HEADSS
Age: years old
Gender:
HEADSS assessment
H - Home environment:
Living situation:
Relationships at home:
Concerns or stresses at home: ,
History of abuse or neglect:
E - Education and employment:
School performance:
Relationship with peers:
Relationship with teachers:
Future aspirations:
Employment status:
Job satisfaction:
A - Activities:
Extracurricular activities or hobbies:
Free time spent on:
Friendships:
D - Drugs, alcohol, and tobacco use:
Substance use:
Frequency: times per
Reasons for starting or continuing use:
S - Sexuality:
Sexual activity:
Sexual orientation:
Contraception use: ,
Condom use:
Concerns about sexually transmitted infections:
S - Suicide and depression:
Feelings of sadness or depression: ,
Self-harm:
Suicidal ideation:
History of suicide attempts:
Mental health treatment or counseling: ,