HEEADSSS Assessment Components
Sleep hygiene is NOT a component of the traditional HEEADSSS assessment. The standard HEEADSSS framework consists of: Home environment, Education and employment, Eating, peer-related Activities, Drugs and alcohol, Sexuality, Suicide/depression, and Safety from injury and violence 1.
Understanding the HEEADSSS Framework
The HEEADSSS assessment is a validated psychosocial interview framework specifically designed for adolescents in healthcare settings 1. The acronym breaks down as follows:
- H - Home environment
- E - Education and employment
- E - Eating
- A - peer-related Activities
- D - Drugs (and alcohol)
- S - Sexuality
- S - Suicide/depression
- S - Safety from injury and violence 1
Key Clinical Points
The HEEADSSS interview is strategically structured to establish rapport by starting with less threatening questions (home, education) before transitioning to more personal or potentially intrusive topics like substance use and sexuality 1. This graduated approach improves adolescent engagement and disclosure accuracy 1.
Important Implementation Considerations
- Confidentiality is essential: Adolescents should be interviewed alone, with clear explanation that information will remain confidential unless there is immediate risk of harm to self or others 1
- Excuse parents/guardians: Create a script to have adults leave during the physical exam portion, which validates the adolescent's developmental need for privacy 1
- Federal and state privacy laws support adolescent confidentiality regarding substance use treatment 1
Common Pitfall to Avoid
Do not confuse HEEADSSS with similar frameworks like HEADSS (which omits the "Eating" component) 1 or SSHADESS (Strengths, School, Home, Activities, Drugs/substance use, Emotions/depression, Sexuality, Safety), which adds a strength-based component at the beginning 1.
While sleep is an important aspect of adolescent health, it is not formally included in the HEEADSSS mnemonic, though clinicians may choose to address it as part of comprehensive care 1.