Paeds · adolescent-and-young-adult-medicine
Adolescent risk assessment and harm minimisation
Also known as Adolescent harm reduction · Youth risk screening · SBIRT in adolescents · HEEADSSS risk assessment · Harm minimisation in young people · Adolescent risk formulation
A fellowship approach to assessing adolescent risk across all domains and applying harm-minimisation principles: structured screening, risk formulation, brief intervention, and pragmatic domain-specific harm reduction that meets young people where they are across ANZ, UK, US and Canada.
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Target exams
Red flags
- Active suicidal plan, intent, access to means, or recent attempt
- Opioid or other overdose, reduced consciousness, or respiratory compromise
- Disclosure of ongoing abuse, sexual assault, exploitation or trafficking
- Medical instability from intoxication, self-harm, or severe restriction
- Acute psychosis, severe agitation, or inability to keep safe
- Injecting drug use with shared equipment or escalating opioid exposure
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Adolescent health and psychosocial risk assessment
- 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
- 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 6: Clinical management – 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, risk assessment and harm reduction
- 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: Assesses risk and applies harm-minimisation principles for young people across substance, mental-health, sexual and injury domains
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Adolescent health, safeguarding and risk
- History
- Communication
- Clinical
- 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: Applying SBIRT and harm-reduction counselling for adolescent risk
- Patient Care 5: Patient Management
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Systems-Based Practice 3: System Navigation for Patient Centered Care – Coordination of Care
- Professionalism 1: Professional Behavior and Ethical Principles
- Communicator
- Health Advocate
- Professional
- Pediatrics: Foundations EPA — Assessing and providing care for adolescents including harm reduction
- Pediatrics: Core EPA — Providing preventive care and risk-reduction counselling
Overview & Definition
A registrar sees a 16-year-old for a sports check. Vaping is "just social," mood is "fine," and the visit closes in eight minutes. Six weeks later the same teenager is in resus after a fentanyl overdose. The missed work was not a rare diagnosis. It was risk that nobody asked about, and a plan that demanded abstinence the young person could not yet give. [5] [7]
Adolescent risk assessment is structured inquiry across the domains that actually drive morbidity and mortality in young people — substance use, mental health and suicide, sexual and reproductive health, injury and violence, digital exposure, and social determinants. HEADSS (and its HEEADSSS expansion) is the interview framework; validated instruments are the adjuncts that sharpen specific domains. [1] [2]
Harm minimisation (often called harm reduction) is a pragmatic public-health stance: reduce the adverse consequences of a risk behaviour even when the behaviour itself continues. It does not abandon abstinence as one possible goal — it stops treating abstinence as the only acceptable outcome, because that stance pushes away the young people at greatest risk. [5] [7]
The clinical skill is the marriage of the two: assess risk thoroughly, then meet the young person at their readiness with a response that lowers harm today while keeping the door open for bigger change later. [4] [8]
Core sequence of risk assessment and harm minimisation
- 1
Engage
Youth-friendly, time alone, conditional confidentiality, non-judgemental stance.
- 2
Assess
HEADSS/HEEADSSS plus validated screens where a lead appears.
- 3
Formulate
Integrate into a risk tier: universal, selected, or indicated.
- 4
Brief intervention
Motivational interviewing; personalised feedback; explore readiness.
- 5
Harm-reduction bundle
Pragmatic, domain-specific: naloxone, condoms, cut-down, means restriction.
- 6
Follow-up
Safety plan, low-threshold re-access, timed review, build transition.
References12ShowHide
- [1]Cohen E, Mackenzie RG, Yates GL 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]Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of pediatrics & adolescent medicine, 2002.PMID 12038895
- [3]Steinberg L A Social Neuroscience Perspective on Adolescent Risk-Taking. Developmental review : DR, 2008.PMID 18509515
- [4]Levy SJ, Williams JF Substance Use Screening, Brief Intervention, and Referral to Treatment. Pediatrics, 2016.PMID 27325634
- [5]Kimmel SD, Gaeta JM, Hadland SE, Hallett E, Marshall BDL Principles of Harm Reduction for Young People Who Use Drugs. Pediatrics, 2021.PMID 33386326
- [6]Bagley SM, Hadland SE, Schoenberger SF, Gai MJ, Topp D, Hallett E Integrating substance use care into primary care for adolescents and young adults: Lessons learned. Journal of substance abuse treatment, 2021.PMID 34080547
- [7]Winer JM, Yule AM, Hadland SE, Bagley SM Addressing adolescent substance use with a public health prevention framework: the case for harm reduction. Annals of medicine, 2022.PMID 35900132
- [8]Cushing CC, Jensen CD, Miller MB, Leffingwell TR Meta-analysis of motivational interviewing for adolescent health behavior: efficacy beyond substance use. Journal of consulting and clinical psychology, 2014.PMID 24841861
- [9]Chadi N, Hadland SE Youth Access to Naloxone: The Next Frontier? The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2019.PMID 31648752
- [10]MacArthur GJ, van Velzen E, Palmateer N, Kimber J, Pharris A, Hope V Interventions to prevent HIV and Hepatitis C in people who inject drugs: a review of reviews to assess evidence of effectiveness. The International journal on drug policy, 2014.PMID 23973009
- [11]Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department. Archives of pediatrics & adolescent medicine, 2012.PMID 23027429
- [12]Brent DA, Horowitz LM, Grupp-Phelan J, Bridge JA, Gibbons R, Chernick LS Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments. JAMA network open, 2023.PMID 36790810