Engaging with people who have difficulty communicating can take time and may result in misunderstandings which can cost a lot in terms of time and cost and emotion for all involved. Research and anecdotal evidence have both shown that using Talking Mats is efficient and cost effective in that staff or carers can get better quantity and quality of communication with the people they work in a shorter time with than with usual methods of communication. The average time for someone trained in Talking Mats to have a Talking Mats conversation is 15 minutes, although some people may choose to talk for longer.

In addition, staff often rely on relatives to gather information about a person’s needs and preferences. The process of gathering that information can be protracted owing to availability of family members and, because it is second-hand, is liable to misinterpretations. This in turn can lead to frustrations which can damage relationships, result in poor care and cost time.

At a practical level, the feedback from staff has been that the wipe clean, ready-made Talking Mats symbol sets give immediate access to a practical communication tool. Staff compared this favourably with the time taken to source images on-line, print them out, cut them up and develop them to a standard that is infection control compliant.

The Talking Mats team have invested their time and skills over several years to develop topics which are based on sound research. For example the Health and Well-being Resources is based on the World Health Organisation ICF, the Children and People’s Resource is based both on WHO-ICFCY and GIRFEC. The Eating and Drinking Resource has been co-produced with people with eating and drinking difficulties and a range of different professionals. The Talking Mats symbols have been carefully designed to represent both concrete and abstract topics

In addition sending staff on a Talking Mats training course results in a work force which is effectively trained in communicating with a wide range of people as well as having a bespoke communication tool. Using Talking Mats is efficient for organisations both in terms of time and costs.

Thanks to Alison Matthews for a great guest blog on Talking Mats supporting people with learning disability to have a political voice  In the photo from left to right Alison Matthews, John Hendrickson ( chair of NW LDA) , Shahnaz Ashraf, Rosemary Trustam, Darren Heywood (vice chair)

The North West Learning Disability Alliance (LDA) is a campaign group focussing on the rights of people with learning disabilities. The NW regional self -advocates forum met twice to identify their priority concerns which were due to be discussed at the regional conference in Blackpool. Members of the NW LDA attended a conference planning event and  we discussed ways in which people could be supported to voice their views on services. It was agreed that given the need for local and national politicians representing their citizens to hear the views of people with learning disabilities, the conference would be a way to develop this with the help of social media. The NW LDA was then invited to have a stand at the conference in Blackpool.

Talking Mats seemed the obvious approach to support discussions around the concerns as it provided a structured means of people expressing their views and provided potential objectivity in that people could also praise services, as well as voice concerns, which in fact some did! We wanted to take photographs of people with their mats as we felt it would bring the concerns or issues to life, it certainly seemed a more powerful way of enabling people to speak out. Our idea then was to e mail relevant local councillor or MP and to support people to get their voices heard wherever possible.

Some of the challenge was in planning the vocabulary needed and in finding the appropriate visual scale. The list of concerns created by the self- advocates provided an ideal starting point.  The scale we opted for consisted of symbols which enabled people to say whether they were worried about the topic or happy/not concerned. The topic itself was ‘services’. Finding symbols was a real challenge so we opted for a mixture in the end, photos, symbols, photosymbols and our own line drawings.

We spent time with the self -advocates who produced a mat, first exploring their knowledge of social media, in particular Twitter and Facebook. Many already had accounts and e mail addresses, some people came ready with topics they wanted to get off their chests or people they wanted to praise.  Everyone said whether or not they wanted to e mail their MP or local councillor with a photo of them and their mat and whether they wanted us to post the photograph of them with a mat on social media.  For Twitter we used the hashtag our voices matter (#ourvoicesmatter).

People raised concerns about a variety of issues to do with service cuts, from cuts to the NHS and the need for local pharmacies to stay open, to cuts to transport and the need for additional support with relationships. One person mentioned specifically that she wanted to feel safe at home and talked about crime directed towards people with learning disabilities. Most people were worried about benefit cuts

We had some positive responses, one person wanted to highlight how happy she feels in her new flat and one person specifically wanted to compliment his local councillor who he felt really listened to people with learning disabilities. Ivan Lewis MP tweeted his support for the campaign. In terms of learning for next year’s conference, we will develop the vocabulary and the process of collecting e mail addresses and twitter accounts for MP’s. One very valuable lesson we learned about the numbers engaged in the activity was to hold next year’s sessions before the party on the last night.  It seems the participants at the self advocates conference work hard and play hard too!

