To inform or not to inform?

[Good&Evil]

I have recently been faced with this 'ethical dilemma':

A parent decided that he should take his autistic child of 6 off his medication (seroquel which had in turn replaced risperdal) for reasons that were not fully scientifically valid. He started weaning off his child by a quarter of the dosage without any psychiatric assessment (although he has now decided to ask for a 'second' opinion).

The problem that I faced was: should I inform the other staff members about the current situation? As background information, we work offer structured support on a two day a week basis to this client with autism. Formerly this client had some behavioural problems whilst switching medication.

Reasons for informing: concealing information is not ethically correct. Should problems have arisen I would have been responsible for harm to self, others, property, etc.

Reasons for not informing: creating expectancy for problem behaviours could lead to the fulfillment of the expectations due to the shaping of the behaviour.

What would you have done in this case? I'll post what I did after hearing your views.

[anon_e-mouse]

perhaps

to Dad: do you want feedback about whether the reduction in medication is working and how your child is coping while with us?
if so i will ask the staff to tell me if they notice anything unusual.

To staff: let me know if you notice anything unusual about .... he is under a bit more strain than usual because of things to do with home, go easy on him as his tolerance to staff behavior might be affected this week.

[Good&Evil]

perhaps

to Dad: do you want feedback about whether the reduction in medication is working and how your child is coping while with us?
if so i will ask the staff to tell me if they notice anything unusual.

To staff: let me know if you notice anything unusual about .... he is under a bit more strain than usual because of things to do with home, go easy on him as his tolerance to staff behavior might be affected this week.

I'll carify a bit what i meant by my very verbose post:

Should I inform the other staff members that this kid is being taken off his medication? Or should i keep it secret in case expectations of bad behaviours lead to more problems?

[janeth]

Tricky !!Iwould have probaly maintained the confidence but encouraged parent strongly to obtain a second opinion if i thought that the change was being initiated through unproven advice. In addition i would have talked with the parent about how to monitor the change so that any side effects could be picked up really quickly. As far as the rest of team i would have done something similar to anon e mouse and raised their sesitivity to recording any changes.due to poss changes at home. I would always reserve the rightto go back to the parent at any time and tell them that ineeded to discuss it with the team if i felt that the effects on the child were becoming negative. so what did you do.

[forumAdmin]

I think I would have made sure the staff working with the child were on top form (best communicators healthy and physically able) - the kind the child has best relationship with and move the slightly ill / hungover(never) staff to another role for the day. it is those 2 days that are important for safety.
I would agree with janet and anon_e-mouse aswell on pretty much all of it.
though in the heat of situation and politics we sometimes do not remember the details of what we should do!!

[dave]

inform the staff

I'm not to o interested in the ethics of reducing the medication or medication in general but if something major has changed and I have to manage the consequences I'd want to know.

love and kisses

David

[anon_e-mouse]

ok for clarification,
I dont think that the "creating expectations of bad behaviour" is as bad as "creating a culture of secrets in children services"

i too am agreeing with the other posts the welfare of the child is paramount. If you know that something significant has happened to the child, in thais case the withdrawl of prescribed medication, regardless of your opinion on the pros and cons of medication, the situation should be monitored and documented. This will require the full support of the staff as, lets face, the staff are the ones who are doing the monitoring.

As dave says I too would like to know, remember that even if it creates an expectation it also provides a possible cause. I would rather hope that the staff perception was then "this is probably because of the med" rather than "this kid is out of control and a nightmare to work with" having a cause reason or even excuse that develops caring and understanding relationships is preferable.

I dont think that keeping a secret in this situation is constructive, short or long term.
I would encourage you to present this to dad in a way that shows the benefit of you and the staff team working alongside the family rather than opposed to the family.

[forumAdmin]

good point and if you have a good well trained staff team
the self fulfilling profecy should not happen. you should have no worries about sharing the info........................

get some others to join the discussion
although I am interested in what you did I think we should keep this open a few days at least.

[Good&Evil]

I did not do anything splashy in this case. I thought it over and decided that I should inform the other staff members about the situation. That is what I would have liked them to do if the roles had been inverted. So far (about 3 weeks into the ‘weaning’) nothing really significant has been recorded – the child has been challenging but not to an extent we had never seen before.

With regards to the medication, we did talk to the father about implications, etc. Not sure that we had any effect in the decision but he has decided to seek out a second opinion (from a different psychiatrist).

[andy]

Good call

[stevel]

Good call, can you ever be justified in not giving staff all the relevent information to work with a client ?

[anon_e-mouse]

well done.

[doreen]

Good decision G&E. By any chance, did the head jerking coincide with the weaning off of medication?

[Good&Evil]

Good decision G&E. By any chance, did the head jerking coincide with the weaning off of medication?

Sorry for the delay in the response. Actually, it did. I really had failed to make this observation.