At the end of a recent training session, we asked the trainees to tell us how they planned to use Talking Mats as part of their work. Their comments were as follows:

• This tool will be useful in helping some residents make decisions, informed choices and express their needs. It will take time for some residents to feel confident in using this tool.
• I’d like to use it with some residents to be able to adapt Talking Mats more to their understanding.
• I’d like to use this tool for resident’s reviews to find out what the residents likes/dislikes are.
• Talking Mats will be great for service evaluation.
• Talking Mats will be great for asking residents about things they want to do.
• Updating Care Plans regularly from outcomes of Talking Mats.
• It can be used to get to know people’s needs and wishes more.
• Share the findings with colleagues and joint services.
• Hopefully through its use I’ll learn to pass it onto others.
• A gardening set. Service evaluation and well-being assessing stress levels/anxiety/emotional state?
• I’d use it to promote choices of activities.
• Care Inspectorate forms. Finding out how people enjoy time at the service and how to improve on it.

Can you let us know how you use Talking Mats as part of your work?

We are very grateful to David Brennan, a Dementia Support Worker from Ayrshire for this powerful blog.

Over the years our service has supported many people with a diagnosis of Dementia, now and then we encounter individuals whose cognitive difficulties have greatly affected their ability to communicate. This can (in some cases) result in distress for the services user and their families, distress that could be reduced or even avoided if the individual had a way of being understood by those around them.
As a service we welcomed the opportunity to engage in the Talking Mats Training and as a Dementia Support Worker I was eager to have a tool that could help me overcome communication obstacles, having experienced situations where those I support become so frustrated because they desperately want to relay a piece of information, but simply cannot find the words to express themselves.
I saw talking Mats as a communication system for those who struggle with speech. However, after using the practice in a practical environment I realise that I have had underestimated its potential, for it has much wider applications in our role.
My first experience of using Talking Mats was when producing the video for the second training session. I enlisted the help of a gentleman from the neighbouring Day Care centre.
We had never met prior to the session. The Gentleman had no communication difficulties that I was aware of.
Using the Talking Mats acted as an instant ice breaker, giving two complete strangers a reason to sit down and interact together, quickly striking up a rapport. The Gentleman appeared at ease and was happy to talk in detail about the tiles for the chosen subject of ‘Leisure Activities’
The activity revealed more than expected though. Through the course of the conversation he voiced feelings on things he was perhaps not happy with. I discovered he was unhappy that he did not get out in the open air enough due to poor mobility and that he would have preferred to see musicians coming into his Day Care Centre. This was crucial feedback
It occurred that Talking Mats also had an effective use in the assessment and quality assurance process that exist within services, providing crucial feedback for continued person-centred planning.
Taking this on board I considered examples of service users within my current caseload where the activity could prove beneficial.
I have been working with one gentleman for many months. He could be described as a Man’s man, someone who often replies to attempts at conversation with short responses, even when speaking with his wife. He may struggle to remember the names of people and places but he typically has little other difficulty in communicating.
I attempted the same topic with this man. Much of the answers were as expected. He spoke about football and his favourite team, but the structure of the Talking Mats encouraged him to open up about some of the smaller details that until now he hadn’t felt the need to disclose.
In the most recent example I was asked to take part in a colleague’s Talking Mat video for her training. She is one of our newest members of staff and although we have already developed a good working relationship the activity allowed her more insight to the nature and history of her co-worker.
For my experience, as someone who can struggle with sensory stimulation, it allowed me to express some of my needs and obscure preferences (around the office and in general) in a safe environment where I felt able to communicate what would normally be very personal information. And to have someone listen and thoughtfully consider this was a rewarding experience too.
As a service, new to the Talking Mats system, we are just scratching the surface of how we can best implement this into our roles, but the possibilities are already multiplying at a rapid pace, almost as much as the benefits we are seeing.

David Brennan
Dementia Support Worker

This post is about the importance of the Talking Mats blog and how it can be used as a rich resource of information for anyone interested in communication. One of the first ‘tasks’ that I was asked to do after starting my new job at Talking Mats was to create and give a presentation to an international audience of trainees at our most recent course for Accredited Trainers. I had only been in post for 2 weeks and I was also a trainee on the course, so the pressure was on!

