You should begin spending time alone with your patients at whatever age they first exhibit the psychosocial changes associated with puberty. At every visit, the adolescent should be assessed for new stressors and overall well-being.

If the parents are present, first introduce yourself to the adolescent to make clear that the teenager is the patient. Then try having the adolescent introduce the other people in the room.

Parents, family members, or other involved adults should not be present during the HEEADSSS interview because a parent’s presence is likely to limit how much sensitive information the patient will provide.

This does not mean that parents should be ignored. Always ask them whether they have any concerns and assure them of further interaction once the interview is over.

Be certain to explain the purpose, such as: “We speak privately with our patients about stressors that may appear during adolescence so they can practice taking responsibility for their health care needs.” With explanation, adults accept the need for confidential care.