`La prise en charge institutionnelle des personnes
handicapées mentales présentant des troubles graves de
la personnalité et du comportement’ (The care offered by
services to people with intellectual disabilities presenting severe
personality disorders and challenging behaviour)
Face to face training course
30 June – 2nd July 2003
Gérard ZRIBI, Director, AFASER
Ariane VIENNEY, Director Foyer AFASER
Thierry BEULNE, Directeur, Atelier AFASER
Paul BERRY, Psychotherapist & TRIADD observer
François LERASLE (facilitator)
Institut le Val Mandé, 7, rue Mongenot 94165,
Saint Mandé, France
A three day in-house training course with a combination
of expert exposés and participant input, attended by TRIADD observer
and therapist, who also discussed case studies presented.
To give professionals the possibility of acquiring
basic knowledge and a better understanding of people with dual diagnosis
(intellectual disability/ mental health problems)
To reflect on the best means of care and support for
this target group.
About the person
Presentation of the main mental health problems and
Approach to different types of learning disability
Looking at psychological, sociological, social, cultural elements in
order to reach a fuller definition of the personality and problems
Methodology of observation and understanding different behaviours.
The project of the service-provider (`Le projet institutionnel’)
and the role of the different players
Making the service-provider’s project and the individual’s
project fit together ( L’adéquation entre projet institutionnel
et projet individuel)
The multi-disciplinary team
The link with external partners
Example of the functioning of a workshop (CAT) and other services (foyers)
for people with dual diagnosis
Development of an individual care plan project and the constraints of
the service (élaboration d’un projet d’accompagnement
individuel et contraintes institutionnelles).
Partnership and complementarity between the psychiatric
services and the social and socio-medical sector.
Theoretical exposés by experts working as service
directors and having written on this subject. Each participant was asked
to read key words (Triadd) to enhance basic understanding of concepts
and to prepare a case study or situation relating to their work directly
with users. Discussions on presentations and exchanges took place on
cases presented by participants.
Key words from Triadd project
ZRIBI, G,POUPEE-FONTAINE,D, Dictionnaire du handicap – Editions
ENSP 4ième édition, 2002
ZRIBI, G, SARFATY, J, sous la direction – Handicpaés mentaus
et psychiques – vers de nouveaux droits, Editions ENSP, 2003
GALLAND, A, L’enfant handicapé mental – Editions
ALBERNHE, TH, Psychiatrie et Handicap – editions Masson, 1997
CTNERHI, Classification internationale des handicaps – CTNERHI,
Pedagogical professionals, support staff, workshop
monitors, paramedical staff, directors of services.
There were 20 participants, 4 men and 16 women. The
evaluator was present for the first two and a half days of the course.
The first day of the course was devoted to basic issues
in the area of dual diagnosis. The second day was devoted to case studies.
On the third day the issues of service provision were presented and
discussed. Each day was held by a different course lecturer and all
had been involved in planning the course. The evaluator was involved
in the case studies section.
It should be noted that this was a rather heterogeneous
group of participants in that their qualifications and experience ranged
widely. Some participants had been only very recently trained and had
little practical experience, others were directors of a service with
many years experience. The overall results were reported to be satisfactory
or better on most points of the course, but the less experienced participants
were more positive than their very experienced colleagues. Only 2 participants
had visited the web site before the course and only four had read the
key words. Those who had had these experiences were however generally
quite satisfied with the content. A point system was allocated to the
questionnaire enabling the evaluator to judge whether the results tended
to be positive or negative – a useful context for the comments.
The results were:
1. course satisfaction: 59 positive points 21 neutral/negative
2. course objectives: 60 positive points 20 neutral/negative points
3. learning effectiveness: 47 positive points 33 neutral/negative points
4. improvement due to the course – level of knowledge before the
course was reported as 47/100 points, after the course 65/100
5. 14 of the 20 participants reported substantial improvement of knowledge
of dual diagnosis due to the course
6. 18 of the 20 participants commented that the course content was appropriate
for their work.
General comments from the French participants included
statements such as:
1. the basic lectures on the first day provided an
excellent starting point for the course especially the explanation of
the differences between mental disability and mental health problems
2. there were very positive comments on the cases studies presented
on the second day, the vignettes being especially helpful
3. case discussions in smaller groups were considered to be a powerful
method of learning to understand the problems facing staff both in the
area of diagnosis and treatment
4. the detailed discussion of services and the issues facing staff,
families as well as service administrators, especially in the context
of community living for this group
5. on the negative side, there was a tendency to state that the course
was not long enough and that there was not enough time to discuss the
cases to the degree of detail the participants would have liked.
Follow-up questionnaires by participants are still
being received and assessed.
Intellectual disability, personality disorders, challenging
behaviour, service-provider, psychological dysfunction, dual diagnosis
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