We are excited by the growing use and impact of Talking Mats in CAMHS. With this in mind, we have updated our compilation of mental health blogs, and are pleased to share a new compilation with you. If you have used Talking Mats in a mental health setting and would like to share your experiences with us, please do get in touch at info@talkingmats.com – we would love to hear from you! 

You can also access the blogs listed above by clicking the following links:

We are delighted to share a poster from Licenced Trainers Brid Corrigan and Libby Mills of NHS Greater Glasgow & Clyde, and Student Speech and Language Therapist Heather Pollock, developed as part of an Impact Project with the University of Strathclyde.

The poster reports on an evaluation of the impact of Talking Mats training on clinical practice across several Child and Adolescent Mental Health Services (CAMHS) in and around Glasgow. We were thrilled to hear the poster had been accepted at the Solving the Mental Health Crisis: Global Solutions Across the Lifespan Conference, held on Friday 21st June.

The project demonstrates how Talking Mats can be used by several members of the multidisciplinary team to build rapport and set goals with young people in both the inpatient and community CAMHS setting. A huge well done to everyone involved in the project for shining a light on how Talking Mats can help to hear the young person’s voice as part of their CAMHS journey.

Talking mats are delighted to announce the new Talking Mats ’ Sexual health and relationships’ advanced seminar and resource which is now available to book.

Resource background and development

This resource has been developed in partnership with the REACH team in Perth and Kinross council. In her blog Let’s talk about sex: part one Julia Pollock, a speech and language therapist with this multidisciplinary team describes why this resource is much needed and how it has helped open up discussions on a subject that otherwise might be more challenging. Her second blog Let’s talk about sex: part two describes the impact that this talking mats resource has had on one young person as they navigate their way through  the criminal justice system and their sexual development from childhood to adult hood’

What is in the Talking Mats Sexual health and relationships resource ?

The resource has three topics:

1. Sexual knowledge. This topic allows practitioners to explore what young people know. It also includes a sub mat of body parts to be used if more concrete options are required
2. Being close. This topic explores the young person’s view of intimacy. It can be used to explore what they have experienced in relationships and or what they want.
3. Sexual interests. This topic grew out of the Reach team’s focus on working with young people at risk of being involved in harmful sexual behaviour so it is to be used with care and is not appropriate for all thinkers. The options need to be personalised carefully.

Using this resource

From our piloting and testing phase this Talking Mats sexual health and relationship resource has been found to be very helpful for those working in this field but, it needs to be used with sensitivity and care. The options and images that we have developed are clear but are sometimes explicit. It is for this reason that this resource is not going to be available on our digital platform. It is important that practitioners using the resource are aware of the issues and think carefully about which topics and options are helpful for the young person they are working with before presenting them. Practitioners using this resource  need to work in a context that enables the young person to access any ongoing support for issues that may arise.

Accessing this resource

To access this resource, you need to:

1. Have completed the Talking Mats foundation course.
2. Be familiar with your organisation’s child protection and adult support and protection procedures
3. Be clear about why you are using this resource and for what purpose for example to explore sexual relationships in general or to open up discussions about harmful sexual behaviour. You need to be experienced enough to be able to adapt the resource for those different contexts.
4. Book onto our advanced seminar which we are hosting on the 18th of September 1:00 PM to 3:00 PM in conjunction with the REACH multidisciplinary team. This seminar allows for the context, challenges, risks and benefits of using the resource to be fully explained. This will include best practice examples and impact stories. It will give you the opportunity to explore the resource further and to ask any questions. The cost is £80 per participant and this covers the resource and the seminar.

Click here to book your place on this Advanced seminar. Places will be limited so make sure to book soon. Resources will be posted out the week before the seminar.

This week’s guest blog, the first of 2 from the authors (Lois Cameron, Nikky Steiner and Luccia Tullio), describes the development process of a set of symbols aimed at supporting practitioners to reflect on the role of identity within their practice. 

Every person has their own unique identity, just like they have their own unique fingerprint.

