11/13/24, 8\:10 PM Guide | HEEADSSS assessment

HEEADSSS assessment

Table of contents

Introduction

An important consideration when taking a medical history from a young person (12-25 years) is identifying health risks and
behaviours unique to this age group.
We know that such factors can have a profound and cumulative impact on the life course, in
mental well-being, the development of chronic conditions, educational achievement, socio-economic development and the
attainment of life goals.
1,2
Thorough, sensitive, and appropriate psychosocial assessment can then be key to identifying strengths and risks for young
people and supporting interventions that promote current and future physical and mental health. 3
This is where the tailored
approach of the HEEADSSS assessment is very useful.
The traditional assessment progresses from addressing less sensitive topics to more sensitive issues, as outlined by the
acronym\:
Home
Education and employment
Eating and exercise
Activities, hobbies, and peer relationships
Drugs and alcohol
Sexual activity, sexuality, and gender identity
Suicide, self-harm, depression, mood, and sleeping patterns
Safety
This conversation generally takes place as a face-to-face, semi-structured interview with the young person, understanding
that such a conversation does inevitably encounter barriers, including the clinician’s lack of familiarity and con
assessments and sta
4
As such, developing skills in sensitive and empathetic communication with young people is key to creating a con
respectful space where young people can disclose information perceived as important to their lives.
3

The interview

A HEEADSSS assessment forms a valuable part of the discussion when
then be used to identify new stressors and assess overall well-being in the future.
5
First introduce yourself to the adolescent to make clear that the young person is the patient. It’s imperative that at the
beginning of the conversation, we help the young person feel comfortable and con
Be respectful of a young person’s a
misgendering someone (using the wrong gender pronouns or name) can be upsetting and unsupportive. It is as simple as
asking,
" W h a t g e n d e r p r o n o u n s d o y o u u s e ?" " W h a t n a m e s h o u l d I u s e ?"
6
.
Then, try having the adolescent introduce the other people in the room. Parents, family members, or other involved adults
should ideally not be present during the HEEADSSS interview as a parent or carer’s presence is likely to limit how much
sensitive information the patient will provide.
This does not mean that parents should be ignored. Always ask them whether they have any concerns and reassure them of
further interaction once the interview is over.
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Be certain to explain the purpose, such as\:
“ W e s p e a k p r i v a t e l y w i t h o u r p a t i e n t s a b o u t s t r e s s o r s t h a t a r e m o r e c o m m o n f o r
y o u n g p e o p l e s o t h e y c a n b e g i n t o t a k e r e s p o n s i b i l i t y f o r t h e i r h e a l t h c a r e n e e d s .
” With explanation, adults generally accept the
need for con
Con
the interview, with a line such as\:
“ D u r i n g t h i s v i s i t , I’ l l a s k y o u s o m e v e r y p e r s o n a l q u e s t i o n s t o b e s t h e l p y o u . I p r o m i s e t h a t
w h a t e v e r y o u s a y w i l l b e k e p t p r i v a t e b e t w e e n u s a n d n o t b e p a s s e d a l o n g t o y o u r p a r e n t s o r a n y b o d y e l s e o u t s i d e t h i s c l i n i c ,
u n l e s s y o u g i v e p e r m i s s i o n .
”
Importantly, the young person should be aware\:
“ T h e o n l y e x c e p t i o n w o u l d b e i n a c i r c u m s t a n c e i n w h i c h a d i s c l o s u r e t o
s o m e o n e i s r e q u i r e d b y l a w – l i k e i f y o u’ r e a t r i s k o f h u r t i n g y o u r s e l f o r s o m e o n e e l s e i s h u r t i n g y o u .
”
From this point, nothing about the HEEADSSS interview, including the order of questioning, should ever be treated rigidly. Each
young person should receive a tailored approach.
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Home

Who lives with you? Tell me about your family or the people who are important to you.
Where do you live? Can you describe where you live, like your house or apartment?
How would you describe your relationships with the people you live with?
Is there someone at home or in your support network you feel comfortable talking to about stress?
Has anyone new come to live with you recently?
Has anyone recently left your household?
Do you have any devices at home, like a phone or computer? How do you use them?
Have you experienced any big changes lately, like moving to a new place or living away from home?
Have you ever felt unsafe or experienced any violence at home?

