COUN226 Lecture Notes - Lecture 9: Elder Abuse, Nocturnal Enuresis, Racial Discrimination Act 1975
19 May 2018
School
Department
Course
Professor
COUN226 Ethical & Professional Issues in Counselling
Lecture 9 – Children and Vulnerable Adults
Dr Karen Whalley
Overview
• Counselling minors
• Parental rights
• Protection from harm
• Child abuse & neglect
• Bullying
• Counselling vulnerable adults
• Elder abuse
Counselling minors
Counselling minors
Ethics and law can be in conflict when counselling minors
•
Conflict about confidentiality or decision-making
•
Very little in ethics codes about rights of minor clientsàcounsellor
judgment required
•
PACFA: Code of Ethics 2017
Ethical standards for clinical practice
1. Put clients first
f. Practitioners working with children and adolescents learn,
understand and comply with legal requirements in their State or
Territory regarding Mandatory Reporting
2. Work to high professional standards
c. Practitioners give careful consideration to whether they are
competent to work with particular client groups including:
- children and young people
- couples and families; and
- groups with particular characteristics or special needs
• 3. Build a relationship of trust
g. Practitioners take into account the complexities of informed consent
with particular groups of clients. In consultation with the client, carers
and/or significant others, they uphold clients’ autonomy and obtain
informed consent within the limitations pertaining to particular clients,
respecting the concept of dignity of risk for the client. These groups
include, but are not limited to the following
- children who may be too young to have the capacity to consent
independently of their parents’ or carers’ consent;
- Other clients with limited capacity to consent due to disability,
age or other cause; and
- Involuntary clients who are legally mandated to undertake
counselling or psychotherapy
Counselling minors: PACFA
Practitioners should normally be willing to respond to their client’s requests
for information about the way that they are working and any assessment
that they may have made. This professional requirement does not apply if it
is considered that imparting this information would be detrimental to the
client or inconsistent with the counselling approach previously agreed with
the client. An example of this may include restrictions of information shared
between parents and children. Clients may also have legal rights to
information and this needs to be taken into account.
Considerations
Counselling minors
Younger children often do not have an understanding of confidentiality
or a need for privacy
1.
Adolescents may have a heightened desire for privacy 2.
Do not assume that children do not want their parents to know
information they have told counsellors
3.
Children sometimes tell an adult their concerns hoping that the adult
will act as an intermediary in telling their parents
4.
Children may not be able to make decisions that are in their best
interest
5.
Parental rights
Parental rights
• Difficult to balance rights of parents vs. minor
• Parents as allies rather than adversaries
• You assume responsibility if withheld information leads to client harm;
using controlled substances, sexual abuse or risk taking behaviour
• Establish confidentiality boundaries at outset
–Written informed consent document
Responding to parental demands for confidential information
Discuss with the minoràare they willing to disclose to their parent?
If are not worried about disclose no issue
○
1.
Try to persuade the parent that the child’s best interests are not
served by revealing the information
2.
Schedule a joint session with the parent and minor àcounsellor as a
mediator
3.
Inform the child ahead of time and then disclose the information to the
parent OR refuse to disclose the information to the parent - need to
get approval from supervisor if client still refused caues it can be the
parents legal right.
4.
Rights of non-custodial parents
• Children with separated/divorced parents
• Avoid siding with either parent in court
–Need to maintain relationship with both parents - be unbias focus on
the child
–Counsellor knows little about home life/marriage
–Child custody evaluators best placed to testify
• If subpoenaed to court answer questions relating to fact, not opinions -
don’t support one parent over the battle stick to the fact a child has a right
to relationship with both parents
Need to seek legal advice is subpoenaed as it can breach confidentality
If asked is one parent more fit, say I don’t have enough information to
answer that qustion
Protection from Harm
Children at risk of harm to self/others
• If minor’s disclosure indicates risk of harm to self or others àmust inform
parents and principle
• Especially difficult to assess suicide risk in minors
• Balance:
–Reporting every risky behaviour to parents reduces disclosure
–Consequences if risky behaviours leads to serious harm
Consult with other counsellors if you are unaware of how risky the
behaviour is.
Age is more important younger children need more protection if you
have to tell parent have the child there or at least warn them what you
are going to say to ensure the therpeutic relationship is still okay.
Child abuse & neglect
Child Abuse
Different types of child abuse:
Physical abuse 1.
Sexual abuse 2.
3. Emotional abuse
4. Neglect
Physical Abuse
• When a child has suffered/is at risk of suffering non-accidental physical
trauma or injury
• Physical abuse can include:
–hitting
–shaking
–throwing
–burning
–biting
–poisoning
Need to detect parent at risk of this. Cant rely on child to report.
