We are grateful to Rachel Woolcomb OT, for sharing this Talking mats story.
Within my occupational therapy practice I have found Talking Mats to be an excellent thinking tool to help my clients establish their priorities for therapy.
I was asked to work with a teenage girl who had sustained a brain injury resulting in a mild cognitive impairment which was impacting on her participation and ability to learn at school.
She had undergone formal cognitive testing with a clinical psychologist, however had shown poor levels of engagement with the assessment process (which had taken over two hours). She was reported as having erratic focus and inconsistent answers to questioning. The results were therefore deemed to be inconclusive and no recommendations made. I knew that Talking Mats would provide me with similar information to that which the psychologist was trying to gain, but in a way that would be engaging and client focused. I also felt that the concept of the Talking Mat, which enables the thinker to express their own views rather than a “right or wrong” answer, would help to improve participation.
I selected the learning and thinking topic cards from the communication set within the Health and Wellbeing pack. These cards cover areas that I would normally look at within any cognitive assessment and are functionally relevant. Together we selected the visual scale, choosing the question “how well are you managing?”
She explained that organising herself, writing, listening, reading, problem solving and planning were all going well. She talked about how she sometimes had difficulties concentrating and paying attention due to getting distracted in the classroom. She also felt she was struggling more than before with calculating and that this was affecting her scores in Math tests. She explained that remembering and making decisions were “not going well’ and she was particularly worried about the fact she had forgotten some of the teaching she had received prior to her brain injury. I was also able to conclude from the way she understood the concept of the mat, as well as her ability to engage and attend for the whole session, that she could concentrate, learn new skills and had the ability to weigh up information to help her make decisions.
Together we used the information gained from the Talking Mat to set goals for therapy which were focused around having a range of strategies to help her concentrate in class, remember new information, and make decisions.
Two months later, once having completed a therapy programme, we used the Talking Mat again to explore her current thinking about the topic area. She explained that making decisions was something she no longer had difficulty with as her confidence had grown. She felt that there had been some improvement with her ability to remember information and we discussed the strategies she now used to help her concentrate in class, which included ways to minimise any distractions.
In summary, the Talking Mat enabled her to think about how her brain injury had affected her ability to remember, make decisions and learn. This provided valuable information from which a therapy programme could be created. The Talking Mat also provided a visual representation of her perception of the issues before and after therapy, showing clearly her progress. This was well received by her parents, teachers and the other professionals involved in her care.
Once again I have been amazed by the power of the Talking Mat to produce a breadth of information in a relative short space of time and I will be advocating its use within cognitive assessment and rehabilitation across all ages.
It was great to be able to attend the Intermediaries for Justice Conference on the 9th May in City University London. From the very beginning there was a real buzz of excitement in the room. Intermediaries demonstrated throughout the day their commitment and passion for their job despite frequently working in difficult circumstances as well as having a role that is not always appreciated. They are employed by the crown, magistrates and family courts in England, Wales and Northern Ireland. Intermediaries support two way communication between personnel involved in the justice system supporting those previously judged incapable of giving clear and effective evidence to do so.
There was a real buzz from the outset at the conference. At times, it can be quite a lonely role being an intermediary. If you get the role right and put the appropriate communication scaffolds in place, everyone communicates well – then some in the justice system find it hard to recognise that you have done anything at all! Baroness Newlove, the victims commissioner for England and Wales who was one of the key note speakers said ‘You need to see how intermediaries work to believe what they do ‘ Being a skilled communicator and being creative is the bedrock of intermediary practice. Baroness Newlove was clear that there needs to be greater access to registered intermediaries and but also there were clear management and long term support issues that need to be addressed by government.
