Psych CASC / OSCE · Child and adolescent psychiatry — childhood trauma and maltreatment
Explain safeguarding and TF-CBT after childhood maltreatment — CASC communication station
MRCPsych/FRANZCP-style communication station: explain reporting duty, trauma-informed next steps, TF-CBT PRACTICE in plain language, safety first, optional medication adjunct, and teach-back.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the CAMHS registrar. The examiner plays the non-offending parent. [2]
Candidate instructions. Explain in accessible language why a child-protection notification is required, how you will keep the child safe, what trauma-related symptoms mean (without over-labelling), how TF-CBT works step by step, that medication is not first-line alone, and how mother will be involved as a safe caregiver. Check understanding and safety-net for crisis. [1][2][3]
Candidate scenario
The child has nightmares, hypervigilance and school avoidance after physical abuse by mother’s ex-partner, who still tries to contact the family. You recommend statutory notification, multi-agency safety planning, and TF-CBT once safe. Mother fears "social services will take my child" and fears therapy will "make it worse". She asks about "a tablet to calm him". [2][4]
Marking domains
- Empathy, structure, trauma-informed stance (choice, collaboration, non-blame of non-offending parent)
- Clear explanation of reporting duty and safety without inventing statute numbers
- Plain-language PTSD/trauma symptoms vs maltreatment as exposure
- TF-CBT PRACTICE explained accessibly (skills then story work; parent involvement)
- Medication as possible adjunct only, with early review language
- Safety-netting, crisis contacts, teach-back [1][2][3]
Reveal assessor key
Open. Name time; ask main fears first (removal, reliving, tablets). Validate that she sought help. [3]
Reporting/safety. Because there is reasonable concern a child has been abused and may still be at risk, we have a legal duty to notify child-protection services so a multi-agency plan can keep him safe — this is about protection, not punishing you. We work to keep him with safe carers whenever possible. Limit contact with the alleged perpetrator. [2][4]
Symptoms. Nightmares, jumpiness and avoidance after abuse can be trauma reactions (PTSD pattern if criteria met). Abuse is what happened; the diagnosis names the mental health impact we treat. Many children improve with safety and the right therapy. [2]
TF-CBT. A structured talking therapy with skills first (calm body, name feelings, helpful thoughts), then carefully telling the story of what happened with support, practice facing safe reminders, sessions with you as the safe parent, and planning for future safety. Evidence supports this approach for children with abuse-related trauma symptoms. He stays in control of pace; this is not random flooding. [1][2]
Medication. Tablets are not the first or only step. If depression or severe anxiety remains, a specialist might discuss an SSRI carefully with close monitoring — not a calm-down sedative like long-term benzodiazepines. [2]
Close. Summarise, teach-back, crisis contacts, next appointment and who will call child protection. [3]
References
- [1]Cohen JA, Deblinger E, Mannarino AP, Steer RA A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms J Am Acad Child Adolesc Psychiatry, 2004.PMID 15187799
- [2]Cohen JA, Bukstein O, Walter H, et al. Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder J Am Acad Child Adolesc Psychiatry, 2010.PMID 20410735
- [3]Harris M, Fallot RD Designing trauma-informed addictions services New Dir Ment Health Serv, 2001.PMID 11291263
- [4]Gilbert R, Widom CS, Browne K, et al. Burden and consequences of child maltreatment in high-income countries Lancet, 2009.PMID 19056114