Alison Matthews is a Speech & Language Therapist, Director of Total communication Services CIC and member of the North West Learning Disability Alliance

April 2016

Talking Mats was used as part of a Speech and Language therapy assessment  for a boy with a stammer (dysfluent speech).  He was very aware of his stammering and would change what he was going to say or avoid some situations because he anticipated that he would stammer. He had low self-esteem about his speech and felt that whenever anyone laughed in his class, it was to do with his stammer.

Talking Mats was used to gather information about which situations and  people made speaking easier, and any situations and particular people which caused more of a challenge.  The activity provided much more information than originally anticipated.

A starter mat was used  to show how a Talking Mat worked, using pictures of food. He engaged well with this, and understood the process quickly.  We then moved onto discussing his speech – we wrote names of people in his life and situations which involved speaking onto pieces of paper,  and he placed these on the mat where he felt appropriate.  We started with people and situations which appeared more positive, then gradually moved onto those it was anticipated would be more challenging.

His insight into his speech and what helped him or made speaking more difficult was impressive. We were able to use this information to compile a list of “Do’s and Don’t’s” for people he came into regular contact with. He agreed that this information could be shared with school to give them strategies to support him there.

The most powerful part of the Mat was him being able to say that he did not feel happy about talking with his big brother sometimes, because he could make fun of his speech, and this made him feel really upset. This was a powerful revelation for his Mum who had sat in on the session, as she had not realised he felt this way.    After the session, the family  had a chat around the table at tea-time about how his therapy session had gone that day – with Mum’s support he was able to say to his brother about how his teasing had made him feel. His older brother had thought it was all a bit of fun and hadn’t realised the impact it was having. They agreed the older brother wouldn’t tease him anymore.

When he came back for his next session, he commented on being much happier about his talking at home, and felt the activity had been really helpful. His Mum was very positive about it too, and proud of how he had managed to speak up for himself and be able to say how other people could help him with his talking.

Our thanks  to Kirsten Taylor, Speech and Language therapist for sharing this powerful story

What are the top 10 blogs for using Talking Mats with adults? Over the years we have posted lots of blogs on different aspects of our framework . If you are working with adults with communication disability these blogs maybe particularly helpful

1. Where is the best place to start using the Talking Mats health and well-being resource? 
2. A blog from Denmark which highlights the effectiveness of using Talking Mats with people with dementia
3. Goal setting with a woman with Multiple sclerosis  
4. Using the  app with someone with aphasia 
5. The development of a resource to help people with learning disability raise concerns 
6. How can Talking Mats support Capacity to make decisions
7.  Involving  people in their decisions about eating and drinking 
8. Thoughts on using Talking Mats with people with dementia to explore mealtimes 
9. Using Talking Mats with someone with a learning disability and dementia
10. Use  in a rehab setting in South Africa 

If you want to explore our  resource and training more  please visit our shop

We are delighted that we have been able to support Kirsty Hamiliton to become our paid Talking Mats office junior. As Kirsty was leaving school she wanted to get some experience doing real work but this is a challenge for her as she has severe autism. The social interaction and pace of change involved in a busy office is not easy for her, but she likes sorting and organising things, so we decided to give it a go.  We have to confess that Joan and I needed some persuasion. At  that time we were busy setting up Talking Mats as a start-up social enterprise and taking on an additional commitment added further complexity to our initial phase of getting started .However, Margo who was one of our associates and also worked with Kirsty in her NHS job is persuasive and we gave it a go!

It has not always been plain sailing. There were challenges; initially, Kirsty only managed to volunteer for an hour at a time and needed significant support to help her manage that. Through having a structured environment, Kirsty moved to volunteering for two hours a week and lots of progress made both in the tasks performed but also level of supervision required. Her support worker no longer stays with her in the office. Karen our Talking Mats Training Administrator is responsible for her work and once a task is set up Kirsty works on them independently.

There have been huge benefits to Talking Mats and they have outweighed the difficulties. We have someone who

• has an eye for detail
• who likes putting things into sets; a huge advantage if you are working with symbols
• who can work at  speed and with great focus  on visual tasks that the rest of us find hard,
• who is reliable and comes  to her work every week
• who keeps us grounded by reminding us of our core business i.e. to improve the lives of people with communication difficulties

We have also learnt a lot about supporting someone with severe autism in to work and we would like to ask other organisations and companies to think about whether they have opportunities that people with communication disability can take advantage of. It has really made me reflect on my time in the NHS as a Speech and language therapy manager. Despite the investment that the NHS makes to people with learning disability, there are limited opportunities for employment for people with autism and learning disability in statutory services, yet we are sure staff have the skills to support this. We have no doubt that Kirsty’s social and communication skills have grown hugely in her time with us. We think statutory services are missing a huge opportunity to make a real difference to an individual’s health and well-being that will begin to challenge the continued current health inequalities that exist.

