Consent and mandated clients

 

Informed consent is a human right. But honouring it for clients who are mandated by a court or statutory agency can be a challenge. We look here at how your organisational policy on informed consent can be helpful.  

Is this you?

Your organisation has a policy on consent. It has never been an issue because you have always worked with voluntary clients.

But things have changed.

You are now funded to deliver a response to offending, family violence or other problem that used to be dealt with by formal statutory or court intervention. The alternative for the client, as the context for their engagement with you, was a formal or worse intervention (eg conviction, or prison).

What does this mean for your organisational policy on consent?

In these circumstances, consent is undoubtedly compromised. Yet you are required by the Social Services Accreditation Standards and Public Health and Disability Standards to have policy and procedures to ensure all clients (whether mandated or not) exercise their right to informed consent.

So what should your organisation’s policy provide and is there potential for it to help transform an involuntary and unequal situation into more of a voluntary one?  YES. A good informed consent policy can help guide empowering practice and authentic engagement with clients.  Here’s what we see as some key elements of this type of policy.

Consent is a process

Your policy needs to recognise that there are multiple points in the relationship with a client where consent can be sought. Each of these points offers the client the chance to re-assert their rights to autonomy and make decisions for themselves; to help equalise the situation.

While a person should be asked to consent when they enter a service, this should not be with carte blanche effect. It should only mark the beginning of the consent process. Your policy should require that consent is sought at every key point of involvement with the client. It should be supported and reinforced by other policies addressing client/whānau rights to participate and person/whānau centred responses.

Culture matters 

In the Anglo world, certainly in the liberal western tradition of thought, consent is seen in individualistic terms. But that’s just one perspective. Both the significance and process of giving consent can vary cross-culturally and this needs to be recognised in your policy. Important policy requirements include accessing cultural advice and asking the client about their expectations for giving consent.  Where collective cultural values are important, the consent process may need to allow for time and the participation of whānau and others.

Be real

Acknowledging the constraints on a client’s choices is important. It’s essential for building an open and honest relationship with a client/whānau. It’s integral to empowering the client within the consent process.

A consent policy should therefore require kōrero with the client about the reasons and conditions of the referral and consequences of non-compliance with those conditions.  And don’t forget to cover your agency’s role and responsibilities.

You must explain to the person ordered to attend a Family Violence Perpetrator programme or a young person attending your service as part of their Supervision with Activity order that your agency will have to report to the court/Oranga Tamariki if they don’t comply with the terms of service and likelihood of a court-imposed sanction.

Inform, inform

The Health and Disability and Social Services Accreditation Standards require informed consent. This means providing the full raft of information that a client needs to make their decisions and giving accurate and balanced information. Options should be canvassed and the consequences of giving or refusing consent (e.g risks, benefits, costs). The client should be encouraged to ask questions on the basis there are no silly questions

We all need support

The last but probably one of the most important policy requirements is that we should assume a client will need support to give consent. We work with clients often in mental distress or dealing with conditions or circumstances that can diminish their capacity to make decisions and give informed consent.

We should assume support will be needed unless there are grounds to show otherwise. What the support involves will depend on the client. It could range from whānau, communicative assistance, use of an Easy Read translation or linking a person to an advocate eg Health and disability advocate, Disability organisation, VOYCE for a young person in care or legal guardian.

Conclusion

We can’t avoid or shy away from the reality that we are often working with clients in coercive contexts. But there are still many opportunities for a client to exercise choice about engaging with your service.

Yes, engagement is about manaakitanga and skilled work. It’s also about respecting and supporting a person to make their own decisions and give or not give consent in an informed way.

Your Informed Consent policy is important not just to comply with accreditation standards but because it supports client empowerment and authentic and transformative relationships with clients.

 

Impact of youth-related reforms

What will be the implications of the youth-related changes in the Oranga Tamariki reforms?  Now is the time to review your organisational policies if you want to get on board.

Today, I’m going to overview the changes. I consider how they address a key area of positive youth development – belonging – and the implications of the reforms for community and community services.

The Oranga Tamariki (OT) reforms.

The upcoming OT reforms establish new legislative principles and include age changes for leaving care, aftercare support and youth justice. The changes support positive youth development, in particular, “belonging” as a key developmental area for our youth.

Belonging in what sense?

