Talking Mats has adopted day 69 of the justice for LB Campaign. This campaign was started was after Connor Sparrowhawk drowned in the bath whilst staying in  an assessment treatment unit .  In the words of his mum Connor was ‘a beautiful, hilarious and loved beyond words dude’.  So, after decades of trying to improve services for people with learning disability, closing the long stay hospitals, bringing in person centred approaches, we are left in 2014 with huge inequalities in the health and life opportunities  for people with learning disability and life’s like Connor are cut short in such a shocking, unnecessary and untimely manner.

How many more tragic deaths are we going to see before residential services for people with learning disability are going to change?  We need to see at the heart of  service culture an ability to really listen , put the views of the patient at the heart of planning and see the families as key partners. Sometimes I think people see listening as a ‘soft issue’. Other things get measured but does the quality of listening ever get measured? It should because in my view it is a critical patient safety issue.

Over the last few years I have had the privileged of working with a diverse group of people with a range of communication support needs. They have developed an interactive workbook for NHS Education Scotland. They share their experiences of contact with services to help staff understand how to improve communication and listening skills. They created 10 vision statements for staff of the things that were key to them. They told powerful personal stories to illustrate those statements. The stories illustrate both good and bad practice. You can download the free resource at http://goo.gl/QdOOev .

Listening to people what strikes me time and time again is the lottery of service delivery. There are some great stories where people have received quality treatment and interaction but that is not universal for there are stories where you are left questioning the compassion and humanity of staff in so called ‘caring’ roles. The question for all of us is how we shift the culture so that we can all experience a person centred and listening health service. I hope the energy and impetus of #107 campaign ignites the flame of change so that ‘all dudes’ gets a safe and quality service. If you want to join the campaign then please follow @justiceforLB .

Teens are comfortable using communication tools in the form of social media. They can feel less comfortable with direct communication and often find it hard to put their feelings into words. Using a Talking Mat when talking to teenagers provides a communication tool which takes the focus off face to face interaction. It gives a thinking space to help them to express their feelings. It also allows you to have a balanced conversation because it talks about the positive things in daily life as well as the opportunity to talk about difficult things.
Tina is a 13 year old girl who initially had coped well with the transition to High School but in February had started to refuse to come to school. She was unable to explain what the problem was and when asked about the reason for her absence, would say “ I hate school”.
The “Consulting children and Young people -secondary resource” was used to consult with Tina. She was presented with some of the options from “My body and Skills” to think about how she was feeling. Tina used the top scale Happy(Things are going well and Not happy (things are not going well).
During the Talking Mats interview she opened up about how she felt about travelling to school (she hated going on the school bus and felt embarrassed) She clearly identified the fact that she has specific learning needs as she has difficulty understanding and concentrating in class and often falls behind with her written work. Attending her maths class was particularly difficult and she did her best to avoid going. She also talked about her difficulty with talking to adults and also to her peers. Often she feels excluded in conversations as although she is listening, she doesn’t always understand what they are discussing and doesn’t know what to say. She has a problem with sleeping and feels her mood is low a lot of the time. She also commented that she can feel extremely angry and this has a negative effect on her behaviour. On the positive side, she loves to read and feels happy about her diet and her weight.

Helping Tina to grade her feelings about specific issues helped to identify what needed to be done in the first instance to get her back to school.
Alternative travel arrangements were put in place, extra support provided for her in class and from the learning support base.
She is attending school again and the pupil support team are gathering together the appropriate “team around the child” to explore her difficulties further.

Find out more about how to use Talking Mats by signing up for a training course at Talking Mats.

The communities where children grow up can have a significant impact on the well-being of both children and families. The Consulting Children and Young people pack contains the topic “My Wider World”. This topic allows exploration of the impact of both school and life out of school as well as the support systems available to them. The World Health Organisation reminds us of the importance of gathering environmental information from children. As a child develops the environments of their everyday life are closely connected to home and school and finding out how the child feels will give insight into their independence and activity. Negative environmental factors often have a greater impact on children than on adults. In order to promote a child’s well-being, effort needs to be given to enhancing a child’s physical environment as well as their social or psychological environment.

