Developing rights-based standards for children having tests, treatments, examinations and interventions: using a collaborative, multi-phased, multi-method and multi-stakeholder approach to build consensus.

Children continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The rights-based standards for children undergoing tests, treatments, investigations, examinations and interventions were developed using an iterative, multi-phased, multi-method and multi-stakeholder consensus building approach. This consensus approach used a range of online and face to face methods across three phases to ensure ongoing engagement with multiple stakeholders. The views and perspectives of 203 children and young people, 78 parents and 418 multi-disciplinary professionals gathered over a two year period (2020-2022) informed the development of international rights-based standards for the care of children having tests, treatments, examinations and interventions. The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.    Conclusion: This is the first study of its kind which outlines international rights-based procedural care standards from multi-stakeholder perspectives. The standards offer health professionals and educators clear evidence-based tools to support discussions and practice changes to challenge prevailing assumptions about holding or restraining children and instead encourage a focus on the interests and rights of the child. What is Known: • Children continue to experience short and long-term harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. • Professionals report uncertainty and tensions in applying evidence-based practice to children's procedural care. What is New: • This is the first study of its kind which has developed international rights-based procedural care standards from multi-stakeholder perspectives. • The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.

Gender-affirming surgery for transgender Adolescents: Ethical and legal considerations.

In this paper, we consider the ethico-legal issues surrounding gender-affirming surgeries in minors, with a specific focus on English law. First, we outline and discuss the current clinical guidelines on genital surgery for minors with gender incongruence/dysphoria. Second, we consider the recent legal developments following R (on the application of) Quincy Bell and A v Tavistock and Portman NHS Trust and others, and we discuss how these might impact the ability of doctors to agree to surgical procedures when their patients are still minors. Finally, we explain why the removal of the adulthood threshold is justified. However, we argue that surgical interventions should remain differentiated from fully reversible interventions, and that clear guidance on eligibility criteria for genital surgery is needed from clinical guidelines, which, in consideration of the legal, professional and regulatory framework in which clinicians work, can provide needed reassurance regarding when it is in the best interests of competent young people to be considered suitable candidates for genital surgery.

Using participatory drama workshops to explore children's beliefs, understandings and experiences of coming to hospital for clinical procedures.

Children attending hospital for a clinical procedure such as a scan or blood test can experience anxiety and uncertainty. Children who are informed and supported before and during procedures tend to have a more positive experience. Despite this, there is a lack of empirical evidence directly from children around how they would like to be supported before, during and after a procedure. This qualitative study used improvised drama workshops to investigate children's (n = 15, aged 7-14 years) perceptions and opinions of attending hospital for a procedure and what would help them have a positive encounter. Children portrayed themselves as having a small presence during a hospital procedure, depicted by the two themes of 'having to be brave but feeling scared inside' and 'wanting to get involved but being too afraid to ask'. Within both themes, children described how the directive and reassuring language and actions used by health professionals and parents marginalized their contributions. This study shows that children attending hospital for procedures value the opportunity to have a presence and active role, to express their emotions, join in interactions and be involved in making choices about their care.