Youth prevention and early intervention service planning — CASC/communication station · Psych CASC / OSCE

Prompt

You are the psychiatry registrar meeting a school principal, a GP lead, a parent of a 18-year-old with attenuated psychotic symptoms, and a health service finance officer. They have 10 minutes to agree a district youth mental health plan after a spike in emergency presentations and a report of median DUP of 11 months.

Station brief

Format. Multi-party communication / systems station, approximately 8–10 minutes. Facilitate a shared plan; avoid monologue and avoid picking only beds or only school days.[9]

Candidate instructions. Name prevention levels plainly; set honest expectations for school programmes; outline UHR care without default antipsychotics; propose multi-element early intervention and DUP reduction; close with measurable metrics and equity.[1][2][5][8]

Candidate scenario

Materials on the table: ED youth presentations up 20%; median DUP 11 months; wait for youth psychology 16 weeks; one secondary school willing to pilot a skills curriculum; parent present wants "preventive antipsychotic so it never becomes schizophrenia"; finance officer offers either 4 inpatient beds or a one-day wellbeing event.[3][7]

Marking domains

Uses Gordon universal / selective / indicated language with concrete examples [1]
Explains Rose prevention paradox against beds-only or high-risk-only thinking [2]
Honest about small average school programme effects and need for fidelity [3]
Indicated depression pathway referenced as incidence-reducing psychological care [4]
UHR: minority conversion; no default long-term antipsychotic; CBT-informed + comorbidity care [5][6]
FEP: multi-element EIS and DUP reduction rationale [7][8]
Collaborative tone; parent alliance; metrics (DUP median, treatment coverage, school reach, equity)

Reveal assessor key

Open. "We need three layers of prevention plus a fast door for first episode — not a false choice between beds and a single school day." Sketch universal / selective / indicated on the board.[1][2]

School principal. Support a skills-based curriculum with teacher training and evaluation; set expectation of small average effects, not elimination of depression.[3]

GP lead. Primary care pathway for subthreshold depression (brief psychological indicated prevention; step up if MDD); clear escalation for risk and for suspected psychosis.[4]

Parent. Validate fear. Explain UHR is a risk state: many do not convert; best care now is structured monitoring, treat anxiety/sleep/substance issues, psychological therapy; antipsychotics are not automatic prophylaxis and can cause weight and metabolic harm — decide together if symptoms intensify or frank psychosis appears.[5][6]

Finance. Reject pure beds-or-wellbeing-day dichotomy. Propose: (1) sustain multi-element early intervention capacity; (2) detection work to cut DUP; (3) school pilot with fidelity budget; (4) limited acute capacity as safety net. Name EIS evidence vs usual care.[7][8]

Close. Agree 12-month metrics: median DUP, time to youth appointment, school programme reach by equity quintile, UHR conversion and non-conversion care quality, metabolic monitoring when AP used. Book review date. Implementation needs workforce, not only announcements.[9]

References

[1]Gordon RS Jr An operational classification of disease prevention Public Health Rep, 1983.PMID 6856733
[2]Rose G Sick individuals and sick populations Int J Epidemiol, 2001.PMID 11416056
[3]Werner-Seidler A, Perry Y, Calear AL, et al. School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis Clin Psychol Rev, 2017.PMID 27821267
[4]Cuijpers P, van Straten A, Smit F, et al. Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions Am J Psychiatry, 2008.PMID 18765483
[5]Fusar-Poli P, Bonoldi I, Yung AR, et al. Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk Arch Gen Psychiatry, 2012.PMID 22393215
[6]Davies C, Cipriani A, Ioannidis JPA, et al. Lack of evidence to favor specific preventive interventions in psychosis: a network meta-analysis World Psychiatry, 2018.PMID 29856551
[7]Marshall M, Lewis S, Lockwood A, et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients Arch Gen Psychiatry, 2005.PMID 16143729
[8]Correll CU, Galling B, Pawar A, et al. Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis JAMA Psychiatry, 2018.PMID 29800949
[9]Campion J, Javed A, Lund C, et al. Public mental health: required actions to address implementation failure in the context of COVID-19 Lancet Psychiatry, 2022.PMID 35065723

Station brief

Format. Multi-party communication / systems station, approximately 8–10 minutes. Facilitate a shared plan; avoid monologue and avoid picking only beds or only school days.[9]

Candidate scenario

Marking domains

Uses Gordon universal / selective / indicated language with concrete examples [1]

Explains Rose prevention paradox against beds-only or high-risk-only thinking [2]

Honest about small average school programme effects and need for fidelity [3]

Indicated depression pathway referenced as incidence-reducing psychological care [4]

UHR: minority conversion; no default long-term antipsychotic; CBT-informed + comorbidity care [5][6]

FEP: multi-element EIS and DUP reduction rationale [7][8]

Collaborative tone; parent alliance; metrics (DUP median, treatment coverage, school reach, equity)

Reveal assessor key

School principal. Support a skills-based curriculum with teacher training and evaluation; set expectation of small average effects, not elimination of depression.[3]

GP lead. Primary care pathway for subthreshold depression (brief psychological indicated prevention; step up if MDD); clear escalation for risk and for suspected psychosis.[4]

References

[1]Gordon RS Jr An operational classification of disease prevention Public Health Rep, 1983.PMID 6856733
[2]Rose G Sick individuals and sick populations Int J Epidemiol, 2001.PMID 11416056
[3]Werner-Seidler A, Perry Y, Calear AL, et al. School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis Clin Psychol Rev, 2017.PMID 27821267
[4]Cuijpers P, van Straten A, Smit F, et al. Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions Am J Psychiatry, 2008.PMID 18765483
[5]Fusar-Poli P, Bonoldi I, Yung AR, et al. Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk Arch Gen Psychiatry, 2012.PMID 22393215
[6]Davies C, Cipriani A, Ioannidis JPA, et al. Lack of evidence to favor specific preventive interventions in psychosis: a network meta-analysis World Psychiatry, 2018.PMID 29856551
[7]Marshall M, Lewis S, Lockwood A, et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients Arch Gen Psychiatry, 2005.PMID 16143729
[8]Correll CU, Galling B, Pawar A, et al. Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis JAMA Psychiatry, 2018.PMID 29800949
[9]Campion J, Javed A, Lund C, et al. Public mental health: required actions to address implementation failure in the context of COVID-19 Lancet Psychiatry, 2022.PMID 35065723