Discuss IPV exposure and safety planning with a non-offending parent — OSCE

Candidate instructions

You are the paediatric registrar. You have just interviewed a seven-year-old boy alone, referred for behavioural problems, who disclosed that he hears shouting and things breaking at night. His mother, seen separately, has now disclosed that her partner hits and frightens her. You have ten minutes with her. She is frightened and minimising, and she fears that telling anyone will make things worse. She wants to understand: (1) why what happens at home affects her son, when he is never hit; (2) what happens now and whether he will be taken away; (3) what you can do to help her; and (4) whether she has to leave. Explain with empathy and honesty, do not blame her, do not require her to leave, check understanding throughout, and agree a clear safety plan. [1]

Encounter

Mother: "He's never laid a hand on him. It's between me and my partner. Why would the doctors even be involved?" [1]

Registrar: "Thank you for telling me this — I know how hard that was. I want to explain plainly why your son's health is my concern. Children are very attuned to what happens around them, even when no one touches them. Hearing shouting, breaking things, or a parent being hurt night after night keeps a child's body in a state of alarm — it affects their sleep, their concentration, their behaviour and their health over time. So what happens between the adults in a home is not separate from the child. Your son's behaviour and his stomach aches are very likely connected to what he is living with. That is why I am involved, and why I asked." [1] [4]

Mother: "So what happens now? Are you going to take him off me?" [3]

Registrar: "I want to be honest with you. My job, and the job of the team, is to keep your son safe and to support you — not to punish you. You are not in trouble, and you are not to blame for what is happening. Because a child is being affected, I do have a professional duty to let our child-protection team know, so that we can put the right support around your family. That does not mean your son is taken away. In the vast majority of cases the plan is to support the family and keep the child safe at home. Child protection's first aim is help, and they will work with you. I will be part of that too." [3] [1]

Mother: "He's got a gun. For hunting. I'm scared it's going to get worse if my partner finds out I talked." [2]

Registrar: "Thank you for telling me that — it is important, and it helps me keep you and your son safe. I take that very seriously. Can I ask: is the gun kept locked away, or can your partner get to it easily? The reason I ask is that when there is violence at home and a firearm that can be reached, the danger to everyone in the home goes up sharply — and that is something we can act on today. We will not do anything that puts you at more risk. I will only write down what you have told me in a record your partner cannot see, because I would never want my notes to make things worse for you. Can we talk about how to make things safer right now?" [2] [1]

Mother: "Do I have to leave him? I can't — I've got nowhere to go." [1]

Registrar: "No. You do not have to leave, and no one here will make that a condition of helping you. Leaving is a big decision and, honestly, the time around leaving can be the most dangerous — so it has to be your decision, made safely and with support. What I can do is connect you with people whose whole job is this: a confidential service that can help you with a safety plan, a place to go if you ever need it, legal advice, and someone to talk to who understands. It is completely free and confidential, and we can give you the number in a way your partner will never see. Whatever you decide about the relationship, I am here for your son and for you, for as long as you need." [1]

Mother: "What about my son? Can you help him?" [4]

Registrar: "Yes. There is a specific therapy — trauma-focused therapy — that helps children who have lived through this kind of stress, and it works best when it involves the safe parent, which is you. We will also keep an eye on his sleep, his behaviour and his learning over time, and we will work with his school so he has support there too. You are doing the right thing by being here, and by talking to me. Before we finish, can we agree on one or two things — a number you can call, and a plan for what you would do if you ever felt in danger tonight? And I would like to see you and your son again soon, so we can make sure the support is working." [4] [1]

Marking domains

• Communication (25%): plain language, empathy, checks understanding, invites questions, avoids jargon and never blames the non-offending parent. [1]
• Clinical content (30%): explains why IPV exposure harms a child who is never hit (toxic stress), the role of the child-protection team as help rather than punishment, the rationale for lethal-means assessment, and the offer of trauma-focused therapy for the child. [1] [4]
• Safety (20%): asks about and acts on the firearm as a time-critical lethal-means risk; commits to documenting only in a record the perpetrator cannot access; agrees a concrete safety plan and helpline. [2]
• Shared decision-making and non-coercion (15%): explicitly does not require the parent to leave the relationship as a condition of support; respects her autonomy and the danger of the leaving period; frames the plan as protective and collaborative. [1]
• Professionalism and global (10%): honest about the duty to report, calm and non-judgemental, names who the family can contact, and agrees a fixed follow-up. [3]