HEADSSS ASSESSMENT

Introduce myself

“I am _____ and I will be helping you today”

Discuss confidentiality

“During this visit, I’ll ask you some very personal question to best help you. I promise that whatever you
say will be kept private between us, and not be passed along to anybody else.”

HOME

- Rather, start by asking “Where do you live?” or “Tell me about your living situation.” Then ask:
“Who lives with you?”
- Proceed by asking what relationships are like at home and whether there has been a recent
change: moving, running away, divorce, or having someone join or leave the household. 

Examples of Questions

· Who lives at home with you? Where do you live? How long? Do you have your own room?

· How many brothers and sisters do you have and what are their ages? Are your brothers and sisters
healthy?

· Are there any new people living in your home?

· Are your parents healthy? What do your parents do for a living?

· What are the rules like at home?

· How do you get along with your parents, your siblings? What kinds of things do you and your family
argue about the most? What happens in the house when there is a disagreement?

· Is there anything you would like to change about your family?

EDUCATION & EMPLOYMENT

-  A common error is to ask “How are you doing in school?” Invariably, the patient will simply
answer “fine” or “good,” necessitating additional questioning. Instead, try asking: “Tell me
about school. What do you like about it, and what don't you like?”

Examples of Questions

· Which school do you go to? What grade are you in? Any recent changes in schools?

· What do you like best and least about school? Favourite subjects? Worst subjects?

· What were your most recent grades? Are these the same or different from the past? Have you ever
failed or repeated any years?

· How many hours of homework do you do daily?

· What do you want to do when you finish school? Any future plans/goals?

· Do you work know? How much? Have you worked in the past?

· How do you get along with teachers, employers?

· How do you get along with your peers? Inquire about “bullying”.

EATING

- Use this question, for example: “As I ask all my patients-does your weight or body shape cause
you any stress? If so, tell me about it.” Then follow with specific questions about diet, eating
habits, nutritional knowledge and beliefs, and pathologic dieting behaviors. 

ACTIVITIES

- Begin by asking: “Tell me what you do with your friends” or “What do you do for fun?” Be
concerned about teenagers who cannot readily name friends or describe their activities beyond
“hanging out.”

Examples of Questions

· Are most of your friends from school or somewhere else? Are they the same age as you?

· Do you hang out with mainly people of your same sex or a mixed crowd?

· Do you have one best friend or a few friends? Do you have a lot of friends?

· Do you spend time with your family? What do you do with your family?

· Do you see your friends at school and on weekends, too? Are there a lot of parties?

· Do you do any regular sport or exercise? Hobbies or interests? · Do you have a religious affiliation,
belong to a church, or practice some kind of spiritual belief?

· How much TV do you watch? What are your favourite shows?

· Do you read for fun? What do you read? · What is your favourite music?

· Do you have a car – use seat belt?

· Have you ever been involved with the police? Have you ever been charged? Do you belong to a
group/gang?

DRUGS

- For patients in early adolescence, approach the topic obliquely:  “We talked about what you
and your friends do to have fun. Do any of your friends use drugs or alcohol (or get drunk or
high)?”
- Next you might ask: “Tell me about a time that you felt pressured by friends to use drugs or
alcohol, if any.” The answer may lead to a discussion of specific circumstances and types of
substances tried.
 - “Many young people experiment with drugs, alcohol, or cigarettes. Have you or your friends
ever tried them? What have you tried?”

Examples of Questions

· When you go out with your friends or to party, do most of the people that you hang out with drink or
smoke? Do you? How much and how often?

· Do any of your family members drink, smoke or use other drugs? If so, how do you feel about this - is it
a problem for you?

· Have you or your friends ever tried any other drugs? Specifically, what? Have you ever used a needle?

· Do you regularly use other drugs? How much and how often?

· Do you or your friends drive when you have been drinking?

· Have you ever been in a car accident or in trouble with the law, and were any of these related to
drinking or drugs?

· How do you pay for your cigarettes, alcohol or drugs?

SEXUALITY

- It may benefit rapport to seek permission before proceeding: “Do you mind if I ask you a few
more personal questions to learn how I can best assist you?”
- It is also helpful to expressly acknowledge the discomfort most patients feel about discussing
this topic. Say, for example: “I know that this may be embarrassing for you, but I ask these
questions of all my teenaged patients to make sure I can give my best advice.”
- Especially with younger adolescents, you might observe: “Tell me about any of your friends
who are starting to be in romantic relationships.” To older adolescents, simply say: “Tell me
about any romantic relationships you've been involved in.”

Examples of Questions

· Have you ever been in a relationship? When? How was it? How long did it last?

· Are you involved in a relationship? Have you been involved in a relationship?

· How was that experience for you?

· How would you describe your feeling towards guys or girls?

· How do you see yourself in terms of sexual preference, i.e. gay, straight, or bisexual?

· Have you had sex? Was it a good experience? Are you comfortable with sexual activity? Number of
partners?

· Using contraception? Type and how often (10, 50, or 70% of the time).

· Have you ever been pregnant or had an abortion?

· Have you ever had a pap smear? · Do you have any concerns about Hepatitis or AIDS?

· Have you had an experience in the past where someone did something to you that you did not feel
comfortable with or that made you feel disrespected?

· If someone abused you, who would you talk to about this? How do you think you would react to this?

· For females: Ask about Menarche, last menstrual period (LMP), and menstrual cycles. Also inquire
about breast self examination (BSE) practices.

· For males: Ask about testicular self-examination (TSE) practices.

SUICIDE & DEPRESSION

- Asking about suicidal behavior does not precipitate or trigger it, and clinicians should not be
reluctant to question patients unambiguously: “You’ve told me that you’ve been feeling bad
lately. Have you felt so bad that you’ve thought seriously about harming yourself?” 

SAFETY

- Proceed to questions about the threats most prevalent in the patient’s community. In some
settings, these threats may be school violence and guns; in other settings, these may be sports
injuries, sexual violence, or risk taking related to motor vehicles. Then ask about any other
threats. Avoid letting assumptions based on the patient’s racial, ethnic, or socioeconomic status
lead you to skip taking parts of the history.

WRAPPING UP INTERVIEW

- You may end the psychosocial interview by asking adolescents to tell you in whom they can trust
and confide if they have problems. Emphasize that your approach is nonjudgmental and that
you welcome future visits. You may say: “I’m here for you, and I want you to feel comfortable
confiding in me. If you have something personal to talk about, I’ll try to give you my best
advice and answer your questions.
- Give them an opportunity to express any concerns you have not covered, and ask for feedback
about the interview. If they later remember anything they have forgotten to tell you, remind
them that they are welcome to call at any time or to come back in to talk about it
- For teenagers who demonstrate significant risk factors, relate your concerns. Ask if they are
willing to change their lives or are interested in learning more about ways to deal with their
problems. This leads to a discussion of potential follow-up and therapeutic interventions. Many
adolescents do not recognize dangerous life-style patterns because they see their activities not
as problems but as solutions.