Sim Library: Communication 4: HEEADSSS Assessment

Theme: History taking / Adolescents
Suitable for: Paediatric trainee (ST1-3), GP trainee
Clinical scenario: Adolescent patient in A&E, who was brought in drunk having been found collapsed in the street. Now sober and the nurse has noticed some fresh looking cuts on one wrist.
Information for candidate: You are asked to take a psychosocial history from Jamie, a 15 year old in A&E. They were brought in drunk having been found collapsed in the street. Now sober and the nurse has noticed some fresh looking cuts on one wrist.

You can use the HEEADSSS assessment format.

Information for actor: You are a teenager who has been brought into A&E having been found passed out drunk in the street.

The doctor in this scenario is going to take a history – the following information can be volunteered if you are asked (elaborate as you wish):

Home: You live with your parents and older sister, she is not at home much as she has fallen out with your parents

Education: doing GCSEs at the moment, good at art, not sure of what you want to do after you leave school, not sure about going to college. Have missed quite a bit of school lately

Eating: No issues with eating or appetite, tend to skip breakfast to get out of the house

Activities: Spend time with friends outside of school, most have finished and are not at college.

Drugs: There were drugs at the party you were at last night but you didn’t take any. You smoke cigarettes. Some friends smoke cannabis regularly and you think some people last night were taking pills.

You drink at parties and although this is the first time you have been in hospital, there have been other times when you got so drunk you don’t remember what happened. This worries you a bit as there was a girl at school who you have heard was raped when she was drunk.

Sexuality: you don’t have a partner at the moment but have had sex before. You did want to have sex with this person at the time. Can’t remember if you used protection, are not on contraception

Suicide / depression: You feel stressed at the moment but don’t want to die. When you have felt very low, you have used some scissors to scratch your arm

Safety: no bullying at the moment, but there were some rumours spread last year on social media about you and the school were involved. You avoid the people who did this, they still go to school with you. No gang involvement and no one is forcing you to do anything you are not comfortable with.

Home feels safe, no one in your family has been violent towards you – but there are a lot of arguments.

Information for scenario lead: You can remind the candidate of the format of the HEEADSSS assessment before the scenario.

Terminate the scenario when the candidate has finished taking the history

Possible points for discussion in debrief: HEEADSSS Assessment

Which (if any) parts of the HEEADSSS assessment were difficult to address?

What concerns do you have after speaking to this patient and who to discuss them with?

Adolescents and risk taking behaviour

‘Teachable moment’?

Vulnerable teenagers – risk of sexual exploitation?

Depression and self harm

The clinical details of this simulation scenario are not based on any one particular case. Similarity to any real life clinical scenario or child is purely coincidental.