We are grateful to Nicola King SLT, who describes how she and colleagues use Talking Mats not only to gain feedback from parents about the therapy process, but also about the parent’s understanding of the child’s diagnosis and its impact.
The options to start the discussion are included in the mind map below. Click on image to enlarge.

Issues raised by one parent were
1) Information given to me –unsure . The mum went on to say ‘I’m worried/ frightened. I don’t want to ask too much as I’m frightened as to t he answers
2) My child’s progress –unsure. The mum offered ‘I’m inpatient’

Nicola commented –‘These were huge issues and each response gave me a chance to explore what she was thinking and meaning. For the first time this mum offered her fears about ASD and ADHD. She enjoyed the Talking Mats process and after the interaction agreed for the first time to an onward referral which ensured support was in place for her son starting school.
The Talking Mats format was a brilliant way to have that ‘difficult conversation’ ‘

The intention at the core of the Scottish Strategy Getting it Right For Every Child (GIRFEC) is to keep the child at the heart of the planning process. Helping the child to set personal outcomes based on what is important to them, should be the starting point. In practice, this can be difficult as many of the well-being indicators are difficult for children and parents to grasp. A primary headteacher highlighted the limitations, explaining that she was trying to find out about how safe one of her pupils felt. When the pupil asked her to explain what she meant, she replied “Well, do you feel safe in my office or do you think one of the books might fall off the shelf onto your head?”

The Consulting Children and young people resource allows you to reorganise the symbol sets to reflect on each of the specific well being Indicators. If we take the example of safety, we can make the concept more accessible to the child by providing concrete examples. This may include: asking for help if needed,  feeling listened to, as well as, safety in specific settings for example at home; in school; with friends or using social media. The CCYP resource helps the interviewer to think about the child’s age and stage of development and uses examples that are meaningful.

The visual framework means that their is a clear record of the shared understanding between the child and the interviewer of the concept of safety.

We are planning to run specialist sessions on using Talking Mats with the SHANARRI indicators in order to ensure that the child’s view is at the heart of the planning process. If you are interested please let us know what would work best for you.

Email us at info@talking mats and tell us if you would prefer a Saturday session, a Twilight session or a half day session and state your preference for morning or afternoon.

One of the many ‘non-traditional’ uses of Talking Mats has been the work that has been undertaken with university students (both undergraduate & post graduate) at the University of Stirling. Since 2008, staff in the Career Development Centre at the University have been trained to use Talking Mats as a tool to help students to articulate their career thinking and planning.
We have established from our research and trialling of a range of topic cards that students respond well to the process. While the majority of the students we work with have no speech or language difficulties, the process of TM enables students to articulate their thoughts and to feel more at ease to raise particular issues. It can be very hard for students to talk openly about financial worries, academic issues, or career anxiety. TM gives a platform for this to be done in a non-threatening way and quickly allows the Careers Adviser to see where the student is ‘at’ in their thinking. This then allows the adviser to work more efficiently & effectively to support the student to develop their career plans /strategy.
Staff feedback would indicate that they enjoy working with TM in both one to one and group settings with students. There are many perceived advantages to using TM but one of the main ones is that it can make better use of the time available and that it can be a good way to see quickly where the key issues are that need to be addressed. TM also fits well with current Career Guidance Theory, allowing the student to narrate the ‘story’ and arrive at their own solutions to the ‘problem’ under discussion.
There are of course some students who do have additional learning needs and TM is again an ideal tool. In particular, students with dyslexia and dyspraxia comment positively that the visual aspect of the cards allows them to process the information and structure their thinking in a clearer way that just talking to a careers adviser can.
International students who sometimes have poor English language skills respond well to using TM as it allows us to get a clearer picture of the students thinking than sometimes is the case from a more ‘traditional’ discussion
Action Planning and Goal setting are a big part of the Career Management process and TM is a really useful tool to ‘kick-start’ this process for students. The visual impact is powerful and enables students to see clearly what they are considering and the cards allow the students to physically move the cards to help them to decide how to move forward in their thinking and planning. Students consistently comment that they appreciated the opportunity to see clearly the issues that they are considering and allow them to move forward.

Many thanks to Elaine Watson, Careers Adviser, University of Stirling and one of our accredited trainers for this stimulating description of how she is implementingTalking Mats

Whilst developing the eating and drinking resource, we tried it out with people with a range of eating and drinking difficulties. I talked to Ellie, who had swallowing difficulties following a stroke. She found it really helpful to use the mats to think about different aspects of meals (mealtimes, where you eat and the process of eating). Ellie had very good insight into her eating and drinking difficulties and had developed clear strategies to help manage them. She found breakfast and snacks the most difficult meals to manage. She was also very clear that pureed and soft moist foods were the safest and easiest for her. After we had done the mat, Ellie reflected on her eating and drinking, saying that it was limiting but that she could see that things had improved. One of the most difficult things for her was the impact of her swallowing difficulties on some of the social aspects of eating. She really misses going out for a meal with family and friends, something that we often take for granted.

