Paeds · adolescent-and-young-adult-medicine
Adolescent consultation, HEEADSSS assessment and confidentiality
Also known as HEEADSSS interview · Adolescent psychosocial assessment · HEADSS assessment · Confidential adolescent consultation · Triadic adolescent interview
A fellowship approach to running the adolescent consultation: youth-friendly setup, rapport, time alone, conditional confidentiality with its lawful limits, a full HEEADSSS psychosocial assessment with validated screens, same-visit action on positive screens, and red-flag interrupts across clinic, ED, inpatient and telehealth settings.
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Target exams
Red flags
- Parent answers every question and refuses to leave; sensitive disclosure suppressed
- No confidentiality statement given, or a promise of absolute secrecy you cannot keep
- Positive depression or suicide-risk screen filed for delayed review without same-visit risk assessment
- Active suicidal intent disclosed and the clinician defers action to preserve secrecy
- Disclosure of abuse, assault or family violence
- Sensitive consultation exposed to a parent through the patient portal, itemised bill or pharmacy text
- Adolescent who looks well but has dangerous psychosocial risk hidden behind normal vitals
- Same-language family member used as interpreter for a sexual, substance or abuse disclosure
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Adolescent health and the psychosocial interview
- Current 2026 PREP curriculum — Learning Objective 1.2.1: Communicate with a child or young person in a way which is appropriate to the position of that child within their own culture
- Current 2026 PREP curriculum — Learning Objective 1.2.2: Communicate with parents or carers
- Current 2026 PREP curriculum — Learning Objective 2.4.2: Promote the health of young people, including health risk and health enhancement behaviours
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Renewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatrics
- Clinical Applications
- Adolescent medicine and the psychosocial interview
- Long Cases
- Short Cases
- Communication stations
- 2. Professional skills and knowledge: Communication
- 4. Professional skills and knowledge: Patient management
- 5. Health promotion and illness prevention
- 11. Adolescent health
- General Paediatrics: Provides developmentally appropriate care for young people including psychosocial assessment and confidential care within legal frameworks
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Adolescent health, communication and safeguarding
- History
- Communication
- Clinical
- Development
- General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
- General Pediatrics Content Outline — Domain 11: Adolescent Medicine and Gynecology
- General Pediatrics Content Outline — Domain 16: Mental and Behavioral Health
- General Pediatrics EPA 3: Providing well-child and adolescent care including preventive care and anticipatory guidance
- Patient Care 1: History and Physical Examination
- Patient Care 5: Patient Management
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Professionalism 1: Professional Behavior and Ethical Principles
- Professionalism 2: Accountability and Conscientiousness
- Communicator
- Collaborator
- Health Advocate
- Professional
- Pediatrics: Foundations EPA — Assessing and providing care for adolescents
Overview & Definition
A 15-year-old walks in with a parent for a "school medical." The parent starts to answer every question. If you let that continue, you will hear about growth and school, and you will miss the things that can kill this young person — depression, substance use, unsafe sex, abuse. The adolescent consultation is the structured encounter that prevents that miss. [1] [3]
The HEEADSSS assessment is a psychosocial interview that walks through the domains most likely to harbour risk in this age group: home, education and employment, eating, activities, drugs, sexuality, suicide and mood, and safety. It grew out of the original HEADSS instrument described by Cohen in 1991, which covered home, education, activities, drugs, sexuality and suicide. The extra "E" and "S" (eating and safety) are later expansions that many clinicians now use routinely. [1] [10]
Confidentiality in this setting is almost always conditional (sometimes called qualified). You promise to keep what the young person tells you private — except where there is serious risk of harm to themselves or others, where there is abuse, or where the law requires you to act. This promise is what makes the rest of the interview work. If an adolescent believes their parents will hear everything, they simply do not tell you the dangerous things. [2] [4]
The reason this matters in one sentence: most adolescent death and serious illness is preventable, and it is preventable in the conversation you have in this room. Suicide, injury, substance-related harm, unintended pregnancy and sexually transmitted infection are driven by behaviour and risk that a structured, confidential consultation can surface and shift. [1] [4]
What the consultation does
- 1
Creates trust
Greet the young person first; set a joint agenda before anything clinical.
- 2
Opens disclosure
Time alone plus a confidentiality line lets sensitive topics surface.
- 3
Surfaces risk
HEEADSSS walks every domain so none is skipped by accident.
- 4
Acts on risk
Positive screens get same-visit assessment, not a filed referral.
- 5
Builds a plan
Agree the plan with the adolescent, then rejoin the parent.
References17ShowHide
- [1]Cohen E HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. Journal of adolescent health : official publication of the Society for Adolescent Medicine, 1991.PMID 1772892
- [2]Ford CA Delivery of confidentiality assurances to adolescents by primary care physicians. Archives of pediatrics & adolescent medicine, 1997.PMID 9158445
- [3]Miller VA Adolescents Spending Time Alone With Pediatricians During Routine Visits: Perspectives of Parents in a Primary Care Clinic. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2018.PMID 29887486
- [4]Chung RJ Confidentiality in the Care of Adolescents: Policy Statement. Pediatrics, 2024.PMID 38646690
- [5]Mangione CM, Barry MJ, Nicholson WK, et al. Screening for Depression and Suicide Risk in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA, 2022.PMID 36219440
- [6]Knight JR Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of pediatrics & adolescent medicine, 2002.PMID 12038895
- [7]White PH Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics, 2018.PMID 30348754
- [8]McKay EA Parents' Perspectives on Confidentiality in Clinical Preventive Services for Adolescents. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2025.PMID 40580168
- [9]Pasternak RH 21st Century Cures Act ONC Rule: Implications for Adolescent Care and Confidentiality Protections. Pediatrics, 2023.PMID 37010402
- [10]Smyth M HEEADSSS Up: Evaluating the Efficacy of a Blank Proforma in the Use and Documentation of an Adolescent Psychosocial Risk Assessment Tool. Adolescent health, medicine and therapeutics, 2024.PMID 41030311
- [11]Wong JW Implementing the electronic HEEADSSS screening tool in a paediatric emergency department. Emergency medicine Australasia : EMJ, 2024.PMID 39327905
- [12]Waller D Psychosocial assessment of adolescents and young adults in paediatric hospital settings: patient and staff perspectives on implementation of the e-HEEADSSS. BMC health services research, 2023.PMID 37349759
- [13]Barrett C Adolescent Sexual Health: A Focus on the Sexual Health Portion of HEADSS Examination. Pediatrics in review, 2025.PMID 40306707
- [14]Adu-Gallant C Evaluation of tools to assess decision-making capacity in minor adolescents in clinical settings: a systematic review with narrative synthesis. BMC medical ethics, 2026.PMID 42363197
- [15]Katzman CL Adolescent Time Alone With a Provider: Adolescent-Mother Dyads' Perspectives on Its Role to Support Emerging Autonomy. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2025.PMID 40838902
- [16]Addison J HEADSS Up! Missed Opportunity for Psychosocial Screening in Hospitalized Adolescents. Hospital pediatrics, 2021.PMID 33789962
- [17]Klein JD Time Alone During Health Visits for Adolescents and Young Adults: Secondary Analysis of a Nonrepresentative Global Youth Consultation. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2026.PMID 42429696