Teletraining Research and Information around Dual Diagnosis


TRIADD training: Italy

Frontal training course with guided exercises.

17th October 2003 – 29th October 2003 – 13th November 2003 – 27th November 2003

Dr. Gianpaolo La Malfa, “Careggi” Hospital, Florence; Vice President SIRM
Dr. Marco Bertelli, Direttor SIRM and Direttor AIsQuV
Dr.ssa Claudia Cavalieri, USL Agency of Bologna


From a basis of stimulating theoretical ideas and clinical experience presented by the trainers, the participants were divided into two groups in order to analyse two real cases. In the first, participants were asked to identify the diagnostic elements and to suggest an intervention strategy. In the second, participants were asked to adapt the socio-educational support and assistance, bearing in mind the medication received by the user.

To provide the basic elements of knowledge necessary to promote a dialogue and collaboration between professionals and various departments concerned

To lay the foundations for a future collaboration on the methodology of managing people with dual diagnosis, between the various services and various operators.

Two parallel sessions, one in the morning, one in the afternoon, on the same day.
Thirty trainees, maximum, for each session
Sixteen hours each session, subdivided into 4 half days of 4 hours each

First Day: 17th October 2003
Theme: What is dual diagnosis: diagnostic criteria, roles and limits of therapy
Trainerocente: Gianpaolo La Malfa

Second Day: 29th October 2003
Theme: Transference and theories of intervention
Trainer: Marco Bertelli

Third Day: 13th November 2003
Theme: Medication in the rehabilitation of patients with DD: drawbacks and opportunities
Trainer: Claudia Cavalieri

Fourth Day: 27th November 2003
Theme: The relationship with the patient with Dual Diagnosis: what is there to know?
Trainer: Gianpaolo La Malfa

Theoretical elements – Presentation of clinical cases – Work in small groups – Report back in plenary.

CD Rom


The Italian course, which was held over a series of one day meetings, like the Belgian course, was completed at the end of November. Forty nine participants were involved (approximately one third being females). The results of the evaluation were similar to the other courses.

Only three of the 49 participants had visited the web-site and six had read the key words. However, of this small proportion all reported that the site and the key words were useful or very useful. The overall effectiveness of the course is reflected in the responses to the participants’ knowledge before and after the course. Before the course 22 participants report ratings of 1- 3 on the five point scale (5 being the highest rating) and 8 rated their knowledge as 4 or above. At the end of the course the ratings were so that 33 participants scores a rating of 2/3 out of 5, and 14 rated their knowledge as 4 plus. Indeed all but one participant report increased knowledge of dual diagnosis since attending the course. Compared to the other courses the average increase from a mean of overall knowledge of dual diagnosis of 2.9/5.0 to 3.3/5.0 reflects the general trend - namely that the course had a positive effect on learning for the participants.

The course participants were very positive about the objectives and pedagogical methods of the course and rated the course lecturers very highly in their competence and knowledge of dual diagnosis. A high ratio, 42 of the 49 participants said they would be able to use the course content in their job.

An issue raised later concerns the mix of professionals taking part in this course. Twenty one of the participants - almost half - reported that the participants were not well mixed. The qualifications of the participants were as follows:
- 5 university graduates
- 11 educators
- 10 social assistants
- 7 teachers
- 9 completed high school
- 3 psychologists
- 1 nurse
- 3 no reply

The actual jobs of the participants were as follows:
- 30 educators
- 9 social assistants
- 9 co-ordinators of services

The participants made numerous comments on their evaluation questionnaires. Many reported that they liked the enthusiastic lecturers, the material on diagnostic procedures and the multi-disciplinary approach. The major criticism was the lack of participation of personnel from the mental health department and in particular psychiatrists (21 participants stated this). One person stated that the ‘course was totally ineffective’ because of this absence.

One person said ‘I don’t think I learned a new method, but I received many hints for reflection which will lead me to an approach which is different to the one I had in the past’. Another said ‘I would appreciate more work on concrete cases which we have to face in our work’. On a final positive note one person said ‘it would be great to organise a follow-up course in 2004 with the same teachers’. A full summary of the comments is available on request.

It is interesting to note that several of these critical points were also mentioned in the survey carried out before the courses were held.

The evaluator was present at the end of the course to discuss with the course participants. Several issues were raised. These concerned especially:

1. the problems of co-operation with psychiatrists who do not seem to have an interest in this field
2. the issue of emotional development in clients with dual diagnosis
3. the issue of treatment of clients with dual diagnosis with communication problems (i.e. who cannot communicate verbally with staff, who have in turn extreme difficulty in understanding their needs)
4. the problem of multidisciplinary work – how to contact the other professionals, how to build up a good team and work effectively together. In general it can be said that this course was very successful with course content being relevant, staff being very competent and the material useful in the day to day work of the participants.

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