Information on consent
At Lesley Hartman & Associates Inc. we follow provincial guidelines and consent legislation regarding a child/youth’s right to have their mental health decisions respected. In Nova Scotia the age of majority is 19 years old. Any person under this age is considered a minor. However, there is no law that grants or denies any decision-making entitlement to minors; therefore, if they are able to understand the risks and benefits, they are legally entitled to make decisions regarding their own health care.
To read more about this Nova Scotia Board of Examiners in Psychology (NSBEP) Working with Children and Adolescents (.pdf)>>
What is informed consent?
it must be given by the individual;
it must be knowledgeable (they have all the relevant information to make an informed decision);
it must be related to the specific information at issue; and
it must be voluntary.
What is capacity to consent?
For the consent of an individual to be valid, the individual must have the capacity to consent. In the context of The Personal Health Information Act (PHIA), capacity means:
the ability to understand information that is relevant to the making of a decision related to the collection, use or disclosure of personal health information and
the ability to appreciate the reasonably foreseeable consequences of a decision or a lack of a decision. (Section 3(b))
PHIA recognizes the common-law principle of “mature minors,” which recognizes that the capacity to consent is incremental and situational. The capacity of each individual minor must be considered in the context of each episode of care. For example:
A 17-year-old may have the capacity to consent to (or withhold) disclosure of information related to one issue while lacking the capacity to consent to disclosure related to another.
Read more about PHIA Consent, Capacity, and Substitute Decision Makers (.pdf) >>
In Nova Scotia, as there is no set age a child/youth must reach before they are able to provide consent for treatment, assessment or release of information, the clinician/therapist must determine, on a case-by-case basis, whether the child/youth is capable of making an informed decision.
Factors to be considered include: emotional regulation, ability to self-reflect, ability to place peer influences and age specific values in perspective, ability to learn from experiences and willingness to seek advice. They must be able to understand the nature and purpose of the treatment and/or assessment and the consequences of giving or refusing consent.
What does this mean for my child's therapy?
The younger your child, the more involved you will likely be in the treatment. To the best of our abilities, we want parents to see themselves as part of their child’s treatment team. However, it also means that your older child or teen may have the legal right to refuse to engage in treatment. It may mean that they have the legal right to request a different kind of treatment than the one you would prefer, or that they have the legal right to refuse to consent to us talking to you about their treatment.
Practically speaking, we manage this by trying to engage our child and youth clients actively in the decision-making around their treatment. We do this from the beginning. Our intake workers will speak with your older child or teen as well as speak with you, to find out how they view the problem and what goals they have for therapy or assessment. This results in youth and children who are much more engaged, and in better therapeutic outcomes. This doesn’t mean you as a parent are left out! Our clinicians understand the importance of family for the well-being and progress of all children and teens, and we endeavour to include parents as much as possible in your child’s treatment.
My child's parents are not living together. In that case, who consents for our younger child to receive treatment?
At Lesley Hartman & Associates Inc., when the parents/legal guardians of a child are not living together (separation, pending separation, divorced or they have never lived together), we provide treatment to younger children as long as we have consent from one custodial parent as well as the assent of the child.
Assent is essentially the same thing as consent (which was detailed above). To have a child assent to treatment means that they do not have the legal right to consent (this is the parent’s job), however, we attempt to explain the risks and benefits of not receiving treatment and receiving treatment, in a developmentally accessible way, and we use the child's wishes to inform the decisions about treatment.
When there is an existing custody arrangement including legal provisions regarding decision making on behalf of the child, this should be disclosed and parental consent obtained from the parent identified.