Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent...

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Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD

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Page 1: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD

Page 2: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

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

Page 3: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Historical OverviewRecognition that children have rights is long standing Hammurabi code 1770 B.C. Religion Thomas Spence late 18th century – early 19th century Charles Dickens – mid 19th 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

Page 4: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Adolescent rights

Cultural paradigms, Social necessity

Accepted patterns of authorityTransition from childhood to

adulthood different worldwide (walkabout, rights of passage)

Family, societal rolesPoverty

Definitions and names• child, adolescent, teenager, youth, young person

Perceived conflicts with parental rights

Page 5: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Adolescent Rights: Review of Select Articles

Gonca Yilmaz MD, PhD

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Page 6: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Vulnerable groups

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Adolescents

Children with mental health difficulties

Asylum seeker families

Disabled children

Children in care

Black and ethnic minority Families and those

living in poverty

Page 7: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

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

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Page 8: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Types Of Rights 54 Articles

Three types of rights Of protection Of provision Of participation

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Page 9: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

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)

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Page 10: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Rights Of Provision

Children deprived of basic needs in developing countries (UNICEF 2004)

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Page 11: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Secondary school drop outs

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Page 12: 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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Poverty And Hazardous Child Labour:

A Vicious Circle

Page 13: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

External Barriers to Care

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Page 14: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Provision Of Information

Article 13: freedom of expression - the right to seek, receive and impart information and ideas of all kinds

CHILD 2015

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Page 15: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

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)

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Page 16: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Right To Participation

Frequently violated in paediatric practice: Children often excluded Opinion/consent not sought Good practice but rare

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Page 17: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Participation In Health Care

Participation to decisions

Outpatient and hospital services

Young people views

All matters of concern to them

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Page 18: 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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Page 19: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Article 16 – the right to privacy and respect for confidentiality

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Page 20: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Consultation Plan

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Child -young person

Waiting room

Communication with the child

Informing children about therapy

Provision of information

Informed consent

Advocacy

Page 21: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Case 1Brittany 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?

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Page 22: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Case 1 continuedShe 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?

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Page 23: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

A conflict

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Page 24: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

StrategiesBe 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

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Page 25: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Case 2Patience 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.

Page 26: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

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!”

Page 27: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Case 3Ahmet 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?

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Page 28: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

The percentage of children

aged 11, 13 and 15 years who

reported having been bullied

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Page 29: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

. BULLYINGAggressive behaviorImbalance of power. Bullying is repeated over time.

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Page 30: Ayesha Kadir MD, PhD Gonca Yilmaz MD, PhD. Introduction Introduction and history of adolescent rights Historical overview Why this is relevant to health.

Thank you!

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