Teletraining Research and Information around Dual Diagnosis


TRIADD training: France


`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 psychological dysfunctions.
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 Nathan, 1993
ALBERNHE, TH, Psychiatrie et Handicap – editions Masson, 1997
CTNERHI, Classification internationale des handicaps – CTNERHI, 1989.


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 points
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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