Sexual Abuse
When an adult, adolescent or stronger child involves a child in sexual
activity
•
Sexual abuse can be physical, verbal or emotional:
–kissing or holding a child in a sexual manner
–exposing a sexual body part to a child
–having sexual relations with a child under 16 years of age
–talking in a sexually explicit way that is not age appropriate
–making obscene phone calls or remarks to a child
–sending obscene mobile text messages or emails to a child
–persistently intruding on a child's privacy
–penetrating the child's vagina or anus by penis, finger or any
object
–showing pornographic films, magazines or photographs to a
child
–having a child pose or perform in a sexual manner
–forcing a child to watch a sexual act
•
Emotional Abuse
• When a child's social, emotional, cognitive or intellectual development is
impaired or threatened
–rejection
–hostility
–teasing/bullying
–yelling
–criticism
Neglect
QLD Criminal Code - under 12 years leaves child unsupervised for a period of
time without ensuring a child's basic necessities of life are not met, and their
health and development are affected
• Basic needs:
–food
–housing
–health care
–adequate clothing
–hygiene
–adequate supervision
Signs of Potential Child Abuse - need to investigate if seeing this signs cause
it can be related to something else so need to check
Showing wariness and distrust of adults •
Rocking, sucking or biting excessively •
Bedwetting or soiling •
Demanding or aggressive behaviour •
Sleeping difficulties, often being tired and falling asleep •
Low self-esteem •
Difficulty relating to adults and peers •
Excessive friendliness to strangers •
Abusing alcohol or drugs •
Having broken bones, unexplained bruising, burns/welts in different
stages of healing
•
Feeling suicidal or attempting suicide •
Having difficulty concentrating •
Being withdrawn or overly obedient •
Being reluctant to go home •
Creating stories, poems or artwork about abuse •
Sexually transmitted infections/age inappropriate sexual behaviour •
Wearing long sleeves and trousers in hot weather •
Signs of potential neglect
Malnutrition, begging, stealing or hoarding food •
Poor hygiene, matted hair, dirty skin or body odour •
Unattended physical or medical problems •
Comments from a child that no one is home to provide care •
Being constantly tired •
Frequent lateness or absence from school •
Inappropriate clothing, especially inadequate clothing in winter •
Frequent illness, infections or sores •
Child Protection
Child Protection
• QLD Government agency for child protection: Department of
Communities, Child Safety and Disability Services
• Dedicated to protecting children/young people from harm or who are at
risk of harm and whose parents cannot provide adequate care or protection
for them
• Administer the Child Protection Act 1999
Reporting Child Abuse in QLD
If you suspect a child has experienced harm, or is at risk of
experiencing harm
–Do not need to prove that harm has actually occurred
•
Contact the Department of Child Safety, Youth and Women
–Child Protection worker’s job to assess and, where necessary,
further investigate if a child or young person is at risk of
significant harm
•
Reporting suspected child abuse or suspected child abuse is legally
mandated for some professionals: Doctors, registered nurses, school
staff, person employed in licensed care service
•
Section 22 — Protection from liability for notification of, or information
given about, alleged harm or risk of harm
•
Bullying
Bullying
• Bullying is when an individual or a group of people with more power,
repeatedly and intentionally cause hurt or harm to another person or group
of people who feel helpless to respond
• Four Types:
–Physical
–Verbal
–Hidden/covert
–Cyberbullying
Bullying: Relevant Legislation
• Relevant Commonwealth legislation relating to bullying, harassment,
discrimination and violence include:
–Disability Discrimination Act 1992
–Human Rights and Equal Opportunity Commission Act 1986
–Racial Discrimination Act 1975
–Racial Hatred Act 1995
–Sex Discrimination Act 1984
Bullying: Relevant QLD Policies
–Safe Supportive and Disciplined School Environment Policy
–Code of School Behaviour
–Responsible Behaviour Plan for Students
–Student Protection
–Inclusive Education Policy
Vulnerable adults
Vulnerable adults
• Duty to protect clients who are vulnerable to maltreatment due to
diminished capacity
• Examples:
–Developmentally disabled
–Severely mentally ill
–Physically disabled individuals
–Critically ill individuals
–Elderly
Elder Abuse
Elder Abuse
• Physical abuse
• Sexual abuse
• Psychological or emotional abuse
• Neglect
• Abandonment
• Financial or material exploitation
Physical and psychological consequences
Declining functional abilities •
Increased dependency •
Increased sense of helplessness •
Increased stress •
Feelings of isolation, alienation and mistrust •
Depression •
PTSD •
Dementia •
Malnutrition •
Bed sores •
Death - 3 times high in elderly neglect •
Risk factors for elderly abuse
The elderly person who:
Has memory problems •
Has physical disabilities •
Has depression, loneliness, lack of social support •
Tendency to act disruptively •
Has a shared living situation •
Potential signs of elderly abuse
The person may be:
• afraid of someone close to them
