HEEADSSS assessment

Key:
Green = essential questions
Blue = as time permits
Red = optional or when situation requires
Home Drugs
Who lives with you? Where do you live? Do you have Do any of your friends use tobacco? Alcohol? Other
your own room? drugs?
What are relationships like at home? Does anyone in your family use tobacco? Alcohol? Other
drugs?
To whom are you closest at home?
Do you use tobacco? Alcohol? Other drugs?
To whom can you talk at home?
Is there any history of alcohol or drug problems in your
Is there anyone new at home? Has someone left family? Does anyone at home use tobacco?
recently?
Do you ever drink or use drugs when you’re alone?
Have you moved recently?
(Assess frequency, intensity, patterns of use or abuse,
Have you ever had to live away from home? (Why?) and how youth obtains or pays for drugs, alcohol, or
Have you ever run away? (Why?) tobacco)
Is there any physical violence at home? (Ask the CRAFFT questions)

Education and employment Sexuality

What are your favourite subjects at school? Your least Have you ever been in a romantic relationship?
favourite subjects?
Tell me about the people that you’ve dated. OR Tell me
How are your grades? Any recent changes? Any about your sex life.
dramatic changes in the past?
Have any of your relationships ever been sexual
Have you changed schools in the past few years? relationships?
What are your future education/employment plans/goals? Are your sexual activities enjoyable?
Are you working? Where? How much? What does the term ‘safe sex’ mean to you?
Tell me about your friends at school. Are you interested in boys? Girls? Both?
Is your school a safe place? (Why?) Have you ever been forced or pressured into doing
something sexual that you didn’t want to do?
Have you ever had to repeat a class? Have you ever had
to repeat a grade? Have you ever been touched sexually in a way that you
didn’t want?
Have you ever been suspended? Expelled? Have you
ever considered dropping out? Have you ever been raped, on a date or any other time?
How well do you get along with the people at school? How many sexual partners have you had altogether?
Work?
Have you ever been pregnant or worried that you may be
Have your responsibilities at work increased? pregnant? (females)
Do you feel connected to your school? Do you feel as if Have you ever gotten someone pregnant or worried that
you belong? that might have happened? (males)
Are there adults at school you feel you could talk to What are you using for birth control? Are you satisfied
about something important? (Who?) with your method?
Do you use condoms every time you have intercourse?
Does anything ever get in the way of always using a
condom?
Have you ever had a sexually transmitted disease (STD)
or worried that you had an STD?
Key:
Green = essential questions
Blue = as time permits
Red = optional or when situation requires
Eating Suicide and depression
What do you like and not like about your body? Do you feel sad or down more than usual? Do you find
yourself crying more than usual?
Have there been any recent changes in your weight?
Are you ‘bored’ all the time?
Have you dieted in the last year? How? How often?
Are you having trouble getting to sleep?
Have you done anything else to try to manage your
weight? Have you thought a lot about hurting yourself or
someone else?
How much exercise do you get in an average day?
Week? Does it seem that you’ve lost interest in things that you
used to really enjoy?
What do you think would be a healthy diet? How does
that compare to your current eating patterns? Do you find yourself spending less and less time with
friends?
Do you worry about your weight? How often?
Would you rather just be by yourself most of the time?
Do you eat in front of the TV? Computer?
Have you ever tried to kill yourself?
Does it ever seem as though your eating is out of
control? Have you ever had to hurt yourself (by cutting yourself,
for example) to calm down or feel better?
Have you ever made yourself throw up on purpose to
control your weight? Have you started using alcohol or drugs to help you
relax, calm down or feel better?
Have you ever taken diet pills?
What would it be like if you gained (lost) 10 pounds?
Activities Safety
What do you and your friends do for fun? (with whom, Have you ever been seriously injured? (How?) How
where, and when?) about anyone else you know?
What do you and your family do for fun? (with whom, Do you always wear a seatbelt in the car?
where, and when?)
Have you ever ridden with a driver who was drunk or
Do you participate in any sports or other activities? high? When? How often?
Do you regularly attend a church group, club, or other Do you use safety equipment for sports and or other
organized activity? physical activities (for example, helmets for biking or
skateboarding)?
Do you have any hobbies?
Is there any violence in your home? Does the violence
Do you read for fun? (What?) ever get physical?
How much TV do you watch in a week? How about video Is there a lot of violence at your school? In your
games? neighbourhood? Among your friends?
What music do you like to listen to? Have you ever been physically or sexually abused? Have
you ever been raped, on a date or at any other time? (If
not asked previously)
Have you ever been in a car or motorcycle accident?
(What happened?)
Have you ever been picked on or bullied? Is that still a
problem?
Have you gotten into physical fights in school or your
neighbourhood? Are you still getting into fights?
Have you ever felt that you had to carry a knife, gun, or
other weapon to protect yourself? Do you still feel that
way?
Source: Goldenring and Rosen 2004