Refugee and unaccompanied asylum seeking children and young people: key practice considerations

These pages were developed in partnership with the Child Protection Standing Committee and the Advocacy Committee to support paediatricians in the assessment and management of children and young people of refugee background, with links to key external information and resources.

Language, communication and interpreters

For children and young people with English as a second language any assessment should be undertaken with the support of a culturally appropriate, registered interpreter (considering ethnic and gender issues).

It is not appropriate for other children or young people to act as interpreters, or for people not trained as interpreters to perform this role. An interpreter telephone service can be used where access to a face-to-face interpreter is not possible.

It is important to remember that a health assessment may be the first opportunity that a child or young person has had to talk about their needs with a registered interpreter. Remember to look at the young person not the interpreter when speaking and use positive, friendly, non-verbal communication.

It is important to explain to the young person and their carer that you will see the young person and their carer both individually, and then together. It is useful to discuss the care plan and any other issues (together with family and social worker if present) at the end of the assessment particularly if there is an interpreter present, provided consent and confidentiality issues are considered.

Consent

Paediatricians should refer to GMC guidance regarding information about obtaining consent and what to do if consent is refused. Information is also provided in the Child Protection Companion (log in/subscription required), and by the BMA.

You must have consent or other authority before examining, investigating or treating a child or young person.  Unaccompanied minors may be able to consent to their own treatment however it is always good practice to attempt to contact their parents/guardians for a history and to communicate follow-up management.

In the UK, children and young people, including unaccompanied minors, can consent to treatment if they are deemed Gillick Competent, meaning they can:

  • understand the nature, purpose, benefits, risks and consequences of not proceeding;
  • retain the information discussed;
  • use and weigh this information, and
  • communicate their decision to others. 

A child or young person with capacity to consent, who refuses, should have their decision respected unless there are exceptional circumstances.

Young people over 16 years should be assumed to have capacity unless there is reason to believe that they have an impairment of mind or brain that affects their capacity for the specific decision at the specific time.  If there is doubt about capacity, an assessment of capacity should be undertaken.

Young people aged 16 years or over who are assessed to lack mental capacity for a specific decision at a specific time should have an Independent Mental Capacity Advocate appointed, with the best interests decision-making process of the Mental Capacity Act 2005 followed.

More information on Mental Capacity and Best Interests can be found in the Disability Matters eLearning Package.

Confidentiality

As for all children and young people, it should be explained that in the UK health information is recorded on a computer health system and shared with other health professionals, such as the GP and health visitor, and that health information may be shared with other agencies such as school and social services. 

It should also be explained that details will not be shared with outside agencies such as legal or immigration officials unless the young person/family consent to this. A copy of the care plan and any information shared with other professionals should be sent to the young person/family in the usual way.

More detailed information about confidentiality is provided in the Child Protection Companion and the GMC also provide guidance on this. Caldicott principles on record keeping and information sharing should be followed.