Adolescent health care for young people in out-of-home care — OSCE communication and safeguarding station

OSCE — Communication and safeguarding station

Candidate instructions

You are the paediatric registrar. You have 8 minutes per station. [1]

Station A (entry assessment). A 15-year-old girl in statutory foster care is brought by her caseworker for an entry health assessment one week after her second placement in nine months. The caseworker expects a full report. Conduct the opening of the consultation: engage the young person trauma-informed, clarify consent authority, state the confidentiality frame, and outline the entry-to-care assessment plan. [1]

Station B (lawful override). Later the same day, during private time, the young person discloses an active suicide plan for that night. Manage the immediate situation, including how you break confidentiality ethically and the safety plan. [1]

Examiner brief and marking domains

Domain 1 — Trauma-informed engagement (Station A). Greets the young person first; sets a safe, paced frame; explains the purpose of the visit; offers choice about the caseworker's presence and the sequence of the interview. Demonstrates the trauma-informed principles of safety, trust, choice, collaboration and strengths. [3] [4]

Domain 2 — Consent authority and confidentiality (Station A). Clarifies and documents who holds parental responsibility, recognising statutory care may mean the state holds it; assesses the young person's own capacity for the decisions at hand under the mature-minor principle; states conditional confidentiality aloud and is explicit about what the caseworker and carer will and will not be told, sharing the minimum necessary and lawful. [1]

Domain 3 — Assessment plan (Station A). Outlines the AAP timing — initial screening on entry, initial assessment within 30 days, comprehensive multidisciplinary assessment within 60 days — and names the bundle: growth, vision, hearing, dental, development and education, mental health and trauma screen, reproductive and sexual health, immunisation reconstruction with catch-up, targeted laboratory testing, and an adolescent HEEADSSS. [1] [3]

Domain 4 — Lawful, ethical override (Station B). Secures immediate safety — does not leave the young person alone, removes means if safe, escalates to crisis or ED the same day. Breaks confidentiality ethically: tells the young person what must be shared and why, shares the minimum necessary with those who need to act, involves carer and safeguarding as required, documents decisions and the safety plan. Treats under best interests while capacity is reassessed; does not discharge on hope alone. [1] [3]

Domain 5 — Relationship preservation and follow-up (Station B). Acknowledges the young person's wish for privacy, explains the safety reason, stays engaged so the breach does not become abandonment, sets the safety-net (who to call tonight, when to return), and plans to rebuild the frame at the next contact. [1]

Examiners' notes for full marks

A distinction candidate will name the principle (mature-minor capacity, conditional confidentiality, best interests, trauma-informed care) rather than inventing jurisdiction-specific ages or thresholds, will treat the caseworker's expectation as a confidentiality problem to be managed rather than a default to comply with, and will recognise that reproductive-health screening is indicated given the elevated risk in this population. [5] [2]

Anticipated pitfalls

• Letting the caseworker set the agenda and answer for the young person. [3]
• Promising absolute secrecy that cannot be kept. [1]
• Failing to clarify consent authority before the assessment. [1]
• Overlooking the elevated reproductive and mental-health risk and not screening. [2] [5]
• Discharging a high-risk young person without an active safety plan. [1] [6]