Explain online sexual exploitation and the safety plan to an adolescent and parent — OSCE

Candidate instructions

You are the paediatric registrar. A 15-year-old boy, medically stable after a paracetamol overdose, has just disclosed financial sextortion: an online contact is demanding money or will send his sexual video to his contacts. His father has arrived, is angry, and wants to take and smash the phone. You have ten minutes. Your task is to speak with the young man and his father together: (1) explain plainly what has happened and that their son is the victim of a crime; (2) explain why the phone and the messages must be kept safe and not destroyed; (3) outline what the team will do now — the safety plan, the reports, and the pursuit of image removal; and (4) agree a clear next step. Be honest, do not blame the young man, and check understanding throughout. [1]

Encounter

Father: "I'm taking that phone and I'm smashing it. This is his own fault — why would he send something like that to a stranger?" [1]

Registrar: "I can hear how angry and frightened you are, and that is completely understandable. Can I ask you to hold on for one moment before you take the phone, because I want to explain something important. What happened to your son is not his fault. A person he met online deliberately manipulated him into sending an image, and is now using that image to threaten and extort him. That is a crime committed against him — he is the victim here, and he is not in trouble. I want us to work together to stop this." [1]

Father: "Then why shouldn't I get rid of the phone? That thing is the problem." [3]

Registrar: "I understand the instinct — but the phone is actually the strongest evidence we have to stop this person and to get the image taken down. The messages, the threats, and the usernames on that phone are what the authorities will use to identify the offender and to remove the image. If we destroy it, we lose that evidence and the person who did this becomes much harder to stop. So keeping the phone safe — and I mean safe, not taken away as a punishment — is part of the plan. Your son is understandably frightened of losing it, because right now it is his view of the threat and his way to reach out. We keep it secure, with him or with a trusted adult, and we let the experts handle what is on it." [3]

Young man: "Are you going to tell the police? Are people going to find out?" [4]

Registrar: "I want to be honest with you about what happens next, because you deserve to know. Because you are under eighteen and someone is using an image of you to threaten you, our team has a duty to act, and that means two things happen in parallel. We contact the child-protection authority, whose job is to make sure you are safe, and we contact the online-safety authority — in Australia that is the eSafety Commissioner — whose job is to get the image taken down and to help identify the person who did this. I will not be looking at or forwarding the image myself; that is their job, done properly. We will share only what is needed to protect you, and we will be clear with you and your dad about what we are doing. Your name does not go out publicly — this is a protection process, not exposure." [4]

Father: "What about him — he's been hurting himself. Is he safe to go home?" [2]

Registrar: "That is exactly the first thing we are checking. The overdose and the threats tell us he has been under enormous pressure, and financial sextortion specifically carries a real risk of people feeling there is no way out. So before any decision about going home, our team will do a proper assessment of his safety — whether he is having thoughts of harming himself, and what support he needs. If he is not safe to go home right now, we keep him here and keep him supervised. If he is safe with a solid plan, we make sure there is close follow-up. Either way, he is not facing this alone anymore — adults are now acting to stop it, and that is the most important thing. What questions do you both have right now?" [2]

Marking domains

• Communication (25%): plain language, empathy, checks understanding of both the young man and the father, avoids jargon, and does not blame the young person for the image. [1]
• Clinical content (30%): frames the event as a crime against the young man; explains the evidence-preservation principle (keep the phone safe, do not destroy); outlines the dual reporting pathway (child-protection authority plus the online-safety body) and image removal; conveys that acute suicide risk is assessed first. [3] [4]
• Honesty and shared decision-making (20%): is truthful about the duty to report and about uncertainty; involves the young man in what happens next where safe; agrees a clear plan. [4]
• Safety (15%): confirms a structured safety assessment determines disposition; names who the family can contact; ensures the device is secured, not destroyed. [2]
• Professionalism and global (10%): maintains a calm, non-judgemental, collaborative stance with both the adolescent and the angry parent; documentation and handover implied. [1]