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Clinical Framework: HEEADSSS

HEEADSSS is the standard structured mnemonic for comprehensive psychosocial assessment of adolescents. It covers the eight domains most predictive of adolescent health outcomes: Home, Education, Eating, Activities/Affect/Ambitions, Drugs, Sexuality, Suicide/Depression, and Safety. Always conduct the interview privately (without a parent or guardian present) to encourage honest disclosure and respect the adolescent's developing autonomy. Build rapport through the earlier, less threatening domains before approaching sensitive topics. Document only what is clinically relevant; maintain confidentiality unless a safety concern arises.

HEEADSSS — Adolescent Psychosocial Assessment

A structured interview framework for comprehensive psychosocial assessment of adolescents (ages 12–21). HEEADSSS covers: Home, Education, Eating, Activities/Affect/Anger/Ambitions, Drugs, Sexuality, Suicide/Depression, and Safety. This tool is not scored — it is a structured conversation guide. Always conduct this interview with the adolescent alone (without parents or guardians) after explaining confidentiality and its limits.

Interview Guidance

Begin with less sensitive domains (Home, Education) to build rapport before moving to more sensitive areas (Drugs, Sexuality, Suicide). Use open-ended, non-judgmental language. Explain confidentiality at the start — what you will keep private and the specific limits (imminent harm to self or others). Respect the adolescent's autonomy while maintaining a safe clinical relationship.

H — Home Environment

Assess the adolescent's home and family situation. Who lives at home? Are relationships stable and supportive? Any recent changes (divorce, new partner, moves, loss)?

Suggested questions / prompts:

  • Who do you live with?
  • How are things at home? Any major changes recently?
  • Do you feel safe at home?
  • How do you get along with your parents/guardians?
E — Education and Employment

Explore school performance, attendance, learning difficulties, and future goals. For working adolescents, assess hours worked and impact on sleep and school.

Suggested questions / prompts:

  • How are things going at school?
  • Any changes in grades or attendance?
  • Do you have any learning difficulties?
  • What are your plans after school?
  • Do you work? How many hours?
E — Eating

Screen for disordered eating, body image concerns, and nutritional adequacy. Adolescents are at risk for both under-nutrition and obesity.

Suggested questions / prompts:

  • How do you feel about your weight and body?
  • Have you ever tried to lose or gain weight in unusual ways?
  • Are there foods you avoid or restrictions you follow?
  • Consider SCOFF questionnaire if eating disorder is suspected.
A — Activities, Affect, Anger, Ambitions

Assess peer relationships, hobbies, screen time, emotional regulation, conflict management, and future ambitions. Affect and anger management are important mental health indicators.

Suggested questions / prompts:

  • What do you enjoy doing in your free time?
  • Tell me about your friends — who do you spend time with?
  • How do you handle anger or frustration?
  • Do you have any dreams or goals for your future?
  • Have you noticed changes in your mood or energy?
D — Drugs

Screen for tobacco, alcohol, cannabis, and other substance use. The CRAFFT questionnaire is validated for ages 12–21. Ensure the adolescent is alone before asking.

Suggested questions / prompts:

  • Have you ever used tobacco, alcohol, or other drugs?
  • Do any of your friends use drugs or alcohol?
  • Consider CRAFFT questionnaire for comprehensive substance use screening.
  • If positive CRAFFT: assess frequency, quantity, context, consequences.
S — Sexuality

Ask about sexual development, orientation, activity, and sexual health in a non-judgmental, gender-neutral way. Assess contraception, STI prevention, and reproductive concerns.

Suggested questions / prompts:

  • Are you attracted to guys, girls, or both? (gender-neutral opener)
  • Are you currently in a romantic relationship?
  • Are you sexually active?
  • Are you using contraception or protection against STIs?
  • Any concerns about your sexual health or development?
S — Suicide/Depression/Self-Harm

Screen directly for depression, self-harm, suicidal ideation, plan, and means. Do not avoid this topic — direct questioning does not increase suicide risk. Consider PHQ-9 if depression is suspected.

Suggested questions / prompts:

  • Have you ever felt so sad or hopeless that you stopped doing the things you usually enjoy?
  • Have you ever hurt yourself on purpose?
  • Have you ever thought about suicide or wished you were dead?
  • If yes: Have you made a plan? Do you have access to means?
  • Consider PHQ-9 or PHQ-2 for depression screening.
S — Safety

Assess safety in multiple domains: home, peers, online, driving, and community. Screen for violence exposure, bullying, and physical safety risks.

Suggested questions / prompts:

  • Do you wear a seatbelt? Do you ever ride with impaired drivers?
  • Have you ever been in a fight or experienced bullying (in person or online)?
  • Do you feel safe in your neighbourhood and at school?
  • Is there a gun in your home? Is it locked?
  • Are you safe from people who may want to hurt you?