The main aims of the presentation was to promote the Talking Mats Blog as a source of rich information which is accessible to anyone, that Accredited Trainers can use it in their own training courses, and also to encourage Accredited Trainers to write their own blog posts to describe how they use Talking Mats in their working and personal lives.

I wanted to try and make the presentation look a bit more dynamic than the usual ‘death by PowerPoint’ that can sometimes occur after a whole day of looking at slides! I decided to use Prezi, “a cloud-based  presentation software and storytelling tool for presenting ideas on a virtual canvas”, as I’d had good feedback about it when I had used it in the past and thought this would be a perfect opportunity to roll it out again. You can see the completed presentation here.

When the day came to give the presentation, I wasn’t feeling on top form after having flu for a few days previously. Because of this my memories of it are rather hazy (which isn’t good for the purposes of writing a blog about the presentation!) but from what I’ve heard, apart from looking ill, I managed to get my points across without confusing (or frightening) the audience!

It was a fantastic opportunity to take part in the Accredited Training course and to hear the stories of all the trainees who are dedicated to using Talking Mats to improve the lives of the people they help on a daily basis.

I’ve also just found out that the team at Talking Mats have been blogging for 4 years, so get reading!

What are social care outcomes and how do we measure them? The Adult Social Care Outcomes Toolkit (ASCOT) was developed over a number of years as a way of measuring user views on their social care. The ASCOT has been developed by researchers at PSSRU, University of Kent http://www.pssru.ac.uk/ascot/index.php

 There are eight domains of ‘social care-related quality of life’ included in the ASCOT. These include:

• Control over daily life
• Personal cleanliness and comfort
• Food and drink
• Personal safety
• Social participation and involvement
• Occupation
• Accommodation cleanliness and comfort
• Dignity

The measure has been tested with service users from different user groups and there are a number of different versions available, including an easy-read version.

Many people with who have communication difficulties are not able to provide views via interview alone.  Talking Mats is a communication tool that can be used with people who have communication difficulties. The mat consists of a set of symbols or pictures that are tailored to the subject you want to talk about.

The ASCOT Talking Mat: Tizard Centre’s Jill Bradshaw with Ann-Marie Towers and Nick Smith (both from PSSRU) have worked with the Talking Mats team at Stirling to develop three ASCOT Talking Mats.  These will enable people to give their views on:

• Where I Live.  This is a starter mat, designed to introduce people to the approach and for those people who might find more abstract concepts more challenging;
• My Care. People will be supported to give their views about whether aspects of their care are going well or not going well.
• Control over my Care. People will be given tools to think about how much choice they have over different aspects of their care.  The second and third mats have options for both basic and more abstract concepts.

The TM version of the ASCOT will enable researchers to investigate user views regarding social care outcomes.  By using this more inclusive methodology we will be able to engage with these seldom heard groups.  The use of symbols in combination with a structured approach will enable us to represent these participants’ own feelings/perspectives in the research, rather than us having to rely on the views of proxies.

Researchers at the University of Kent will be piloting the ASCOT Talking Mats with people with dementia and people with intellectual and developmental disabilities (learning disabilities).

Jill Bradshaw (Accredited trainer) Lecturer in Learning Disabilities, Tizard Centre, University of Kent

Ann-Marie Towers (Research Fellow) and Nick Smith (Research Officer). PSSRU, University of Kent

The Children and Families Act 2014 makes clear that local authorities in England must have regard to the views, wishes and feelings of the young person and the parents. How do you ensure children and Young People are fully involved in decisions about their support and what they want to achieve? This blog describes how Talking Mats can be used to support the Education and Health Care Plans (EHCP).

A question like ‘What do you want to be able to do in the next 12 months,  that you can’t do now ?’ is difficult for us all. For children and young people who struggle with communication, this is even more of a challenge.Talking Mats is an ideal tool to support the young person to consider this big question because it breaks down the dialogue into bite-size chunks, makes abstract concepts more concrete, and creates a visual record of the discussion.

The top scale can change depending on the topic and what the interviewer wants to find out.  It can vary from

• things I like/ don’t like/ unsure
• things that are important to me / not important/ not sure,
• things I want to try/ don’t want to try/ not sure .

