Client Capacity and Parental Involvement Assessment Form

Name of Client

Age

Date of Assessment

YYYY

Caseworker Conducting Assessment

Supported Decision

A child or young person may have capacity to make decisions about their own mental health treatment, without the assistance of others. However, support from others should be actively encouraged, and capacity may also be achieved with support from others in understanding information relevant to the proposed treatment. Who are the persons assisting the child or young person during this capacity assessment? (please write ‘nil’ if no-one else present or contact made through text or call)

Confidentiality and limits to confidentiality explained?

Yes

Category 1 - Risk of Parental Harm

Indicate if client is at risk of parental harm, and parental consent should not be collected

Physical Abuse

Emotional/Psychological Abuse

Neglect

Medical Neglect

Traumatization / Retraumatization

Reduced ability to cope

None

Category 2 - Risk of Self Harm (If Parents Informed)

Complete refusal of treatment (even with another provider)

Risky behaviours

Increased suicidality

Increased self-harm

None

Category 3 - No Risk

No risk - Client is keen to involve parents (GILLICK COMPETENCY TEST NOT REQUIRED)

No risk - Client is NOT keen to involve parents

Gillick Competency Test (to be done if not able to attain parental consent)

For each of the following criteria (A, B, C), please provide details including: i) how this was explained to the child/young person; ii) the child/young person’s responses indicating understanding or lack thereof. This may include understanding of cause and effect; consequences for self and others; permanent or long-term outcomes; iii) any written, visual or other materials provided; iv) any factors that were considered important to the person and/or supports

A. Does the child / young person understand, in general terms, that they have a mental illness, or symptoms of a mental illness that affects their mental health and wellbeing?

Yes

B.1. What is the treatment being proposed?

B.2. Does stability of capacity need to be demonstrated before consent can be given for this treatment decision?

Yes – ensure that the ‘stability of capacity’ (Section H) is completed. Seek consent from parent or legal guardian until stability is demonstrated

No – the capacity decision from this assessment can be acted on directly

C. The child/young person is capable of understanding in general terms:

The nature and purpose of the treatment proposed

The benefits and risks of treatment, and alternatives to the treatment

The consequences of not receiving the treatment

D. Is the child/young person able to make a decision and communicate the decision in some way?

Yes

E. If a ‘NO’ response was documented for any of the above questions (A, C, D) this may indicate that the person lacks capacity to make the decision at this point in time.

Before forming this view, you should ensure that every effort has been made to encourage and support the child or young person to be able to make their own decision. Consider the following ways to enhance capacity: • Providing all relevant information for the decision in a way the person understands. This may include written, pictorial, verbal and other means. • If the choice is between alternatives, do they have the information on the different options? Are the choices clear, or have they been presented in a way that might be confusing? Are the same options being presented each time, or are different options being given? • Impact of the environment on decision making, e.g. noise, distractions, interruptions, trauma triggers. Can the person be made to feel more at ease? • Have cultural and religious needs been recognised and taken into account in providing information and choices, e.g. setting, appropriate support people, adapting to beliefs and customs. • Have communication needs been adequately addressed, e.g. use of interpreters, written information in the person’s preferred language, use of plain English, no jargon, use of visual aids? • Timing – can the person be given time to consider their options? Can the decision be delayed until a time when the person can make a decision? Is there a time of day that is better for the person to take in and retain information? • Can a family member, friend, carer or advocate help the person to make a choice or express a view? • Does the person feel that they are able to give their decision freely and voluntarily? Consider the language used, the setting, the influence of others, and other factors that may be perceived as coercive.

F. Capacity Decision

At this point of time, I assess that the above mentioned client

Has capacity (is Gillick competent) to make this mental health assessment and or/treatment decision

Does NOT have capacity to make this mental health assessment and or/treatment decision (complete section H)

G. Alternative "Safe" Person

H. Action Taken (Failed Capacity Assessment)

Parent / Guardian's consent acquired (Please indicate evidence in your casenotes / I&R form)

Referral made to other SSA

Referral made to school counsellor

Referral made to police / emergency services (high risk client)

Complete client refusal of treatment

Capacity assessed by:

Date & Time of Capacity Assessment