Refugee, asylum-seeking and newly arrived children — OSCE communication and screening station

OSCE — Communication and screening station

Candidate instructions

You are the paediatric registrar. You have 8 minutes per station. [1]

Station A (on-arrival assessment). A nine-year-old girl is brought by her mother for an on-arrival health assessment six weeks after the family fled a conflict zone. They share no language with your team. A caseworker phones and expects a full copy of your assessment for the immigration file. Conduct the opening of the consultation: engage the child and family trauma-informed through a trained interpreter, clarify guardianship and consent, state the confidentiality frame, and outline the on-arrival screening plan. [1]

Station B (detention and advocacy). You are asked to review the girl's younger sibling, who has spent three months in immigration detention. The mother reports sleep disturbance, regression and withdrawal. Conduct the assessment and explain your management, including your advocacy role regarding the detention environment. [6]

Examiner brief and marking domains

Domain 1 — Trauma-informed, interpreter-mediated engagement (Station A). Greets the child first, before the family; sets a safe, paced frame; arranges and uses a trained, professional interpreter rather than the child or an untrained staff member; explains the purpose of the visit; offers choice about the sequence of the interview and examination; lets the child keep a comfort object and the family close. Demonstrates the trauma-informed principles of safety, trust, choice, collaboration and strengths. [2] [5]

Domain 2 — Guardianship, consent and confidentiality (Station A). Clarifies and documents who holds parental responsibility; for a young child there is no mature-minor capacity, so consent rests with whoever holds responsibility. States conditional confidentiality aloud through the interpreter, in language the family can understand, and is explicit about what the caseworker will and will not receive — managing the request lawfully rather than complying by default, sharing the minimum necessary, and telling the family before any override. [1] [5]

Domain 3 — Screening plan (Station A). Outlines the stepwise pathway — initial screening on arrival, initial health assessment, comprehensive multidisciplinary assessment, ongoing medical home — and names the bundle: growth, vision, hearing, dental, development and education, mental health and trauma, the infectious-disease screen (tuberculosis, hepatitis B and C, HIV, parasites, malaria as indicated), lead, iron, vitamin D, and immunisation reconstruction with catch-up. [1] [4]

Domain 4 — Detention assessment and trauma-informed response (Station B). Takes a trauma-informed history through the interpreter, screens the younger sibling for mental-health difficulty with validated instruments, examines for regression and any acute or chronic physical need, and plans evidence-based, trauma-focused intervention as first line. Avoids diagnostic overshadowing and does not dismiss the regression as "just the background." [3] [2]

Domain 5 — Advocacy and the harm of detention (Station B). Names the principle, grounded in systematic-review and meta-analytic evidence, that immigration detention harms children's mental and physical health and is never in a child's best interests. Documents the health impact, provides vigilant health surveillance, and advocates for community-based alternatives, while maintaining a therapeutic relationship with the family and a clear, lawful confidentiality frame. [6]

Examiners' notes for full marks

A distinction candidate will name the principle — trained interpreter, guardianship, conditional confidentiality, best interests, trauma-informed care, the harm of detention — rather than inventing jurisdiction-specific policies or screening panels. The candidate will treat the caseworker's request for a full file as a confidentiality problem to be managed lawfully rather than a default to comply with, will arrange a professional interpreter rather than improvising, and will recognise that a single post-arrival assessment undercalls the child's potential and that trauma-driven behaviour is an adaptation rather than a primary disorder. [2] [5]

Anticipated pitfalls

• Using the child or an untrained staff member as interpreter for sensitive content. [5]
• Complying with the caseworker's request for a full file without managing the confidentiality frame lawfully. [1]
• Missing the on-arrival infectious-disease, lead or vitamin D screen, or failing to catch up immunisation. [4]
• Dismissing the detained sibling's regression as "just the background" rather than screening and advocating. [6]
• Failing to recognise that a febrile child from a malaria-endemic region has malaria until proven otherwise. [4]