---
asset_id: C3.03
title: Scenario Card: The Medication Refusal
tier: Yellow
status: Shell awaiting clinical validation
owner: Clinical owner
audience: Facilitators
generated_at: 2026-06-19
source_refs:
  - apps/sim-ariasos-com/nexus-pediatric-5min-sim-enterprise-plan.md
  - apps/sim-ariasos-com/nexus-pediatric-5min-sim-enterprise-plan.pdf
  - generated-local/nexus-pediatric-safety-studio-assets/aria-microphase-asset-buildout-20260619.md
  - generated-local/aria-research-substrate/nexus-5min-sim-budget-20260619/manifest.json
  - https://sim.ariasos.com
  - https://www.crisisprevention.com/en-GB/blog/general/cpi-crisis-development-model/
  - https://www.crisisprevention.com/blog/behavioral-health/risk-behaviors/
  - https://www.crisisprevention.com/en-AU/blog/general/understanding-the-importance-of-integrated-experience/
claim_boundary: "Executive and clinical review artifact. Not clinical policy. Not approved for rollout until Nexus/CPI/addendum/risk/legal validation."
---

# Scenario Card 03: The Medication Refusal

Internal only. Do not use until signed by the clinical owner.

## Child Context

Draft child context: 14-year-old with self-harm history, refusing morning medication.

Validation: <<CLINICAL: awaiting Nexus/CPI validation>>

## Moment

Draft moment: Facing the wall and refusing to engage.

Validation: <<CLINICAL: awaiting Nexus/CPI validation>>

## Missed Step

Draft missed step: Nurse opens curtain, sits on bed, and makes the interaction about winning compliance.

Validation: <<CLINICAL: awaiting Nexus/CPI validation>>

## Right Response

<<CLINICAL: awaiting Nexus/CPI validation>>

Approved facilitator language:

____________________________________________________________

## Provisional CPI Alignment

Best-guess alignment: Defensive behavior unless refusal creates immediate clinical danger under Nexus policy.

Validation: <<CLINICAL: awaiting Nexus/CPI validation>>

## Provisional Safety Threshold

Best-guess threshold: Directive response may be appropriate, but only inside validated medication-refusal policy and choice boundaries.

Validation: <<CLINICAL: awaiting Nexus/CPI validation>>

## Safety Threshold

<<CLINICAL: awaiting Nexus/CPI validation>>

Validated threshold for when to stay verbal/environmental, call team support, or move to immediate safety intervention:

____________________________________________________________

## Repair / Debrief

<<CLINICAL: awaiting Nexus/CPI validation>>

Approved repair prompt:

____________________________________________________________

## Documentation / Escalation Reminder

<<CLINICAL: awaiting Nexus/CPI validation>>

Approved documentation reminder:

____________________________________________________________

## Draft Takeaway

Choice is treatment when it is clinically available.

Validation: <<CLINICAL: awaiting Nexus/CPI validation>>