David Stuart



Is patient aware of how our chemsex services work? -Brief, 20 min sessions, focused on our primary responsibilities; chems use, goal achievement, change, harm reduction; not to be distracted by exploration of underlying issues. Make BEST use of brief time.

Begin session with a (very) recent history (1st visit). OR (follow-up visit) with a summary of goal accomplishment (or otherwise) in last week(s).

  • Affirm accomplishments & successes. They did something right; what was that?
  • Explore non-accomplishments; what wasn’t done right? What can be improved upon? Lessons learned.
  • Prepare for coming week. Does patient understand their personaltriggers? Is patient’s mastery of craving management improving?

If ambivalent; decisional balance/pros & cons.

  • “What brought you here?”                    
  • “Why have you come?”
  • “How can we help you?”                
  • "What do you want to achieve here?”
  • "How can we best make use of these sessions”?

If someone isn’t motivated… that’s ok; let them go. 

Invite them to reflect and return when they are more certain of what they want to achieve.

NO PATIENT LEAVES WITHOUT A GOAL/PLAN. Some kind of Change. Even if that goal is to reflect on use and return with a goal to work towards. Be firm on this. Being adherent to this, is how we can best help our patients. Don’t be distracted by their fears, ambivalence, dramas. No patient leaves without a plan/goal. 1 day goal, 7 day goal, 6 week goal.

Is patient aware of their plan before leaving? Clear on their goal? Some advice on how to be successful with it? Can they clearly explain their plan to the next worker they see, next visit? Are they aware of ALL the weekly sessions?

Guidance for Handovers, client notes
  • Reason for presentation:
  • History/contexts of recent use
  • Goal identified?
  • Motivation to achieve goals?
  • Plan (for coming weeks. Returning?)
  • Any urgent risks?
  • Follow up email? referral made? Info sent?