Psychosocial Health Screening (HEADSS) in Adolescents

Psychosocial interviewing in the context of a routine pediatric or adolescent visit requires adequate time and privacy.
The primary goal of the initial phase of the interview is to build rapport with both the adolescent and their parents.
The practitioner should clearly explain the purpose of the inquiry (e.g., ensuring things are going well at home, school, and with peers) and outline the limits of confidentiality.
Conducting a separate, private interview with the adolescent is critical, as the patient may not want to discuss sensitive topics in the presence of their parents.
The separate interview provides the adolescent with an opportunity to confirm or refute the parent's presentation and to describe problems from their own perspective.
The clinician should begin the interview using icebreakers and open-ended, non-sensitive questions before gradually transitioning to more targeted and sensitive topics.

The HEADSS Interview Guide is a structured tool utilized during the screening of adolescents to assess symptoms, subjective distress, and functional impairment across major psychosocial domains.

Domain	Focus Area	Representative Screening Questions (Child/Adolescent)
H - Home	Family dynamics, living situation, and interpersonal relationships.	"How are things at home?"
E - Education	Academic success, school absenteeism, teacher relationships, and peer dynamics at school.	"How do you like school and your teachers?" "How well do you do in school?"
A - Activities	Peer group composition, hobbies, and extracurricular involvement.	"Do you have a best friend or group of good friends?" "What do you like to do?"
D - Drugs	Experimentation with or regular use of substances.	"Have you used drugs or alcohol?" Inquiry into tobacco or other substance use.
S - Sexuality	Sexual development, relationships, safe sex practices, and specific organ concerns.	"Are there any issues regarding sexuality or sexual activity that are of concern to you?" Assess awareness about safe sex and contraception.
S - Suicide / Depression	Mood disturbances, self-harm, suicidal ideation, and risk of harm to others.	"Everyone feels sad or angry some of the time. How about you?" "Did you ever feel so upset that you wished you were not alive or so angry you wanted to hurt someone else badly?"

While the adolescent's perspective is central, obtaining a psychosocial history from the parents is equally necessary to assess the family environment.
The clinician should invite the parent to present any psychosocial concerns regarding the child's learning, feelings, behavior, or peer relationships.
Home Domain: The clinician should specifically ask the parents, "How well does the family get along with each other?".
Education Domain: The clinician should ask, "How well does your child do in school?".
Parents should also be questioned separately regarding their level of communication with the adolescent on sensitive matters and whether they have noticed any unusual behaviors.

Evaluating the safety of the adolescent within the context of their home and community is of paramount importance during the HEADSS screening.
The interview must sensitively assess whether the adolescent has been exposed to frightening events, such as abuse, neglect, bullying, marital discord, or domestic and community violence.
The clinician must screen for indications of dangerousness to self or others, including any severely altered mental status (e.g., intoxication, delirium, rage, or hopelessness).
A thorough assessment of high-risk behaviors is required; this includes exploring issues such as running away from home, staying out without permission, truancy, gang involvement, unprotected sexual encounters, and substance experimentation.
The clinician must simultaneously assess the capacity of the parents to adequately provide for the adolescent's physical, emotional, and social needs, noting if this capacity is diminished by psychiatric disorders, family dysfunction, or socioeconomic disadvantages.