• irritable, or shaking, trembling or crying
• depressed or withdrawn, talking of suicide
• uninterested in their usual interests
• presenting as helpless, hopeless or sad
• worried or anxious for no obvious reason
• reluctant to talk openly
Steps to help detect elder abuse
Consider the possibility of elder abuse when working with older clients
who are depending on family/others for care
•
Interview family members separately to increase the likelihood of
honest disclosures
•
Provide a supportive environment where clients feel safe to reveal
information
–Do not discuss concerns because of shame, fear of retaliation,
or fear they will be institutionalised
–May not realise what they are experiencing is abuse, or feel it is
their fault
•
Help the client and their family improve the quality of care •
Know the risk factors for elder abuse •
Prevalence/cost of elder abuse
• Physical, sexual, psychological, financial abuse & neglectà14,000 to
43,000 elderly in QLD
• Elder abuse admissions to QLD hospitals resulted in cost of $9.9 to $30.7
million
• Financial abuseà$14 million reported
–Elder Abuse Prevention Unit estimates the real figure to be between
$1.8 to $5.8 billion
Elderly abuse: Legal issues
• Currently no mandatory reporting laws for elder
abuse in Australia (no Elder Abuse Act)
–Limited form of mandatory reporting in aged care facilities
(Commonwealth Aged Care Act)
• Relevant Legislation:
–Domestic & Family Violence Protection Act 1989 –Aged Care Act
1997 (amendments 2007)
–Criminal Code
–Guardianship & Administration Act 2000
–Mental Health Act 2000
–Health Rights Commission Act 1991
Elderly abuse: Ethical issues
• Ethical obligation to report
–non-maleficence
–beneficence
• Try to involve elderly client in reporting process
Assessment Guidelines
Is it an emergency? •
The decision making capacity of the older person •
The consent of the older person •
The type and prevalence of abuse •
The health and functional status •
The relationship to the abuser •
The supports currently used – informal, formal, legal •
The role of other services involved •
Reporting elder abuse
Government agencies:
• The Guardianship and Administration Tribunal
• The Adult Guardian
• The Public Trustee
Other Services:
• Qld Aged & Disability Advocacy
• Elder Abuse Prevention Unit
• Seniors Enquiry Line
Informed Consent in Vulnerable Adults
• When is adult deemed incapable of giving informed consent?
Legally incompetent vs. dependent on others but retain legal rights •
If legally unable to give consent, attempt to gain assent •
Potential biases with elderly clients
• Guard against clinician age bias
• Stereotyping and discrimination against elderly people is a problem among
mental health professionals
–More reluctant to work with older people
–Tend to view them has having poorer prognoses
–See them as being more set in their way and less able to change
Week 9 Lecture
Friday, 4 May 2018
11:35 AM
COUN226 Ethical & Professional Issues in Counselling
Lecture 9 – Children and Vulnerable Adults
Dr Karen Whalley
Overview
• Counselling minors
• Parental rights
• Protection from harm
• Child abuse & neglect
• Bullying
• Counselling vulnerable adults
• Elder abuse
Counselling minors
Counselling minors
Ethics and law can be in conflict when counselling minors •
Conflict about confidentiality or decision-making •
Very little in ethics codes about rights of minor clientsàcounsellor
judgment required
•
PACFA: Code of Ethics 2017
Ethical standards for clinical practice
1. Put clients first
f. Practitioners working with children and adolescents learn,
understand and comply with legal requirements in their State or
Territory regarding Mandatory Reporting
2. Work to high professional standards
c. Practitioners give careful consideration to whether they are
competent to work with particular client groups including:
- children and young people
- couples and families; and
- groups with particular characteristics or special needs
• 3. Build a relationship of trust
g. Practitioners take into account the complexities of informed consent
with particular groups of clients. In consultation with the client, carers
and/or significant others, they uphold clients’ autonomy and obtain
informed consent within the limitations pertaining to particular clients,
respecting the concept of dignity of risk for the client. These groups
include, but are not limited to the following
- children who may be too young to have the capacity to consent
independently of their parents’ or carers’ consent;
- Other clients with limited capacity to consent due to disability,
age or other cause; and
- Involuntary clients who are legally mandated to undertake
counselling or psychotherapy
Counselling minors: PACFA
Practitioners should normally be willing to respond to their client’s requests
for information about the way that they are working and any assessment
that they may have made. This professional requirement does not apply if it
is considered that imparting this information would be detrimental to the
client or inconsistent with the counselling approach previously agreed with
the client. An example of this may include restrictions of information shared
between parents and children. Clients may also have legal rights to
information and this needs to be taken into account.
