Adolescent risk assessment and harm minimisation OSCE — screening, brief intervention and the harm bundle

Station objectives

1. Secure time alone and state conditional confidentiality with its limits. [1] [7]
2. Complete a focused HEADSS assessment and apply validated screens where leads appear. [1] [2]
3. Deliver a motivational-interviewing brief intervention matched to readiness. [6]
4. Assemble a domain-specific harm-reduction bundle. [3] [5]

Candidate brief

You are the paediatric doctor in a youth-friendly clinic. You have 10 minutes for Station A (private risk assessment and brief intervention) and 12 minutes for Station B (opioid disclosure, harm-reduction bundle, and a confidentiality decision). Examiners score process, safety, partnership language, and the quality of the harm bundle. [1] [3]

Station A — Vaping, low mood, inconsistent condom use

Setup: A 16-year-old, seen alone, vapes nicotine daily, describes two weeks of low mood with sleep change but no current plan, and is sexually active with inconsistent condom use. [2] [4]

Expected actions:

• Complete focused HEADSS domains; ask about coercion separately. [1]
• Add a substance screen (CRAFFT) and a suicide screen (ASQ/Columbia); if mood screen is positive, perform a full same-visit risk assessment. [2] [4]
• Use motivational interviewing to explore readiness; evoke rather than impose change. [6]
• Offer a harm bundle: vaping cut-down plan, condoms and STI testing to disclosed sites, means-awareness if any suicidal content. [3]

Station B — Opioid disclosure

Setup: A 17-year-old discloses intermittent opioid use; the most recent pills may not have been what they expected. They ask you not to tell their parent. [5] [3]

Expected actions:

• Assess safety, overdose history, and opioid-use-disorder features; consider fentanyl exposure. [5]
• Offer take-home naloxone plus overdose education (young person and, with consent, family/peers), safer-use messaging, and substitution-treatment linkage. [5] [3]
• Clarify the confidentiality frame: substance-use care can stay confidential unless serious risk overrides; explain the limits and document. [7]
• Arrange blood-borne-virus testing and needle-syringe access if injecting; bundle sexual-health and mental-health care. [3]

Marking anchors

Clear pass: secures time alone and conditional confidentiality; structured HEADSS; correct use of validated screens; same-visit action on any positive lead; motivational-interviewing brief intervention; a concrete, non-judgemental harm bundle; clear confidentiality reasoning. [1] [3] [6] Borderline: good rapport but incomplete screening, vague follow-up, or a harm bundle limited to one domain. Fail: no private time; abstinence-only lecturing; files a positive screen without acting; ignores suicide risk; punitive stance. [4] [7]

Debrief pearls

• Harm reduction is clinical care, not moral endorsement. [3]
• Engagement is itself an outcome; the plan succeeds if the young person returns. [3]
• Pair every positive screen with same-visit action — never file and refer. [4] [7]