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Clinical guidelines

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people Second edition

Chapter 3 Appendix

Appendix 3.1. Stages of adolescent development
 Early (10–13 years)Middle (14–17 years)Late (18–21 years)
Central question ‘Am I normal?’ ‘Who am I?’
‘Where do I belong?’
‘Where am I going?’
Major developmental issues
  • Coming to terms with puberty
  • Struggle for autonomy commences
  • Same-sex peer relationships all important
  • Mood swings
  • New intellectual powers
  • New sexual drives
  • Experimentation and risk taking
  • Relationships have self centred quality
  • Need for peer group acceptance
  • Emergence of sexual identity
  • Independence from parents
  • Realistic body image
  • Acceptance of sexual identity
  • Clear educational and vocational goals, own value system
  • Developing mutually caring and responsible relationships
Main concerns
  • Anxieties about body shape and changes
  • Comparison with peers
  • Tensions between family and adolescent over independence
  • Balancing demands of family and peers
  • Prone to fad behaviour and risk taking
  • Strong need for privacy
  • Maintaining ethnic identity while striving to fit in with dominant culture
  • Self responsibility
  • Achieving economic independence
  • Deciding on career/vocation options
  • Developing intimate relationships
Cognitive development
  • Still fairly concrete thinkers
  • Less able to understand subtlety
  • Daydreaming common
  • Difficulty identifying how their immediate behaviour impacts on the future
  • Able to think more rationally
  • Concerned about individual freedom and rights
  • Able to accept more responsibility for consequences of own behaviour
  • Begins to take on greater responsibility within family as part of cultural identity
  • Longer attention span
  • Ability to think more abstractly
  • More able to synthesise information and apply it to themselves
  • Able to think into the future and anticipate consequences of their actions
Source: Chown P, Kang M, Sanci L, Newnham V, Bennett DL 20081
Appendix 3.2. HEEADSSS assessment
Assessment areaSuggested questions
H – Home Explore home situation, family life, relationships and stability
Where do you live? Who lives at home with you?
Who is in your family (parents, siblings, extended family)?
What is your/your family’s cultural background?
What language is spoken at home? Does the family have friends from outside its own cultural group/from the same cultural group?
Do you have your own room?
Have there been any recent changes in your family/home recently (eg. moves, departures)?
How do you get along with mum and dad and other members of your family?
Are there any fights at home? If so, what do you and/or your family argue about the most?
Who are you closest to in your family?
Who could you go to if you needed help with a problem?
E – Education/Employment Explore sense of belonging at school/work and relationships with teachers/peers/workmates, changes in performance
What do you like/not like about school (work)? What are you good at/not good at?
How do you get along with teachers/other students/workmates?
How do you usually perform in different subjects?
What problems do you experience at school/work?
Some young people experience bullying at school: have you ever had to put up with this?
What are your goals for future education/employment?
Any recent changes in education/employment?
E – Eating/Exercise Explore how they look after themselves, eating and sleeping patterns
What do you usually eat for breakfast/lunch/dinner?
Sometimes when people are stressed they can overeat, or under eat: do you ever find yourself doing either of these?
Have there been any recent changes in your weight? In your dietary habits?
What do you like/not like about your body?
If screening more specifically for eating disorders you may ask about body image, the use of laxatives, diuretics, vomiting, excessive exercise, and rigid dietary restrictions to control weight.
What do you do for exercise?
How much exercise do you get in an average day/week?
A – Activities/peer relationships Explore their social and interpersonal relationships, risk taking behaviour, as well as their attitudes about themselves
What sort of things do you do in your free time out of school/work?
What do you like to do for fun?
Who are your main friends (at school/out of school)?
Do you have friends from outside your own cultural group/from the same cultural group?
How do you get on with others your own age?
How do you think your friends would describe you?
What are some of the things you like about yourself?
What sort of things do you like to do with your friends?
How much television do you watch each night?
What’s your favourite music?
Are you involved in sports/hobbies/clubs?
D – Drug use/cigarettes/alcohol Explore the context of substance use (if any) and risk taking behaviours
Many young people at your age are starting to experiment with cigarettes/drugs/alcohol. Have any of your friends tried these or other drugs like marijuana, injecting drugs, other substances?
How about you, have you tried any? If Yes, explore further
How much do you use and how often?
How do you (and your friends) take/use them? Explore safe/unsafe use, binge drinking, etc.
What effects does drug taking or smoking or alcohol have on you?
Has your use increased recently?
What sort of things do you (and your friends) do when you take drugs/drink?
How do you pay for the drugs/alcohol?
Have you had any problems as a result of your alcohol/drug use (with police, school, family, friends)?
Do other family members take drugs/drink?
S – Sexuality Explore their knowledge, understanding, experience, sexual orientation and sexual practices – look for risk taking behaviour/abuse
Many young people your age become interested in romance and sometimes sexual relationships. Have you been in any romantic relationships or been dating anyone?
Have you ever had a sexual relationship with a boy or a girl (or both)? – If Yes, explore further
(If sexually active) What do you use to protect yourself (condoms, contraception)?
What do you know about contraception and protection against STIs?
How do you feel about relationships in general or about your own sexuality?
(For older adolescents) Do you identify yourself as being heterosexual or gay, lesbian, bisexual, transgender or questioning?
Have you ever felt pressured or uncomfortable about having sex?
S – Suicide/Self harm/depression/mood Explore risk of mental health problems, strategies for coping and available support
Sometimes when people feel really down they feel like hurting, or even killing themselves. Have you ever felt that way?
Have you ever deliberately harmed or injured yourself (cutting, burning or putting yourself in unsafe situations eg. unsafe sex)?
What prevented you from going ahead with it?
How did you try to harm/kill yourself?
What happened to you after this?
What do you do if you are feeling sad, angry or hurt?
Do you feel sad or down more than usual? How long have you felt that way?
Have you lost interest in things you usually like?
How do you feel in yourself at the moment on a scale of 1 to 10?
Who can you talk to when you’re feeling down?
How often do you feel this way?
How well do you usually sleep?
It’s normal to feel anxious in certain situations – do you ever feel very anxious, nervous or stressed (eg. in social situations)?
Have you ever felt really anxious all of a sudden – for what particular reason?
Do you worry about your body or your weight? Do you do things to try and manage your weight (eg. dieting)?
Sometimes, especially when feeling really stressed, people can hear or see things that others don’t seem to hear or see. Has this ever happened to you?
Have you ever found yourself feeling really high energy or racey, or feeling like you can take on the whole world?
S – Safety
S – Spirituality
Sunscreen protection, immunisation, bullying, abuse, traumatic experiences, risky behaviours
Beliefs, religion, What helps them relax, escape? What gives them a sense of meaning?
Sources: Goldenring J, Rosen D 2004 and Sanci L 200114,76


  1. Chown P, Kang M, Sanci L, Newnham V, Bennett DL. Adolescent health: enhancing the skills of general practitioners in caring for young people from culturally diverse backgrounds. GP resource kit, 2nd edn. Sydney: NSW Centre for the Advancement of Adolescent Health and Transcultural Mental Health Centre, 2008.
  2. Goldenring J, Rosen D. Getting into adolescent heads: an essential update. Contemporary Pediatrics 2004;21:64.
  3. Sanci L. Adolescent healthcare principles. Melbourne: The Royal Australian College of General Practitioners, 2001.
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