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HEEADSSS: A Psychosocial Interview Format for Adolescents A Psychosocial Interv

HEEADSSS: A Psychosocial Interview Format for Adolescents A Psychosocial Interview Format for Adolescents Interview Questions Home & Environment Education & Employment Eating & Exercise Activities Drugs/Substances Sexuality Suicide/Depression Safety Adapted from Contemporary Pediatrics,, Getting into Adolescent Heads (July 1988), by John M. Goldenring, MD, MPH, & Eric Cohen, MD Background Adolescence is a challenging time when many emotional and physical changes take place. Most adolescents make it through their teenage years and enter adulthood without major trauma. However, for some teenagers this may be a very dangerous time of experimentation. Social Workers can play an important role in helping with this transition. Many social workers find it difficult to discuss sensitive issues with adolescents. HEADSSS is a screening tool to assess risks that can be used for all adolescents. It provides a systematic approach to the adolescent interview progressing from the least threatening topics to the most personal and sensitive subjects. The acronym stands for: Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/Depression, and Safety. This interview format is flexible and can be catered to all adolescents. The note a social worker strikes at the outset of the assessment interview may affect the entire outcome. Parents, family members, or other adults should not be present during the HEADSS assessment unless the adolescent specifically gives permission, or asks for it. Confidentiality It is not reasonable to expect an adolescent to discuss sensitive and personal information unless confidentiality can be assured. All adolescents and families, including caregivers (most commonly a parent or both parents), should be told about confidentiality at the beginning of the interview. Each social worker must determine the nature of his/her own confidentiality statement. Belief Systems As a social work practitioner your own set of beliefs, based on your knowledge, experience, and level of tolerance in dealing with particular situations will set the standard in providing developmentally-appropriate care to youth and their families. Social work practitioners interfacing with youth may be confronted with difficult situations where this particular belief HEEADSSS Adolescent Psychosocial Assessment Guide | 2 system may be “tested”, if not challenged. Social workers should be prepared to engage with youth in a non-judgmental manner. Based on particular individual belief systems, these are some “assumptions” that many of us may have about youth:  youth live in a home with two parents  all youth go to school and get along with peers and teachers  all youth are heterosexual It is of significant importance not to “assume”, but rather to ask non-judgmental questions in a respectful, caring fashion. Starting the Interview A. Introduction: Set the stage by introducing yourself to the youth and parents. Suggestion -- If the parents are present before the interview, always introduce yourself to the adolescent first. In fact, ask the adolescent to introduce you to the other people in the room. This gives the adolescent a clear message that you are interested in him/her. B. Understanding of Confidentiality: Ask either the parents or the youth to explain their understanding of confidentiality and the limits therein. C. Confidentiality Statement: After the youth and family have given you their views on confidentiality, acknowledge their responses and add your views accordingly (confidentiality statement), based on the particular situation. Interview Elements: Home Opening Lines: (Less/More) Developmentally-Appropriate Home Less More Reason Tell me about mom and dad. Where do you live, and who lives there with you? Parent(s) may have separated, divorced, died, or left the home. Open-ended question enables one to collect “environmental” as well as personal history. Examples of POSSIBLE Questions  Who lives at home with you? Where do you live? How long? Do you have your own room?  How many brothers and sisters do you have and what are their ages? Are your brothers and sisters healthy?  Are there any new people living in your home?  Are your parents healthy? What do your parents do for a living?  What are the rules like at home? HEEADSSS Adolescent Psychosocial Assessment Guide | 3  How do you get along with your parents, your siblings? What kinds of things do you and your family argue about the most? What happens in the house when there is a disagreement?  Is there anything you would like to change about your family? Asking about parental abuse or substance use (also see Drugs section) may be difficult. Using a scenario may facilitate this line of questioning, i.e. “Working with youth I have learned from some ‘kids’ that their relationship with their parents is a difficult one; by this I mean they argue and fight. Some youth have told me that 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?” Interview Elements: Education & Employment Opening Lines: (Less/More) Developmentally-Appropriate Education & Employment Less More Reason How are you doing in school? Are you in school? What are you good at in school? What is hard for you? What grades do you get? Poor questions can be answered “okay”. Open- ended question ask for information about strengths and weaknesses and allow for quantification / objectification. Examples of POSSIBLE Questions  Which school do you go to? What grade are you in? Any recent changes in schools?  What do you like best and least about school? Favorite subjects? Worst subjects?  What were your most recent grades? Are these the same or different from the past? Have you ever failed or repeated any years?  How many hours of homework do you do daily?  How much school did you miss last/this year? Do you skip classes? Have you ever been suspended?  What do you want to do when you finish school? Any future plans/goals?  Do you work know? How much? Have you worked in the past?  How do you get along with teachers, employers?  How do you get along with your peers? Inquire about “bullying”. HEEADSSS Adolescent Psychosocial Assessment Guide | 4 Interview Elements: Eating & Exercise Opening Lines: (Less/More) Developmentally-Appropriate Eating & Exercise Less More Reason Do you have any struggles with eating or body image? How would you describe your eating habits? Does your weight or body image cause you any stress? Poor questions can be shrugged aside. Open- ended question allow you to explore possible eating disordered behavior or body-related self- esteem problems in a non-threatening way. Examples of POSSIBLE Questions  What do you like and not like about your body?  Have there been any recent changes in your weight or body?  Tell me about any exercise that you do or get in your daily routine.  What do you think would be a healthy diet? How does that compare with your current eating patterns?  What would it be like if you gained/lost 10 pounds?  Have you ever taken body pills or supplements that you hoped would bring about changes in your body? Interview Elements: Activities Opening Lines: (Less/More) Developmentally-Appropriate Activities Less More Reason Do you have any activities outside of school? What do you do for fun? What things do you do with friends? What do you do with your free time? Good questions are open-ended and allow youth to express him/herself. Examples of POSSIBLE Questions  Are most of your friends from school or somewhere else? Are they the same age as you?  Do you hang out with mainly people of your same sex or a mixed crowd?  Do you have one best friend or a few friends? Do you have a lot of friends?  Do you spend time with your family? What do you do with your family?  Do you see your friends at school and on weekends, too? Are there a lot of parties?  Do you do any regular sport or exercise? Hobbies or interests?  Do you have a religious affiliation, belong to a church, or practice some kind of spiritual belief?  How much TV do you watch? What are your favorite shows?  Do you read for fun? What do you read?  What is your favorite type of music? Favorite band? HEEADSSS Adolescent Psychosocial Assessment Guide | 5  Do you have a car – use seat belts?  Have you ever been involved with the police? Have you ever been charged? Do you belong to a group/gang? Interview Elements: Drugs & Substances Opening Lines: (Less/More) Developmentally-Appropriate Drugs, Substances Less More Reason Do you do drugs? Some young people experiment with drugs, alcohol, or cigarettes. Have you or your friends ever tried them? What have you tried? Good question is an expression of concern with specific follow-up. With younger teens, it is best to begin by asking about friends. Examples of POSSIBLE Questions  When you go out with your friends or to party, do most of the people that you hang out with drink or smoke? Do you? How much and how often?  Do any of your family members drink, smoke or uploads/Management/ heeadsss-assessment-guide-usu.pdf