Homelessness and housing instability — OSCE

Station brief (candidate)

You are the paediatric registrar in a general paediatrics clinic. A four-year-old girl has been brought in with a recurrent asthma exacerbation. Her mother has missed two recent appointments and the address on file is incorrect. When you ask gently about housing, her mother becomes tearful and tells you the family has been sleeping on her sister's lounge room floor for six weeks since an eviction. You have eight minutes to assess the situation and agree a plan. [4] [1]

Candidate tasks

1. Establish rapport in a trauma-informed, non-judgemental way, explaining your role and why you are asking about housing. [3]
2. Screen broadly across the five domains of harm — physical health, growth and nutrition, development and education, mental health and behaviour, and access and continuity. [3]
3. Screen sensitively for domestic and family violence, and recognise any safeguarding concern. [4]
4. Agree a plan that addresses the asthma, builds a portable health summary, and links the family to housing and support services. [10] [13]

Examiner guidance — expected behaviours

The candidate opens with a trauma-informed, strengths-based introduction, naming their role, normalising the housing question, and reassuring the mother that the information will help them provide better care. [3] [4]

The candidate screens broadly beyond the presenting asthma — asking about growth and feeding, development and school, the mother's own wellbeing, the vaccination record, and whether prescriptions and the GP are still accessible. [3]

The candidate screens sensitively for domestic and family violence, recognising that violence and housing instability are tightly entangled, and identifies whether the situation has crossed into safeguarding territory requiring a child-protection pathway. [4]

The candidate agrees a plan that treats the asthma to community standard, builds a portable health summary (diagnoses, medications, vaccines, growth, referrals), and makes a warm referral to social work and housing services rather than handing over a phone number. [10] [13]

The candidate avoids judgemental language, avoids treating the housing difficulty as the mother's failure, and frames the paediatrician's role as screener, treater, linker and housing advocate. [3]

Why this station works

Housing instability is a paediatric health problem that is hidden beneath presenting complaints, and the family will rarely volunteer it without a routine, non-judgemental screen. [1]

This station tests whether the candidate can hold the vital-sign screening principle, perform a trauma-informed broad assessment, communicate without judgement, recognise safeguarding and domestic-violence risk, and convert the encounter into an actionable plan that protects continuity and links the family to housing — the core skills of social paediatrics. [3] [13]