Considerations
Counselling minors
Younger children often do not have an understanding of confidentiality
or a need for privacy
1.
Adolescents may have a heightened desire for privacy
2.
Do not assume that children do not want their parents to know
information they have told counsellors
3.
Children sometimes tell an adult their concerns hoping that the adult
will act as an intermediary in telling their parents
4.
Children may not be able to make decisions that are in their best
interest
5.
Parental rights
Parental rights
• Difficult to balance rights of parents vs. minor
• Parents as allies rather than adversaries
• You assume responsibility if withheld information leads to client harm;
using controlled substances, sexual abuse or risk taking behaviour
• Establish confidentiality boundaries at outset
–Written informed consent document
Responding to parental demands for confidential information
Discuss with the minoràare they willing to disclose to their parent?
If are not worried about disclose no issue
○
1.
Try to persuade the parent that the child’s best interests are not
served by revealing the information
2.
Schedule a joint session with the parent and minor àcounsellor as a
mediator
3.
Inform the child ahead of time and then disclose the information to the
parent OR refuse to disclose the information to the parent - need to
get approval from supervisor if client still refused caues it can be the
parents legal right.
4.
Rights of non-custodial parents
• Children with separated/divorced parents
• Avoid siding with either parent in court
–Need to maintain relationship with both parents - be unbias focus on
the child
–Counsellor knows little about home life/marriage
–Child custody evaluators best placed to testify
• If subpoenaed to court answer questions relating to fact, not opinions -
don’t support one parent over the battle stick to the fact a child has a right
to relationship with both parents
Need to seek legal advice is subpoenaed as it can breach confidentality
If asked is one parent more fit, say I don’t have enough information to
answer that qustion
Protection from Harm
Children at risk of harm to self/others
• If minor’s disclosure indicates risk of harm to self or others àmust inform
parents and principle
• Especially difficult to assess suicide risk in minors
• Balance:
–Reporting every risky behaviour to parents reduces disclosure
–Consequences if risky behaviours leads to serious harm
Consult with other counsellors if you are unaware of how risky the
behaviour is.
Age is more important younger children need more protection if you
have to tell parent have the child there or at least warn them what you
are going to say to ensure the therpeutic relationship is still okay.
Child abuse & neglect
Child Abuse
Different types of child abuse:
Physical abuse 1.
Sexual abuse 2.
3. Emotional abuse
4. Neglect
Physical Abuse
• When a child has suffered/is at risk of suffering non-accidental physical
trauma or injury
• Physical abuse can include:
–hitting
–shaking
–throwing
–burning
–biting
–poisoning
Need to detect parent at risk of this. Cant rely on child to report.
Sexual Abuse
When an adult, adolescent or stronger child involves a child in sexual
activity
•
Sexual abuse can be physical, verbal or emotional:
–kissing or holding a child in a sexual manner
–exposing a sexual body part to a child
–having sexual relations with a child under 16 years of age
–talking in a sexually explicit way that is not age appropriate
–making obscene phone calls or remarks to a child
–sending obscene mobile text messages or emails to a child
–persistently intruding on a child's privacy
–penetrating the child's vagina or anus by penis, finger or any
object
–showing pornographic films, magazines or photographs to a
child
–having a child pose or perform in a sexual manner
–forcing a child to watch a sexual act
•
Emotional Abuse
• When a child's social, emotional, cognitive or intellectual development is
impaired or threatened
–rejection
–hostility
–teasing/bullying
–yelling
–criticism
Neglect
QLD Criminal Code - under 12 years leaves child unsupervised for a period of
time without ensuring a child's basic necessities of life are not met, and their
health and development are affected
• Basic needs:
–food
–housing
–health care
–adequate clothing
–hygiene
–adequate supervision
Signs of Potential Child Abuse - need to investigate if seeing this signs cause
it can be related to something else so need to check
Showing wariness and distrust of adults •
Rocking, sucking or biting excessively •
Bedwetting or soiling •
Demanding or aggressive behaviour •
Sleeping difficulties, often being tired and falling asleep •
Low self-esteem •
Difficulty relating to adults and peers •
Excessive friendliness to strangers •
Abusing alcohol or drugs •
Having broken bones, unexplained bruising, burns/welts in different
stages of healing
•
Feeling suicidal or attempting suicide •
Having difficulty concentrating •
Being withdrawn or overly obedient •
Being reluctant to go home •
Creating stories, poems or artwork about abuse •
Sexually transmitted infections/age inappropriate sexual behaviour •
Wearing long sleeves and trousers in hot weather •
Signs of potential neglect
Malnutrition, begging, stealing or hoarding food •
Poor hygiene, matted hair, dirty skin or body odour •
Unattended physical or medical problems •
Comments from a child that no one is home to provide care •
