Poverty, food insecurity and social prescribing — OSCE communication and social-prescribing station

Observed structured encounter testing destigmatised screening for material hardship, use of the Hunger Vital Sign, co-design of a social prescription with the family, a diagnostic-overshadowing and safeguarding decision, and policy-level advocacy for children in poverty.

osce communication and social-prescribing station3 min readVerification in progress

Prompt

Station A is a routine well-child visit at which a mother discloses food insecurity and the candidate must screen, co-design a social prescription and avoid stigma; Station B is the discovery of faltering growth requiring the candidate to investigate organic disease alongside the social response and to make a safeguarding judgement.

Candidate instructions

You are the paediatric registrar. You have 8 minutes per station. [2]

Station A (screening and co-design). A four-year-old girl is brought for routine immunisation by her mother, who has recently lost her casual job. The mother asks quietly whether you know anywhere that gives food. Screen the family for food insecurity and broader material hardship using validated tools, frame the questions destigmatisingly, co-design a social prescription with the mother, and outline the follow-up plan. [3] [5]

Station B (investigation and safeguarding). On growth measurement you find the child's weight has fallen across two centiles since her last visit. Investigate the organic differential alongside the social response, make a diagnostic-overshadowing-aware assessment, and decide whether this presentation also requires a safeguarding response. [1] [4]

Examiner brief and marking domains

Domain 1 — Destigmatised, universal screening (Station A). Greets the mother and child warmly; frames the social questions as routine and universal — "we ask all families these questions because they matter for children's health" — to reduce shame; uses neutral, non-judgemental language; offers privacy and a trained interpreter if needed; and demonstrates that the answers will change the plan, not the respect shown to the family. [3] [5]

Domain 2 — Validated screening tools (Station A). Uses the two-item Hunger Vital Sign for food insecurity — whether the family worried food would run out, and whether the food bought did not last — and identifies a positive screen correctly; adds a validated multi-domain social-needs instrument covering housing, income, utilities, transport and safety; and records the findings as clinical data. [3]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References6Show ledger

[1]Luby JL Poverty's Most Insidious Damage: The Developing Brain JAMA Pediatrics, 2015.PMID 26191940
[2]Schickedanz A, Dreyer BP, Halfon N Childhood Poverty: Understanding and Preventing the Adverse Impacts of a Most-Prevalent Risk to Pediatric Health and Well-Being Pediatric Clinics of North America, 2015.PMID 26318943
[3]Hager ER, Quigg AM, Black MM, et al. Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity Pediatrics, 2010.PMID 20595453
[4]Drennen CR, Coleman SM, Ettinger de Cuba S, Frank DA, Chilton M, Cook JT, Cutts DB, Heeren T, Casey PH, Black MM Food Insecurity, Health, and Development in Children Under Age Four Years Pediatrics, 2019.PMID 31501233
[5]Garg A, Brochier A, Messmer E, Fiori KP Clinical Approaches to Reducing Material Hardship Due to Poverty: Social Risks/Needs Identification and Interventions Academic Pediatrics, 2021.PMID 34740423
[6]Copeland WE, Tong G, Gaydosh L, Hill SN, Godwin J, Shanahan L, Costello EJ Long-term Outcomes of Childhood Family Income Supplements on Adult Functioning JAMA Pediatrics, 2022.PMID 35994270