Education and employment

How would you describe your school? Do you feel safe there? Why or why not?
Have you ever experienced bullying at school?
Do you feel included and like you belong at school?
Is there a teacher or another adult at school you trust and feel comfortable talking to about important things?
How are your grades going? Are there any subjects you're
Have there been any recent changes or events at school that have a
What do you want to do after school? Do you have any goals for your education or career?
Are you working part-time? Where do you work, and how many hours do you work each week?
Further exploration
How many days have you missed from school recently?
Have you changed schools in the past few years?
Can you tell me about your friends at school?
Have you ever repeated a class or grade?
Have you ever been suspended or expelled?
Have you ever thought about leaving school early?
How well do you get along with people at school or work?
Have your responsibilities at work increased recently?
What are your favourite subjects at school?
Are there any subjects you don't enjoy as much?

Eating and exercise

Do you ever feel stressed about your weight or how your body looks? Can you tell me more about how it makes you feel?
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Have you noticed any changes in your weight lately?
Have you tried to change your eating habits or diet in the past year? What did you do, and how often?
Further exploration
What do you like and not like about your body?
Have you tried anything else to manage your weight?
Can you tell me about your exercise routine?
What do you think a healthy diet looks like?
How does your current eating compare to what you think is healthy?
How would you feel if you gained or lost 5kg?
Do you ever feel like your eating is out of control?
Have you ever used medication or supplements to try to lose weight?

Activities, hobbies, and peer relationships

What activities do you enjoy doing in your free time? How do you hang out with your friends and family, and where do you
usually go?
Do you spend a lot of time online? What do you like to do on the internet?
About how much time do you spend each day using devices like computers, TVs, or phones?
Do you ever feel like you want to spend less time on screens or online activities?
Have you ever had any negative experiences with social media that you'd like to talk about?
Further exploration
Do you play any sports or participate in physical activities?
Do you attend any religious or spiritual events regularly?
Have you ever sent messages or posted things online that you later regretted?
What kinds of books do you enjoy reading for fun?
How do you feel after playing video games?
What music genres or artists do you like to listen to?

Drugs and alcohol

Some young people try smoking, vaping, drugs, or alcohol. Have you heard about friends who have tried these?
Have you tried smoking, vaping, drugs, or alcohol? If yes, can you tell me more about it, like how often, how much, and who
you were with?
How do drugs, smoking, or drinking a
Have you noticed yourself using more drugs or alcohol lately?
Where do you get cigarettes, drugs, or alcohol from? Do you buy them, and how do you get money for them?
Does anyone in your family smoke, drink alcohol, or use drugs?
Further exploration
Is there a history of alcohol or drug problems in your family?
Do you ever drink or use drugs alone?
Have you ever been in a car with someone who was high or had used drugs or alcohol?
Do you use alcohol or drugs to feel better or
Do you forget things you did while using drugs or alcohol?
Have your family or friends ever said you should cut down on drinking or drug use?
Have you ever gotten into trouble while using drugs or alcohol?
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Sexual activity, sexuality, and gender identity

Have you ever felt attracted to someone or had romantic feelings for someone else?
How would you describe your sexual orientation? For example, do you see yourself as queer, heterosexual, or somewhere
else on the spectrum?
Have you ever been in a relationship that included sexual activity, like kissing or touching?
Further exploration
Do you
Have any of your relationships been violent or involved coercion?
What does the term "safer sex
" mean to you?
Have you ever been forced or pressured into doing something sexual that you didn’t want to do?
Have you ever been touched sexually in a way that you didn’t want?
How many sexual partners have you had?
What contraception are you using, if any?
Do you use condoms every time you have intercourse? Or use other forms of protection?
Have you ever been pregnant or worried about pregnancy? Or worried about getting someone pregnant?
Have you ever had a sexually transmitted infection or been concerned about one?

Suicide, self-harm, depression, mood, and sleeping patterns

On a scale of 1 to 10, how would you rate your mood recently? Can you tell me more about why you feel that way?
Do you
Have you been feeling sadder or down more often than usual?
Do you often feel bored or like there's not much that interests you?
Have you been having trouble falling asleep or staying asleep?
Have you thought a lot about hurting yourself or someone else?
Further exploration
Does it seem like you've lost interest in activities you used to enjoy?
Have you been spending less time with friends than you used to?
Do you prefer being alone most of the time?
Have you ever tried to harm yourself or kill yourself?
Have you ever used self-harm (like cutting) as a way to calm down or feel better?
Have you started using alcohol or drugs to relax, calm down, or feel better?