The theme by various speakers throughout the day was the challenge of communication in the justice system. As one speaker put it ‘Justice is being delivered in a system designed in the 18th century which makes it difficult to fit the needs of the 21st century and ensure all have access to legal process ‘ Another speaker spoke of registered intermediaries levelling the playing field but there is still not equal access as defendants do not have automatic access to the scheme . As well as communication difficulties arising through the child’s age and or the person’s disability the issue of cultural communication was raised particularly in relation to gang culture
The conference loved meeting Oliver – the first dog in Europe trained to be court friendly and whose role is to support children to give evidence . Research in America has shown that stroking pets can help reduce fear and support children in court
Talking Mats is a communication framework that some intermediaries use . One said she could not do the role without Talking Mats and two intermediaries have described their use of them in two previous blogs . Click to read a blog by Nicola Lewis https://www.talkingmats.com/assisting-vulnerable-people-to-communicate/ and one by Catherine O’Neil https://www.talkingmats.com/talking-mats-used-court/ . So Talking Mats was delighted to be asked to the conference to have a stand and run a workshop. It was great to have Aileen O’Hagan with us and she talked through some case examples when she had used Talking Mats in her role as a intermediary. One example involved working with a young person with selective mutism where Aileen used Talking Mats to great effect to help prepare and plan for her witness interview . She created options around the optimum environment for the interview e.g. lightening, seating etc but also options around the mode of giving evidence . The witness wanted to write things down and wanted the intermediary to speak them out loud.
The day left me in no doubt that intermediaries are effective in enabling the voice of those who would not otherwise be heard, be heard. I remain concerned and puzzled as to why Scotland does not have the scheme. We do have appropriate adults but this role does not have the legal standing nor the training and qualification demands of the registered intermediary scheme and in practice the focus of the work is different . I hope this situation will change.
The intermediaries for justice organisation have now established themselves as a charity and if you want to find more about their work then visit http://www.intermediaries-for-justice.org.
If you are an intermediary and have found Talking Mats helpful then we would love to hear form you. We are always up for more guest blogs so please get in touch
One of the reasons why Talking Mats works is because it reduces the demand on the ‘thinker’ to remember the question, find the vocabulary needed to answer, construct the answer into a sentence, and then say it clearly. This reduced demand allows more ‘thinking time’.
Here’s a link to our website with more reasons why Talking Mats works
https://www.talkingmats.com/about-talking-mats/#whyitworks
Another reason people respond well to it is there is no right or wrong answer. It is not a test.
Sometimes the listener can forget their role and use the interaction as a test or as a language exercise. E.g . ‘Do you know what this picture is? ‘What’s this one called?’ This makes the demands on the thinker instantly increase as they are required to formulate an answer. Checking the persons level of understanding first may be necessary but it shouldn’t be done as part of the Talking Mat.
In our training we recommend avoiding ‘why’ questions , as they can make a person feel they have made an error. If the listener wants to know more, then a sub mat can be done
Our mission statement is to maximise the person’s capacity to express what they think. Let’s help them to do that!
Thanks to Laura Holmes for this blog about the support she gets from Talking Mats for ‘Learning Conversations’ with the children she works with.
I use Talking Mats for a variety of purposes in my role as a Speech and Language Therapist (SLT) for NHS Stockport Children’s Therapy Services Team, working with children with speech, language and communication needs (SLCN) in mainstream primary schools.
The introduction of the SEND Reforms in 2014 and SEND Code of Practice (January 2015) firmly places children and young people at the centre of the planning process – ‘No Decision About Me, Without Me’. The following principles underpin the reforms,
- Support for children and young people with SEND should be based on an understanding of their views, wishes and feelings.
- Wherever possible, children, young people and their parents should participate in decision making, and should be supported to participate.
- Support should help children and young people achieve the best possible outcomes, and prepare them for adulthood. (Howe C., et al 2016)
One of the main advantages of the Talking Mats approach is that it has enabled me to have ‘learning conversations’ with some of the children I work with. These learning conversations support children to participate meaningfully in decision-making in terms of setting SLT targets based on their views, wishes and feelings, which are then incorporated/ linked into their SEN/ Education, Health and Care Plans.
I usually introduce the Talking Mats approach using ‘practice’ mats focusing on familiar topics such as animals, food, activities. Once a child is using the mats to clearly indicate their views/feelings on these familiar topics, I introduce topics such as ‘My Body and Skills’ and ‘What I do and Support’, using the Talking Mats ‘Consulting Children and Young People – Primary’ resource, to support a learning conversation. I use original and/or digital versions depending on what each child responds best to. Here is an example of a mat focusing on the topic ‘What I Do and Support’, using the topline question ‘Happy About/ Not Sure/ Not Happy About’:
Using the Talking Mats approach as a basis for this learning conversation enabled me to learn about B’s views and feelings regarding the things he does and the support he currently receives. This approach also provided me with a deeper understanding of how he felt about these skills, as he was noticeably more communicative when we had the mat to focus on rather than answering direct questions.