Doing the ‘meals’ mat helped Ellie to see that although she still has many difficulties, mealtimes have become less stressful. For example, although eating and drinking is still a long, slow process, Ellie and her family have adapted to this and now manage ok, especially if they plan ahead. Some useful action points were also identified for the professionals working with Ellie –  it would be good for her to have suggestions about a greater range of breakfast options as well as a variety of snacks which she could eat between meals.

Using the mats really helped to clarify the progress that Ellie has made with her eating and drinking since her stroke.

View  the images used in the resource by downloading this short selection

To order your copy of the resource click here  The resource will be available on our digital Talking Mat shortly

Over the past  year we have been funded by the Scottish Government to develop a Talking Mat to enable adults  with Learning disabilities to raise issues of concern.  We have worked in close partnership with Survivor Scotland and Kingdom Abuse Survivors Project  .  Together we have developed and trialled a Talking Mat  . The final report for this project is here :Talking Mats and Survivor Scotland final Report

This year the Scottish Government recognised the value of using Talking Mats as a conversation framework to enable people with learning disability to reflect on their lives and express their views including raising  any areas of concern.  One of the key themes from the national Scottish strategy for people with learning difficulties ‘Keys to Life’ is to  keep people safe, but it was also recognised that the Talking Mat that had been designed could also help with other themes –

• Helping people with learning disabilities stay in control
• Shift the culture and ensure care is genuinely person centred
• Evidence that the views of people with learning disabilities have been taken into account
• Support people to cope with adversity and loss and enhance  resilience
• Address health inequalities and reduce early deaths

The Scottish Government has funded a 3 year project which we are calling Keeping Safe.

This project will

• Produce a new resource based on the feedback from earlier projects This has 3 topics of conversation . Firstly ,How people are feeling about their Health and well-being secondly, their relationships. For people who are able to think and express their views at a more abstract level  the resource has a third topic and gives them  space to reflect on their thoughts and feelings.

•  Train staff in the 14 health boards across Scotland to use Talking Mats and this resource specifically. This training will be provided jointly with KASP so staff can be supported to think through how they respond appropriately to any concerns that may arise
• Ensure that all health board areas have accredited trainers who will be able to lead ongoing training and sustain use of the resource

If you work with adults with learning disabilities in Scotland and would be like to be part of this exciting initiative please contact us at info@talkingmats.com.

Thanks to an OT colleague for this powerful story of how Talking Mats helped a woman with Multiple Sclerosis with goal setting by getting to the root of the problems she was having.

I am an OT working in a community rehabilitation team in Scotland.  I have been seeing a woman (who I will call Jill) with MS.  Jill has been experiencing increasing problems associated with her MS and finding it difficult to cope.  During my first visit, Jill found it difficult to tell me about the problems she had been experiencing, and almost impossible to consider how we could translate these problems into tangible goals that we could work on.   She was closed to any suggestions I made about potential rehabilitation goals.  In her mind, the problems she had were there to stay, nothing could be done about them and she would just have to struggle on.  We didn’t seem to be getting anywhere just talking about it.  Jill was getting a bit exasperated and I was finding it difficult to keep a structure to our conversation and steer it towards agreeing on a goal that we could work towards.  I felt there was a real risk of her disengaging from the service because we could not agree on a way forward.

Then I decided to use Talking Mats to see if that would help.  I knew that using Talking Mats could help people with cognitive problems as well as those with communication difficulties.  I wondered if doing a general Talking Mat using the Health and Well-being TOPIC symbols would help me identify what Jill thought her main problem areas were.  Then I planned to do a sub-mat to look at her priority areas in more detail.  My aim was to try and identify one or two rehabilitation goals (reflecting Jill’s priorities) that we could work towards.  I really felt that there was potential to make a positive impact on Jill’s quality of life if I could get her to engage and agree on a goal to work towards.

Using Talking Mats proved to be a great success.  Jill very quickly got the concept of it.  It seemed to be much easier for her to pick up a symbol card, consider it, and then place it on the Mat.  Using the Mat appeared to reduce the ‘cognitive load’ of the conversation and gave her structure to work within which she found much easier.  Jill was able to identify what her main problem areas/ priorities were: – Mobility and Learning/ Thinking (see picture of her Mat above).  Jill was pleased that she had got her message across and actually seemed to enjoy the process of using Talking Mats.

