Intake Interview

Response Style

• Start with the Quick Reference table below.
• Ask if the user wants the detailed prompt banks and decision pathways.

Quick Reference

Interactive Mode (Lightweight)

Use this mode when the clinician asks to go step-by-step.

1. Confirm readiness and explain confidentiality/limits before starting.
2. Screen safety early (SI/HI/abuse) and pause if urgent concerns arise.
3. Ask one domain at a time from the selected framework and wait for responses.
4. Summarize key findings and confirm accuracy before moving on.
5. At the end, synthesize 4Ps and suggested next steps.

Usage

This skill can be invoked when you need to:

• Conduct a comprehensive intake interview
• Screen adolescents for psychosocial concerns
• Structure a biopsychosocial assessment
• Perform a systematic safety evaluation
• Ensure thorough documentation of intake

Example requests:

• "Help me conduct an intake interview"
• "Guide me through a HEADSS assessment"
• "I need a biopsychosocial interview template"
• "How do I structure a safety assessment?"

Framework Details

HEADSS Assessment (Adolescent Psychosocial Screening)

Purpose: Structured framework for adolescent psychosocial screening covering key risk and protective factors.

Domains:

• H - Home: Living situation, family relationships, household stressors
• E - Education/Employment: School performance, attendance, peer relationships
• A - Activities: Hobbies, sports, peer groups, screen time
• D - Drugs: Substance use (tobacco, alcohol, drugs), peer use
• S - Sexuality: Sexual activity, orientation, safety, relationships
• S - Suicide/Safety: Mental health, self-harm, violence exposure

Sample Questions by Domain:

Home

• Who lives with you? How are things at home?
• Any recent changes, conflict, or stressors?
• Do you feel safe where you live?

Education/Employment

• How is school or work going? Attendance and performance?
• Any bullying, learning challenges, or major stressors?
• Goals or plans for the next year?

Activities

• What do you do for fun? Who do you spend time with?
• Physical activity, hobbies, clubs, or faith community?
• Screen time or social media use that feels problematic?

Drugs

• Any tobacco/vaping, alcohol, cannabis, or other substances?
• How often? Any problems or consequences?
• Do friends or family use?

Sexuality

• Are you dating or in a relationship? Any concerns?
• Are you sexually active? Protection or contraception use?
• Any questions about orientation, consent, or STI risk?

Suicide/Safety

• Any thoughts of hurting yourself or ending your life?
• Any self-harm, past attempts, plan, or intent?
• Any exposure to violence, access to weapons, or feeling unsafe?

Biopsychosocial Template

Purpose: Comprehensive intake structure addressing biological, psychological, and social factors contributing to current presentation.

Biological Factors:

• Medical history, current medications
• Sleep, appetite, energy
• Substance use
• Family medical/psychiatric history

Psychological Factors:

• Mental status examination
• Current symptoms and timeline
• Previous mental health treatment
• Trauma history
• Coping strategies

Social Factors:

• Relationships and support system
• Living situation and safety
• Employment/education/finances
• Cultural and spiritual factors
• Legal involvement

Interview Guide (Prompt Bank):

Presenting Problem

• Chief complaint in the patient's words
• Onset, duration, triggers, and course
• Current stressors and functional impact

Biological Factors

• Medical history, current medications, allergies
• Sleep, appetite, energy, pain
• Substance use and withdrawal symptoms
• Family medical and psychiatric history

Psychological Factors

• Mood, anxiety, trauma exposure, psychosis symptoms
• Prior mental health treatment and response
• Coping strategies and strengths
• Suicidality or self-harm history

Social Factors

• Housing stability and safety
• Relationships and support system
• Education/employment and finances
• Cultural, spiritual, and identity factors
• Legal issues or custody concerns

Strengths and Resources

• Protective factors, resiliency, motivation
• Community supports and prior successes

Documentation Template (Biopsychosocial Intake Summary):

• Identifying info
• Presenting problem and history of present illness
• Biological factors
• Psychological factors
• Social factors
• Risk assessment (suicide, violence, safety)
• Strengths and protective factors
• Diagnostic impression (provisional)
• Level of care recommendation
• Initial treatment plan and next steps

Safety Assessment Protocol

Purpose: Systematic evaluation of suicide, homicide, and safety risks with clear decision pathways.