At the end of the session we discussed what B would like to work on in particular. B shared that he wanted to work on asking for help, and making choices. These two targets were then set in his updated therapy plan, which also included recommendations in terms of supporting B to follow routines in school, for example through increasing use of visual supports and strategies, and also in terms of providing opportunities for B to try new things in school with an appropriate level of support and guidance. It will be useful to carry out follow-up learning conversations using sub-mats – for example, submatting ‘routines’ (once the recommended supports and strategies are in place) using the topline question ‘what helps/not sure/ what does not help’, will enable B to share what he feels works best for him.
Using the Talking Mats approach has often taken a child’s therapy ‘journey’ down unexpected paths as the mats have sometimes revealed areas of difficulty and/or challenges for that child which were not previously apparent or identified. These areas would not have been targeted otherwise, indicating the power of Talking Mats to empower and enable the children I work with to participate in their own therapy planning.
References:
Howe C., et al. (2016)
Guidance for Speech and Language Therapists on their roles and responsibilities under the Children and Families Act 2014 and associated Code of Practice
Royal College of Speech and Language Therapists Position Paper. RCSLT: London
For further information about Talking Mats training options click here
Many thanks to Elaine Hunter, National Allied Health Professions Consultant with Alzheimer Scotland for this blog
Background
Connecting People, Connecting Support is a new policy document in Scotland and shares how allied health professionals (AHPs) in Scotland can support people with dementia, their families and carers to live positive, fulfilling and independent lives for as long as possible.
The policy document presents an evidence-informed case to support a biopsychosocial approach to practice for ALL AHPs in Scotland when working with people living with dementia – what we call the AHP approach. The fundamental understanding driving the AHP approach is that people living with dementia CAN benefit from AHP-led interventions. In this week’s blog we are sharing the AHP contribution to maximising psychological wellbeing.
Maximising Psychological Wellbeing
What do we mean by psychological wellbeing?
The central importance of finding ways to communicate (verbal and non-verbal) that work for each individual and which make meaningful connections that may have wide-ranging benefits in relation to overall wellbeing and quality of life is recognised. Psychological interventions of different intensities are reflected to promote emotional health and psychological wellbeing, with the provision of psychological interventions for depression, anxiety, and expressions of stress and distress. This element builds on established AHP psychological interventions and therapies.
Why is psychological wellbeing important?
People with most types of dementia will at times struggle to find the right words or follow a conversation.
- Communication difficulty can be exhausting for the person, families and carers
- We know that people can often find it difficult to talk about dementia and many people living with dementia experience social isolation
- Dementia can have a profound psychological impact and may be linked to feelings of anxiety and depression.
- A non-pharmacological therapeutic approach is advocated for the treatment of psychological symptoms and a person-centred stepped-care model of support.
3 ways allied health professionals CAN maximise psychological wellbeing?
1. Maintain and maximise communication
AHPs are aware that optimum communication occurs in environments that are comfortable, where a person can feel relaxed and safe, and when the AHP-led intervention is tailored and individualised. AHPs have experience in training others in conversation skills and cuing strategies, identifying key elements for effective everyday communication and supporting opportunities to practice communication strategies in a social context, helping the person to gain confidence in the interaction. Speech and language therapists can provide personalised communication advice (aimed at, for example, developing communication passports, assessing communication networks and maximising communication opportunities) that is shared with family members to facilitate their communication skills. Where language difficulties present as a primary feature of the dementia, as in primary progressive aphasia, speech and language therapists will carry out assessments to identify specific communication impairments and abilities. Their findings will contribute to the diagnosis and be used to plan therapy and strategies.
2. Psychological interventions
AHP core psychological skills are unique to each profession and vary according to their undergraduate education and postgraduate development activity. AHP interventions to maximise psychological wellbeing require excellent communication skills and the ability to integrate psychological interventions and psychological therapies into core AHP practice. A number of approaches based on the psychological understanding of dementia and its effects, including reminiscence approaches, life-story work, anxiety management, and engaging in everyday occupations and activities, will be core to AHPs’ day-to-day practice.