We are proud that Kirsty has moved from volunteer to paid status and proud of all the team at Talking Mats that has enabled this to happen. She’s a great colleague to have in our social enterprise .

We are very grateful to Anna Volkmer for sending us this blog, Lets Talk about Capacity…
She has just had an excellent book published –  Dealing with Capacity and Other Legal Issues with Adults with Acquired Neurological Conditions http://www.jr-press.co.uk/dealing-capacity-legal-issues.html. In it she describes how AAC methods, including Talking Mats, can be used to support people in expressing their decisions.

Prior to 1959 people who were considered “non-compus mentis” were cared for under the “parens patriae” principle. Literally translated this meant that they were ‘parents of the country’ and decisions to protect them and their property were made by the Crown (the Lord Chancellor). These people were often described as “Chancery Lunatics”. In 1959 the “parens patriae” jurisdiction gave way to the Mental Health Act. This Act instructed that “the judge may, with respect to the property and affairs of a patient, do or secure the doing of all such things as appear necessary or expedient…for making provision for other persons or purposes for whom or which the patient might be expected to provide were he not mentally disordered” (section 102 (1)(c)). Unfortunately, this Act did not make adequate provision for non-financial decisions such as medical decisions. During this period it was case law that guided professionals in supporting their patients who lacked capacity in medical decision making. It was not until 2005 that the first Mental Capacity Act was given Royal Assent, accompanied by the Mental Capacity Act Code of Practice in 2007.

I returned to the UK from a 5-year stint working in Melbourne, Australia, just after the Mental Capacity Act had been published. Mental capacity was on the tip of everyone’s tongues and as the speech and language therapist working on a multi-disciplinary team I became an integral part of this process. Patients I was seeing, often people with primary progressive aphasia or other types of dementia, were asking about how to make future decisions. They and their families were keen to understand how the mental capacity act worked, how to prepare for the future and how to have their voices heard. On the other side of the coin I was working on an inpatient ward where staff were concerned about ensuring we were fully assessing the decision making capacity of people with cognitive and communication difficulties, often holding best interest discussion to plan for the future of these individuals. Many of these decisions related to dysphagia, but others related to accommodation and finances.

What concerned me was the lack of evidence available across the speech and language therapy arena in this area. There was little to none in terms of written research, let alone written advice or even examples of good practice tailored to speech and language therapy clinicians. As I asked around I found an enormous disparity in the services that speech and language therapy clinicians were providing across different trusts. I had previously written a book on dementia, and had included a chapter on assessments of decision-making. At this stage some of the only research related to communication and decision-making had come from Talking Mats. This had demonstrated that using the talking mats tools can support families and caregivers in conversations with their loved ones when discussing decisions to be made. They found that conversation enabled people in understanding, retaining and expressing themselves in decision-making discussions.

Following a particular stimulating discussion with the publishers at J&R press, they invited me to submit a book proposal on this topic. As I was developing this idea I found the topic of mental capacity was raised more and more often at study days and seminars I attended. At these study days I started linking in with more like minded speech and language therapists such as Mark Jayes, Hannah Luff and Claire Devereux. These were clinicians who all agreed on the diversity of our potential role in supporting our patients around mental capacity issues. These common interests enabled a collaboration. Our book is now published.

Through these connections I became aware of other work being done; Mark Jayes holds a NIHR doctoral fellowship award and is conducting research in the development of a communication and capacity assessment tool kit. Claire Devereux is the chair of the Southern Psychiatry of Old Age Clinical Excellence Network, together we have held a workshop with the clinical specialists where we developed a consensus document on role of the speech and language therapist in capacity assessment. This is to be published in Bulletin magazine later this year. Hannah Luff is a clinical lead speech and language therapist at South London and the Maudsley NHS Trust and is currently a member of the review panel looking at the NICE SCIE dementia guidelines.

The wonders and value of networking never ceases to delight, enthuse and inspire me! And you can purchase our book at the following website (there is currently a discount rate until 21^st February):

http://www.jr-press.co.uk/dealing-capacity-legal-issues.html

You can follow me on my blog https://annavolkmersbigphdadventure.wordpress.com/ or on twitter @volkmer_anna

 We are very grateful to Tom Tutton from Autism Spectrum Australia for this interesting blog. 