Now we have got a starting point.  In my next session I’m hoping to complete sub-Mats with Jill in the Topics of Mobility and Learning/Thinking.  This will allow us to explore these areas in more detail.  Using Talking Mats was a real breakthrough in Jill’s rehabilitation.

To read another blog about using Talking Mats with someone with Multiple Sclerosis click here

We are launching our fantastic eating and drinking resource to support shared decision making. This has been co-produced with the help of  people with eating and drinking difficulties and a range of different professionals. The resource is designed to help people think about, discuss and make informed decisions about how to manage their eating and drinking more safely. People with eating and drinking difficulties should initially be assessed by a qualified Speech and Language Therapist and Dietitian who will recommend appropriate strategies to help them eat and drink safely. This resource is particularly useful in helping people understand the effect that their eating and drinking difficulties can have on their health. It also helps people talk about how they feel about recommended strategies.
When discussing eating and drinking, there are many issues to consider. We have provided symbols under three main topics to help present ideas in a structured way that reduces the likelihood that the person will be influenced.

Click on this image to see it more clearly.

Discussing these topics separately means that people can firstly consider how they feel about different meal times, where they eat and types of food and then think about the impact that their eating and drinking has on their health. It also allows people to have a conversation about some of the suggested strategies and how acceptable these are.

We have run seminars specifically on this new resource in London and Stirling

Contact info@talkingmats.com for further information if you wish to attend a seminar in the future.

Thanks to Lauren Pettit for this thought provoking blog about using Talking Mats in a rehabilitation setting in South Africa to compare goals of adults with aphasia, their Speech and Language Therapists and their significant others.
I am a Speech-Language Therapist in Johannesburg, South Africa and I work in neuro rehabilitation for people who have had a stroke or head injury. Over the past few years, I have been inspired to learn more about implementing communication modes to assist people to participate effectively in various communication interactions.
Talking Mats™ is such a wonderful tool that enables people to communicate so many things, from their needs and desires, to engaging in higher level conversations. I have seen the benefits of this tool used in a rehabilitative setting. I recently completed my dissertation with the Centre for Augmentative and Alternative Communication (CAAC) at the University of Pretoria, in South Africa.
The study included adults with aphasia who were still attending therapy at least 6 months after their stroke and were working on activities and tasks in various therapies, for example: Occupational Therapy, Physiotherapy, Speech-Language Therapy, therapies. I wanted to understand what was important for them to work on in rehabilitation to improve in various areas of life. Some of the adults with aphasia had very little or no speech, others had difficulty expressing themselves and finding the appropriate words to use in a phrase or sentence. Talking Mats™ was therefore used to assist them to rate important life areas. The life areas (activities and participation domains) were identified by the International Classification of Functioning, Health and Disability (ICF). This classification system was created by the World Health Organisation (WHO) and may guide therapy assessment and management. The areas were depicted as symbols with a supplemented written word on each card. These nine cards were: Domestic Life, Relationships, Work and Education, Leisure or Spare time, Self Care, Learning and Thinking, Coping, Communication, and Mobility. The adults with aphasia were asked what was important to them to work on in rehabilitation. The adult with aphasia could place the card under Yes, Maybe or No on the velcro mat and provide a comment if he/she wished or was able to. The Speech-Language Therapists who worked with the adults with aphasia and their significant others (a family member/friend or carer, who knew the person well) were also included in the study. They were asked to identify which areas they thought were important for the adult with aphasia to still work on in therapy.

(Click on graphs to see clearly)

It was very interesting to see varied opinions in the results. Six of the areas received similar ratings from all the participants and Communication was highlighted as an important area to work on by all. There were statistical differences found for the following domains: Work and Education, Leisure or spare time and Self Care. The adults with aphasia wanted to work on Leisure or Spare time and Self Care, however, Work and Education was not important to them to work on in rehabilitation, whereas the Speech-Language Therapists rated Work and Education as important for the adults with aphasia to work on. Significant others did not rate these domains as important.
This study gave a glimpse into how some rehabilitation teams are currently communicating and working together and that very often, the people who have difficulties expressing themselves are perhaps not always given the time and space to understand the therapy plan and identify and communicate their individual therapy needs. This needs to be explored further. Talking Mats™ provided a structure and gave the adults with aphasia a ‘voice’ and the opportunity to engage in this complex communicative interaction. I am in the process of sharing the results from the study with the participants. I have encouraged them to sit together in their teams and identify areas that could currently be focussed on in their therapy. Many participants were eager to discuss the results after the interviews were conducted and were interested in the concept of prioritising their rehabilitation needs. I hope they see their participation in this study as the opportunity to further engage in their rehabilitation needs and that it gives them the confidence to participate more fully in many other areas of their lives that they identified as important.
I would so appreciate your thoughts and input. Please respond to Lauren lolpettit@gmail.com

We’re delighted that Andrea Powell, an Occupational therapist in Edinburgh has written a Blog for us about her experiences of being involved in group work with people who use AAC.

