[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Paediatric nursing](https://durgical.com/en/nursing/areas/pediatric/) › The adolescent patient: confidentiality, the HEADSSS interview from the nursing side, screening and referral # 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 Nov 13, 2026 ## Key points - HEADSSS domains: home, education, eating, activities, drugs, sexuality, sleep, and mood with suicidality and safety. - About 1 in 7 adolescents aged 10 to 19 has a mental health condition; suicide is among the leading causes of death at 15 to 29. - Explain clearly at the start what is confidential and when information must be shared, according to the law and the institutional protocol. - A positive screen goes to the clinician for a full assessment and, when needed, referral. - Half of adult mental disorders begin by 18 and most go undetected: ask, do not wait for the adolescent to raise it. ## 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) - Greet the adolescent by name and explain confidentiality and its limits before asking — trust opens the conversation. - Explain to the parent that part of the visit is with the adolescent alone — this respects growing autonomy. - Start with home, school and activities, then eating, drugs, sexuality and sleep — easier topics build rapport. - Ask directly about mood, self-harm and suicidal thoughts — WHO asks health workers to detect these problems early. - Use the institution's validated screening tools and record the answers objectively — a shared record allows follow-up. - Pass a positive screen to the clinician and follow the suicide-risk protocol — the screen leads to a full assessment. - Give clear information on mental health, sexual health and the services available — informed adolescents choose better. - 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)](https://durgical.app/estudiar/?add=/en/nursing/the-adolescent-patient-confidentiality-the-headsss-interview-from-the-nursing-si/) ## Elsewhere in DurgiPedia - [Adolescence: development and the HEADSSS interview](https://durgical.com/en/behavioral-science/adolescence-development-and-the-headsss-interview/) - [Puberty](https://durgical.com/en/physiology/puberty/) - [Consent in minors: progressive autonomy in Colombian law](https://durgical.com/en/medical-ethics/consent-in-minors-progressive-autonomy-in-colombian-law/) ## Connections ## Related 2 - [Youth-friendly health services for adolescents and young people](https://durgical.com/en/nursing/youth-friendly-health-services-for-adolescents-and-young-people/) - [Communicating with children by age, and with their parents](https://durgical.com/en/nursing/communicating-with-children-by-age-and-with-their-parents/) ## Related conditions 6 - [Anorexia nervosa](https://durgical.com/en/conditions/anorexia-nervosa/) - [Bulimia nervosa](https://durgical.com/en/conditions/bulimia-nervosa/) - [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/) - [Suicidal behaviour and suicide risk](https://durgical.com/en/conditions/suicidal-behaviour-and-suicide-risk/) - [Obesity](https://durgical.com/en/conditions/obesity/) - [Chlamydia infection](https://durgical.com/en/conditions/chlamydia-infection/) [← All of nursing](https://durgical.com/en/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](https://europepmc.org/article/PMC/PMC12083294) (Europe PMC (open access), 2025); [Mental health of adolescents (fact sheet)](https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health) (World Health Organization, 2025); [Adolescent and young adult health (fact sheet)](https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions) (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.)](https://www.minsalud.gov.co/Documentos%20y%20Publicaciones/Modelo%20de%20servicios%20de%20salud%20amigables%20para%20adolescentes%20y%20j%C3%B3venes.pdf) (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. --- Source: https://durgical.com/en/nursing/the-adolescent-patient-confidentiality-the-headsss-interview-from-the-nursing-si/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/the-adolescent-patient-confidentiality-the-headsss-interview-from-the-nursing-si/