Children in out-of-home care and foster care — OSCE communication and safeguarding station

OSCE — Communication and safeguarding station

Candidate instructions

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

Station A (entry assessment). A four-year-old boy in statutory foster care is brought by his caseworker for an entry health assessment three days after his third placement in a year. The caseworker expects a full report. The child does not speak. Conduct the opening of the consultation: engage the child and carer trauma-informed, clarify consent authority, state the confidentiality frame, and outline the entry-to-care assessment plan. ^[1]

Station B (lawful safeguarding override). Later in the same assessment, on examination you find a suspicious inflicted injury. Manage the immediate situation, including how you break confidentiality ethically, activate safeguarding, and preserve the therapeutic relationship with the child and carer. ^[1]

Examiner brief and marking domains

Domain 1 — Trauma-informed engagement (Station A). Greets the child first, before the carer; sets a safe, paced frame; explains the purpose of the visit; offers choice about the sequence of the interview and the examination; lets the child keep a comfort object and the carer close. Demonstrates the trauma-informed principles of safety, trust, choice, collaboration and strengths. ^{[3] [4]}

Domain 2 — Consent authority and confidentiality (Station A). Clarifies and documents who holds parental responsibility, recognising statutory care may mean the state holds it; for a young child there is no mature-minor capacity, so consent rests with whoever holds parental responsibility; states conditional confidentiality aloud in language the child can understand, and is explicit about what the caseworker and carer will and will not be told, sharing the minimum necessary and lawful. ^[1]