How can children aged 8-12 years be involved in decision-making and consent processes in outpatient Child and Adolescent Mental Health Services (CAMHS)? An embedded case study.

Involving children in decision-making and consent processes in their own healthcare has long been a challenging area of clinical practice. The reasons for this are the challenges in assessing child development capabilities in decision-making, and the lack and ambiguity of guidance and frameworks that support this area of practice. This study addresses these challenges in relation to outpatient CAMHS and provides an in-depth examination of how children can consistently be involved in decision-making and consent processes. The study has triangulated children’s, parents’, and clinicians’ perspectives to provide a theoretical understanding of children’s involvement and how this can be used within clinical practice. The method used in this study has been an embedded case study design and the critical realist inquiry of retroduction. A variety of methods and analytical tools transcending the research paradigms have been used to elicit the relevant data. The study includes several literature reviews, a patient clinical record evaluation, a semi-structured questionnaire administered to clinicians, and four focus groups, two with children and two with parents. The findings are i) children can be involved in decision-making and consent processes; ii) children want to be involved in decision-making and consent processes; iii) The onus is on the adults supporting the child in the decision-making process to maximise the child’s involvement in the process and iv) the theories of prioritising, knowing and navigating are fundamental to understanding the decision-making process and provide an evidence base for this area of practice. This study provides practical solutions in translating the theory into practice. In conclusion, decision-making is a multifaceted process that needs time, resources, and skills to facilitate it properly. For the first time, children have been heard in how they want to be involved in decision-making and consent processes. A critical examination of how children can be involved in decision-making and consent processes has been undertaken. The development of the theories of prioritising, knowing, and navigating are critical to fully understanding and implementing this area of practice.Florence Nightingale Foundation (Research Scholarship)Royal College of Nursing Foundation (Research Grant