process, based on the interpreted responses from the Interpreter. V0.3 20/09/21