With additional enhanced training opportunities, psychological interventions can also become core to AHP roles and integral to a team approach to a stepped-care model of assessment and intervention. Psychological interventions include motivational interviewing, behavioural activation, mindfulness based cognitive therapy, cognitive stimulation therapy, cognitive rehabilitation and cognitive behavioural therapy. Specific psychological interventions providing individualised, formulation-led interventions in response to stress and distress in dementia, ranging from low-intensity to specialist interventions, can also be within AHP remits.
3.Psychological therapies
Psychological therapies are highly specialised psychological interventions that include the established AHP disciplines of art psychotherapy and music therapy.
Art psychotherapy creates opportunities for verbal and non-verbal communication by using art to enable people to feel connected to a sense of self, other people and the environment around them. It can support people living with dementia by reducing anxiety and increasing coping skills (Safer & Press, 2011), depending on how interested the person is in art activities, art materials and how they feel about one-to-one or group activities. Art psychotherapy can be particularly helpful for people who find it hard to express their thoughts and feelings verbally, enabling self-expression and enhancing sense of self and personhood.
Music therapy builds on people’s ability to respond to music to develop a therapeutic relationship and facilitate positive changes in emotional wellbeing and communication through engagement in live musical interactions. It has a robust evidence base as an effective, non-pharmacological intervention that can significantly improve and support the mood, alertness and engagement of people with dementia, reduce the use of medication, and help to manage and reduce agitation, isolation, depression and anxiety (Ridder et al., 2013).
These art-based therapies are particularly helpful when people find their emotions are too confusing to express verbally, when verbal communication is difficult or when words are not enough.
Supervision for the AHP professions is integral to all of the interventions.
On reflection
Thank you for taking the time to read this blog and we would like to know
- As an AHP, how do you currently support people living with dementia to maximise the persons psychological wellbeing?
- As person living with dementia, what support would you like to receive from allied health professionals to maximise your psychological wellbeing?
- As family carer, what support would you like to receive from allied health professionals to maximise your psychological wellbeing?
We look forward to hearing from you.
Email me at EHunter@Alzscot.org
References
There are references supporting this text which you will find in the original policy document and can be viewed here https://www.alzscot.org/assets/0002/7356/AHP_Report_2017_WEB.pdf with all the evidence informing the policy available at www.alzscot.org/ahp
On the 17th April we held a seminar exploring the innovative work being done to support young people with communication needs within justice and mental health settings in both New Zealand and Scotland Read about the morning in our first blog Talking Trouble, New Zealand kindly gave a gift to all delegates of their fantastic Top Tip cards shown in the photo . You can download your own set here
The afternoon session continued the underlying theme that communication support needs are often hidden and many looked after children have support needs that remain unidentified.
Dr Ann Clark from Queen Margaret University presented her research findings looking at Panel members’ and Children’s Reporters’ perspectives on communication in Hearings. Her informative presentation highlighted the need and desire for more training on Speech, Language and Communication Needs. The conclusion was that it is better to assume ALL children who are attending a Hearing have additional support needs, whether or not they have a diagnosis of Speech Language and Communication Needs (SLCN) and Social Work support is also essential in achieving positive outcomes for Looked After Children. SLCN in Hearings April 2018
Our interactive session asked participants to reflect on the information presented during the day and to think about opportunities to improve practice in supporting communication as well as the barriers faced. The main themes that emerged from the barriers were:
- Identifying Speech, Language and Communication Needs in children and young people
- Constraints within Speech and Language therapy services
- Lack of education and training – the word “communication” because practitioners think they know about it when in fact there is a large knowledge gap
- Routes to services can be either Offending or Mental Health pathway
- The balance of power and control in relationships between the practitioner and the person with SLCNs – how committed are we to put genuine inclusive communication approaches in place.
Identify the barriers helps to inform the opportunities and the themes emerging were:
- Some good collaborative practice is happening already and the impact of working together is proven in research – we need to extend this further.
- Joint training sessions – good visual and other communication supports
- SLT have a vital role going forward
- We have a real opportunity at the moment to effect real change in a legislative context with recent Government policy
Kim Harley Kean, Head of the Royal College of Speech and language therapy Scotland office concluded the day and injected a great sense of impetus going forward. She asked 2 key questions:
Q: Is communication support and equality an issue in justice and care services?
Q: Do we want to do something about that?
