Durgical
EN
Open the app

The adolescent patient: confidentiality, the HEADSSS interview from the nursing side, screening and referral

  • Safe practice

A structured, confidential conversation about home, school, eating, activities, drugs, sex, sleep and mood finds the risks adolescents rarely mention.

Updated

What it is

Adolescents usually come for a physical complaint, while the risks that matter most (mental health, substance use, sexual health, violence, self-harm) stay hidden. A psychosocial interview organised by life domains, known as HEADSSS, helps find them. Nurses often do the first contact or a self-completed screen, explain confidentiality and pass a positive screen to the clinician for a full assessment and referral. The adolescent-friendly services page covers how the service itself is organised.

What it requires

  • A private space and part of the visit without the parents.
  • Open questions, without judgement, from the less sensitive domains (home, school) to the more sensitive ones.
  • Risk factors: violence, bullying, abuse, harsh parenting, poverty, harmful alcohol use, chronic illness.
  • A referral network: psychology, psychiatry, social work, nutrition and sexual and reproductive health services.

How it is applied (and why)

  1. Greet the adolescent by name and explain confidentiality and its limits before asking — trust opens the conversation.
  2. Explain to the parent that part of the visit is with the adolescent alone — this respects growing autonomy.
  3. Start with home, school and activities, then eating, drugs, sexuality and sleep — easier topics build rapport.
  4. Ask directly about mood, self-harm and suicidal thoughts — WHO asks health workers to detect these problems early.
  5. Use the institution's validated screening tools and record the answers objectively — a shared record allows follow-up.
  6. Pass a positive screen to the clinician and follow the suicide-risk protocol — the screen leads to a full assessment.
  7. Give clear information on mental health, sexual health and the services available — informed adolescents choose better.
  8. Agree on the next step with the adolescent, and with the family when appropriate — shared plans are followed more.

In nursing practice

  • Eating disorders and depression are linked to suicide risk.
  • Higher-risk groups include adolescents with chronic illness, pregnant adolescents and young parents, and those exposed to violence.
  • Protective factors: sleep, exercise, coping skills, supportive family, school and friends.
  • In Colombia, the nurse often does the pre-consultation in adolescent-friendly services and links the young person to the team.

Common mistakes

  • Interviewing with the parents in the room the whole time.
  • Promising total secrecy, then having to break it.
  • Avoiding the question about suicide for fear of putting the idea in the adolescent's head.
  • Finding a risk and not arranging the referral before the adolescent leaves.

Test yourself

Think of the answer, then tap the question to see it.

What do the letters of HEADSSS cover?

Home, education, eating, activities, drugs, sexuality, sleep, and mood with suicidality and safety.

Why should part of the visit be without the parents?

Adolescents are more likely to talk about sensitive risks in private, and it respects their growing autonomy.

What happens when the nurse's screen finds a risk?

The positive screen goes to the clinician for a full assessment, and the adolescent may be referred to mental health, social work or other services.

What is said about confidentiality at the start?

What stays confidential and when information must be shared, according to the law and the institutional protocol.

Add to my cards (4)

Elsewhere in DurgiPedia

Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Improving compliance with conducting HEADSS biopsychosocial assessment for adolescents in a paediatric inpatient setting (Tan JSK et al.), BMJ Open Qual (Europe PMC (open access), 2025); Mental health of adolescents (fact sheet) (World Health Organization, 2025); Adolescent and young adult health (fact sheet) (World Health Organization, 2024); Servicios de salud amigables para adolescentes y jóvenes: un modelo para adecuar las respuestas de los servicios de salud (2.ª ed.) (Ministerio de la Protección Social de Colombia y UNFPA (MinSalud), 2008).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.