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Clinical Framework: PACES

PACES is a structured mnemonic for adolescent psychosocial assessment. Its five domains — Parents/Peers, Accidents/Alcohol/Drugs, Cigarettes, Emotional Issues, and School/Sexuality — provide a concise and reproducible framework for identifying risks and supports in adolescent patients. PACES is used as a rapid screen or as a complement to the more comprehensive HEEADSSS framework. Always conduct the interview privately to encourage honest disclosure and respect the adolescent's developing autonomy. Self-esteem, peer pressure, and family tension all affect willingness to share — maintain a nonjudgmental, flexible approach and build trust before approaching sensitive topics.

PACES — Adolescent Psychosocial Assessment

PACES is a structured mnemonic for adolescent psychosocial assessment, used as an alternative or complement to HEEADSSS. It covers five core domains: Parents/Peers, Accidents/Alcohol/Drugs, Cigarettes, Emotional Issues, and School/Sexuality. Its shorter format is useful for rapid screening or when time is limited. As with all adolescent assessments, conduct privately to encourage honest responses.

PACES domains

P

Parents / Peers

Family relationships, peer influence

A

Accidents / Alcohol / Drugs

Injury history, substance use

C

Cigarettes

Tobacco and vaping use

E

Emotional Issues

Mood, depression, self-harm, safety

S

School / Sexuality

Academic performance, relationships

Safety first: Suicidal ideation, abuse, or imminent safety concerns trigger mandatory reporting and immediate provider notification regardless of confidentiality.

Who do you live with? How are things at home? Who are your closest friends? Do you feel pressure from friends to do things you're not comfortable with?

Have you been in any accidents or injuries recently? Do you drink alcohol? Have you used marijuana, vaping, or other drugs? How often?

Do you smoke cigarettes or use any tobacco products? Have you ever tried vaping or e-cigarettes? How often and for how long?

How have you been feeling lately — happy, sad, anxious, angry? Have you ever felt like hurting yourself or that life wasn't worth living? Do you feel safe?

How is school going? Passing your classes? Are you in a relationship? Do you have questions about sex, identity, or orientation? Are you sexually active?