Supplemental Background Information for the WebPatientEncounter
Pediatrics Clerkship
The Psychosocial interview (aka the “HEADS” assessment)
A. Setting the stage for optimal communication
1) The psychosocial interview is designed to elicit extremely personal and intimate
information, which may not be expected from the patient.
2) Setting the stage will allow for information to be closer to the truth.
3) The patient will not disclose personal information without having a sense of the
following issues:
a. Why is the provider asking personal questions?
b. What will they do with the answers? Will they judge me or share my secrets?
c. Is it worth sharing such private information? Can this person do anything to
help me?
d. Limits of confidentiality: Prior to starting, give confidentiality statement: for
example, “All of the things we talk about alone stay private, that means I will
not tell your parents anything we talk about. But if your life is in danger
because you were going to hurt yourself or someone else or if you were being
abused, you and I would have to work together and get other people involved
to keep you safe”.
B. Once the stage has been set, the interview can begin.
a. Best if teen alone (e.g., parent in waiting room).
b. Parent may be more likely to allow for private time if you emphasize the
importance of parental participation in the beginning of the visit and
remember to elicit parental concerns before they leave the room.
C. Other counseling tips
1) Proceed from general, less intimate topics (eg, school) to more personal (eg, sex)
2) Be non-judgmental; try not to express shock/dismay (may disrupt full disclosure)
3) Be careful to avoid yes/no questions
4) Get most “therapeutic” history, not the most thorough
5) Listen for what they are doing right (What do you admire or respect about them?)
a. e.g. a high risk teen whose behavior you don’t agree with may have been
“honest” or “loyal” or “a survivor”
D. The “SSHADESS” assessment
 The following are examples of questions to ask. There are other ways to ask these
questions, and not every question within each category would necessarily be
asked in a single patient encounter.
S: Strengths – Tell me about yourself. How would you describe yourself? What do
you like about yourself? What are your strengths?
Supplemental Background Information for the WebPatientEncounter
Pediatrics Clerkship
S: School - Grade, school name, grades, what are they doing to improve, what are
their plans for after finishing school, ever skipped/repeated grade level,
suspensions (Note: Teens with no future goals or plans may not believe they
have a future and are at high risk for substance use/depression/suicide.)
H: Home - Family composition (who lives at home with you?), any other living
situations (foster home, juvenile detention, step parents, grandparents), family
violence assessment (how do you resolve arguments in your family? Does it
ever get physical?)
A: Activities - Peer relationships, exercise, hobbies. What do you do for fun? (Note:
A teen with nothing to do is more likely to fill their time with negative
behaviors)
D: Drugs - Ever smoked cigarettes? Drank alcohol? Smoked marijuana/weed? Ever
thought about quitting? If yes, do cessation counseling. If no, give quit
message, motivational interviewing statements. If never tried substances, ask
why and congratulate on smart decision.
E: Emotions - In terms of your mood, are you usually happy, sad or a bit of both?
Who can you talk to when you are feeling down? When you have a bad day,
what do you do? It is normal to feel sad sometimes…have you ever felt so sad
that you thought you might be depressed?...wanted to hurt yourself?...wanted to
kill yourself? Has anyone in the family committed suicide?
S: Sexual activity - Extremely important to approach this subject with no
preconceptions of level of sexual activity or of sexual orientation. Some teens
resent adult assumptions that they have had sex.
Questions may include: In terms of your sexuality, are you mostly
attracted to boys, girls, both or neither? Have you ever been in a relationship
before? Have you begun dating? Are you currently seeing someone? What is the
person like? Have you begun to become sexual with that person, by this I mean
hugging, kissing or even touching in private places? What do you think makes a
person ready for sex? Have you had sex with this or any other person? Have you
ever had sex before…has it been with men, women, both? Ever had an STD?
Ever been tested for an STD? Ask if they want to be tested, discuss confidential
visit.
Supplemental Background Information for the WebPatientEncounter
Pediatrics Clerkship
S: Safety - Interpersonal violence is primary concern. Many youth believe that
carrying a weapon will protect them without considering that it puts them at
much greater risk of death.
“Do you feel safe at school?” “Are there a lot of fights at your school?”
“Do people bring weapons to school?” “Do you get in fights” “What
makes you mad enough to fight?” “Are you able to walk away from fights,
how do you do that?” “What do you usually do when you are really mad or
frustrated?” “Have you ever been severely injured in a fight?” “Do you
think a knife or gun would make you safer?” If treating a teen for a violence
related injury, it’s important to explore whether they have plans to get even.
Ask about seatbelts, guns, family violence (e.g., Any problems with fighting
in the home? Do you feel safe at home? Is there anyone who hurts you or
touches you when you don’t want to be touched? How do your parents get
along?)