Identity is about how we see ourselves and how the world sees us.

Background

The Royal College of Speech and Language conference 2021 was titled ‘breaking barriers and building better.’  Professor Harsha Kathard from the University of Cape Town gave the keynote presentation and reflected on the key role understanding identity has in clinical practise, stating that ‘understanding identity is key to inclusion’.  Secondly, she stressed that if we want to develop  better services  and support then ‘Turning the gaze to reflect on our positionality is central to change’ .Ash R et al (2023) in their editorial for the British Medical Journal  highlight how interventions normally focus on single categories of social identity and ‘fail to account for the combinations of, or intersections between, the multiple social characteristic that define an individual’s place in society.’ They argue that ‘systems of care may consequently overlook overlapping systems of discrimination and disadvantage and exacerbate and conceal health inequities.’

The Development group

Following feedback from clinicians and people who use Alternative and Augmentative Communication (AAC) a working group was formed in March 2021 to explore the role of identity, diversity, equality and inclusion with in AAC practice. 

Communication Matters and AAC networks within the UK advertised the group and 12 people responded.  These people came from a range of organisations and had a range of lived experiences of diversity including people who use a communication aid to help them communicate. The work was funded by the Central London Community Health Trust and Talking Mats Ltd facilitated the meetings and the work

The group worked shaped the resource by reaching a consensus about the components of life that contributed to identity. In the end the group agreed on gender, sexuality, disability, race, neurodiversity, culture, family structure, voice, bilingualism, religion, mental health, personality, politics, intimacy, connecting with others and occupation. The process of developing the symbols was hugely helpful in unpicking what was actually meant by the various aspects e.g. voice. The original image for voice represented accents but the group discussion shaped the image to represent much more so the final image included a rainbow flag, a more general sound wave to represent tone, a Spanish word and an image to represent disability. As one group member said ‘my cerebral palsy is part of my identity. If I am having a voice I want to reflect that identity – I want a cerebral palsy voice’. Identity and the issues surrounding it can be emotive but the focus on the symbols helped contain the emotion and supported group members to listen to the perspective of others.

The whole iterative process of developing the resource and clarifying what the symbols should look like allowed the group to be clear about the individual meanings of abstract topics. This wider understanding was captured in a glossary to go alongside the symbols. For example, Identity has the following definition: Every person has their own unique identity, just like they have their own unique fingerprint. Lots of different characteristics make up our identity. This is what makes us different from other people. Sometimes we may share some of these characteristics with other groups of people, which can also be part of our identity.  Identity is about how we see ourselves and how the world sees us.

Equality, Diversity and Inclusion: a visual framework to support the exploration of Identity within practice.

The resource is seen as a support for constructive reflection by practitioners on identity and allows them to consider the different aspects of their patients’ lives that may impact on their interventions. The final Talking Mats symbols have the suggested top scale of ‘I considered a lot’, ‘I considered a bit’, ‘I have not considered yet ‘. It could be used individually or by a team as a group discussion tool. 

The glossary is included to allow practitioners to reflect on the wider meaning of the symbols and what the options capture.

As the resource uses the Talking Mats framework, it is recommended that practitioners have completed their Talking Mats foundation level training

If you are interested in completing Talking Mats Foundation Training, you can see the training options in our shop here.

References

Kashard H 2021 Keynote breaking barriers and building better The Royal College of Speech and Language conference.

Ash Routen, 1 Helen-Maria Lekas, 2 Julian Harrison, 3 Kamlesh Khunti1,2023 Interesectionality in health equity research BMJ 2003 https://www.bmj.com/content/383/bmj.p2953

Our thanks for this blog go to Olivia Ince, Talking Mats Licenced Trainer and Speech & Language Therapist. This blog post reflects on the use of a Talking Mat with a Thinker called M who speaks English as an additional language. The Listener in this Talking Mat is Jono Thorne who is a colleague of Olivia. Jono did this Talking Mat for his video as part of a Foundation Training course run by Olivia.