Having responded with a unanimous YES she helped us to see the potential we have for change. It was obvious from the day that collaboration is vital and the event demonstrated how many different professions and organisations want to do something about the issues. We can be more effective if we do this collectively, even across continents!
The majority of participants felt we should use the event to establish a collaborative network. The key purposes would be to:
- Market – get message out there – tell more people – politicians, government and public – about Speech Language and Communication in Criminal Justice Settings explaining how SLT and Talking Mats have a vital role.
- Share stories, gather evidence.
- Facilitate enriching conversations between practitioners, for example, about aptitudes and approaches needed to negotiate communication behaviour change among professionals as well as people with SLCN…
If you would like to join the network and help to influence change please email info@talkingmats.com with a request to add your name to the youth justice mailing list.
Addressing the communication needs of people in youth justice is key to improving lives. The lack of attention to this is costly. On the 17th of April, we organised a seminar to look at the underlying issues and share good practice.
We were delighted with the collaborative mix of people attending. We had representatives from: the Scottish government, the NHS; Third sector organisations working in youth justice, the police, social workers, professional bodies, universities and social work.
Our thanks to Professor Richard Simpson for chairing the day and setting the tone by emphasising from the start that understanding communication is key to improving service delivery. Following his introduction a series of excellent and stimulating presentations took place creating a fusion of ideas and practice from Scotland and New Zealand.
- Kim Hartley Kean, head of the Royal College of Speech and language therapy Scotland office highlighted the current position in Scotland
- Sally Kedge and Alayne Mckee described the approach adopted by their organisation Talking Trouble in New Zealand.
- Jane Macer the therapeutic service co-ordinator from Starley Hall Fife described an whole system approach to embedding good communication practice within an organisation
- Yvonne McKeown and Sandra Polding Speech and Language Therapists working with young people in a NHS inpatient psychiatric unit in Glasgow shared some case examples.
In different ways the speakers brought up very similar themes:
- Communication can be treated glibly. There is a lack of understanding of what communication difficulties are and of the impact that they have on the lives of young people. These difficulties are often hidden and take time to identify. Lack of identification can have a huge impact on the future lives of young people.
- Finding ways to hear the young person’s voice is key both for the young person but also for organisations in order to deliver appropriate and effective care.
- Recognition of the intergenerational cycle and the importance of getting care and support correct so we break patterns and enable change.
- Providing collaborative solutions and understanding the breadth of communication will help services improve. However, given services often don’t know what they don’t know in terms of the impact of communication difficulties we have to find ways to express those solutions in language that those services can relate to and understand. Listening to organisations and exploring their processes by analysing the communicative demands of each stage can be a helpful way to start.
- Moving forward it is important to knock on open doors i.e. work with people who are receptive to recognising the impact of communication difficulties on young people and their lives but also find the strategic influencers who are sympathetic, in the words of our New Zealand colleagues ‘the aunts and uncles in the field’ who can help to promote the issue and raise awareness at a National level.
- You can’t explore the issue of trauma and adverse childhood experiences without certain precursor, building blocks being in place. This takes time and requires a constancy of approach.
- The importance of inclusive, visual tools becoming common place so that they are not used in isolation and in a vacuum.
- The challenge of supporting and nurturing a young person’s inner voice when they have significant difficulties with language.
- Lack of understanding of communication difficulties may lead to services responding to internalized behaviours that can lead to a fork in life; one way can send the young person down a route of offending behaviour services and the other mental health services.
- The solutions lie in partnership and collaboration between professions and services.
There were lots of creative ways of using Talking Mats that were shared. A couple of examples that stand out were
- Using Talking Mats with social workers to help them unpick what they already know about a young person’s language and communication. This approach helped them think about all the different aspects that contribute to communication and where the young person’s strengths and weaknesses lay e.g. non verbal communication , humour , word finding , understanding complex information, understanding simple information etc .
- Using Talking Mats to support a psychiatric assessment of a young person. One person used his Talking Mat to say he was hearing voices something he was unable to disclose verbally. In this case this enabled an accurate mental state assessment and non-custodial sentence.
I will leave the last word to a young man living in an inpatient unit to support his mental health, his words about communication difficulties are ‘They make you more vulnerable when bad stuff happens’ how true that is and this is why it is important we work together to improve services .