As a student occupational therapist, I worked part time as a support worker with an amazing lady Jennifer, (Jennifer is a pseudonym) Jennifer just happened to use an iPad to communicate. At this time I was about to commence my final year studies and was required to research and write a dissertation on a subject of interest. The lightning bolt of inspiration came when I, with Jennifer attended a weekly AAC user support group which was run and organised by a group of SLT’s.

The group was a wonderful resource that truly benefited the people who used it. I witnessed how much Jennifer valued spending time chatting with friends who also used an AAC device and who understood the unwritten rules of engagement. Such as patience while I set up my speech, don’t look at my screen while decide what I want to say etc. Her confidence in using different types of conversation grew while attending the group. It encouraged her to add to her already wide and variety vocabulary. As her support worker I also valued the opportunity to gain access to training on how to use her AAC and how I could provide better support to her.

I began reading around AAC and how people integrate of devices into their lives.  I was however shocked to find that the wonderful group Jennifer attended was a rare occurrence for many users. The more I read, the more I realised that many users struggled to continue using an AAC device due to lack of support, access to trained professionals and most did not have wonderful resources like user support groups.

As an OT I was interested to explore the role in which I would play within AAC provision and found that as an OT I would be mainly providing support and advice on positioning, accessing devices and ergonomic type support.

However I felt that as an OT we have many more skills that didn’t appear to be to be getting utilised, within in my dissertation proposal I postulated that OT’s could expand their role within AAC to i) collaborating on assessments for AAC; ii) training on devices once they have been issued to users; and, iii) running and facilitating groups for AAC users and communications partners in the community.

OT’s are highly trained specialists skilled at understanding what is achievable and realistic for an individual. Occupational therapists assess individuals holistically in order to establish realistic and manageable goals which can be graded and adapted to suit the individual. Through the utilisation of appropriate grading of an occupation, a user can experience success and therefore less failure and frustration, ensuring the challenge is set at the appropriate level for the individual concerned (Park 2009).

Running and facilitating groups as a therapeutic tool is something that occupational therapists have been doing since the earliest days of the profession and groups are now utilised in many areas of practice (Howe and Schwartzberg 2001). By continuing this tradition, occupational therapists are well placed to take the lead in running and facilitating groups for AAC users, integrating social and community activities into the groups, for example, meeting in local shops to provide real life experience of interactions and, importantly, promoting the use of AAC to the general public. There are similar projects being attempted in Motherwell to increase the awareness of Dementia and make local businesses “Dementia friendly” (Shafii and Crockett 2013). Providing groups for AAC users not only enables them to learn how to use their devices, but also provides a support network of other users and communication partners.

I feel that if the skills of an OT were utilised in more than ergonomics then more positive outcomes could be seen for the user of AAC. I believe that if there were more OT’s taking on additional roles within AAC provision it could help reduce the pressure for SLT’s and the waiting lists to see SLT’s. It would also enable more users to be assessed to use AAC.

Part 1 highlighted how Talking Mats training can help improve your competency when consulting children and young people. In this part,we are grateful to Anita Devi, Education Consultant for illustrating the key differences between Statements and EHC plans. The changes have been implemented to enable individuals and families be active agents in their own lives rather than passive recipients of services.

Using Talking Mats as a communication tool  enables practitioners to fulfil all stages of the assessment process and contributes to the development of the plan. The differences of the new system under the SEND reforms are illustrated in the table below (double click on the image to see it more clearly):

The local offer provides information on what services children, young people and their families can expect from a range of local agencies, including education, health and social care. Knowing what is out there gives  more choice to individuals and to families.

The Local Offer has two key purposes:

1. To provide clear, comprehensive, accessible and up-to-date information about the available provision and how to access it, and

2. To make provision more responsive to local needs and aspirations by directly involving disabled children and those with SEN and their parents, and service providers in its development and review.

For children and young people, who struggle with communication, this can be quite a challenge. What is required is a communication tool that makes the process real and meaningful. Talking Mats breaks down the dialogue into bite-size chunks and gives the child or young person the space and time to meaningfully express his/her preferences and opinions.

Earlier in the year, Anita Devi & I published an article on “Listening to the learner :seeking the views of children and young people with communication difficulties.” It highlights the importance of creating a listening culture within the learning environment and using all modes of communication available. If we take the time to do this, the child or young person’s perspective will be taken seriously and the unique circumstances of each individual kept central to the process.