Being constantly tired •
Frequent lateness or absence from school •
Inappropriate clothing, especially inadequate clothing in winter •
Frequent illness, infections or sores •
Child Protection
Child Protection
• QLD Government agency for child protection: Department of
Communities, Child Safety and Disability Services
• Dedicated to protecting children/young people from harm or who are at
risk of harm and whose parents cannot provide adequate care or protection
for them
• Administer the Child Protection Act 1999
Reporting Child Abuse in QLD
If you suspect a child has experienced harm, or is at risk of
experiencing harm
–Do not need to prove that harm has actually occurred
•
Contact the Department of Child Safety, Youth and Women
–Child Protection worker’s job to assess and, where necessary,
further investigate if a child or young person is at risk of
significant harm
•
Reporting suspected child abuse or suspected child abuse is legally
mandated for some professionals: Doctors, registered nurses, school
staff, person employed in licensed care service
•
Section 22 — Protection from liability for notification of, or information
given about, alleged harm or risk of harm
•
Bullying
Bullying
• Bullying is when an individual or a group of people with more power,
repeatedly and intentionally cause hurt or harm to another person or group
of people who feel helpless to respond
• Four Types:
–Physical
–Verbal
–Hidden/covert
–Cyberbullying
Bullying: Relevant Legislation
• Relevant Commonwealth legislation relating to bullying, harassment,
discrimination and violence include:
–Disability Discrimination Act 1992
–Human Rights and Equal Opportunity Commission Act 1986
–Racial Discrimination Act 1975
–Racial Hatred Act 1995
–Sex Discrimination Act 1984
Bullying: Relevant QLD Policies
–Safe Supportive and Disciplined School Environment Policy
–Code of School Behaviour
–Responsible Behaviour Plan for Students
–Student Protection
–Inclusive Education Policy
Vulnerable adults
Vulnerable adults
• Duty to protect clients who are vulnerable to maltreatment due to
diminished capacity
• Examples:
–Developmentally disabled
–Severely mentally ill
–Physically disabled individuals
–Critically ill individuals
–Elderly
Elder Abuse
Elder Abuse
• Physical abuse
• Sexual abuse
• Psychological or emotional abuse
• Neglect
• Abandonment
• Financial or material exploitation
Physical and psychological consequences
Declining functional abilities •
Increased dependency •
Increased sense of helplessness •
Increased stress •
Feelings of isolation, alienation and mistrust •
Depression •
PTSD •
Dementia •
Malnutrition •
Bed sores •
Death - 3 times high in elderly neglect •
Risk factors for elderly abuse
The elderly person who:
Has memory problems •
Has physical disabilities •
Has depression, loneliness, lack of social support •
Tendency to act disruptively •
Has a shared living situation •
Potential signs of elderly abuse
The person may be:
• afraid of someone close to them
• irritable, or shaking, trembling or crying
• depressed or withdrawn, talking of suicide
• uninterested in their usual interests
• presenting as helpless, hopeless or sad
• worried or anxious for no obvious reason
• reluctant to talk openly
Steps to help detect elder abuse
Consider the possibility of elder abuse when working with older clients
who are depending on family/others for care
•
Interview family members separately to increase the likelihood of
honest disclosures
•
Provide a supportive environment where clients feel safe to reveal
information
–Do not discuss concerns because of shame, fear of retaliation,
or fear they will be institutionalised
–May not realise what they are experiencing is abuse, or feel it is
their fault
•
Help the client and their family improve the quality of care •
Know the risk factors for elder abuse •
Prevalence/cost of elder abuse
• Physical, sexual, psychological, financial abuse & neglectà14,000 to
43,000 elderly in QLD
• Elder abuse admissions to QLD hospitals resulted in cost of $9.9 to $30.7
million
• Financial abuseà$14 million reported
–Elder Abuse Prevention Unit estimates the real figure to be between
$1.8 to $5.8 billion
Elderly abuse: Legal issues
• Currently no mandatory reporting laws for elder
abuse in Australia (no Elder Abuse Act)
–Limited form of mandatory reporting in aged care facilities
(Commonwealth Aged Care Act)
• Relevant Legislation:
–Domestic & Family Violence Protection Act 1989 –Aged Care Act
1997 (amendments 2007)
–Criminal Code
–Guardianship & Administration Act 2000
–Mental Health Act 2000
–Health Rights Commission Act 1991
Elderly abuse: Ethical issues
• Ethical obligation to report
–non-maleficence
–beneficence
• Try to involve elderly client in reporting process
Assessment Guidelines
Is it an emergency? •
The decision making capacity of the older person •
The consent of the older person •
The type and prevalence of abuse •
The health and functional status •
The relationship to the abuser •
The supports currently used – informal, formal, legal •
The role of other services involved •
Reporting elder abuse
Government agencies:
• The Guardianship and Administration Tribunal
• The Adult Guardian
• The Public Trustee
Other Services:
• Qld Aged & Disability Advocacy
• Elder Abuse Prevention Unit
• Seniors Enquiry Line
Informed Consent in Vulnerable Adults
• When is adult deemed incapable of giving informed consent?