Autism Spectrum Australia (Aspect) works with people on the autism spectrum and their families. We regularly recommend visual communication strategies because people on the spectrum often have strengths in visual learning. This is especially important in our work through Aspect Positive Behaviour Support where communication can replace challenging behaviour.

In the past, we applied a ‘hierarchy’ of visual representations based on how easily they can be understood.

Generally, objects are considered the easiest form of visual communication to understand; followed by miniatures, remnants, photos, line drawings and symbols and writing, in that order. Although this hierarchical understanding is held true for many people on the spectrum, there can be exceptions. Some individuals find line drawings easier to understand than photographs.

Aspect Practice continually reviews and applies the evidence base to our daily work. So, with the knowledge that the hierarchy does not fit for some people, we reviewed the research literature to see if we could refine our understanding and use of visual communication strategies.

We asked “What evidence is available about the hierarchy of visual representation which could explain how an individual could benefit more from line drawing supports than photos?”

To find the answer, we searched an electronic research database, prioritised 20 papers and then reviewed four papers in detail that seemed to answer our question (references below).

We found information that suggests the factors contributing to a person’s understanding of visual symbols is broader than a simple hierarchy and involves consideration of three main areas:

The individual’s experience

• The individual’s ability to learn
• ‘Iconicity’ of the symbol (more detail about this piece of terminology below)

Ideally, these factors should be considered for every symbol used with every individual. We learned that a symbol can be placed on a continuum in terms of ‘iconicity’. At one end, it can be described as “iconic” or “transparent”, meaning that it is very similar to the object it refers to (e.g. using a juice bottle to present the choice of juice). At the other end, it can be described as “arbitrary” or “opaque”, meaning that there is little or no visual similarity between the real item and the symbol (e.g. the written word “bird” does not look or sound anything like an actual bird).

The generally accepted hierarchy of visual representations aims to organise types of symbols by their level of iconicity, but misses some subtleties. This means that phrases such as “photos are easier to understand than line drawings” are often overgeneralisations.

For example, image 1 looks more like an apple than image 2, even though the second one a photograph. Image 1 would also be easier for an individual to understand if that symbol had been used extensively around them, if it was motivating and functional and if that individual had a strong ability to learn the association of that symbol and an actual apple. Therefore, a person’s ability to understand a symbol does not depend on its iconicity alone, but the ways symbols are used and learned.

In answer to our question, there are several possible explanations why a person may understand line drawings better than photos.

They may have been exposed to line drawings more than photos, meaning they can learn the associations between line drawings and things in the real world more effectively.

• The photos being used contained a background (and had lower ‘iconicity’), whereas the line drawings provided a simple representation on a plain white background.
• The person’s learning style may mean they learn each symbol individually, rather than learning how to associate symbols the real objects in a more general way. If a person who learns this way is exposed to more line drawings, they will learn more through line drawings.

As a general statement, it is clear that greater emphasis needs to be placed on the needs of the individual, as well as the properties of the individual symbol, rather than considering only a hierarchy.

Steve Davies (Positive Behaviour Support Specialist & Speech Pathologist, Aspect Therapy)

Dr Tom Tutton (National Manager, Aspect Practice, Positive Behaviour Support Specialist)

References

• Fuller, Lloyd & Schlosser (1992) Further Development of an Augmentative and Alternative Communication Symbol Taxonomy, AAC Augmentative and Alternative Communication, pp67-74
• Sevik & Romski (1986) Representational Matching Skills of Persons with Severe Mental Retardation, AAC Augmentative and Alternative Communication, pp160-164
• Stephenson & Linfoot (1996) Pictures as Communication Symbols for Students with Severe Intellectual Disability, AAC Augmentative and Alternative Communication, pp244-256
• Dixon, L. S., (1981) A functional analysis of photo-object matching skills of severely retarded adolescents, Journal of Applied Behaviour Analysis, 14, pp465-478

This article was inspired by a blog post written by Dr Joan Murphy, Co-Director, Talking Mats.
Click here to read original blog

Aspect Practice is an initiative where Aspect shares its evidence based practice through information, workshops and consultancies. To learn more about Aspect Practice, visit www.autismspectrum.org.au/content/aspect-practice.

I’ve been thinking about the advantages and risks of social media after Talking Mats recently reached 10K Twitter followers.