We have two resources that can be used to support conversations about planning :

1. Health and Well being – this resource is based on the WHO ICF framework and allows you to have a topic focused conversation on the various aspects that make up well being
2. Consulting Children and Young People this resource gives a much more holistic overview of how the young person or child is feeling about their lives
3. Example from Health and Well being resource

Using the work/education topic from the Looking after yourself  set in the Health and Well –being resource, this pupil is able to express what his aspirations are  post school. Click on picture to enlarge.

2. Example from Consulting Children and Young People resource

This example came from a primary teacher and demonstrates how the process of using Talking Mats can help a young person reflect on their lives and in this case make positive change . The teacher told us about a pupil aged 8 who placed the symbol for ‘being listened to’ in the position for something he liked, and the symbol for ‘listening to others’ in the position for something he didn’t like.  ‘That’s not right’, he exclaimed.

There was no miracle cure she said.  ‘But it was like a light bulb going on!’  He began to engage with work on his interaction and listening skills and ended up a playground champion.

Free Seminar 

We are holding a free half day seminar in London on the 20th October. The seminar is an introduction to how you can use Talking Mats to support pupil participation in planning . If you wish to attend please let us know by responding to our invite. We would love to see you. London Seminar Invite

We are delighted to be a Winner in the People Driven Digital Health Awards which were held in Leeds on Friday 3rd July. These awards were instigated to recognise the work of digital health innovators from across the UK and aim to connect the people who have ideas and make them happen.

The event was organised by mHabitat  and compered by a well known health commentator, Roy Lilley, of the Academy of Fabulous Stuff. The evening was full of fun and energy and we met lots of interesting people and made good connections. There is loads going on in digital health and services should make use of all these fabulous innovations that will improve people’s lives and health services. To get a flavour of the evening follow #PDDAwards15 and to find out about the other winners click here.

Our category, ‘the most impressive third sector digitally enabled service’ recognises third sector services which have embedded digital tools and services into improving people’s experience and outcomes. We very honoured to win this category with our digital Talking Mat. The announcement of the winners was followed by a flurry on Twitter which you can dip into here .

Background

Social workers are required to complete a detailed assessment of their client’s needs. It is recognised that it can be a challenge to ensure clients fully participate in the process if they have cognitive or communication difficulties. The City of Edinburgh Council were keen to explore if we could adapt their standardized assessment tool and make it into a Talking Mat framework. Several staff in the council are already skilled practitioners in Talking Mats so are familiar with the framework and use Talking Mats in their practice. They are enthusiastic about the benefits of using Talking Mats both in terms of how it increases participation of service users but also because in their view it makes interviews easier for staff to undertake.

Structuring Talking Mats assessment framework

In order to develop the bespoke Talking Mat we held a seminar to discuss the social work assessment tool and approach used. Six key staff attended the seminar, facilitated by two Talking Mats associates. The discussion at the seminar identified a structure that would enable us to construct a coherent visual conversation that would cover the issues required to complete the assessment, using mind mapping to support this process. It is also important to identify a top scale that matches the question you are asking and make sure the options you are including are neutral and not leading.

The structure that emerged from this discussion is a Talking Mat that enables people to explore their views on 3 topics

• their home
• their health and well being
• their community involvement

 Trialling the Talking Mats framework

Talking Mats then took the mind maps and developed these into symbol sets that were piloted by social work staff. At the end of the pilot a review was held and changes made which included alterations to

• the language used
• the symbols used
• the topic an option was included under
• making it clearer to staff when options were more abstract and required further explanation and or personalisation

Nicki Ewing from Edinburgh City Council who leads on the project says ‘ I am very excited that staff have a tool that can make assessment more meaningful for service users to participate in and makes it easier for staff to get good quality information’.

Next steps

We are thinking of holding a focus group for others that might be interested in using the framework for their practice if, you are interested please contact Lois  via the info@talkingmats.com email – call your email ‘social work focus group’.

We were recently involved in a discussion about the merits of symbols versus photographs to support communication, a topic which we have spent some time considering over the past few years.

We have also found an excellent small book titled ‘Too late to drive’ by Helen J Bate and published by Pictures to Share C.I.C. In it Helen discusses the meaning of pictures and visual perception in relation to dementia. There are some excellent quotes such as ‘Recognition is not the same as relevance, and relevance is what is important to us when we have dementia’ and ‘The images that really talk to people are produced with a skill and an understanding of the visual image as a method of unspoken communication’..

