Young People | HEADSS Assessment

🔍 Introduction & Background

Adolescence is a time of significant change—emotionally, physically, and socially. Most teenagers navigate this period with relative ease, but for some, it can be marked by risky behavior and vulnerability. The HEADSS (or HEEADSSS) assessment is a systematic, flexible screening tool that helps professionals gather important information about an adolescent’s life. Originally adapted from works such as Getting into Adolescent Heads by Goldenring and Cohen, it covers:

• Home & Environment
• Education/Employment
• Eating & Exercise
• Activities
• Drugs/Substances
• Sexuality
• Suicide/Depression
• Safety

The tool is designed to progress from less threatening topics to more personal, sensitive subjects. It helps clinicians identify both risk and protective factors, providing a basis for further intervention and support.

🔐 Confidentiality & Practitioner Guidelines

Confidentiality is key to effective assessment. Adolescents need assurance that their personal information will be handled with care. Before starting the interview:

• Explain the limits and nature of confidentiality to both the youth and any accompanying family members.
• Ensure that, unless explicitly requested by the adolescent, parents or caregivers do not remain in the room during the sensitive parts of the assessment.
• Adopt a non-judgmental and empathetic approach, recognizing your own beliefs and assumptions about youth and family life.

Remember that your introduction and confidentiality statement set the tone for the entire assessment. Make sure the adolescent feels heard, respected, and safe.

📋 The HEADSS Domains

The assessment covers the following key domains. For each domain, sample questions and guiding considerations are provided.

🏠 Home & Environment

Focus: Family composition, living arrangements, and home dynamics.

• Who lives with you? Do you have your own room?
• What is your relationship like with your parents, siblings, or other family members?
• Have there been any recent changes at home (e.g., separation, new family members, or moves)?
• Are there any issues with violence or conflict at home?

Tip: Use open-ended questions to explore both environmental history and personal perceptions of home life.

📚 Education & Employment

Focus: School performance, peer relationships, and work experiences.

• Which school do you attend? What grade are you in?
• What subjects do you enjoy or find challenging?
• How do you get along with your teachers and peers?
• Are there any changes in your academic performance or attendance?
• Do you have a job? How do you balance work and school?

Tip: Ask about both strengths and areas of difficulty to identify risk and protective factors.

🍏 Eating & Exercise

Focus: Eating habits, body image, and physical activity.

• What do you like and not like about your body?
• Have you noticed any changes in your weight recently?
• What does a typical meal look like for you? Do you eat regularly with family?
• How much physical activity do you get on a daily or weekly basis?
• Do you have concerns about your diet or body image?

🎨 Activities

Focus: Extracurricular interests, hobbies, and social interactions.

• What activities do you participate in outside of school?
• How do you spend your free time with friends or family?
• Do you engage in any sports, clubs, or religious activities?
• How much time do you spend on screens (TV, computer, video games)?

💊 Drugs & Substances

Focus: Substance use and its context.

• Do you or your friends use tobacco, alcohol, or other drugs?
• How often do you use these substances, and in what settings?
• Is there a family history of substance abuse?
• How do you obtain these substances, and what is your attitude toward them?

Note: Use structured questions like the CRAFFT screening tool to assess substance use patterns.

🌈 Sexuality

Focus: Romantic relationships, sexual experiences, and safe practices.

• Have you been in a romantic or sexual relationship?
• What does being in a relationship mean to you?
• What are your thoughts on safe sex? What methods do you use for protection?
• Have you ever felt pressured into any sexual activities?
• Do you have any concerns or questions about your sexual orientation?

😢 Suicide & Depression

Focus: Mood, emotional well-being, and self-harm risks.

• Have you felt unusually sad, down, or hopeless recently?
• Do you have trouble sleeping or changes in your appetite?
• Have you experienced feelings of isolation or loss of interest in activities you once enjoyed?
• Have you ever had thoughts of self-harm or suicide? If so, what helped you cope?

Tip: It is important to explore these questions gently. If significant risk is identified, follow up with a more detailed suicide risk assessment.

🔒 Safety

Focus: Personal safety, exposure to violence, and risk behaviors.

• Do you feel safe at home, school, and in your neighborhood?
• Have you ever been involved in or witnessed physical violence?
• Do you use safety measures such as seatbelts or helmets?
• Have you ever carried a weapon for protection?
• Are there situations where you feel at risk of harm?

⚖️ Risk and Protective Factors

The HEADSS assessment is not only a tool for identifying areas of concern but also for recognizing strengths and protective factors that build resilience. Consider:

• Biological and Family Factors: Family history of mental health or substance issues versus a supportive, communicative home environment.
• Educational Factors: Positive academic engagement and supportive relationships with teachers versus disengagement or bullying.
• Social Factors: Involvement in positive activities and peer support versus isolation or association with high-risk peers.
• Personal Coping: Healthy coping strategies, positive self-esteem, and protective behaviors versus risk-taking and impulsivity.

Building on protective factors can guide the development of intervention strategies and support plans tailored to each adolescent’s unique context.

👥 Conducting the Interview: Best Practices

When starting the HEADSS interview, consider the following steps:

1. Introduction: Introduce yourself and, if present, ask the adolescent to introduce you to others. Establish rapport from the outset.
2. Confidentiality: Discuss confidentiality early on. Clarify what information will remain private and under what circumstances it may be shared.
3. Progressive Questioning: Begin with less personal topics (e.g., Home and Education) and gradually progress to more sensitive areas (e.g., Sexuality, Suicide/Depression).
4. Non-Judgmental Approach: Use open-ended, non-assumptive questions. Be flexible and adjust your approach based on the adolescent’s comfort level.
5. Closing the Interview: Ask the adolescent to summarize how they feel about the discussion. Invite any final questions or comments, and explain next steps if needed.

📚 Additional Resources and References

For further details on the HEADSS assessment, refer to these guides and resources:

• headss-assessmentDownload