Family-centred and child-rights-based care — formative SAQs

SAQ 1 — Core concepts, rights principles and participation (10 marks)

A 7-year-old with a complex chronic illness is admitted to the ward for a planned procedure. Her care spans four specialists and a school nurse. Her parents speak a language other than English and arrive with her older sibling. [9] [10]

Questions

1. Name the four IPFCC core concepts and the four UNCRC guiding principles, and state how each set shapes this encounter. (5 marks) [1] [5]
2. Grade the child's possible participation using Hart's ladder, distinguishing genuine participation from tokenism. (3 marks) [12]
3. State two concrete bedside actions that would uphold the child's right to be heard here, and one error to avoid. (2 marks) [6]

Model answer

Core concepts and principles (5). The four IPFCC core concepts are dignity and respect, information sharing, participation, and collaboration; they tell you how to partner — in this encounter, by booking a professional interpreter, sharing honest information in plain language, involving the family in the plan, and treating the parents as equal partners. [1] The four UNCRC guiding principles are non-discrimination, the best interests of the child, survival and development, and the right of the child to be heard; they tell you why the child is owed it — here, the child's own views must be sought and given weight regardless of her family's language or background. [5]

Grading participation (3). Hart's ladder places manipulation, decoration and tokenism outside participation — a child asked to hold a prop during a consent conversation she cannot influence is decoration. Genuine participation runs from assigned-but-informed through consultation to child-initiated, shared decisions with adults. For this 7-year-old, genuine participation means telling her in age-appropriate terms what will happen and asking her view, weighted to her developmental stage. [12]

Bedside actions (2). Two concrete actions: greet the child by name first and ask her, in age-appropriate language, what she understands and what matters to her; record her own views in the notes rather than only the parents'. One error to avoid: using the older sibling as interpreter for high-stakes information — a professional interpreter is required. [6] [9]

SAQ 2 — Bedside delivery, conflict and safeguarding (10 marks)

A 14-year-old with a newly diagnosed serious illness is admitted. She is competent to take part in her care. Her parents wish to be fully informed and involved; the young person asks you to speak to her directly and without her parents present for part of the conversation. [5] [12]

Questions

1. Outline the stepwise bedside algorithm to deliver a family-centred, rights-based encounter. (5 marks) [1]
2. Explain how you would hold the young person's right to be heard alongside the family's right to participate, without silencing either. (3 marks) [5]
3. State when cultural or family autonomy would not override your duty to act, and name the escalation pathway. (2 marks) [1]

Model answer

Stepwise algorithm (5). Prepare — identify who is present, language, culture and accessibility needs and a private setting. Build trust — greet the young person by name first, explain roles, signal the family is a partner. Share honest information — plain language, invite questions, disclose knowns and unknowns, teach-back. Elicit the child's and family's views — ask the young person directly and weight her views. Collaborate on a shared plan built around her goals. Agree and document — who decided, the information shared, the young person's views recorded. Review and improve — close the loop and feed experience back into service improvement. [1]

Holding both rights (3). The young person holds rights independently of her parents under Article 12, so you offer confidential time and speak to her directly, recording her own views. The family's right to participate is upheld by sharing information and building the plan collaboratively. The two are held together by asking the young person what she is comfortable sharing with her family and supporting that conversation, rather than letting "the family will decide" silence her. [5]

Limit of autonomy and escalation (2). Cultural or family autonomy never overrides a duty to act on serious, foreseeable harm to the child — if a safeguarding concern emerges, statutory duties lead. The escalation pathway is senior clinician, social work, ethics consultation or a child advocate, with the young person's best interests and her recorded views carried forward. [1]