Legal Conundrum - Minors Signing Treatment Plan

[hppygr8ful, ASN, RN, EMT-I]

So I've been a nurse for close to 20 years with the balance spent in Psych. We opened a Preadolescent program last year. One of my jobs is to explain the treatment plan and have the minor sign the plan. Please note these kids are 8-12 years old. I am being told having the kids sign is legal but in California which is where I am that children under 13 cannot sign their treatment plan unless they have the maturity and insight to understand what they are signing. I am 18 mos from retirement and don't want to jeopardize my job until I am ready to go. I am worried that this could somehow affect my license if this is reported. Any thoughts you have would be greatly appreciated.

[hppygr8ful, ASN, RN, EMT-I]

I actually have a day off tomorrow so I'll probably just try to call my malpractice carrier to get their input as well.

[JKL33]

Is the act of signing just meant to be an exercise that encourages participation/buy-in? I know this is not the same but sometimes actions like these are used for that purpose rather than a true legal purpose. Example is older elementary children being asked to sign a paper listing classroom rules of conduct. 

I would be very surprised if what your patients are being asked to sign is meant to convey legal consent. It seems wording would matter and it would also matter whether they understand the intent of the document (what it is and what it isn't). 

Interesting question! I'd be interested in your thoughts on the above and also what the lawyer says. Hope you get answers. 

[Gratefulbutnotstupid, ASN, LPN, RN]

I have to agree with JKL33.  I don't think the agency you work for would want to jeopardize themselves by telling staff that something was legal if it wasn't.  They must have some kind of legal department or company that represents them if needed.  That being said, I understand your concern.  The way it was explained to you, puts the onus upon you to decide whether or not this minor has the maturity and insight to understand what their signing, in other words informed consent.  This has probably never been a problem because no one really has looked into it enough or no one has cared until something happens and then someone cares.   I am glad you're calling your malpractice carrier, just to put your mind at ease.  Just one more question.  Is this treatment plan, just medical or more psychological and is the plan signed by a group (nurse, behaviorist and others) and then signed by a guardian?  Hope this all is nothing and wishing you a wonderful retirement.

[FolksBtrippin, BSN, RN]

 

When I worked in child adolescent psych, we always had kids sign their treatment plans, it's about buy-in, and involving the child in their care. One really good question for the child is "is there anything on this plan that you think I need to add or take away?” Usually kids say no. But sometimes they have a goal for themselves, and it's really important to include that in a way that can be framed as a healthy goal for the child. Even a pretty negative statement can be reframed as a healthy goal. Example "I hate my parents" can be reframed as a goal to "improve family relationships" which can have interventions such as family therapy,  interpersonal skills groups, etc.

Some things they don't have a choice about, for example, going to school is on every treatment plan, they need to go to school. (We had teachers on the unit for school). 
 

Of course, you should ask your manager or educator what they mean by "legal" but my understanding is that psych units have to include the patient in treatment planning to be in compliance with regulations.