Poverty, food insecurity and social prescribing — OSCE communication and social-prescribing station

OSCE — Communication and social-prescribing station

Candidate instructions

You are the paediatric registrar. You have 8 minutes per station. [2]

Station A (screening and co-design). A four-year-old girl is brought for routine immunisation by her mother, who has recently lost her casual job. The mother asks quietly whether you know anywhere that gives food. Screen the family for food insecurity and broader material hardship using validated tools, frame the questions destigmatisingly, co-design a social prescription with the mother, and outline the follow-up plan. [3] [5]

Station B (investigation and safeguarding). On growth measurement you find the child's weight has fallen across two centiles since her last visit. Investigate the organic differential alongside the social response, make a diagnostic-overshadowing-aware assessment, and decide whether this presentation also requires a safeguarding response. [1] [4]

Examiner brief and marking domains

Domain 1 — Destigmatised, universal screening (Station A). Greets the mother and child warmly; frames the social questions as routine and universal — "we ask all families these questions because they matter for children's health" — to reduce shame; uses neutral, non-judgemental language; offers privacy and a trained interpreter if needed; and demonstrates that the answers will change the plan, not the respect shown to the family. [3] [5]

Domain 2 — Validated screening tools (Station A). Uses the two-item Hunger Vital Sign for food insecurity — whether the family worried food would run out, and whether the food bought did not last — and identifies a positive screen correctly; adds a validated multi-domain social-needs instrument covering housing, income, utilities, transport and safety; and records the findings as clinical data. [3]

Domain 3 — Co-design and social prescribing (Station A). Asks the mother what she needs and what she would accept, respecting her autonomy and dignity; prioritises with her rather than for her; outlines the five-step pathway (screen, assess, co-design, connect, follow up); names concrete, fixable interventions — food programs, income maximisation, welfare-rights support, housing assistance — and identifies the link-worker or community-resource pathway that will deliver them; and commits to following up whether the referral worked. [5]

Domain 4 — Organic investigation and avoidance of diagnostic overshadowing (Station B). Recognises that faltering growth may be driven by food insecurity but has an organic differential that must be excluded; plots growth, takes a full dietary and feeding history, checks a full blood count and iron studies, arranges a developmental screen, and treats any organic cause in parallel with the social response; explicitly avoids attributing the finding to "just social" before the workup is complete. [1] [4]

Domain 5 — Safeguarding judgement (Station B). Distinguishes material hardship from neglect but recognises that severe, persistent unmet need that endangers a child crosses into safeguarding territory; clarifies the concern, documents the findings, and shares the minimum necessary and lawful information with child-protection services if the threshold is met; treats under best interests; involves social work and the family; and coordinates the clinical, social and safeguarding plans so the response supports rather than punishes the family wherever possible. [2]

Examiners' notes for full marks

A distinction candidate will name the principle — poverty as the most prevalent modifiable risk to child health, universal routine screening with validated tools, the five-step social-prescribing pathway, and avoidance of diagnostic overshadowing — rather than inventing jurisdiction-specific income lines or benefit programme names. The candidate will treat the mother's food question as a clinical disclosure that triggers screening and action, not as a social aside, and will co-design the plan with the family rather than dictating it. The candidate will hold both truths — organic disease and material deprivation coexist — and will investigate and treat both in parallel. [1] [6]

Anticipated pitfalls

• Failing to screen because the family "looks okay" or would "tell you if they were struggling." [3]
• Screening without a referral pathway — raising a need and then abandoning it. [5]
• Using stigmatising or judgemental language that suppresses disclosure. [2]
• Attributing faltering growth to poverty alone without investigating organic disease. [1] [4]
• Dictating the plan to the family rather than co-designing it with them. [5]
• Failing to follow up whether the social prescription actually reached the family. [5]
• Missing the threshold at which material deprivation compounded by severe unmet need requires a safeguarding response. [2]