M is a young adult who came to the UK as an unaccompanied asylum-seeking child. M is from a country in Central Africa and speaks a language which is not widely spoken outside of the region. Accessing interpreting and translation services in the UK for their native language is very difficult and M has therefore had difficulties learning English. This means the people around M often have difficulties finding out M’s views, which is why Jono thought a Talking Mat could be an invaluable communication tool for M.

M already uses some visual support, for example hand gestures and using objects such as food items when having a conversation in the kitchen. The people around M are unsure what M’s level of comprehension is in English and therefore they make adaptions such as simplifying their language. M’s expressive language in English is typically the use of one- or two-word utterances and yes/no responses. 

To see if M would be able to engage with the Talking Mat process, Jono chose a simple topic to start with and one which he knew would interest M: food. The Top Scale used was like/unsure/ don’t like. Jono noted that M quickly understood the concept of the Talking Mat and the visual element seemed to support M’s understanding. The Talking Mat process including the side-by-side listening also facilitated rapport building.

Jono noticed that M was decisive and seemed certain about their placement of the option cards. The Talking Mat helped M to share their views on a larger number of items than would likely have been possible via a verbal conversation. M also joined in with the recap of their Talking Mat as part of the review and reflect by reading out the Option cards with Jono, which meant M was even more involved with the process.

There were a couple of difficulties for M during the Talking Mat process: the blanks and the option to change where the Option cards were placed. Jono tried to explain these steps using simple language but M did not appear to understand these concepts due to their level of comprehension of English. As M had seemed sure of their initial placement of the Option cards and they joined in with the recap, Jono felt that the Talking Mat was an accurate reflection of M’s views that day. Continuing to model these steps to M will likely help them to develop their understanding of these parts of the Talking Mats process over time.

Jono reflected on how useful it was to now know which foods M likes and doesn’t like. He also reflected on the potential future use of Talking Mats with M on more complex topics and to facilitate participation in decision-making now that it’s clear M understands how a Talking Mat works.

If you are interested in completing Talking Mat Foundation Training, you can read more about it here.

We are pleased to share a new blog from Talking Mat Associate, Jess Lane, as part of a 2-part series on the use of Talking Mats within Child and Adolescent Mental Health Services (CAMHS).

In Part 1, Jess described how Talking Mats can provide children with a safe space to explore topics that they might otherwise feel unable to communicate about, in a way that is highly supportive, sensitive and impactful. Check it out here:

In Part 2, Jess reflects on the use of Talking Mats by all members of the multidisciplinary team. We also hear from Nikki Low, Specialist Occupational Therapist, who reflects on her use of Talking Mats in the acute mental health setting.

Later in the blog, Jess explores how Talking Mats can be used as part of a post-diagnostic package of support for autistic children to support more focussed, strengths-based conversations, in line with the core principles of neurodiversity affirming practice.

A Multidisciplinary Approach

Welcome back to my 2-part series on the use of Talking Mats within CAMHS. In Part 1, I described how the implementation of Talking Mats by all members of the multidisciplinary team has transformed the way children are supported in the acute mental health setting. I have since reflected with clinicians from across Speech and Language Therapy, Nursing, Psychiatry, Dietetics, Occupational Therapy, Physiotherapy and Psychology on how Talking Mats continue to be used on CIPU to facilitate the direct and meaningful involvement of children in care planning, and to facilitate equity of access to therapeutic intervention.

Nikki Low reflects on using Talking Mats in her role as a Specialist Occupational Therapist:

“I am a Specialist Occupational Therapist working in a Psychiatric Inpatient Unit with children under 12, many of whom, in addition to their mental illness, have an intellectual disability, are neurodivergent and/or have experienced complex trauma. This can make meaningful interactions about thoughts and feelings challenging or even impossible, particularly when discussing sensitive topics.

We strive to provide a client centred approach to care and treatment for our young patients but this can be difficult when they are unable to express themselves. Talking Mats has revolutionised our approach with these children. It has proven to be a powerful tool, transforming communication experiences for individuals of all abilities. I have used Talking Mats to engage patients in assessments and to formulate their treatment goals. Its user-friendly design, customisable features and positive impact make it an invaluable resource in the care and treatment of our vulnerable young patients.

