HEADSS
Adolescent Psychosocial Assessment
The teen-visit script — start benign, end intimate.
What this mnemonic does is sequence an adolescent psychosocial interview from least to most sensitive, building rapport before asking the questions that matter most. HEADSS — Home environment, Education and employment, Activities, Drugs, Sex, Suicide and depression — runs the same way every time so the order itself becomes routine and lowers the teen's defensiveness. Many curricula add Eating and Safety to make HEEADSSS. The AANP exam uses HEADSS to test confidentiality boundaries and the trigger to break them: imminent harm to self or others, abuse, or pregnancy in some states. Know the order, know the carve-outs, and don't skip suicide screening on a quiet teen.
- HHomeWho lives there; relationships; conflict; safety.
- EEducation / EmploymentSchool performance; bullying; job.
- AActivitiesFriends; hobbies; screen time; exercise.
- DDrugsTobacco, alcohol, marijuana, other substances. Vaping increasingly common.
- SSexualityOrientation; activity; partners; contraception; STI risk.
- SSuicide / DepressionMood; self-harm; suicidal ideation. Always ask directly.
Clinical Context
Structured adolescent psychosocial interview, ideally done with the parent out of the room after introductory chat. Start with less-sensitive domains (Home, Education) and build trust before probing drugs, sex, and mood.
Confidentiality is key — disclose at the start what will and won't stay between you (legal mandates around abuse, imminent suicidal or homicidal intent). Pair with SAMHSA's CRAFFT for substance use and the PHQ-A for depression. AANP loves the confidentiality nuance: you can discuss with the teen alone, but you must report any imminent danger to self or others.
Practice Questions
During a well-visit for a 15-year-old girl, the NP asks her parent to step out and begins the confidential portion of the interview using the HEADSS framework. She asks, "Tell me about your grades this year — how is school going, and do you feel safe walking the halls?" Which HEADSS domain is the NP exploring?
Related Mnemonics
- CAGE — Alcohol Use Disorder Screening
- CIWA-Ar — Alcohol Withdrawal Severity
- CRAFFT — Adolescent Substance Use Screen
- DIG FAST — Manic Episode Criteria (DSM-5)
- SAD PERSONS — Suicide Risk Assessment
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