Secure care: a question of capacity, autonomy and the best interests of the child

Hamilton, Angie L.; Jarvis, Daphne G.; Watts, Barbara E.L.

doi:10.1503/cmaj.73252

Cited by 7 publications

(5 citation statements)

References 7 publications

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“…Other professionals emphasize that when properly implemented, coercive admission practices, including IYT, may be a safe resource for youth needing treatment and these practices do not negatively impact treatment outcomes (Hamilton et al, 2020;Hardy, 2011;Tucker et al, 2018). When ascertaining the risks and benefits of coercive treatment, Hardy (2011) reasoned that adolescent treatment coercion "can provide access to a safe treatment environment for reflection and recovery of mental competency, free from negative outside pressure and potential substance abuse" (p. 92).…”

Section: Scenario #2mentioning

confidence: 99%

“…According to paternalism, the decision for involuntary treatment is made out of benevolence or for a person's own good when they are considered, "incompetent to make decisions for themselves or to lack autonomy" (O'Brien & Golding, 2003, p. 170). Paternalism is reasoned to occur more frequently for adolescents beleaguered by behavioral health problems as they are often dependent on their caregivers (Ellila et al, 2008;Hamilton et al, 2020). O'Brien and Golding ( 2003) also point out that paternalism is used as a default justification with minimal assessment into whether it is needed.…”

Section: Ethical Considerations For Involuntary Treatmentmentioning

confidence: 99%

“…In most countries, youth can be legally transported involuntarily (e.g., against their consent) into a treatment program when certain conditions exist under the authority of their legal caregivers (Jost, 2006). Australia (McMillan et al, 2019), Canada (Clark et al, 2019;Hamilton et al, 2020), India (Kelly, 2016), Finland (Askola et al, 2018), and the United Kingdom (Zigmond, 2017) are examples of countries that have established governmental guidelines and principles regarding the use of involuntary transport for individuals experiencing behavioral health issues. In the U.S., however, there is no existing federal legislation for IYT.…”

mentioning

confidence: 99%

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Involuntary Youth Transport (IYT) to Treatment Programs: Best Practices, Research, Ethics, and Future Directions

Gass

Hardy

Norton

et al. 2021

Child Adolesc Soc Work J

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Involuntary youth transport (IYT) is a controversial practice used to admit adolescents into residential care. Critics point out that IYT is in need of regulation and is best used as a last resort. This article examines the risks and benefits of IYT, especially the longterm effects on the client, in order to ensure that all facets of a client’s treatment are trauma-informed and guided by research-based practices and ethical principles. Practices that re-traumatize youth need to be replaced with informed practices that facilitate positive outcomes. This article utilizes an ethical decision-making framework developed for behavioral health professionals to assess and improve the ethical use of IYT. Based on this ethical framework, a more effective and collaborative model is presented that results in less restrictive approaches, greater levels of willingness by the adolescent to enter treatment, and trauma-informed management of difficult emotional or physical behaviors. This model also guides professionals and caregivers on how to proceed when IYT services are deemed necessary. The article presents past research and addresses ethical guidelines and best practices for IYT. Steps for practitioners and future directions are discussed.

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Section: Scenario #2mentioning

confidence: 99%

Section: Ethical Considerations For Involuntary Treatmentmentioning

confidence: 99%

mentioning

confidence: 99%

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Involuntary Youth Transport (IYT) to Treatment Programs: Best Practices, Research, Ethics, and Future Directions

Gass

Hardy

Norton

et al. 2021

Child Adolesc Soc Work J

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“…Proponents argue that the need to protect patient autonomy is outweighed by the severity of the risk and potentially vulnerable capacity due to mental illness and developmental stage. 10,11 On the other hand, critics argue that such practices would undermine trust and result in fewer youth seeking help out of fear of being hospitalized against their will. 6,8,12,13 Involuntary treatment for mental illness is typically justified in circumstances such as psychosis or acute suicidality because they present life-threatening risks.…”

Section: Introductionmentioning

confidence: 99%

“…Involuntary treatment for youth with SUD (ie, “secure care”) is also controversial. Proponents argue that the need to protect patient autonomy is outweighed by the severity of the risk and potentially vulnerable capacity due to mental illness and developmental stage 10,11 . On the other hand, critics argue that such practices would undermine trust and result in fewer youth seeking help out of fear of being hospitalized against their will 6,8,12,13 …”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Involuntary Treatment for Individuals With Substance Use Disorders: A Systematic Review

