Some time ago I got an e-mail message from one of my students: She couldn’t come to class. She was having terrible problems, her life had fallen apart, she was just sitting and crying. She was sorry, but her assignment would be late.
Immediately, my mind went back to a familiar acronym: Headsss. The letters stand for an interviewing technique developed in 1991 for adolescent patients — H for home (the doctor starts by asking about the teenager’s home situation), E for education and employment, A for activities. And then, in a progression meant to move from less sensitive topics to touchier subjects, it is on to D for drugs and finally the three S’s: sexuality, suicide and safety.
These are not easy questions to ask — even home and education may be fraught subjects for many adolescents. Sometimes a teenager will say, “If I tell you something, will you absolutely promise to keep it a secret?”
And the pediatrician must respond with the truth — or, much better, establish the rules with every patient, before the question even comes up. “I say this in front of the parent and the teen,” Dr. Michelle S. Barratt, a professor of pediatrics at the University of Texas Medical School at Houston, told me. “ ‘I’m going to talk to your teen about some things that are easier to talk about without a parent in the room, and I’m going to keep things confidential unless it’s life-threatening.’ And I use those words.”
No, these aren’t easy conversations. “There’s been a fear that talking to children or adolescents about suicide is somehow suggestive or puts them at higher risk,” said Dr. Benjamin N. Shain, head of child and adolescent psychiatry at NorthShore University HealthSystem outside Chicago. “Repeated studies have shown this is not the case.”
http://www.nytimes.com/2009/12/08/health/08klas.html?th&emc=th
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