The new legislation addresses three meanings of belonging for our rangatahi/youth:

  • the tangible – physical spaces we occupy and to which we connect – home, turangawaewae, whenua, land, community, neighbourhood, country
  • the relational – our membership and connections with whānau, family, hapū, aiga, peers and spiritual beliefs. This is the basis on which a young person can say “I am loved” (according to the Circle of Courage, a positive youth development approach)
  • the restorative – recognising a feeling of belonging is essential to resilience, the ability to cope with life and pain and to recover from trauma, mental health and addiction issues.

New principles

The new principles of the Act will guide the Ministry in the exercise of its powers and functions. Some of them apply generally to children and young people and some are specific to young people involved in youth justice, and to youth who are 18 years and over transitioning from care.

A young person’s need to belong in tangible, restorative and relational senses is recognised and supported:

  • young people should be increasingly supported to make their own decisions
  • young people should be supported to address the impacts of harm
  • the relationships between a young person and their family, whānau, hapū, iwi and family group should be supported and strengthened where appropriate
  • their mana must be protected by recognising the young person’s whakapapa and respecting whanaungatanga responsibilities
  • respect for a young person’s identity- gender, culture, sexuality, language, religion etc
  • recognise and address barriers to inclusion and participation that can be faced by disabled children.

Raising age for youth justice

From 1 July, most 17-year-olds who offend will come into the Youth Court jurisdiction. This is a long overdue reform and will hopefully lead to further reforms enabling even older youth to be dealt with in the youth system in preference to adult courts.

The youth system, like the adult system, holds offenders to account. However, there’s more scope in the youth system for the tangible, relational and restorative aspects of belonging for a young person to be recognised and addressed. In other words, more scope for positive youth development.

Instead of having to appear in the adult courts, from 1 July, most 17-year-olds will be either diverted by police (as an Alternative Action) or,  be referred directly to a family group conference before any charge can be laid against them. A family group conference has the potential to address a young person’s need for belonging:  their tangible need for a place to call “home, and for trusting relationships to support them to take responsibility for wrongdoing, make amends and if appropriate, provide reparation to victims.

Age increase for leaving care and support for independence

The new legislation finally makes our country compliant with the UN Convention on the Rights of the Child, making Oranga Tamariki the responsible parent it was always meant to be.

The care and protection system will apply to 17-year-olds. The reforms also provide a lot more support for rangatahi to transition from care to independence. A young person in care will be entitled to live with a caregiver up until age 21 and to access advice and assistance up until 25 years.

Oranga Tamariki already makes some provision for young people to be supported to transition from care. But the support to remain with a caregiver and provision for assistance until 25 years old are big shifts.

Supporting the young person’s path to independence is the kaupapa and addressing their need for belonging (in a tangible, relational and restorative sense) is crucial:

  • maintaining their sense of home (tangible) with an existing caregiver
  • supporting and building trusted relationships (eg whānau, aiga and others that exist)
  • supporting the young person to address the impacts of harm

Implications for community and youth services

The changes are going to have a significant impact on OT itself. Funding for the changes was announced by the Minister of Children earlier this year.

Most youth services already work with rangatahi up to 25 years. But there may be impacts on these and other services, for example, more demand for:

  • youth-friendly placements and care opinions
  • health services to extend and open up to 17-year-olds (instead of making 18 the magic age for accessing a service)
  • for iwi and others who are delegated to run FGCs
  • for youth and other services who assist young people transitioning from care.

Buy-in from the community is crucial if these reforms are going to work. Rangatahi are part of families, whānau, hapū and family groups. It is at these levels therefore that the potential of the reforms to support young people’s sense of belonging and positive development has to be activated. Adequate resourcing and funding by government and local authorities for the community to do so is vital.

Review your organisational policies

If your organisation wants to be part of these changes it is a good idea to review your policies and procedures.

Some issues to consider include:

  • your definition of a young person
  • if you’re wanting to get on board with the extended youth justice jurisdiction, whether your policies adequately address legal obligations such as reporting and intersect with the court
  • do the changes impact on your duty of care
  • how you address youth participation
  • whether your policies adequately support  youth inclusive practice for the diversity of youth in this country
  • the alignment of your policies and practices with the new legislative principles (general and specific youth principles).

Do you want policy help?

Contact The Policy Place if you need help with reviewing and updating your policies to support service provision to rangatahi. We want to awhi you in order to support some of our most disadvantaged young people. Let’s work together on this!