HEEADSSS is a psychosocial interview for adolescents: Home, Education and employment, Eating, Activities, Drugs, Sexuality, Suicide and depression, and Safety. Copy the free template, see two filled examples, and check what to cover in each part, starting with confidentiality.
Blank HEEADSSS assessment template
FreeHEEADSSS ASSESSMENT Patient: [Name] Age: [Age in years] Date of visit: [Date] Clinician: [Name, credentials] Seen alone: [Yes or no, and for how long] Parent or caregiver present for: [Parts of the visit, such as the history and the plan] CONFIDENTIALITY Explained to: [Adolescent, parent or caregiver, or both] Limits explained: [Serious risk of harm to self or others, abuse, and what the law requires you to report] Adolescent's understanding: [Agreed, and any questions] HOME Living situation: [Who lives at home, and any recent moves or changes] Relationships: [How they get along, conflict, who they can talk to] Concerns: [Violence at home, housing, or food worries] EDUCATION AND EMPLOYMENT School: [Grade, attendance, performance, recent changes] At school: [Friends, bullying, connection with teachers] Work and plans: [Job and hours, plans after school] EATING Eating pattern: [Meals, skipped meals, dieting] Body image: [How they feel about their weight and shape] Concerning behaviors: [Restricting, bingeing, purging, or excessive exercise] Growth: [Weight, height, BMI percentile] ACTIVITIES Interests: [Sports, hobbies, clubs, faith, time with friends] Screens and sleep: [Hours online, devices at night, hours of sleep] DRUGS Substance use: [Tobacco, vaping, alcohol, cannabis, other drugs; use by friends and family] Screening tool: [Such as the CRAFFT or S2BI, with result] SEXUALITY Identity and relationships: [Sexual orientation and gender identity if shared, current relationships] Sexual activity: [Ever sexually active, partners, consent, any pressure] Sexual health: [Condoms, contraception, STI testing, pregnancy concerns, HPV vaccine] SUICIDE AND DEPRESSION Mood: [Low mood, irritability, anxiety, sleep, loss of interest] Screening tool: [Such as the PHQ-A or ASQ, with result] Self-harm and suicidal thoughts: [Ever and recent, intent, plan, past attempts] Risk level: [Low, moderate, or high, with reasoning] SAFETY Injury prevention: [Seatbelts, helmets, driving, riding with impaired drivers] Violence and abuse: [Fighting, bullying, dating violence, abuse, firearms at home and how stored] Online safety: [Contact with strangers, sharing images, cyberbullying, exploitation] STRENGTHS Strengths and supports: [What the adolescent is good at or proud of, and trusted adults] SUMMARY Key concerns: [Main problems or risks identified] Overall picture: [How the concerns and strengths fit together, and the level of concern] PLAN Counseling given: [Topics discussed, and the adolescent's response] Referrals: [Mental health, sexual health, school support, or other] Safety plan: [If needed: warning signs, coping steps, contacts, emergency steps] Shared with parent or caregiver: [What, with the adolescent's agreement] Follow-up: [When, and how to reach the clinic confidentially] Signed: [Clinician name, credentials, date and time]
Use it for
Each one follows the template. Use them to judge how much detail every part needs.
Pediatric clinic, annual checkup
Annual checkup, 15-year-old boy. Confidentiality and its limits explained to him and his mother together: what he says stays private unless someone is at serious risk of harm. Mother present for the history and the plan; seen alone for 15 minutes. He had no questions.
Lives with his mother, stepfather, and 11-year-old sister; gets on well with all of them, closest to his mother. No violence at home. Grade 10, mostly Bs, enjoys science; no missed days this year. Steady group of friends; no bullying. Works 6 hours a week at a grocery store.
Eats 3 meals most days; skips breakfast twice a week. Happy with his body; no dieting, bingeing, or vomiting. Weight 59 kg (130 lb), height 172 cm (68 in), BMI near the 50th percentile. Plays on the school soccer team. About 3 hours a day of gaming and video; phone in his room at night; sleeps about 7 hours on school nights.
Tried a nicotine vape twice at a party 3 months ago, none since. No alcohol, cannabis, or other drugs. Some friends vape. S2BI: nicotine once or twice in the past year; no other use.
Has not had sex. Attracted to girls; not in a relationship. Knows where to get condoms and contraception. HPV vaccine series complete.
Mood good; enjoys school and soccer. PHQ-A 3. No self-harm and no suicidal thoughts, now or in the past.
Always wears a seatbelt; wears a bike helmet “sometimes.” No fighting or bullying. No firearms at home. Plays online games with people he hasn’t met; doesn’t share photos or personal details, and knows how to block and report.
Strengths: close to his mother, steady friends, proud of making the team. Summary: healthy 15-year-old at low psychosocial risk. To address: vaping experimentation, screen time and sleep, and helmet use.
Brief advice: praised him for stopping vaping, and discussed how nicotine dependence develops. He agreed to charge his phone outside his room on school nights and to wear a helmet. Shared with his mother, with his agreement: healthy overall, plus the sleep and helmet goals. Told he can contact the clinic on his own, in confidence, within the limits explained. Next checkup in 1 year.
Pediatric clinic, visit for falling grades
17-year-old girl, brought by her father for falling grades. Confidentiality and its limits explained to both: private unless she or someone else is at risk of serious harm, or abuse is disclosed. Father present for the history and the plan; seen alone for 25 minutes.
Parents separated 4 months ago; she splits the week between their homes. Close to her father; arguing more with her mother. No violence at home. Grade 12; grades down from mostly As to Cs over 3 months, with 6 days missed this semester. Quit her part-time job. Worried about applying to nursing programs.
