Medicine

HEADDS ASSEMENT FOR ADOLESCENTS HOME

Who lives with the young person? Where? Do they have their own room? What are relationships like at home? What do parents and relatives do for a living? Ever institutionalized? Incarcerated? Recent moves? Running away? New people in home environment?

EDUCATION AND EMPLOYMENT

School/grade performance--any recent changes? Any dramatic past changes? Favorite subjects--worst subjects? (include grades) Any years repeated/classes failed Suspension, termination, dropping out? Future education/employment plans? Any current or past employment? Relations with teachers, employers--school, work attendance?

ACTIVITIES

On own, with peers (what do you do for fun?, where? when?) With family? Sports--regular exercise? Church attendance, clubs, projects? Hobbies--other activities? Reading for fun--what? TV--how much weekly--favorite shows? Favorite music? Does young person have car, use seat belts? History of arrests--acting out—crime

DRUGS

Use by peers? Use by young person? (include tobacco, alcohol) Use by family members? (include tobacco, alcohol) Amounts, frequency, patterns of use/abuse, and car use while intoxicated? Source--how paid for?

SEXUALITY

Orientation? Degree and types of sexual experience and acts? Number of partners? Masturbation? (normalize) History of pregnancy/abortion? Sexually transmitted diseases--knowledge and prevention? Contraception? Frequency of use? Comfort with sexual activity, enjoyment/pleasure obtained? History of sexual/physical abuse?

SUICIDE/DEPRESSION

Sleep disorders (usually induction problems, also early/frequent waking or greatly increased sleep and complaints of increasing fatigue) Appetite/eating behavior changes Feelings of 'boredom' Emotional outbursts and highly impulsive behavior History of withdrawal/isolation Hopeless/helpless feelings History of past suicide attempts, depression, psychological counseling History of suicide attempts in family or peers History of recurrent...