We (and by we I really mean my co-director, Lois, who had the vision – and at times the addiction! -to embrace and develop social media for Talking Mats) have worked hard at engaging with people who have a similar ethos as us i.e. to support and improve the lives of people with communication disabilities. We have linked with  people who could teach us new ways of looking at the world we work in and with whom we could share our ideas. We realised that social media is a powerful tool to connect with like-minded people across the world. In combination with Twitter and Facebook we write regular blogs illustrating relevant- and at times fun – issues from our work. We hope our website is  seen as a rich resource of information for anyone interested in communication.

However, I recently listened to a TED talk given by Wael Ghonim. He spoke about how in 2011 his use of social media helped spark the Arab Spring when he set up a Facebook page which attracted tens of thousands of followers and became a place for crowdsourcing and sharing. However, his initial euphoria turned to despair as the revolution turned ugly and the social media he was involved with also turned unpleasant. He describes what he now believes are 5 main problems with the direction that social media has taken.

1. Social media can spread rumours that become seen as truth
2. Social media can result in ‘echo-chambers’ – we only communicate with people we agree with
3. Social media can quickly shift from discussion to disagreement and anger
4. Social media encourages us to make statements (as a result of having only 140 characters) rather than ask questions about complex issues. Everyone can read these statements and we feel we need to defend them
5. Broadcasting becomes more important than engagement; shallow comments become more important than discussion; we talk AT people rather than WITH each other; we become obsessed with numbers of posts and followers rather than with the quality of the discussion and who follows us.

He concluded his talk by suggesting that we need to develop social media protocols to create civility and respect and reasoned argument e.g.  get credit for the number of people whose mind you change. I found his arguments compelling and uncomfortable – I do recognise Wael Ghonim’s ‘problems’ when I venture into other areas on social media such as politics.

However, this has not been our experience and we are reassured that in the social media world of communication disability people are civil, respectful and generous. We at Talking Mats like to think that we are using social media as a forum for engagement, thoughtfulness, quality discussions, learning new ideas and developing understanding without hostility, anger and shallowness..

And long may this continue…..

Get your New Year’s resolution Talking Mat here!
Talking Mats is a social enterprise whose  vision is to improve the lives of people with communication difficulties. 2015 has been another exciting year for us. We have had great opportunities to work with a fantastic range of people and hear great stories: from wee ones in nurseries using Talking Mats to encourage active participation and decision making, to older people and their families through our dementia family training project. It is our core belief that good communication is fundamental to a quality service. Making sure there is space for active listening to views and concerns particularly, if individuals have difficulties communicating is central to effective interactions and individualised, person centered care. We are really grateful to all the people who have supported the work of Talking Mats; people with communication support needs, staff who work with them and organisations that we are privileged to work with on a consultancy basis.
It will not surprise you to know that as an organisation we like to set goals and then go for them so as our thank you to you all for your continued support , we have created our very own New Year’s resolution Talking Mats;
• What are you definitely going to go for ?
• What is in the maybe pile – or that could be for those things you are already doing and will continue
• What is not a goal for you in 2016 .
• Don’t forget to use the blanks to personalize it further!
• Plus take a photo so you can reflect back on where 2016 takes you and whether you achieved your goals .
So open and download it , cut it up and we hope you enjoy using the resolution Talking Mat with friends and family ! resolution pics
We wish you all every health and happiness from all in the Talking Mats team

Fika (coffee time)  in the Talking Mats office is always interesting.  Recently we got chatting about Christmas preparations and who had the longest ‘to do’ list.  There was a definite variation in enthusiasm for all things Christmas.  We needed to do a Talking Mat! This was done on our digital Talking Mats – it’s  easy to import your own images now and make a digital Talking Mat about any topic.

Eating , drinking and games and puzzles got the thumbs up!   (Lois is the games queen and was the most enthusiastic about that).

Holiday, partying and entertaining got consensus.

Extended family coming to stay? This moved around a bit, but was generally positive (say no more!)

Shopping was in the mid section-we all agreed.  Perhaps by now it would be less positive with last minute mayhem.

Gifts was added as a blank (how could the interviewer forget that) and not everyone was comfortable about the commercialisation of Christmas.

‘How do you feel about Juggling demands?’   We all agreed -not sure.  Again remember, Talking Mats is how a person feels at a certain point in time.  Ask us again on Christmas Eve?!

Christmas cleaning?  All agreed was a chore and some thought best not to get too bothered about it

Talking Mats supports a group conversation.  We all got our say

Merry Christmas one and all