Daniel is an 11 year old boy with a diagnosis of Asperger’s Syndrome. He completed a Talking Mat to explore the impact of his environment on his condition. He was asked to grade his responses using the top scale Happy (Things are going well) and Not happy (things are not going well).

He immediately commented about how he felt about school (“yeah –it’s okay”) He expressed a strongly negative reaction when asked about where he lived. He was very unhappy about the location of his house as it is in an extremely remote location and he can never have any friends round to play. He never gets visitors to his house apart from an uncle that may drop by. He feels bad that he doesn’t have any neighbours and would love to live somewhere that has got other houses nearby. He has talked to his mum about it but she says, “she can’t take me places – too much petrol” He knows that his mum is worried about money. He also really dislikes “out of school care” as he is rarely allowed to play on the computer. He is happy with his teacher, support from health services and the emergency services.

Daniel was clearly upset about his lack of social integration and contact with his wider community.
Environmental support included supporting the care-givers in the “out of school club” by providing training and advice about  Asperger’s Syndrome.
Social work became involved to help to help locate local youth groups and finance.

Find out more about how to use Talking Mats by signing up for a training course at Talking Mats.

Using Talking Mats with Tony, a 53 year old man with learning disability and dementia. A guest blog by Rebecca Leighton  Specialist Speech and Language Therapist and Consultant for elenbi-uk 

“When I change I will be different” 

Tony was referred to me for Speech and Language Therapy around 6 months after being diagnosed with mixed dementia.  Dementia was having many effects on him but a key impact was communication difficulties: one of these difficulties was dysarthria (for him, this meant slow, slurred, effortful speech and difficulty maintaining enough breath support to finish his sentences) and  another word-finding problems (difficulty remembering and producing the words he wanted to say – like the “tip of your tongue” phenomenon we all get from time to time, but occurring in most of Tony’s sentences).  These two communication difficulties combined made talking very tiring and frustrating for him.

When I first met Tony, one of my aims was to find out what he wanted to achieve with Speech and Language Therapy.  We discussed this but it was tiring for Tony and it became clear very quickly that using words alone was not helpful.  It also became clear in that first session that although Tony was concerned about his speech, he was more concerned about his future and other areas of his life. He was worried about how he would enjoy life with dementia. He knew he would get worse and he wanted to know how he and his family would cope with that.  Tony said “When I change I will be different. What will I do with myself?”

I introduced Talking Mats to Tony at our next session, suggesting that it would be a way of exploring what he was worried about in terms of his overall health and wellbeing and also  what he might want from Speech and Language Therapy.  We did four Mats over the course of two sessions:

Mat 1: Starter topic (food). Tony managed a three-point scale easily (“like” “dislike” and “not sure”) and told me “This is alright, its easy. I can talk if I want. But I don’t have to.”

Mat 2: “My worries”.  Tony used a three point scale to indicate whether he was “not worried”, “a bit worried” or “very worried” about a range of aspects of his life and future.  We found that Tony’s main worry was what he would do with his time as his dementia progressed.

Mat 3: “Activities with dementia” – a sub-mat based on Tony’s main worry identified in Mat 2. This was done jointly with his advisor, Sabira, from his local dementia support service, who planned the mat with me to ensure it covered all the options Tony had available to him locally. The mat revealed that Tony was already attending a well-being café but wanted to try other well-being cafes too, to meet more people.  He was keen to try the singing group and also felt that his family needed support.  Sabira commented that she thought Talking Mats should be used more with people with dementia and she intended to explore this within her own service.

Mat 4: “What I want help with from Speech and Language Therapy”.  Again we used a three point scale, this time to indicate “yes”, “no” and “maybe” to possible goals for Tony. Options included assessment, therapy and advice. We chatted around each topic, giving Tony more information on each possibility and discussing if and how it could benefit him. Tony made informed choices around each option, and made the decision to start by creating a Life Story.