Legally incompetent vs. dependent on others but retain legal rights •
If legally unable to give consent, attempt to gain assent •
Potential biases with elderly clients
• Guard against clinician age bias
• Stereotyping and discrimination against elderly people is a problem among
mental health professionals
–More reluctant to work with older people
–Tend to view them has having poorer prognoses
–See them as being more set in their way and less able to change
Week 9 Lecture
Friday, 4 May 2018 11:35 AM
COUN226 Ethical & Professional Issues in Counselling
Lecture 9 – Children and Vulnerable Adults
Dr Karen Whalley
Overview
• Counselling minors
• Parental rights
• Protection from harm
• Child abuse & neglect
• Bullying
• Counselling vulnerable adults
• Elder abuse
Counselling minors
Counselling minors
Ethics and law can be in conflict when counselling minors •
Conflict about confidentiality or decision-making •
Very little in ethics codes about rights of minor clientsàcounsellor
judgment required
•
PACFA: Code of Ethics 2017
Ethical standards for clinical practice
1. Put clients first
f. Practitioners working with children and adolescents learn,
understand and comply with legal requirements in their State or
Territory regarding Mandatory Reporting
2. Work to high professional standards
c. Practitioners give careful consideration to whether they are
competent to work with particular client groups including:
- children and young people
- couples and families; and
- groups with particular characteristics or special needs
• 3. Build a relationship of trust
g. Practitioners take into account the complexities of informed consent
with particular groups of clients. In consultation with the client, carers
and/or significant others, they uphold clients’ autonomy and obtain
informed consent within the limitations pertaining to particular clients,
respecting the concept of dignity of risk for the client. These groups
include, but are not limited to the following
- children who may be too young to have the capacity to consent
independently of their parents’ or carers’ consent;
- Other clients with limited capacity to consent due to disability,
age or other cause; and
- Involuntary clients who are legally mandated to undertake
counselling or psychotherapy
Counselling minors: PACFA
Practitioners should normally be willing to respond to their client’s requests
for information about the way that they are working and any assessment
that they may have made. This professional requirement does not apply if it
is considered that imparting this information would be detrimental to the
client or inconsistent with the counselling approach previously agreed with
the client. An example of this may include restrictions of information shared
between parents and children. Clients may also have legal rights to
information and this needs to be taken into account.
Considerations
Counselling minors
Younger children often do not have an understanding of confidentiality
or a need for privacy
1.
Adolescents may have a heightened desire for privacy 2.
Do not assume that children do not want their parents to know
information they have told counsellors
3.
Children sometimes tell an adult their concerns hoping that the adult
will act as an intermediary in telling their parents
4.
Children may not be able to make decisions that are in their best
interest
5.
Parental rights
Parental rights
• Difficult to balance rights of parents vs. minor
• Parents as allies rather than adversaries
• You assume responsibility if withheld information leads to client harm;
using controlled substances, sexual abuse or risk taking behaviour
• Establish confidentiality boundaries at outset
–Written informed consent document
Responding to parental demands for confidential information
Discuss with the minoràare they willing to disclose to their parent?
If are not worried about disclose no issue
○
1.
Try to persuade the parent that the child’s best interests are not
served by revealing the information
2.
Schedule a joint session with the parent and minor àcounsellor as a
mediator
3.
Inform the child ahead of time and then disclose the information to the
parent OR refuse to disclose the information to the parent - need to
get approval from supervisor if client still refused caues it can be the
parents legal right.
4.
Rights of non-custodial parents
• Children with separated/divorced parents
• Avoid siding with either parent in court
–Need to maintain relationship with both parents - be unbias focus on
the child
–Counsellor knows little about home life/marriage
–Child custody evaluators best placed to testify
• If subpoenaed to court answer questions relating to fact, not opinions -
don’t support one parent over the battle stick to the fact a child has a right
to relationship with both parents
Need to seek legal advice is subpoenaed as it can breach confidentality
If asked is one parent more fit, say I don’t have enough information to
answer that qustion
Protection from Harm
Children at risk of harm to self/others
• If minor’s disclosure indicates risk of harm to self or others àmust inform
parents and principle
• Especially difficult to assess suicide risk in minors
• Balance:
–Reporting every risky behaviour to parents reduces disclosure
–Consequences if risky behaviours leads to serious harm
Consult with other counsellors if you are unaware of how risky the
behaviour is.
