The transition from children’s to adult health services for young people with exceptional needs and their families is complex, multifaceted and fraught with concerns and fears. CEN Scotland commissioned Talking Mats to carry out a study to collect the views of 10 young people and their families who are experiencing this transition in Scotland.

The families in the project have given us clear views about their problems and fears and also some thoughtful suggestions for what could be made better. It is often in making small changes that significant improvement can occur. These suggestions include:

• Courses for parents on transition
• More specialist nurses e.g. transition nurses, acute liaison learning disability nurses
• Start preparing early – at least 2 years
• Transition wards for young people
• Training for doctors and nurses about complex needs
• More respite, not less
• Emotional support for parents
• Longer appointment times
• A hotline to GPs

This study captures the complexity and variation of transition health services for young people with complex health needs from the perspective of both the young person and their parents. Despite the problems and fears we also saw evidence of good practice and suggestions, such as those above, which give hope for the way ahead.

To read the full report, including a moving case study, and direct comments from families, please click here CEN Transition Report

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The Keeping Safe Talking Mats resource is a visual framework that has been developed and trialled over 3 years. It provides:

• A listening space for people with learning disability to raise concerns
• A structure for staff to find out what people are thinking about their lives, and raise issues that can be difficult to discuss.

We have produced a poster that describes the development of the resource and where we have got to .  Please click here to view CM poster 20150825

The Scottish government learning disability strategy keys to life has 4 strategic outcomes for  people with learning disability in 2015-2017

1. A health life
2. Choice and control
3. Independence
4. Active Citzenship

Using the Keeping safe resource allows people to  think about , reflect on and have their say in these areas. We have loved training staff working in learning disability across Scotland to use it. The feedback on how it is being used is  very powerful, so watch  out for more blogs that will show how it has helped people with a learning disability  have a say in changing and determining their lives.

Stirling Council hosted a meeting this morning (2^nd October) to discuss Stirling’s response to the Syrian refugees crisis. It was a great meeting with good speakers outlining the Scottish response and also the Stirling response to welcoming families from the refugee camps. There were about 150 people in the hall buzzing with ideas and we were given plenty of time to discuss in groups our thoughts and ideas.

One of the key issues overlying those such as housing, education, health, faith and community support was communication. How we can help people whose first language is not English and who may also have difficulty expressing themselves because of trauma?

Already there have been responses from translation services, the local Islamic Centre and the University. Another possibility is the use of Talking Mats to help people consider their options and express their views. We have used Talking Mats in other situations where English was not a first language, for example in clinical situations with Polish patients and also in our work in China a few years ago. We found that once the person understood the basic structure of Talking Mats we were able to communicate amazingly well. We have a number of symbol resources that might be helpful and, as a social enterprise, are keen to offer our services.

Like everyone in this morning’s meeting, we look forward to welcoming and supporting the Syrian families who are coming to Stirling.

Sophie Mitchell SLT describes how she supported her students to develop their EHC Plans with the Talking Mats app .

In September 2014 our  team and I were asked to facilitate the production of Education and Health Care plans for the Year 14 students at the Secondary Special School (for adolescents with complex, profound and multiple learning difficulties) where we  are based. As Speech and Language therapists we were asked to work with the students to gain their view on what they would like to be detailed in their plan and also what their aspirations were for their future. We wanted to ensure the production of these plans were as client centred as possible so therefore decided to use the Talking Mats App on the Ipad using the Health and Wellbeing resource.  This resource proved invaluable when working with our students. Not only were our students highly motivated to participate in the sessions due to the Ipad being used, talking mats empowered them to make meaningful decisions about their future, communicate any areas where they would like further support and discuss likes and dislikes. The impact on our students became clear when working with one 19 year old student. Although he did not have any spontaneous expressive language and would only echo things said by others, during a Talking Mats sessions when talking about his likes and dislikes, he appeared to be placing most items under ‘dislike’.  As the session went on the student started to appear agitated, then started pointing towards ‘like’ although no symbol was presented. Suddenly the student said ‘Garden’, still pointing towards the ‘like’. When presented with a gardening symbol he soon placed this under ‘like’. This information was then presented in his plan and his college were instructed to explore opportunities for this student to develop his gardening skills. For all students this information was then used to not only create their Education and Health Care plan but also expand and explore areas they were highly motivated by while still at School and also identify possible work placements for the future.  Furthermore the School invested in Talking mats training to ensure this approach is used throughout each academic year and school staff are skilled to use Talking Mats as each student starts their assessment for their Education and Health Care plan.

We would like to thank Sophie who is from Sandwell and West Birmingham NHS trust  for such a great example of how to use the app in EHC Planning . If you are interested in purchasing the digital Talking Mat then please phone the office 01786479511. We are just changing the purchasing model from subscription to one off sale so its temporarily removed from the web site.

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 delighted that the free seminar we are holding in London on the 20^th of October is now full, so have planned an additional session on the same day.

This is a great opportunity to find out about this communication tool which gives children and young people a voice. Children and young people are experts in their own lives and Talking Mats is a useful framework for enhancing participation and inclusion.  It is suitable for a range of people who need support to express their views, interests and aspirations, and make decisions about their support. e.g. pupils with communication difficulties; pupils who have English as an additional language; and those who are reluctant communicators or who find it difficult to organise their thinking.  We would particularly welcome staff from educational settings.

During the session we will

• Show examples of pupil participation
• Provide hands on experience of the Talking Mats resources, both original and digital
• Exchange practice and ideas

The seminar will be on the 20^th October 2015 from 1.15 pm –3.00 pm and located close to London Bridge station.

To book a place contact info@talkingmats.com.

Places will be allocated on a first come first served basis.

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

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

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’.