With Talking Mats, Tony has been able to give his full views on some very difficult topics for him. He has done so in a way which has reduced the demand on his speech, which made the discussion easier and less tiring for him. He has taken control of his Speech and Language Therapy care and has made informed decisions about his therapy goals.  Perhaps more importantly he has taken control of his future and made informed choices about what he wants for himself and his family for the rest of his life.

Talking Mats could be used by many services for people with dementia.  Imagine how empowered people with dementia would be, for example, if their social worker or dementia adviser were able to use Talking Mats with them to identify their needs and wishes and help them choose what they want for their present and future. What better way to involve people in their own care?

The only caveat? Get in there early. Empower people to tell their story while they are still able to use pictures and words to do so.  Dementia can steal these skills, burdening families with making decisions on behalf of their loved ones.  As a daughter, mother, wife and sister myself, I know I would feel much more at ease with making a decision for my relative with prior knowledge of what they themselves would have wanted. Talking Mats is one way of finding that out.

The Health and Well-being resource is based on the WHO International Classification of Functioning, Disability and Health (ICF) which is a framework which covers almost every aspect of daily life and can be applied over different cultures (WHO 2001).

Use of the WHO ICF helps professionals to think holistically about the people they are working with. We have produced four sets of symbols, based on WHO ICF, to help people express their views about different aspects of their lives. These cover 13 topics:

You can use the symbols in different ways, depending on the cognitive abilities of the person you are working with. For example, if you are working with someone who can understand abstract concepts, you could start with the 13 main health and well-being symbols. Your top scale might be ‘managing’ and ‘not managing’. Here is an example of a mat completed by Duncan who had a stroke which affected his ability to communicate through speech:

Using these symbols as a starting point, Duncan could tell us that his main concerns related to worries about his health, expressive communication and work. From here, we did ‘sub mats’ to help Duncan identify the specific areas he wanted to work on/explore.

Here is the mat Duncan completed in relation to his health:

Having done this mat with Duncan, it became clear that he was worried about various aspects of his health, particularly the risk of having another stroke. The wider team were able to give him and his wife information about stroke prevention. Other mats were also completed, exploring expressive communication, work and education and higher level communication (which is included in the ‘learning and thinking’ topic, and covers written communication as well as memory and concentration). Using the Health and Well-being symbols, we were able to work with Duncan to help him identify the main issues that he wanted to work on and then work towards more specific rehabilitation goals. Duncan had copies of all the mats he had completed and found it useful to refer to them over the months. This helped everybody stay on track in relation to his goals and he was also able to track his progress over time.

Have a look at our Health and Well-being resource on our website. It is available both as an original Talking Mat with a physical mat and symbol cards or as a  digital version  as part of The Talking Mats pro subscription

I undertook the ‘Talking Mats’ on-line course to acquire a new skill and a way to enhance my communication with people with dementia in practice. I have found the learning strategies used are varied and interactive – so there is not a sense of sameness, even though visually there is a consistent layout to the presentation of each module (this expedites navigation). This enhances engagement and my interest so that I am never reticent in logging on to complete the next module! In the beginning, I felt that I could move a lot quicker through the course if the modules were available once each part was completed, instead of having to wait for feedback on each assignment. However, nearing the end of the training course, the benefits of this approach are now clearer. Spaced learning and spaced practice allows for thinking time and internalisation of the module components. In this way, I have come to appreciate the part skills involved in the overall process and how they come together. I now find myself observing the skills involved and the reactions of all communicating as well as the surrounding environment, body language etc. I have also found myself looking back over the past module materials to ensure I am integrating as I go and to remind myself of the rationales for the actions that need to be taken, as well as ensuring that I am more and more familiar with the new terminology that I have been exposed too.

