ATLANTA—When children participate in discussions about health care options, their health outcomes improve, and new processes must be introduced to ensure their involvement in health care decisions, say Jonathan Todres, professor of law at Georgia State University, and Angela Diaz, director of the Mount Sinai Adolescent Health Center.
Their right to participate has an enormous potential impact on their lives and their future as adults, Todres said.
“Involving children increases the likelihood that they will follow treatment plans,” he said. “It also might improve the treatment plan itself, because engaging children more meaningfully makes it more likely that they will open up and share what is happening in their lives.”
International children’s rights law establishes that any child capable of expressing views has the right to be heard on all matters that affect them. Todres and Angela Diaz, a professor of pediatrics, discuss the value of advocating for those rights in the health care context in “Adolescents’ Right to Participate: Opportunities and Challenges for Health Care Professionals,” published in the Annals of Global Health. Such rights are critical in health care situations where significant consequences are at stake, Todres said.
The article cites numerous studies which show the merit of child participation in various settings, from school to health care to the juvenile justice system. Involvement can contribute to children’s development, enhance self-esteem and confidence, reduce fear and foster some sense of control over their lives. Denying children’s involvement in the decision-making process has a negative effect, resulting in children feeling excluded, devalued, ignored, confused and anxious about their future.
Todres and Diaz outline ways in which health care providers can promote adolescents’ right to participate, including ensuring that scheduling an appointment is easy and hassle free and allowing walk-in appointments for clinics that serve at-risk youth. Todres and Diaz also advocated not making insurance and billing matters the first priority in initial meetings, creating an environment that is colorful, well-lit and clean with messages that support diversity, and explaining the what, why and the how at each step of a treatment plan. Initial interactions can set the tone for whether adolescents feel their input will be considered in a meaningful way and should be considered part of the continuum of care, not just a triage tool for the health care provider, they said.
“We believe that the rights of children and adolescents should be reflected in the entire health care process,” Todres said, “from the moment they call to make an appointment, to the built environment where they access care, to the interactions with all staff, including clinicians, to the treatment plan and finally to any follow-up care.”
Creating meaningful opportunities for children to be heard can be difficult, Todres acknowledged.
“It requires time, patience, and a commitment to meeting children where they are,” he said, “as opposed to insisting that children fit into adults’ structures and processes.”