Outcomes
I. NEEDS ASSESSMENT
The first stage of the project focused on the ANALYSIS OF STAFF AND USER NEEDS in new partner countries regarding their approach to Dual Diagnosis.
Staff behaviour has been shown to affect the occurrence and the intensity of challenging behaviours in clients with ID; staff have attested a lack of knowledge and confidence in managing problem behaviours and sexually inappropriate behaviours. Staff need support to apply theoretical notions into daily work setting.
Staff also express the need to increase their knowledge on main points of their work with people with ID and mental health problems, such as reduction of clinical symptoms and/or challenging behaviours, improvement of social skills, and enhancement of quality of life.
The outcome of a training can be influenced by a numbers of factors, such as social, cultural, organisational or political context which professionals work in, staff characteristics (experience, skill and knowledge), the perceived utility, relevance and applicability of the training itself.
Background, cultural and other work environment-related characteristics of each trainee will be investigated at the very beginning of the training programme.
Training needs were established at the same time through the administration of:
- A checklist for the detection of theoretical grounds and respective levels of knowledge;
- Unstructured group and individual interviews on main training needs to be applied to daily
The expected outcomes of this first stage would lead to a better theoretical and practical approach of the issue, a holistic approach of the disabled user, and the reduction of a burden for professionals.
Partners carried out surveys in their respective countries. You can download the needs assessment questionnaire by clicking on the appropriate link in the Downloads Menu.
The survey results were summarized as follows:
The tool, translated to Portuguese, included a support document to explain the QoL concepts and was pre-tested by one professional, one family member and one person with Dual Diagnosis (PDD). The questionnaires were sent by e-mail to the associates. Support was requested for the completion of the questionnaire regarding DD sample.
FENACERCI received 128 questionnaires in total (56 professionals – 31 families – 41 PDD).
Feedback on the questionnaire implementation :
- Difficulties in understanding some issues addressed in the questionnaire.
- Support workers don’t have knowledge of the exact meaning of theoretical grounds.
- Lack of existence of documented DD evidence/medical reports.
The questionnaires were answered mostly by women among support workers. The average age was 40. The majority of them have a high degree and work as monitor or assistant (frontline staff). They have been doing this job for up to 10 years on average.
Support workers said that they would need training on basic notions of DD, sex education, quality of life.
The questionnaire for families was answered mainly by women. They answered that the team should address the topic of personal growth and development.
The questionnaire for PDD was answered mainly by men. They answered that the team should focus more on the leisure time topic.
The survey was adapted and translated in Italian. 61 questionnaires were filled in (31 professionals -30 families – 3 PDD). It was difficult to recruit PDD and help them to understand the questionnaire. Support workers were mainly women, average age of 38 and 8 years experience, with a high degree. Most of them were educators and psychologists. The topics that could be more useful in their daily work with PDD would be : technical knowledge of DD, interpersonal skills, better knowledge of DD, communication techniques.
Professionals in Italy work mainly in a multidisciplinary way, i.e in centres, in teams. In Portugal, partnerships are created with the community.
Faculties of psychology were removed by Ceaucescu and reappeared again in 1990. It is very difficult to change attitudes and thinking in such a short time.
Patients are not taken care of in institutions; they live in psychiatric hospitals. The Romanian care practice focuses only on medication; no alternative activities are offered to patients. People with disabilities stay in bed and don’t do anything. There is a high level of stigmatization of psychiatric patients. The QoL concept is new in Romania. Support workers show a lack of motivation to teach families how to take care of PDD, as they are themselves dissatisfied with their own lives. In Romania a professional association for general psychiatry does exist, but nothing has been set up for people with disabilities.
The questionnaire was answered mainly by women. Most of them were psychologists, social assistants and nurses. Support workers work more intuitively according to the symptoms than theoretically.
The topics more useful when working with PDD would be : communication techniques (no communication among staff members), nursing/care, supervision.
Six centres volunteered in participating in the survey. 105 questionnaires (+15) were filled in by 54 support workers, 51 families and 6 users. The questionnaires were answered by mostly women who are educators, social workers, teachers. The topics more useful for daily work : quality of life, sex education, behaviour modelling. Topics for training : problem solving, types of treatment, stress management.
The questionnaire has raised concerns on its overall feasibility. There were problems in understanding and in a lack of tackling actual needs of carers with regard to this topic. Carers agree on the relevance and the lack of training on MH-ID.
The interviewers reported that the questions were not understood by users and that the questionnaire should be thoroughly reviewed to be administered to persons with ID (content, language).
No training is foreseen in Luxembourg with the TRINNODD project ; however the questionnaires were distributed among staff within Apemh - notably those who already followed the TRIADD module a few years ago. A total of 76 people were contacted. 7 completed questionnaires were returned (9,21%). The questionnaires were answered mainly by women whose current occupation is “Aide socio familiale”. The topics more useful in their daily work with PDD would be: communication, difficulties of co-operation between people with DD and people with a psychiatric disorder and no mental disability. The topics for training that staff would need: life-span approach, basic knowledge of DD, psychiatric disorders, knowledge of the symptoms, communication.
II. DEVELOPMENT OF TRAINING MODULES
The synthesis of the needs assessment, the TRIADD guidelines, conclusions and recommendations as well as the results drawn from recent research studies were the starting point to develop the new training modules.
The aim was to develop a training module in each partner country, that will raise the interest and curiosity of the professionals on the subject. This training should be an ongoing process, with preparation work before and after the session. Professionals will be made more aware of the concept of Quality of Life. Staff should be very much engaged in the training sessions which, in order to be most effective, should reach them personally, through concrete cases that will have a real impact.
A general framework was designed by a smaller group within the partnership. The training should indeed address a number of common issues identified by partners and have common standards, such as: detection of early warning signs of psychopathological problems, involvement of psychiatrists in the training session, general recommendations on the use of pharmacology in daily practice, reference points for interpreting challenging behaviour, effective communication between staff members and with families. Each module would then be adapted to each country’s realities and potentialities.