Less appetite; often skips lunch. Weight 54 kg (119 lb), down 2 kg (4 lb) since her visit 6 months ago. Not trying to lose weight; no bingeing or purging. Quit dance 2 months ago. On her phone in bed until about 2 a.m.; sleeps 5 hours on school nights.
Alcohol at 2 parties in the past 3 months, 3 drinks each time. No cannabis, vaping, or other drugs. CRAFFT 1.
Boyfriend of 6 months, same age; she describes the relationship as safe and consensual. Sexually active; condoms most of the time, no other contraception. Last period 2 weeks ago. Interested in contraception.
Low mood and irritability most days for 2 months, with loss of interest, tiredness, and poor concentration. PHQ-A 14. ASQ positive, non-acute: fleeting passive thoughts of not wanting to be alive, a few times in the past 2 weeks, none today. No intent, plan, self-harm, or past attempts. Brief suicide safety assessment: low risk. Protective factors: close to her father and a cousin, wants to study nursing, willing to get help.
No firearms at either home, confirmed with her father. Wears a seatbelt; doesn’t ride with drivers who have been drinking. No dating violence. Online: hurtful comments in a group chat after a falling-out with friends; no threats, no images shared; knows how to block and report.
Strengths: insightful, close to her father and cousin, clear goals. Summary: 2 months of depressive symptoms after her parents’ separation, with falling grades, poor sleep, online conflict, and passive suicidal thoughts. Low suicide risk with strong protective factors. Also needs contraception and alcohol counseling.
Safety plan written with her: warning signs, coping steps, people to contact, the clinic number, and to call 911 or go to the nearest emergency department if she feels unsafe. With her agreement, means safety reviewed with her father: medications locked away at both homes. Referral to the clinic’s mental health counselor for CBT, first visit within 1 week. No medication for now; reconsider if therapy doesn’t help. With her consent, letter to the school counselor about academic support. Agreed to charge her phone outside her room at night. Advised against alcohol, especially while low. Urine test for chlamydia and gonorrhea; contraception visit booked. Shared with her father, with her agreement: low mood, the safety plan, and follow-up, but not her sexual health. Follow-up in 1 week to recheck mood and safety; PHQ-A again in 4 weeks.
Explain confidentiality and its limits to the adolescent and the parent together, then see the adolescent alone.
Avoid: Promising total confidentiality. If you later have to break it, the adolescent may stop trusting care.
An easy place to start, and often a revealing one.
Avoid: Assuming a family structure. Ask who lives at home instead of asking about “your mom and dad.”
Use, frequency, and context, asked without judgment, with a validated screen when you can.
Avoid: Stopping at “no drugs.” Ask about vaping and cannabis by name, because many teens don’t count them.
Sexual health, relationships, and identity, asked in neutral, inclusive words.
Avoid: Assuming heterosexuality. Use words like “partner” until the adolescent tells you more.
Ask directly about mood and suicidal thoughts. Asking does not put the idea in their head.
Avoid: A positive screen with no follow-up assessment. Record the further questions you asked and what you decided.
Risks of injury and violence, in person and online.
Avoid: Skipping online safety. Much adolescent risk, from bullying to exploitation, now starts on a phone.
Adolescents rarely talk about substances, sex, or suicidal thoughts in front of a parent. Explain the plan to both, see the adolescent alone for part of the visit, and record that you did.
Follow the order: home and school first, sensitive topics later. It builds rapport and makes honest answers more likely.
Don’t assume family structure, a partner’s gender, or that a good student has no risks. Ask every adolescent the same questions.
A positive PHQ-A, ASQ, or CRAFFT needs a documented next step: further assessment, a safety plan, or a referral, with a follow-up date.
Write down what the adolescent agreed to share with a parent and what stays confidential, so the next clinician doesn’t disclose it by mistake.
Vero Scribe writes the HEEADSSS assessment in your template from the visit conversation, with consent, or from your dictation after the visit. You decide what goes in the record, edit the draft, and copy it into your EHR.
Home, Education and employment, Eating, Activities, Drugs, Sexuality, Suicide and depression, and Safety. It is a psychosocial interview for adolescents that moves from less sensitive topics to more sensitive ones.
HEADSS is the original version, from the late 1980s. HEADSSS adds Safety, and HEEADSSS adds Eating and Safety. A 2014 update, HEEADSSS 3.0, added questions about social media and online life.
Explain confidentiality to the adolescent and parent together, then do the interview with the adolescent alone. Bring the parent back for the plan, after agreeing with the adolescent what will be shared.
Many clinicians start in early adolescence, around 11 or 12, and repeat it at least yearly and whenever there is a new concern. Adapt the wording to the adolescent’s age and development.
The tool and the result, the further questions you asked, your risk judgment with the reasons, and the next step: a safety plan, a referral, or a follow-up date. The 17-year-old example shows each step.
Yes. Copy it, or download it as a Word or text file. No account needed.
The sick-visit SOAP note for children, with caregiver history, hydration, and weight-based doses.
Growth, development, screening, vaccines, and safety guidance, with 12-month and 5-year examples.
Birth history, feeding and weight change, the full newborn exam, jaundice, and newborn screens.
The full pediatric history and exam for an admission or a new patient, from birth history to plan.
Capture complex adolescent visits and keep follow-up visible.
Child and caregiver conversations, drafted into pediatric notes.
Note templates for well-child visits, adult follow-ups, and older adults.
The codes used most often in pediatrics.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
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