Safety

Have you ever had a serious injury? Can you tell me how it happened?
Do you know anyone who has been seriously injured? What happened to them?
Do you make sure to always wear a seatbelt when you're in a car?
Have you ever met someone in person that you
Have you ever sent a text message while driving? When was the last time?
Have you ever been in a car with a driver who was drunk or high? When was this, and has it happened more than once?
Do you experience or witness a lot of violence at home, school, in your neighbourhood, or among your friends?
Further exploration
Do you use safety equipment like helmets for bike riding or skateboarding?
Have you ever been in a car or motorcycle accident? What happened?
Have you ever been bullied or picked on? Is it still a problem?
Have you been in physical
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Have you ever felt like you needed to carry a weapon for protection?
Do you still feel that way? Have you ever been in trouble with the law?

After the consultation

As you conclude the HEEADSSS assessment conversation with a young person, ensuring the discussion ends on a supportive
and empathetic note is important.
Summarise the key points discussed during the interview. Validate the young person's experiences and feelings,
acknowledging the courage it takes to share personal information.
" T h a n k y o u f o r s h a r i n g w i t h m e t o d a y . a l o n e .
”
I t' s c l e a r t h a t y o u' r e d e a l i n g w i t h a l o t , a n d i t' s i m p o r t a n t t o r e m e m b e r t h a t y o u' r e n o t
If there are any concerns or areas that require follow-up, discuss potential next steps with the young person. This may include
referrals to appropriate professionals or resources, as well as ongoing support strategies.
“ L e t' s t h i n k a b o u t w h a t w e' v e d i s c u s s e d a n d w h a t s t e p s w e c a n t a k e n e x t t o m a k e s u r e y o u h a v e t h e h e l p a n d r e s o u r c e s y o u
n e e d .
”
It remains important to gain consent from the young person before proceeding with any referrals or further actions, including
speaking to their parents or carers. Ensure they understand the purpose and potential outcomes of onward referrals or support
plans.
Respect the young person's wish to keep certain aspects of their life private or personal within the boundaries of
con
It is important to document the HEEADSSS assessment
concerns to be revisited in the future.
When done well, the HEEADSSS framework is a thorough, sensitive, and appropriate psychosocial assessment tool. It can be
key to identifying strengths and risks for young people and aid in supporting interventions, enabling healthcare practitioners to
ensure current and future physical and mental health.

References

1. WHO. (2001). T h e s e c o n d d e c a d e \: i m p r o v i n g A d o l e s c e n t H e a l t h a n d D e v e l o p m e n t . Geneva\: World Health Organization.
2. Australian Research Alliance for Children and Youth. (2014). T h e N e s t A c t i o n A g e n d a . Canberra\: ARACY.
3. Waller, Bailey, Zolfaghari, Ho, Feuerlicht, Ross, & Steinbeck. (2023). Psychosocial assessment of adolescents and young adults
in paediatric hospital settings\: patient and sta
2 3 (683).
4. Saw, Smit, Silva, Bulsara, & Nguyen. (2022). Service evaluation and retrospective audit of electronic HEEADSSS (e-HEEADSSS)
screening device in paediatric inpatient service in Western Australia. I n t e r n a t i o n a l J o u r n a l o f A d o l e s c e n t M e d i c i n e a n d H e a l t h ,
3 4 (6), 401-409.
5. The Sydney Children's Hospital Network . (2024). H E E A D S S S 3 .0 i n t e r v i e w f o r a d o l e s c e n t s . Available from\: [LINK]
6. Hager, A. (2014). S u p p o r t i n g G e n d e r I d e n t i t y \: A B e g i n n e r’ s G u i d e f o r F r i e n d s , F a m i l y , a n d U n i v e r s i t y S t a LINK]
7. Klein, D., Goldenring, J., & Padelman, W. (2014). HEEADSSS 3.0\: the psychosocial interview for adolescents updated for a new
century fueled by media. C o n t e m p o r a r y P e d i a t r i c s .
Source\: geekymedics.com
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