Abstract

Background: Competence (within the legal and bioethical framework in Spain, the term ‘competence’ is used as equivalent to healthcare decision-making capacity) in the field of child and adolescent psychiatry is a complex and evolving issue. Legal frameworks vary by country and legal tradition. Most concerns relate to treatment decisions within mental health, but in fact there is a wide range of decisions with a relevant impact on patients’ lives and quality of life over the long term. Forensic science must adapt its current practice to the worldwide challenge presented by this evidence. Objectives: This article will present a current research project about competence (healthcare decision-making capacity) in a sample of adolescent and child population in Spain. The final objective will be to validate the Spanish version of the MacCAT semi-structured interview consenting to psychiatric admission in adolescents in a mixed sample. We also examine some of the influences that must be taken into account in this research. Methodology: This is an instrumental and methodological study utilizing a sequential mixed-methods design (qualitative content validation followed by a quantitative psychometric evaluation). A process of adaptation of the Spanish MacCAT to consent to psychiatric admission in the adolescent population. A pilot study will initially be conducted to evaluate question comprehension and duration. Subsequently, a cross-sectional study will be carried out to assess inter-rater reliability, internal consistency, and validity. Evaluation will include clinical and neuropsychological assessment in five departments at two University Hospitals. Expected results: We will establish new evidence about the evaluation of competence in adolescent psychiatry; to date, no studies have been identified assessing the capacity to consent to psychiatric admission among Spanish-speaking adolescents, nor the factors potentially related to such competence. To our knowledge, the relationship between competence and illness awareness in the adolescent population remains unexplored in the literature, and its analysis constitutes one of the novel contributions of the present study. In addition, we will adapt and validate a well-known evaluation scale to the specific environments of our medical and psychiatric health departments. Conclusions: Objective evaluation of competence for medical interventions and treatments is a challenge in clinical and forensic examination. New evidence is necessary to operationalize classical evaluations in standardized ways, adapted to different countries, legal systems and forensic traditions.

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