Adolescent substance-use SBIRT OSCE — screening, brief intervention and the harm bundle

Station objectives

1. Secure time alone and state conditional confidentiality with its limits. [1]
2. Administer a validated universal substance-use screen (S2BI) and add CRAFFT where a positive lead appears. [1] [2] [7]
3. Deliver a motivational-interviewing brief intervention matched to readiness. [5]
4. Assemble a domain-specific harm-reduction bundle and handle a confidentiality decision. [3] [4]

Candidate brief

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

Station A — Daily vaping and monthly cannabis

Setup: A 15-year-old, seen alone after conditional confidentiality is stated, vapes nicotine daily with morning cravings and uses cannabis a few times a month. Function and mood are intact. [1] [2]

Expected actions:

• Greet the young person first, set a joint agenda, state conditional confidentiality with limits. [1]
• Administer S2BI for all substance classes; add CRAFFT for the positive vaping and cannabis leads; the monthly-or-more frequency triggers full assessment. [1] [7] [2]
• Perform structured assessment: pattern, route, age of initiation, dependence features (tolerance, withdrawal/craving, loss of control, use despite harm), co-occurring mood, educational decline, fentanyl-exposure risk. [1]
• Use motivational interviewing (OARS) to evoke the young person's own reasons for change; give personalised feedback. [5]
• Offer a harm bundle: vaping cut-down plan with step-down nicotine and consider varenicline where locally approved; cannabis frequency/potency reduction and behavioural-therapy linkage if use-disorder criteria are met. [6]

Station B — Fentanyl-era opioid disclosure

Setup: A 17-year-old discloses taking pills shared at a party "to relax"; the pills may have contained fentanyl. They have never injected. They ask you not to tell their parent. [4] [3]

Expected actions:

• Assess safety, overdose history, and opioid-use-disorder features; consider fentanyl exposure even though opioid use was not intended. [4]
• Offer take-home naloxone plus overdose education (young person and, with consent, family/peers), safer-use messaging (no mixing, start low, never alone), and MOUD linkage. [4] [3]
• Clarify the confidentiality frame: substance-use care can stay confidential unless serious risk overrides; explain the limits, document the reasoning, and use local sensitive-note workflows so the plan is not leaked via a parent portal. [1]
• 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; administers a validated universal screen; correct tiering of the positive lead; structured assessment of dependence and co-occurring disorders; motivational-interviewing brief intervention; a concrete, non-judgemental harm bundle including naloxone; clear confidentiality reasoning. [1] [3] [5] Borderline: good rapport but skips the universal screen, vague dependence assessment, or a harm bundle limited to one substance. Fail: no private time; abstinence-only lecturing; files a positive screen without acting; punitive stance; no naloxone offered in the fentanyl-era scenario. [1] [4]

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. [1] [7]
• Varenicline has 2025 RCT support for youth vaping cessation; follow locally approved guidance. [6]