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Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

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Presentation on theme: "Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health."— Presentation transcript:

1 Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD

2 Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health care providers Review of select articles The right to optimal health and health care The right to involvement in medical decision making The right to information The right to express views and be heard The right to a safe environment, protection from abuse 3 Cases General discussion and questions

3 Historical Overview Recognition that children have rights is long standing Hammurabi code 1770 B.C. Religion Thomas Spence late 18 th century – early 19 th century Charles Dickens – mid 19 th century Declaration of the Rights of the Child (League of Nations) 1924 Save the Children – 1920’s Recognition of the need to specifically address children’s rights is relatively recent 1948: Universal Declaration of Human Rights Covenant on Social, Economic and Cultural Rights Covenant on Civil and Political Rights 1990: United Nations Convention on the Rights of the Child 1997 UNESCO Declaration on the Responsibilities of the Present Generation Towards the Future Generation

4 Adolescent rights Cultural paradigms, Social necessity Accepted patterns of authority Transition from childhood to adulthood different worldwide (walkabout, rights of passage) Family, societal roles Poverty Definitions and names child, adolescent, teenager, youth, young person Perceived conflicts with parental rights

5 Adolescent Rights: Review of Select Articles Gonca Yilmaz MD, PhD 5

6 Vulnerable groups 6 Adolescents Children with mental health difficulties Asylum seeker families Disabled children Children in care Black and ethnic minority Families and those living in poverty

7 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 in accordance with their age and maturity 7

8 Types Of Rights 54 Articles Three types of rights Of protection Of provision Of participation 05.05.20158

9 Rights Of Protection Right to life (art. 6) Right not to be separated from parents (unless this harms the child) (art. 9) Right to special protection such as adoption and fostering if deprived of family (art. 20) All forms of abuse (art. 19) All forms of sexual exploitation (art. 34) Economic exploitation (art. 32) Exposure to illicit drugs (art. 33) 9

10 Rights Of Provision Children deprived of basic needs in developing countries (UNICEF 2004) 10


12 12 Poverty And Hazardous Child Labour: A Vicious Circle Poor family Unsafe home environment Disease / InjuryWorking child Unhealthy working environment Unhealthy breadwinner Lack of education

13 External Barriers to Care 05.05.201513

14 Provision Of Information Article 13: freedom of expression - the right to seek, receive and impart information and ideas of all kinds CHILD 2015 14

15 Rights Of Participation To an identity (name, family and nationality) and to preserve this (arts 7, 8) To express their views freely (arts 12, 13) To have access to information (arts 13, 17) For disabled children to enjoy life and participate actively in society (art 23) 15

16 Right To Participation Frequently violated in paediatric practice: Children often excluded Opinion/consent not sought Good practice but rare 05.05.201516

17 Participation In Health Care Participation to decisions Outpatient and hospital services Young people views All matters of concern to them 05.05.201517

18 05.05.201518

19 Article 16 – the right to privacy and respect for confidentiality 19

20 Consultation Plan 05.05.201520 Child - young person Waiting room Communication with the child Informing children about therapy Provision of information Informed consent Advocacy

21 Case 1 Brittany is 14. Brittany and her friends were at a party & drinking heavily the night of the school dance. At the party, Brittany met Connor, who goes by the nickname “Conman.” He is a friend of Brittany’s best friend’s older brother. Later that evening, Connor raped her. Brittany contacts you for services. And she doesnt want to share this event with his family. Which rights would you priotitise here, why? What else do you need to know about Brittany? 05.05.201521

22 Case 1 continued She continues to come your outpatient clinic. After 1 month,you learn that she is pregnant. How might Brittany’s rights be impacted if she is pregnant? 05.05.201522

23 A conflict 05.05.201523 Minor autonomy Parental consent

24 Strategies Be clear (with all parties) as to who your client is – minor or parent Establish : what confidentiality policies govern your communications with the victim/survivor (including mandatory reporting) Be familiar with the governing confidentiality in your jurisdiction Have protocol in place beforehand Try and get practices to be consistent within your area (if they’re good) Know beforehand where / who are the resources you can call on 05.05.201524

25 Case 2 Patience is a 12 year old girl with HIV. He was diagnosed at 4 years of age, and has been on ART since that time. She has not been formally disclosed. Her mother died of AIDS when she was 10. She lives with her aunt, who brings her monthly for scheduled clinic visits. She goes to school, and can read and write. When asked if she knows why she comes to the clinic every month, she smiles shyly, looks at the ground and says she is getting treated for tuberculosis. Her CD4 count has been falling during the past year, and you suspect poor compliance.

26 Case 2 continued Her aunt asks to speak to you alone, and tells you that a child at school shouted across the playground: “Your mother died of AIDS, and my dad said you’ve got it too!”

27 Case 3 Ahmet is 14 year old boy who comes to your outpatient clinic with abdominal pain and bedwetting. After evaluation, he is diagnosed with depression and started medical treatment. After 10 months of therapy, he returns with no improvement. You discover that he frequently misses the school with abdominal pain and his grades are dropping. You ask to speak with him alone, and he tells that two other children in school steal his homework and push him arround. He is afraid to go to school but his parents told him, he must simply assert himself to solve this problem. What would your interventions be? 05.05.201527

28 The percentage of children aged 11, 13 and 15 years who reported having been bullied 05.05.201528

29 . BULLYING Aggressive behavior Imbalance of power. Bullying is repeated over time. 05.05.201529

30 Thank you! 05.05.201530

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