Our gut feeling is that for many people who use Talking Mats (who we refer to as ‘thinkers’), symbols may be more helpful than photographs and, although we have not carried out any academic research, we have lots of anecdotal evidence from a number of practitioners about some of the pitfalls of using photos. Here are a few:

• The ‘thinker’ tends to get caught up in the detail of a photo e.g. Australian colleagues told us about using photos of different rooms in a day centre but the ‘service users’ got caught up with seeing specific details in the photos rather than considering the over place
• Sometimes a photo can be too specific e.g. we were told of a person with dementia who was shown a photo of cornflakes to represent breakfast but could only focus on the cornflakes
• The ‘thinker’ may be distracted by a photo of a real object e.g a person with learning disability fixed on the make of a particular car instead of considering transport
• We are always wary of using photos of real people as it may be too sensitive for the ‘thinker’ – symbols appear to reduce the emotion impact of the image and be easier for people to comment on
• If the person in the photo has changed, for example their hairstyle or glasses, this can confuse the ‘thinker’
• If the ‘thinker’ has been involved in the place or event in the photo this can affect their views whereas a symbol is more neutral
• Sometimes the clarity and quality of home taken photos can be poor.
• Commercial photos like Photosymbols are good quality but we are aware that  they tend to be used repeatedly, sometimes for quite different meanings

Here is a link to a previous blog which gives some additional information about the development of the Talking Mats symbols.

Academic research evidence on visual images and communication is limited and Helen suggests that that ‘If the academic world wants to explore or challenge anything [in these pages] then at least the conversation has begun’. We would welcome any further information, references or comments.

Please send them to info@talkingmats.com

Many thanks to Sara Toyn, Head of Adult Speech and Language Therapy, who has given us her thoughts on an organisational Talking Mats training course recently held in Powys, Wales. Together with Katie Earing, Sara organised the training course which included participants from a variety of NHS backgrounds and who worked with a range of adults with communication difficulties.

‘I attended a Talking Mats training organised by our team and offered to trained and untrained members of staff working in hospital and community. As an SLT I found it good revision and review of my own practice and also helped refocus some of my ideas and approaches.

The evaluations from all participants were extremely positive. We were overcrammed into too small a room as is the case with many training rooms and usually this is the first comment made on feedback.  I think it is positive that no one mentioned this at all on the evaluations as everyone was very engrossed in the activities and videos.  I have had several individuals point out how much they learnt and they report an increase in confidence in communicating with clients.’

Here are some of the comments from course participants

• This has opened up a whole new world of communication. Thank you.
• Very worthwhile course, have learned a lot and will surely use the mats at work.
• Feel I could integrate this into everyday practice with stroke patients – goal setting, D/C planning etc.
• Good interactive session.
• Completely unique! Thank you.
• Thank you. Excellent training, very transferable skills and will benefit patients.
• Really good. Being specific in the topic and phrasing questions openly, not only using Talking Mats.
• Have a patient in mind for tomorrow morning.
• Thank you. Really useful WHO ICF framework and framework for thinking about people’s cognitive level.

For further information about the training we offer, please click here

Thanks to Karen Wilson, a specialist teacher and one of our accredited trainers, who describes how Talking Mats can help in supporting Looked After Children in having their say.

‘I work as Principal Teacher for children with additional support needs in a mainstream secondary school. In supporting a wide range of children and young people, I am frequently involved in Looked After Children reviews. These reviews can be quite daunting for an adult, as all agencies involved with the young person are represented, along with their carers and their support agencies. I can’t imagine what it must feel like as the child.
Many of these young people find it difficult to express their views, partly because of the circumstances they find themselves in and partly because many of them have communication difficulties linked to their early experiences. I have been struck by how little information is often contained in their Having Your Say form. This should be one of the key ways for young people to express their views and is completed in advance of the review.
I recently used a Talking Mat to help a young person complete her ‘Having Your Say’ form. The young person reported that it was much easier to engage in the process and told me that she had enjoyed doing it. She normally does not like filling in the form. All of those involved in the review expressed surprise and delight at how much more information it was possible to get using a Talking Mat.
I am now working with Talking Mats to explore how this idea can be developed to give more of our Looked After young people a stronger voice in decisions which directly affect them.’

Have a look at the following blogs for further information on theTalking Mats GIRFEC resource and how it is being used