HEADSS Psychosocial Assessment Tool for Adolescents
- Where do you live?
- Who do you live with?
- How much time do you spend at home?
- What do you and your family argue about?
- Can you go to your parents with problems?
- Have you ever run away from home?
- What grade are you in?
- What grades are you getting? Have they changed?
- Have you ever failed any classes or been kept back a grade?
- Do you ever cut classes?
- Have you ever been teased or attacked at school?
- Do you work after school or on weekends?
- What are your career/vocational goals?
- What do you do for fun?
- What activities do you do during and after school?
- Are you active in sports? Do you exercise?
- Who do you do fun things with?
- Who are your friends?
- Who do you go to with problems?
- What do you do on weekends? Evenings?
- Do you drink coffee or tea?
- Do you smoke cigarettes? Have you ever smoked one?
- Have you ever tried alcohol? When? What kind and how often?
- Do any of your friends drink or use drugs?
- What drugs have you tried? Have you ever injected steroids or drugs?
- When? How often do you use them?
- How do you get money to pay for drugs?
- Are drugs used or available in places where you hang out?
- Do you feel you are ready for sex?
- Have you chosen to remain abstinent?
- Have you ever had sex?
- How many sexual partners have you had?
- How old were you when you first had sex? How old was your partner?
- Have you ever had sex with men? Women? Both?
- Do you think you might be lesbian, gay, or bisexual?
- Do you think you need to have sex to find out if you're lesbian, gay, or bisexual?
- Do you want to become pregnant? Have you ever been pregnant?
- Have you ever had an infection as a result of having sex?
- Do you use condoms or another form of contraception for STD and HIV prevention?
- Have you ever had sex unwillingly?
- Have you ever tried sex for money, drugs, clothes, or a place to stay?
- Have you ever been tested for HIV? Do you think it would be a good idea to be tested?
- How do you feel today, on a scale of 0 - 10 (0 = very sad, 10 = very happy)?
- Have you ever felt less than a 5? How long did that feeling last?
- What made you feel that way?
- Does thinking you may be lesbian, gay, or bisexual make you feel that way?
- Did you ever think about hurting yourself or that life isn't worth living, or hope that when you go to sleep you won't wake up?
Adapted with permission, from Goldering JM, Cohen EH: Getting into an adolescent's H.E.A.D.S. Contemporary Pediatrics 1998; 5:7, and Ryan C, Futterman D. Lesbian and Gay Youth: Care and Counseling. Columbia University Press. 1998.