Little did I know when I signed up that the benefits of learning about and how to use ‘Talking Mats’ would stretch wider than what I initially anticipated or wanted! In completing the course, I am now much more aware of my communication practice in general, and the part-skills involved. I can also now see the wide applicability of ‘Talking Mats’ to different populations, age groups and conditions. Communication is everywhere but it needs to be efficient and effective – I am now more confident that my communication practice will improve as a result of this course. For me this is the best outcome possible.

Please click here to find out how to book on the next course 

We wanted to develop a tool that would give a holistic picture of how a child or young person feels about their lives at home at school and in their communities. We took into account the significant developmental changes that occur from 3 to 17 years and the influence of environmental and personal factors surrounding the child or young person.

We asked our artist to reflect the age and stage of the child in developing a symbol set for:

• Early years
• Primary and
• Secondary

The symbols are organised into three topics:

My Body and Skills: In this section you explore how the child is growing and developing by focussing on the functions of the body as well as skills that are emerging.  You can gain an impression of how the child feels he or she is progressing physically, socially, cognitively and behaviourally.

What I do and my support: In this section you look at the child’s lived experience by asking about the activities they participate in, as well as how they feel about the support they receive.

My Wider world: The communities in which children grow up have a significant impact on the well-being of both children and families. In this section you look at the child’s wider world by exploring the impact of nursery or school as well as the support system available to them.

Talking Mats prompts you to cover the relevant topics for each age group you’re working with. You can help children and young people to see their personal strengths and abilities and take time to consider what their problem areas are.

The mind map below shows what is included in the Primary pack – What I do and my support.

If you want to read about how Talking Mats were used to help young people think about targets for their IEP read the 2012 research report.

If you would like the complete Consulting children and young people pack, covering Early years, Primary and Secondary then buy the silver resource which can be purchased either as an original or through a digital subscription.

I want to go on holiday on my own!

At a recent training Jenn Hall who is a Personalisation Development Worker, told the story of her first use of Talking Mats. She used it with a woman that she has known for some time to discuss her views about her going on holiday. The lady is in her forties and has Downs Syndrome.  As she came to the people symbol she looked at it for ages and then placed it in the middle column explaining that she wanted to go on holiday on her own and visit her brother who lives in Spain without her parents. she had never been supported to do this and it was what she really wanted to do.  She also put the food in the middle column explaining that it was hard to understand the menus when she was abroad and that she wanted to learn a few basic words in Spanish. Jenn said that the Talking Mats really enabled the lady to express what she wanted not just go along with the status quo and for those around her to appreciate and understand her views . The Talking Mats has supported discussion with the family to enable this lady’s wish to come true . Hopefully she will have her first successful holiday with her brother visiting him all by herself.

Talking Mats has been working with Survivor Scotland.  They are the organisation that oversees the National Strategy for Survivors of childhood abuse in Scotland. They have focused their work on a whole range of people but recognise the incidence of abuse within Learning disability is very high and that people with a learning disability often don’t have the resources or skills to tell their story and get the support they require. Survivor Scotland are anxious to address this and develop appropriate resources for this group of people.

.In our current project with Survivor Scotland  we have developed 3 sets of Talking Mats that would allow conversations to be had with people with a learning disability. These sets were developed from a previous project that had been conducted in NHS Fife;‘the 6D Cards’ and with the input of staff experienced and skilled in working with survivors of abuse. The sets cover general issues but within those issues, patterns of concern may emerge that would allow people to discuss concerns further.

We then ran 3 training courses. These courses gave participants space to think about disclosure, encouraged them to become trauma aware and built their confidence in supporting and dealing with disclosure. Specific training in Talking Mats was also provided. The training was run jointly with Kingdom abuse Survivors Project, Survivor Scotland and ourselves and was funded by the Scottish Government

The 3 courses have now finished and 40 people have been trained in the resource. They came from all over Scotland from the Western Isles to the Borders and represented a range of professions working with people with a learning disability and with an interest in preventing abuse in learning disabilities: therapists, nurses, social workers, consultants, advocates  They will use this resource in their practice  and it will be evaluated later in the summer