Age is more important younger children need more protection if you
have to tell parent have the child there or at least warn them what you
are going to say to ensure the therpeutic relationship is still okay.
Child abuse & neglect
Child Abuse
Different types of child abuse:
Physical abuse 1.
Sexual abuse 2.
3. Emotional abuse
4. Neglect
Physical Abuse
• When a child has suffered/is at risk of suffering non-accidental physical
trauma or injury
• Physical abuse can include:
–hitting
–shaking
–throwing
–burning
–biting
–poisoning
Need to detect parent at risk of this. Cant rely on child to report.
Sexual Abuse
When an adult, adolescent or stronger child involves a child in sexual
activity
•
Sexual abuse can be physical, verbal or emotional:
–kissing or holding a child in a sexual manner
–exposing a sexual body part to a child
–having sexual relations with a child under 16 years of age
–talking in a sexually explicit way that is not age appropriate
–making obscene phone calls or remarks to a child
–sending obscene mobile text messages or emails to a child
–persistently intruding on a child's privacy
–penetrating the child's vagina or anus by penis, finger or any
object
–showing pornographic films, magazines or photographs to a
child
–having a child pose or perform in a sexual manner
–forcing a child to watch a sexual act
•
Emotional Abuse
• When a child's social, emotional, cognitive or intellectual development is
impaired or threatened
–rejection
–hostility
–teasing/bullying
–yelling
–criticism
Neglect
QLD Criminal Code - under 12 years leaves child unsupervised for a period of
time without ensuring a child's basic necessities of life are not met, and their
health and development are affected
• Basic needs:
–food
–housing
–health care
–adequate clothing
–hygiene
–adequate supervision
Signs of Potential Child Abuse - need to investigate if seeing this signs cause
it can be related to something else so need to check
Showing wariness and distrust of adults •
Rocking, sucking or biting excessively •
Bedwetting or soiling •
Demanding or aggressive behaviour •
Sleeping difficulties, often being tired and falling asleep •
Low self-esteem •
Difficulty relating to adults and peers •
Excessive friendliness to strangers •
Abusing alcohol or drugs •
Having broken bones, unexplained bruising, burns/welts in different
stages of healing
•
Feeling suicidal or attempting suicide •
Having difficulty concentrating •
Being withdrawn or overly obedient •
Being reluctant to go home •
Creating stories, poems or artwork about abuse •
Sexually transmitted infections/age inappropriate sexual behaviour •
Wearing long sleeves and trousers in hot weather •
Signs of potential neglect
Malnutrition, begging, stealing or hoarding food •
Poor hygiene, matted hair, dirty skin or body odour •
Unattended physical or medical problems •
Comments from a child that no one is home to provide care •
Being constantly tired •
Frequent lateness or absence from school •
Inappropriate clothing, especially inadequate clothing in winter •
Frequent illness, infections or sores •
Child Protection
Child Protection
• QLD Government agency for child protection: Department of
Communities, Child Safety and Disability Services
• Dedicated to protecting children/young people from harm or who are at
risk of harm and whose parents cannot provide adequate care or protection
for them
• Administer the Child Protection Act 1999
Reporting Child Abuse in QLD
If you suspect a child has experienced harm, or is at risk of
experiencing harm
–Do not need to prove that harm has actually occurred
•
Contact the Department of Child Safety, Youth and Women
–Child Protection worker’s job to assess and, where necessary,
further investigate if a child or young person is at risk of
significant harm
•
Reporting suspected child abuse or suspected child abuse is legally
mandated for some professionals: Doctors, registered nurses, school
staff, person employed in licensed care service
•
Section 22 — Protection from liability for notification of, or information
given about, alleged harm or risk of harm
•
Bullying
Bullying
• Bullying is when an individual or a group of people with more power,
repeatedly and intentionally cause hurt or harm to another person or group
of people who feel helpless to respond
• Four Types:
–Physical
–Verbal
–Hidden/covert
–Cyberbullying
Bullying: Relevant Legislation
• Relevant Commonwealth legislation relating to bullying, harassment,
discrimination and violence include:
–Disability Discrimination Act 1992
–Human Rights and Equal Opportunity Commission Act 1986
–Racial Discrimination Act 1975
–Racial Hatred Act 1995
–Sex Discrimination Act 1984
Bullying: Relevant QLD Policies
–Safe Supportive and Disciplined School Environment Policy
–Code of School Behaviour
–Responsible Behaviour Plan for Students
–Student Protection
–Inclusive Education Policy
Vulnerable adults
Vulnerable adults
• Duty to protect clients who are vulnerable to maltreatment due to