Bahji,

Leger,

Nidumolu

et al. 2023

Canadian Journal of Addiction

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Background: The Canadian Society of Addiction Medicine La Societe medicale canadienne sur l’addiction Policy Committee created a task force to conduct a systematic review examining the effectiveness of involuntary treatment for individuals with substance use disorders (SUDs). Methods: We followed Preferred Reporting Items for Systematic Reviews & Meta-analyses (PRISMA) guidelines and searched 2 databases for peer-reviewed articles assessing the effectiveness of involuntary treatment modalities for substance use disorders from inception to July 2021. Effectiveness was defined as any SUD-related outcome, including treatment retention, post-treatment substance use frequency, overdose mortality, improvement in functioning, or other patient-centred outcomes. Involuntary treatment was defined as any modality not fully motivated by the individual’s volition to seek treatment. Results: Forty-two studies met the review criteria, with 354,420 participants. Most studies were from the United States, Canada, and China: most measured substance use changes, criminal recidivism, and retention in treatment. Only 7 studies comparing involuntary to voluntary intervention reported improved outcomes in the involuntary group, with most for retention in treatment and only one showing a reduction in substance use. Six out of 7 studies comparing different involuntary interventions occurred in the context of prison or probation. No studies compared the involuntary treatment to no treatment. Only 11 described evidence-based treatment for SUDs, while 5 diagnosed and co-treated psychiatric comorbidity and 11 discussed the motivation for treatment. Conclusions: There is a lack of high-quality evidence to support or refute involuntary treatment for SUD. More research is needed to inform health policy. Contexte: Le comité d’orientation de la Canadian Society of Addiction Medicine La Societe medicale canadienne sur l’addiction a créé un groupe de travail chargé d’effectuer une étude systématique sur l’efficacité du traitement non volontaire des personnes souffrant de troubles liés à l’utilisation de substances (TLUS). Méthodes: Nous avons suivi les directives PRISMA et cherché dans deux bases de données des articles évalués par des pairs sur l’efficacité des modalités de traitement non volontaire des troubles liés à l’utilisation de substances, depuis sa création jusqu'à juillet 2021. L’efficacité a été définie comme tout résultat lié aux troubles liés à l’utilisation de substances, y compris la rétention du traitement, la fréquence de l’utilisation de substances après le traitement, la mortalité par overdose, l’amélioration du fonctionnement ou d’autres résultats centrés sur le patient. Le traitement non volontaire est défini comme toute modalité qui n’est pas entièrement motivée par la volonté de l’individu de se faire soigner. Résultats: 42 études ont répondu aux critères d’examen, avec 354 420 participants. La plupart des études provenaient des États-Unis, du Canada et de la Chine: la plupart mesuraient les changements dans la consommation de substances, la récidive criminelle et la rétention en traitement. Seules sept études comparant l’intervention non volontaire à l’intervention volontaire ont fait état de meilleurs résultats dans le groupe non volontaire, la plupart concernant la rétention en traitement et une seule montrant une réduction de la consommation de substances. Six des sept études comparant différentes interventions non volontaires ont eu lieu dans le contexte de la prison ou de la probation. Aucune étude n’a comparé le traitement non volontaire à l’absence de traitement. Seules 11 études décrivaient un traitement basé sur des preuves pour les TLUS, tandis que cinq études diagnostiquaient et traitaient la comorbidité psychiatrique et 11 études discutaient de la motivation pour le traitement. Conclusions: Il y a un manque de preuves de haute qualité pour soutenir ou réfuter le traitement non volontaire des TLUS. Des recherches supplémentaires sont nécessaires pour éclairer la politique de santé.

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Can Involuntary Youth Transport into Outdoor Behavioral Healthcare Treatment Programs (Wilderness Therapy) Ever Be Ethical?

Magnuson

Dobud

Harper

2022

Child Adolesc Soc Work J

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Secure care: a question of capacity, autonomy and the best interests of the child

Cited by 7 publications

References 7 publications

Involuntary Youth Transport (IYT) to Treatment Programs: Best Practices, Research, Ethics, and Future Directions

Involuntary Youth Transport (IYT) to Treatment Programs: Best Practices, Research, Ethics, and Future Directions

Effectiveness of Involuntary Treatment for Individuals With Substance Use Disorders: A Systematic Review

Can Involuntary Youth Transport into Outdoor Behavioral Healthcare Treatment Programs (Wilderness Therapy) Ever Be Ethical?

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