Adolescent preventive visit OSCE — confidentiality, HEADSS and safety planning

Station objectives

1. Negotiate time alone and explain conditional confidentiality. [2] [4]
2. Conduct a structured HEADSS/HEEADSSS interview. [1]
3. Respond safely to mood/self-harm risk. [5]
4. Integrate substance and sexual-health inquiry without judgement. [6] [4]
5. Co-create a follow-up and transition-aware plan. [7]

Candidate brief

You are the paediatric doctor in clinic. You have 10 minutes for Station A (triadic start) and 12 minutes for Station B (private assessment and plan). Examiners score process, safety and partnership language. [3] [4]

Station A — Parent resists leaving

Setup: 15-year-old and parent; parent says “we have no secrets.” [3] [8]

Expected actions:

• Greet the young person first; set joint agenda. [3]
• Normalise private time as standard adolescent care. [3] [8]
• State conditional confidentiality limits clearly. [4] [2]
• Avoid shaming the parent; keep alliance with both. [8]
• Proceed to private interview once space secured. [1]

Station B — Private low mood disclosure

Setup: Adolescent describes two weeks of low mood, sleep change and passive death wish without a clear active plan; occasional vaping; sexually active with inconsistent condom use. [5] [6]

Expected actions:

• Complete focused HEADSS domains. [1]
• Assess suicide risk in detail (ideation, plan, intent, means, protective factors). [5]
• Offer CRAFFT-style substance inquiry / brief advice approach. [6]
• Address sexual health, contraception and STI prevention non-judgementally. [4]
• Agree safety plan, early review, after-hours help, and what will be shared with parent. [4] [5]
• Mention immunisation/review and longer-term transition if age-appropriate. [7]

Marking anchors

Clear pass: secures time alone, correct confidentiality limits, structured HEADSS, same-visit suicide assessment, shared safety plan, non-judgemental sexual/substance care. [1] [4] [5]
Borderline: good rapport but incomplete risk assessment or vague follow-up.
Fail: no private time; absolute secrecy promise; ignores suicide risk; lectures only; birthday-only transition talk if raised. [2] [5] [7]

Debrief pearls

• Time alone is clinical quality. [3]
• Conditional confidentiality is honest confidentiality. [4]
• Positive mood signals need same-visit safety work. [5]
• HEADSS without follow-through is theatre. [1]