Key Components:

1. Suicide Risk Assessment

   • Current ideation, intent, plan, means
   • Prior attempts and self-harm
   • Protective factors
   • Risk stratification

2. Violence Risk Assessment

   • Homicidal ideation
   • History of violence
   • Access to weapons
   • Target identification

3. Safety Planning

   • Warning signs
   • Coping strategies
   • Support contacts
   • Means restriction
   • Emergency resources

4. Disposition Decision

   • Level of care determination
   • Follow-up planning
   • Documentation requirements

Decision Pathway (Text-Based):

1. Screen for safety early (SI, HI, abuse, domestic violence, psychosis).
2. Imminent risk (active intent, plan, means, or recent attempt):
   • Emergency evaluation, do not leave patient alone, initiate emergency protocol.
3. Moderate risk (active ideation without intent/plan, recent escalation):
   • Full risk assessment, same-day clinical evaluation, increase contact frequency.
4. Low risk (passive ideation only, no plan/intent):
   • Safety plan, coping supports, outpatient follow-up.
5. No current risk:
   • Routine monitoring and preventive safety education.

Violence Risk Quick Check:

• Any thoughts of harming others?
• Any specific target, plan, or access to weapons?
• History of violence or recent escalation?

Clinical Interpretation

Clinical Formulation (4Ps Model):

• Predisposing: long-term vulnerabilities (trauma history, family history, temperament)
• Precipitating: recent triggers (loss, conflict, medical illness)
• Perpetuating: maintaining factors (avoidance, substance use, unstable housing)
• Protective: strengths and supports (relationships, values, coping skills)

Synthesis Checklist:

• Working diagnosis and severity
• Functional impairment and role impact
• Risk level and safety needs
• Level of care recommendation
• Initial treatment focus and goals

Key Questions:

• What is the presenting problem and precipitants?
• What biological, psychological, and social factors contribute?
• What are the patient's strengths and resources?
• What level of care is appropriate?
• What are the treatment priorities?

Safety Protocols

During intake assessment:

• Assess safety concerns early in interview
• Be prepared to interrupt interview flow for safety issues
• Have emergency protocols readily available
• Know your crisis resources and referral pathways
• Document all safety concerns and interventions

Mandatory Reporting:

• Be aware of mandatory reporting requirements (child abuse, elder abuse, danger to others)
• Explain confidentiality limits at start of interview
• Consult when uncertain about reporting obligations

Safety Protocols and Escalation:

• Assess safety before and after sensitive topics.
• If imminent risk, follow emergency protocol and document all actions.
• Use standardized tools (ASQ, C-SSRS) when indicated.
• Develop a safety plan for any positive screen or elevated risk.
• Discuss means safety (firearms, medications) and document counseling.
• Coordinate with supervisors and collateral supports when appropriate.
• Follow mandatory reporting laws (child/elder abuse, danger to others).

Limitations & Considerations

These are support frameworks, not rigid protocols:

• Adapt to patient's presentation and needs
• Maintain conversational, empathic approach
• Cultural humility in all assessments
• Trauma-informed approach
• Language and health literacy considerations
• Allow patient to guide pacing and depth
• Clinical judgment supersedes checklist completion

Cultural Considerations:

• Family structure and roles vary across cultures
• Expression of distress differs
• Help-seeking behaviors culturally influenced
• Spirituality and traditional healing
• Immigration and acculturation stress
• Interpreter services when needed

Trauma-Informed Approach:

• Establish safety and choice
• Transparency about process
• Allow patient control over disclosure
• Recognize potential for re-traumatization
• Avoid forcing trauma narrative in initial intake

Additional Considerations:

• Avoid checklist-only interviews; maintain therapeutic alliance.
• Use trauma-informed, culturally responsive language.
• Use interpreters when needed; document language access steps.
• Be mindful of developmental stage and health literacy.
• Reassess risk dynamically; it can change within the session.

References

HEADSS Assessment:

• Klein DA, Goldenring JM, Adelman WP. HEEADSSS 3.0: The psychosocial interview for adolescents updated for a new century fueled by media. Contemp Pediatr. 2014;31(1):16-28.
• Goldenring JM, Rosen DS. Getting into adolescent heads: an essential update. Contemp Pediatr. 2004;21:64-90.

Biopsychosocial Model:

• Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129-136.
• Borrell-Carrió F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med. 2004;2(6):576-582.

Safety Assessment:

• VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide
• Suicide Prevention Resource Center resources
• Zero Suicide framework

Additional References:

• HEEADSSS 3.0 overview (Contemporary Pediatrics): https://www.contemporarypediatrics.com/view/heeadsss-30-psychosocial-interview-adolescents-updated-new-century-fueled-media
• Biopsychosocial model: https://doi.org/10.1126/science.847460 and https://doi.org/10.1370/afm.245
• VA/DoD CPG for Suicide Risk (2024): https://www.healthquality.va.gov/guidelines/MH/srb/VADOD-CPG-Suicide-Risk-Full-CPG-2024_Final_508.pdf

Status: ✅ Implemented Priority: MEDIUM - Phase 3 Last Updated: 2026-02-03