diminished capacity
• Examples:
–Developmentally disabled
–Severely mentally ill
–Physically disabled individuals
–Critically ill individuals
–Elderly
Elder Abuse
Elder Abuse
• Physical abuse
• Sexual abuse
• Psychological or emotional abuse
• Neglect
• Abandonment
• Financial or material exploitation
Physical and psychological consequences
Declining functional abilities •
Increased dependency •
Increased sense of helplessness •
Increased stress •
Feelings of isolation, alienation and mistrust •
Depression •
PTSD •
Dementia •
Malnutrition •
Bed sores •
Death - 3 times high in elderly neglect •
Risk factors for elderly abuse
The elderly person who:
Has memory problems •
Has physical disabilities •
Has depression, loneliness, lack of social support •
Tendency to act disruptively •
Has a shared living situation •
Potential signs of elderly abuse
The person may be:
• afraid of someone close to them
• irritable, or shaking, trembling or crying
• depressed or withdrawn, talking of suicide
• uninterested in their usual interests
• presenting as helpless, hopeless or sad
• worried or anxious for no obvious reason
• reluctant to talk openly
Steps to help detect elder abuse
Consider the possibility of elder abuse when working with older clients
who are depending on family/others for care
•
Interview family members separately to increase the likelihood of
honest disclosures
•
Provide a supportive environment where clients feel safe to reveal
information
–Do not discuss concerns because of shame, fear of retaliation,
or fear they will be institutionalised
–May not realise what they are experiencing is abuse, or feel it is
their fault
•
Help the client and their family improve the quality of care •
Know the risk factors for elder abuse •
Prevalence/cost of elder abuse
• Physical, sexual, psychological, financial abuse & neglectà14,000 to
43,000 elderly in QLD
• Elder abuse admissions to QLD hospitals resulted in cost of $9.9 to $30.7
million
• Financial abuseà$14 million reported
–Elder Abuse Prevention Unit estimates the real figure to be between
$1.8 to $5.8 billion
Elderly abuse: Legal issues
• Currently no mandatory reporting laws for elder
abuse in Australia (no Elder Abuse Act)
–Limited form of mandatory reporting in aged care facilities
(Commonwealth Aged Care Act)
• Relevant Legislation:
–Domestic & Family Violence Protection Act 1989 –Aged Care Act
1997 (amendments 2007)
–Criminal Code
–Guardianship & Administration Act 2000
–Mental Health Act 2000
–Health Rights Commission Act 1991
Elderly abuse: Ethical issues
• Ethical obligation to report
–non-maleficence
–beneficence
• Try to involve elderly client in reporting process
Assessment Guidelines
Is it an emergency? •
The decision making capacity of the older person •
The consent of the older person •
The type and prevalence of abuse •
The health and functional status •
The relationship to the abuser •
The supports currently used – informal, formal, legal •
The role of other services involved •
Reporting elder abuse
Government agencies:
• The Guardianship and Administration Tribunal
• The Adult Guardian
• The Public Trustee
Other Services:
• Qld Aged & Disability Advocacy
• Elder Abuse Prevention Unit
• Seniors Enquiry Line
Informed Consent in Vulnerable Adults
• When is adult deemed incapable of giving informed consent?
Legally incompetent vs. dependent on others but retain legal rights •
If legally unable to give consent, attempt to gain assent •
Potential biases with elderly clients
• Guard against clinician age bias
• Stereotyping and discrimination against elderly people is a problem among
mental health professionals
–More reluctant to work with older people
–Tend to view them has having poorer prognoses
–See them as being more set in their way and less able to change
Week 9 Lecture
Friday, 4 May 2018 11:35 AM
Document Summary
Overview: counselling minors, parental rights, protection from harm, child abuse & neglect, bullying, counselling vulnerable adults, elder abuse. Ethics and law can be in conflict when counselling minors. Very little in ethics codes about rights of minor clients counsellor judgment required. Ethical standards for clinical practice: put clients first, practitioners working with children and adolescents learn, understand and comply with legal requirements in their state or. Territory regarding mandatory reporting: work to high professional standards, practitioners give careful consideration to whether they are competent to work with particular client groups including: Groups with particular characteristics or special needs: 3. Build a relationship of trust: practitioners take into account the complexities of informed consent with particular groups of clients. In consultation with the client, carers and/or significant others, they uphold clients" autonomy and obtain informed consent within the limitations pertaining to particular clients, respecting the concept of dignity of risk for the client.
