Paeds Cases · child-safety-and-social-paediatrics
Explaining a family-support and prevention plan — OSCE
Communication and structured-discussion OSCE on offering a non-stigmatising, evidence-based prevention and family-support plan to a young first-time mother at the antenatal visit, explaining the rationale (the toxic-stress cascade and the buffering adult), and setting the boundary between support and protection.
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Target exams
Candidate instructions (8-minute station)
You are the paediatric registrar in the community clinic. A 19-year-old first-time mother is seen at her first antenatal visit at 14 weeks. She is in unstable rental housing, her partner has left, she has no family nearby, and she scores positive on a screen for low mood. The pregnancy is progressing normally and there is no suggestion of maltreatment. [2]
Your tasks are: [1]
- Offer a stepped, evidence-based prevention and family-support plan in plain, non-stigmatising language, naming what each part does and why it helps. [2]
- Explain the rationale for prevention in terms a parent can follow — why support now changes the child's future — without making her feel suspected of anything. [5]
- Set the boundary clearly between support and protection: reassure her this is help, not surveillance, and explain when the stance would change. [1]
You are not expected to confront or accuse the mother, to take a child-protection history, or to complete a formal risk-score calculation. [1]
References5ShowHide
- [1]MacMillan HL; Thomas BH; Jamieson E; et al Interventions to prevent child maltreatment and associated impairment. Lancet, 2009.PMID 19056113
- [2]Olds DL; Eckenrode J; Henderson CR Jr; et al Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial. JAMA, 1997.PMID 9272895
- [3]Prinz RJ; Sanders MR; Shapiro CJ; Whitaker DJ; Lutzker JR Population-based prevention of child maltreatment: the U.S. Triple P system population trial. Prevention Science, 2009.PMID 19160053
- [5]Felitti VJ; Anda RF; Nordenberg D; et al Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 1998.PMID 9635069
- [12]Eckenrode J; Campa MI; Morris PA; et al The Prevention of Child Maltreatment Through the Nurse Family Partnership Program: Mediating Effects in a Long-Term Follow-up Study. Child Maltreatment, 2017.PMID 28032513