Psychosocial Assessment
Getting a Good HEADSS Start
The HEADSS (Home, Education, Activities, Drug use and abuse, Sexual behavior, Suicidality and depression) interview is a quick and effective tool for examining the important spheres of adolescence (eg, home, school, peers, and self) that affect health. The HEADSS interview and physical exam should, whenever possible, occur with the provider and patient only; however, some youth--particularly AI/AN adolescents--may want family members involved in the discussion. When speaking with adolescents about their health, remember:
- Youth do not always ask the questions to which they want answers.
Instead, many hope their provider will bring up the issues they are concerned about. That is why the HEADSS interview is such an important tool for identifying problems that should be addressed. - Youth run the spectrum in terms of being very comfortable talking about everything to being extremely guarded.
It is useful to preface the HEADSS questionnaire by informing patients that you will be asking some very personal questions as a way of getting to know them better and identifying issues that may require further evaluation by physical examination, laboratory testing, or educational counseling. Give them permission to refrain from answering questions they are uncomfortable with. - Youth are more likely to be concrete thinkers than abstract thinkers.
To ensure that patients understand the health information you provide, ask them to restate the information in their own words. Encourage patients to call your office if questions arise after the visit, and assure them that no question is silly. - Youth may hold values and beliefs that influence their behavior or limit the information they provide you.
A young patient may have been taught that it is not proper to discuss certain "private" matters outside the home. It may be necessary to reassure patients multiple times of your confidentiality policies and to encourage them to let you know when they have concerns about the questions being asked. It can be helpful to explain why certain questions are asked. Make sure that youth understand your definitions of behaviors such as "sex." Some youth may think of sex as involving only vaginal intercourse. Thus, it is important to be specific.
HEADSS TIP:
A useful approach to eliciting information from adolescent patients about personal issues such as sex or drugs is to begin the conversation with a general query on the topic, then slowly move to questions about other youth, followed by questions about their identified peer group, and finally themselves. For example, "A lot of young people your age have tried cigarettes. What do you think about cigarettes?" "Do any of the kids at your school smoke?" Do any of your close friends smoke?" "Have you ever tried to smoke?"
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