Young Person’s Information – Negotiating Independence

Introduction

For some young people, living with a health condition
like diabetes whilst trying to gain independence can be
frustrating.

A first great step is to demonstrate that you are
responsible and capable. This will help those around you
feel comfortable about you making your own healthcare
decisions.

All decisions you make in life will have positive and
negative parts to weigh up, but it is particularly important
that you are aware of the potential risks to your health
when your decisions involve risky behaviours so you can
make informed choices.

It may be challenging to negotiate with your parents/
carers about gaining some independence in your life. This
is because they care about you and want to see the best
outcome for you. Parents and carers also want to protect
you and can find it hard to stop making all the
decisions for you because they want to help you stay as
healthy as possible. You may find this hard to accept,
especially when things don’t always go the way you
want them to at this stage in your life.

During adolescence you may find that your opinion
differs greatly from your parents/carers and this can
result in a lot of conflict. You will find it easier to
work with (and not against) your parents/carers about
making decisions if you state how you feel in a clear,
rational and open way. You may feel that your
parents/carers are overprotective or worry about you too
much, but remember that they do this because they love
and care for you.

Part of being a teenager is getting a stronger sense of
self-identity (who you are) and beginning to establish
your independence. You may already be starting to
negotiate your independence with your parents/carers as
well as teachers, friends and extended family. It is
important for you to gain independence in your healthcare
too. This will be an advantage when you get older and are
expected to make your own decisions and choices about
taking care of your health. It is a good idea to start
practicing these skills now, while your parents/carers and
other trusted adults are still readily available to help you
out if things get complicated.

Here are a few tips for negotiating your
independence.

1. Make sure you choose the right time to talk with
   your parents/carers about independence. Make sure
   you all have enough time to give one another your
   full attention

2. Always aim to be open and honest with your parents/
   carers as well as your doctor and medical team. If you
   wish to tell your doctor/nurse something without your
   parent/carer being present it is OK to ask for some
   time alone with your doctor. As a young person you
   are entitled to increasing amounts of confidential
   time with your doctor/nurse.

3. Be clear about what you want and why you want it.
   Write down the key points you want to make. This will
   help you to remember everything when you start to
   discuss things face to face.

4. Set small goals for you and your parents/carers
   to achieve together in relation to managing your
   diabetes. You can also set some individual goals and
   discuss these with your parents/carers.

5. Try to stay calm and don’t get angry if the discussion
   isn’t going your way. If you can’t find a happy
   medium, then hit the ‘pause’ button instead of
   getting into an argument and reassess the issue with
   your parents/ carers at a later time. You could use the
   phrase “I need to discuss this with you later” and then
   calmly walk away. You could also try and find
   a neutral person (someone who isn’t on either
   side) to help guide the conversation next time – this
   could be any member of your healthcare team or a
   family friend, for example.

6. Discuss how you are feeling with your
   parents/carers. How they think you feel and how you
   actually feel may be different. Also discuss how your
   parents are feeling as well, because what you think
   they are feeling or worried about and what is really on
   their mind might also be different.

7. Discuss how you are feeling with your doctor or
   nurse and come up with a plan that gives you more
   involvement in your healthcare, for example
   attending part of your appointment on your own.

8. Demonstrate that you’re capable and ready to act
   responsibly. Showing initiative before you are asked to
   do something and doing what is asked of you before
   anyone feels they have to nag you is a good way to
   show your parents/carers that you are capable of
   listening to instructions, making good decisions and
   acting in your own best interests.

9. Don’t push too hard. Small steps will eventually
   achieve big changes. You may push your parents/
   carers too far which could result in taking a few steps
   back. Be gentle in your approach and remember it can
   be hard for them to let you go. Try to tell your parents/
   carers what they are doing well and how they can
   continue to support you.

Gaining independence in all parts of life, including
healthcare, may require a different approach for each
individual. Some young people may already be living away
from home or attending appointments on their own.
Other young people may enjoy not having to make big
decisions in their lives and prefer to leave certain decisions
to their parents/carers. Each person is different.

Problem Solving

Making decisions about your life, health and wellbeing can
be confusing. Being able to problem solve can be a good
way of helping you to make decisions in lots of areas of
your life, not just about your health. Using the following
strategy may help you:

Step 1.

Define the problem or decision to be made and the
feelings involved.

What is the problem or decision to be made (be specific)

How do I feel

Step 2.

Brainstorm solutions: Come up with as many solutions,
choices or options as possible to solve the problem. It
doesn’t matter how silly or unlikely they may seem.

Step 3.

Explore the pros (good bits) and cons (not so
good bits) of each solution or choice.

Think through the consequences of each solution, what
would happen if you carried out a particular solution?

Solution

Pros

Cons

Step 4.

Agree on one or two of the best solutions or choices and
create an action plan

Ask yourself: At this time, which would be the best
solution that you would be willing to try out? Does it
make you feel safe and feel good?

Create an action plan on how you are going to carry out
this solution or decision. Think about situations where you
might use the agreed-upon plan.

Action steps

Where

Who

When

How

Step 5.

Carry it out!

Step 6.

Evaluate outcome and congratulate yourself on your
efforts!

• How did you get on, was the plan successful?

• What did you learn?

• Does the plan need to be tweaked or a new
  plan made?

• If the plan is not working, return to step 2 to make a
  new plan or step 3 to tweak the existing plan

Praise yourself for your efforts and success.

References:

Adapted from: The Royal Children’s Hospital Melbourne (2012). Adolescent Transition
Education Package.

NHS Scotland: Psychosocial interventions for improving adherence, self-management &
adjustment to physical health conditions. Children and young people.

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