HEEADSSS Assessment
A systematic psychosocial screening tool used to evaluate risks and health behaviours in adolescents. The interview progresses logically from the least threatening topics to the most personal and sensitive subjects. This interview structure is designed to be flexible and applicable to all adolescents.
HHome
EEducation / Employment
EEating
AActivities
DDrugs
SSexuality
SSuicide / Depression
SSafety
⚖️ Confidentiality & Clinical Approach
Before You Begin
Adolescents will not share sensitive information unless confidentiality is assured. Address confidentiality and its limits with both the adolescent and caregivers at the beginning of the interview.
Establish Confidentiality
Adolescents will not share sensitive information unless confidentiality is assured. Address confidentiality and its limits with both the adolescent and caregivers at the beginning of the interview.
Establish Rapport
If parents are present, introduce yourself to the adolescent first and ask them to introduce the other people in the room to demonstrate that they are your primary focus. Parents should not be present during the HEEADSSS assessment unless the adolescent specifically requests it.
📋 HEEADSSS Domains
Screening Domains & Interview Questions
Select any domain to expand the full clinical screening guidance, recommended approach, and interview questions. First-line questions are highlighted in teal; extended questions appear in grey.
H
Home
Collect environmental and personal history
▾
Recommended Approach: Use open-ended questions like, “Where do you live, and who lives there with you?” rather than a narrow “Tell me about mom and dad”, as parents may have separated, divorced, died or do not reside together.
Sensitive questioning: Directly asking about parental abuse or substance use can be difficult. To facilitate this, use a scenario: “Working with young people, I’ve learned that some ‘kids’ have a difficult relationship with their parents, meaning they argue and fight. Some of them have also told me they wish their parents did not drink so much or use drugs. Is this a situation in your household? Has anything like it happened to you?”
Screen for:
- Sibling relationships, rules at home, frequency and nature of household arguments
- Potential parental substance use or abuse
Interview Questions
First-Line Questions
- Who lives with you? Where do you live?
- What are relationships like at home?
- Can you talk to anyone at home about stress? (Who?)
- Is there anyone new at home? Has someone left recently?
- Do you have a smartphone or computer at home? In your room? What do you use it for?
If Time Permits / Warrants Exploration
- Have you moved recently?
- Have you ever had to live away from home? (Why?)
- Have you ever run away? (Why?)
- Is there any physical violence at home?
E
Education & Employment
Assess academic performance, peer dynamics, and future goals
▾
Recommended Approach: Ask, “What are you good at in school? What is hard for you?” rather than a vague “How are you doing in school?”
Screen for:
- Recent grade changes, skipped classes, school suspensions
- Bullying, relationships with teachers and peers
- Employment status and future goals
Interview Questions
First-Line Questions
- Tell me about school.
- Is your school a safe place? (Why?) Have you been bullied at school?
- Do you feel connected to your school? Do you feel as if you belong?
- Are there adults at school you feel you could talk to about something important? (Who?)
- Do you have any failing grades? Any recent changes?
- What are your future education/employment plans and goals?
- Are you working? Where? How much?
If Time Permits
- How many days have you missed from school this month/quarter/semester?
- Have you changed schools in the past few years?
- Tell me about your friends at school.
- Have you ever had to repeat a class/grade?
- Have you ever been suspended? Expelled? Have you ever considered dropping out?
- How well do you get along with the people at school? Work?
- What are your favourite subjects at school? Your least favourite?
E
Eating & Exercise
Explore eating-disordered behaviour or body-image stress in a non-threatening manner
▾
Recommended Approach: Ask, “How would you describe your eating habits? Does your weight or body image cause you any stress?”
Screen for:
- Recent changes in weight, feelings about their body
- Exercise routines and the use of supplements or “body pills”
Interview Questions
First-Line Questions
- Does your weight or body shape cause you any stress? If so, tell me about it.
- Have there been any recent changes in your weight?
- What do you like and not like about your body?
- Tell me about your exercise routine.
If Time Permits
- Have you dieted in the last year? How? How often?
- Have you done anything else to try to manage your weight?
- What do you think would be a healthy diet? How does that compare to your current eating patterns?
- What would it be like if you gained (lost) 10 lbs?
- Does it ever seem as though your eating is out of control?
- Have you ever taken diet pills?
A
Activities
Understand the adolescent’s peer group, hobbies, and potential high-risk environments
▾
Recommended Approach: Ask, “What do you do for fun? What things do you do with friends?”
Screen for:
- Screen time, hobbies
- Gang involvement, history of police interaction or arrests
Interview Questions
First-Line Questions
- What do you do for fun? How do you spend time with friends? Family? (With whom, where, when?)
- Some teenagers tell me that they spend much of their free time online. What types of things do you use the Internet for?
- How many hours do you spend on any given day in front of a screen? Do you wish you spent less time on these things?
- Do you participate in any sports?
- Do you regularly attend religious or spiritual activities?
If Time Permits
- Have you messaged photos or texts that you have later regretted?
- Can you think of a friend who was harmed by spending time online?
- How often do you view pornography (or nude images or videos) online?
- What types of books do you read for fun?
- How do you feel after playing video games?
- What music do you like to listen to?
D
Drugs & Substances
Identify substance use, frequency, and related risky behaviours
▾
Recommended Approach: Ask, “Have you or your friends ever tried drugs, alcohol, or cigarettes?” rather than a blunt “Do you do drugs?”
Clinical Tip: With younger teens, it is often most effective to begin by asking about their friends’ use before asking about their own.
