Psych CASC / OSCE · Child and adolescent psychiatry — child protection for psychiatrists
Child protection disclosure — CASC communication station
MRCPsych/FRANZCP-style CASC: respond to child maltreatment disclosure, explain reporting, assess safety and sibling risk, agree plan.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes after reading. You are the CAMHS psychiatry registrar in clinic. A parent is in the waiting room. [1]
Candidate instructions. Respond to disclosure of physical abuse. Ensure the young person feels heard. Explore nature, frequency, weapons, injuries, and who else is at home. Assess mood and suicidal ideas. Explain clearly that you cannot keep serious abuse secret when a child is at risk, without inventing statute numbers. Outline multi-agency next steps (social care/child protection, medical review, police if indicated). Address sibling safety. Agree a plan and follow-up. Do not force the young person to invent details or blame them for family consequences. [1][2]
Candidate scenario
Your patient is 13, referred for anxiety. Mid-session they say: "When Dad drinks he hits me with the belt. He said if I tell, my little brother will be taken away." No life-threatening injury is apparent in clinic. English is fluent. [1]
Marking domains
- Warmth, belief of disclosure, non-blaming stance
- Confirms privacy; does not bring father in without a safety plan
- Explores abuse pattern, injuries, home safety, sibling risk
- Suicide/self-harm risk briefly assessed
- Explains confidentiality limits in plain language without invented legal sections
- Multi-agency plan described (child protection services, medical review, police as indicated)
- Clear agreed next steps and support for the young person
- Avoids collusion, coercion, or forensic contamination with leading questions [1][3][4]
Reveal assessor key
Open. Thank them for trusting you; state you take this seriously; confirm they feel safe talking now; keep father out of the room. [1]
Explore. What happens, how often, injuries, weapons/objects, when dad drinks, whether brother is hit or witnesses violence, whether anyone else knows. Ask about mood, self-harm, and fear of returning home. Use open prompts, not leading details. [1]
Confidentiality and report. "I cannot keep it completely private when you or your brother may be hurt. I need to share key information with the child-protection team so we can help keep you safe." Avoid fake section numbers. Offer to explain process and to support them when adults are told. [1]
Plan. Same-day/urgent multi-agency referral; medical review of injuries if needed; safety plan for tonight (cannot go home if unsafe); sibling assessment; crisis contacts; trauma-informed follow-up and therapy access. [1][3]
Close. Summarise agreed steps; check understanding; do not promise that "nothing will change at home" or that brother "definitely will not be moved" — be honest about uncertainty while emphasising the goal is safety and support. [1][2]
References
- [1]Gilbert R, Kemp A, Thoburn J, et al. Recognising and responding to child maltreatment Lancet, 2009.PMID 19056119
- [2]Gilbert R, Widom CS, Browne K, et al. Burden and consequences of child maltreatment in high-income countries Lancet, 2009.PMID 19056114
- [3]Cohen JA, Mannarino AP, Kliethermes M, Murray LA Trauma-focused CBT for youth with complex trauma Child Abuse Negl, 2012.PMID 22749612
- [4]Appelbaum PS Clinical practice. Assessment of patients' competence to consent to treatment N Engl J Med, 2007.PMID 17978292