Next steps The community justice network met in the afternoon and were challenged to think about the opportunities and barriers in developing services – read the for blog that covers the afternoon ……… If you missed the seminar and want to join a multiagency network to discuss this and help take this forward in Scotland then please let us know .
Click to read the excellent presentations from the seminar
- CJSCENTalkMatsPresentation170418
- Talking Mats presentation 17 April 2018 Sally Kedge Alayne McKee TTANZ final
- TM seminar 04-18
- Talking Mats & Justice CEN April 2018 Draft
Talking Mats in Germany is being extended by one of our trainers Professor Norina Lauer. Here she describes two of her current interesting projects and we look forward to reading her findings.
The German version of the Talking Mats app will now be tested in two more projects in the west of Germany. As the communication symbols were developed for English-speaking clients six German SLT students of the Hogeschool van Arnhem en Nijmegen (han) in the Netherlands want to find out if the words and symbols fit to German clients and their cultural background. Because of cultural differences between Scotland and Germany it is necessary not only to adapt the language but also check the icons.
One of the projects will be conducted with children between the ages of 8 and 10 years. The children will be asked to classify the symbols from their age-group. The question will be whether the symbols and words are relevant for the situation of German children. If not, they will be asked for possible alternatives.
The other project focuses on adults. One group of people with aphasia and one group of healthy persons will be tested. Every tested person scores the 57 icons concerning their correspondence with the words written down below by using a scale from 0 to 3. In addition, possible graphic alternatives will be enquired and collected. The two groups of adults will be used to determine if there is a significant difference between the obtained results from each group.
Our next train the trainer course is in 2 weeks and we’re looking forward to welcoming people from a range of professions and a range of places- New Zealand, Japan, England and Fife!
Becoming a trainer for Talking Mats means the staff member can offer Foundation training within their organisation or partnership. This ensures that the standard of the communication and thinking tool is maintained and sustainability of its use is supported. It is a positive investment for organisations in person -centred practise.
The trainers are provided with resources for delivering the Foundation course and their licence is renewed annually .
Comments from people who attend include:
Practical approach to training made it easy to try out and learn from ‘doing’
A wonderful inspiring course- really looking forward to continuing to work as part of the TM team
Really enjoyed the training. Learnt a lot not just about my use of TM but also just about myself as a presenter and communication
If you’ve attended a Foundation course and would like to become a trainer, our next course is in June. You can find out more details on our webiste or on this link 20180621 Accredited Training flier Jun 2018
Apart from the necessity of fulfilling the requirements of the General Data Protection Regulation which has to be completed by 25th May, I have been pondering on other advantages of complying with the GDPR.
Here at Talking Mats we are all going through files, bagging up paper for shredding, deleting data files on our master computer and preparing text to send to all our customers and contacts to make sure we only hold information that is adequate and relevant.The first advantage for us is that it’s a good way to re-establish contact with people.
I’ve been given the task of going through all the research data and have ploughed through 16 drawers of research data starting in 1992! Way back then I worked with a wonderful professor who was keen to hold onto all our raw data just in case we wanted to check or replicate anything. Its all been under lock and key but the time has come to bite the bullet and get rid of it. I found this to be not only nostalgic but also emotional – all those fantastic participants who gave us their time and insights.
Its also been cathartic because as well as filling bags for shredding I am smashing up discs of video footage. We filmed lots of people with a range of communication difficulties using Talking Mats to compare with the same conversations without Talking Mats to analyse any differences. So… another big advantage is that I’ve destroyed all evidence of my dodgy hair cuts throughout the years!!
I counted 41 completed projects going from the very first one in 1992 which was a demographic survey of people who used AAC (Augmentative and Alternative Communication) systems in Scotland. In 1998 the Gannochy Trust funded the original project where Talking Mats was born Gannoch Final report. We then went on to carry out a wide range of projects which include working with people with Motor Neuron Disease, Stroke, Learning Disability, Children with Additional Support Needs, people living with Dementia to name but a few. The website contains the final reports on all our projects and in looking back at them I am also very proud of the good quality research the team here at Talking Mats has carried out.
Many others are now doing projects using Talking Mats but I leave it to them to organise their own GDPR and hope they also find the process worthwhile and rewarding and not just seen as a chore to be done.