Screen for:
- Family history of substance use, frequency of personal use
- Sharing needles, driving under the influence, how they finance their substances
Interview Questions
First-Line Questions
- Do any of your friends or family members use tobacco? Alcohol? Other drugs?
- Do you use tobacco or electronic cigarettes? Alcohol? Other drugs, energy drinks, steroids, or medications not prescribed to you?
- Is there any history of alcohol or drug problems in your family?
- Does anyone at home use tobacco?
If Time Permits
- Do you ever drink or use drugs when you’re alone?
- Assess frequency, intensity, patterns of use or abuse, and how patient obtains or pays for drugs, alcohol, or tobacco.
S
Sexuality
Assess sexual health, relationships, and safety
▾
Recommended Approach: Ask, “Are you involved in a relationship? How do you see yourself in terms of sexual preference?”
Clinical Tip: Avoid asking “Have you ever had sex?” as this can be misinterpreted, and avoid assuming heterosexuality by asking about “boyfriends or girlfriends”.
Screen for:
- Number of partners, consistency of contraception use
- STD knowledge and testing, history of pregnancy or abortion
- History of non-consensual sexual contact or abuse
Interview Questions
First-Line Questions
- Have you ever been in a romantic relationship? Tell me about the people that you’ve dated.
- Have any of your relationships ever been sexual relationships (such as involving kissing or touching)?
- Are you attracted to anyone now? OR: Tell me about your sexual life.
- Are you interested in boys? Girls? Both? Not yet sure?
If Time Permits
- Are your sexual activities enjoyable?
- Have any of your relationships been violent?
- 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?
- How many sexual partners have you had altogether?
- What are you using for birth control? Are you satisfied with your method?
- Do you use condoms every time you have intercourse? What gets in the way?
- Have you ever had a sexually transmitted infection or worried that you had one?
S
Suicide & Depression
Identify indicators of depression, anxiety, and suicidal ideation
▾
Recommended Approach: Ask, “Do you ever have thoughts about hurting yourself, or wishing that you didn’t exist?”
Clinical Tip: Asking about suicidal thoughts does not increase the risk of suicide. However, overly direct approaches early on can cause the patient to shut down. Any indication of suicidal intent or significant suicidal thoughts requires immediate and extensive exploration and potential intervention. Always consult with supervisors or other mental health professionals if you are uncertain how to proceed.
Red Flags:
Sleep Disorders
Disrupted or significantly changed sleep patterns.
Appetite Changes
Significant increase or decrease in appetite.
Chronic Boredom
Boredom can frequently indicate underlying depression.
Hopelessness
Expressed feelings of hopelessness or worthlessness.
Withdrawal
Pulling away from friends, family, and activities.
Sexual Minority Youth
Identifying as LGBTQ+ is a recognised risk factor.
Screen for:
- Current stress levels, loss of interest in activities
- Past suicide attempts, and non-suicidal self-injury (e.g., cutting)
- If risk is suspected, utilise validated suicide risk assessment tools and seek consultation
Interview Questions
First-Line Questions
- Do you feel “stressed” or anxious more than usual?
- Do you feel sad or down more than usual?
- Are you “bored” much of the time?
- Are you having trouble getting to sleep?
- Have you thought a lot about hurting yourself or someone else?
If Time Permits
- Tell me about a time when someone picked on you or made you feel uncomfortable online.
- Tell me about a time when you felt sad while using social media.
- Does it seem that you’ve lost interest in things that you used to really enjoy?
- Do you find yourself spending less time with friends?
- Would you rather just be by yourself most of the time?
- Have you ever tried to kill yourself?
- Have you ever had to hurt yourself (by cutting, for example) to calm down or feel better?
- Have you started using alcohol or drugs to help you relax, calm down, or feel better?
S
Safety
Determine safety at home, school, and during unstructured time
▾
Recommended Approach: Ask, “Have you ever made decisions that could have put you at risk of being harmed?” or “How do you decide if a person or situation is safe for you?”
Screen for:
- Seatbelt use, texting while driving, riding with impaired drivers
- Physical fights, carrying weapons
- Online safety (e.g., meeting internet acquaintances in person)
Interview Questions
First-Line Questions
- Have you ever been seriously injured? (How?) How about anyone else you know?
- Do you always wear a seatbelt in the car?
- Have you ever met in person (or plan to meet) with anyone whom you first encountered online?
- When was the last time you sent a text message while driving?
- Is there a lot of violence at your home or school? In your neighbourhood? Among your friends?
- Do you use safety equipment for sports and/or other physical activities?
If Time Permits
- Tell me about a time when you have ridden with a driver who was drunk or high. When? How often?
- Have you ever been in a car or motorcycle accident? (What happened?)
- Have you ever been picked on or bullied? Is that still a problem?
- Have you gotten into physical fights in school or your neighbourhood? Are you still getting into fights?
- Have you ever felt that you had to carry a knife, gun, or other weapon to protect yourself? Do you still feel that way?
- Have you ever been incarcerated?
✅ Closing the Interview
Clinical Tips for Wrapping Up
General Assessment
Ask the adolescent to provide an overall “weather report” of their life (e.g., sunny with a few clouds, cloudy with rain likely, rainy) or to describe what they see when they look in the mirror. Note that complaints of “boredom” can frequently indicate underlying depression.
Identify Support
Ask who they trust and confide in, and establish yourself as another trusted adult who can help.
Intervention & Education
If risk factors are identified, discuss potential follow-up and therapeutic interventions, as many youth view their risky behaviours as solutions rather than problems. If their life is going well, explicitly state that. Provide targeted health promotion materials — especially regarding sexual health and substance use — based on the interview.
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Yuh Good: Barbados Adolescent Health Hub @ 2026