As a unit, we have rolled out training to all core staff in order that we can incorporate Talking Mats into our practice. By doing this, we have been able to facilitate more inclusive and person-centred interactions, ultimately fostering a more supportive and empowering environment for all involved.”

Implementing Talking Mats across a whole staff team has increased the capacity and capability of clinicians to routinely involve children in decisions pertaining to their care. It has also contributed to a culture whereby Talking Mats are considered at each stage of a child’s admission, to support assessments of capacity and mental state, medication reviews, engagement with advocacy services and participation in all multidisciplinary team meetings and case conferences.

Post-Diagnostic Support

Most recently, I have used Talking Mats as part of a post-diagnostic package of support for autistic children, to support more focussed, strengths-based conversations around what it means to be autistic. This has involved developing a symbol set based on SIGN guidelines and associated resources, to support children who have recently been diagnosed as autistic, to engage in a conversation about what would be helpful for them to know.

When presented with a Top Scale of Helpful, Not Sure, Not Helpful, children were able to share their opinion on a range of options, including (but not limited to): facts and figures, autistic famous people, links to other work, skills, strategies and resources. An example is provided below. From this, I was able to create a personalised information pack for each child, based on what they would (and would not) find helpful to know about autism.

Most children shared that it would be helpful to find out about autistic famous people. This provided the foundation for a follow-up conversation about identity. Some children shared that they would find it helpful to find out about incidence and prevalence figures. Others did not. This was reflected in their information packs. For children who shared that they would like to understand how being autistic might impact, or otherwise feed into, therapeutic work for anxiety, I worked with colleagues from across Psychology and Nursing to ensure this was accurately reflected in their information packs.

Using a Talking Mat to scaffold conversations about what it means to be autistic has been well received by other clinicians involved in providing post-diagnostic support. By providing children with an opportunity to identify exactly what they would like to know about autism, clinicians have been able prioritise areas of support and signpost to the most relevant resources. This speaks to legislation that calls for the greater involvement of patients in decision making, in line with the mantra: no decision about me, without me.

Anecdotally, I have found that using Talking Mats as part of a post-diagnostic package of support has made a significant contribution to the development of a more streamlined, relevant and person-centred approach to sharing information. Using Talking Mats in this way has provided children with a dedicated space to voice their opinion on a topic that they might not have previously inputted into, that has been actively listened to and directly acted upon.

It is hoped that in sharing how Talking Mats can be used as part of a post-diagnostic package of support, this blog might encourage others to consider how they might achieve similarly positive outcomes for children with other diagnoses.  If you have used Talking Mats as part of a post-diagnostic package of support for children or adults, I would love to hear from you! Please do get in touch at info@talkingmats.com.

Our thanks for this blog go to Deborah Little, Speech and Language Therapist; Clinical Lead for AAC & Total Communication (Children and Young People) NHS Dumfries and Galloway.

“Can we do a Talking Mat today Deborah?  This is the question I am asked as soon as I enter the Learning Centre in one of our local schools by an enthusiastic 8 year old who has been exploring what completing a Talking Mat (TM) is all about this term.  While we are in the early stage of this school’s TMs journey, the impact of embedding the approach into the fabric of how Children and Young People (CYP) are supported to communicate in school is already proving transformative.

Article 12 of The United Nations Convention on the Rights of the Child (UNCRC) guarantees children the right to express their views and opinions freely in all matters affecting them.  The responsibility of ensuring children experience this right is also underlined in NICE guidelines (2022) that state: “Education, health and social care practitioners should always: put the life goals and ambitions and preferences of the disabled child or young person with severe complex needs at the centre of planning and decision making.”

Working with my teaching colleagues within one Additional Support Needs (ASN) setting this year, we reflected on how effectively the CYP were able to give their views and how consistently these views were acted upon in meaningful ways.  We felt that this was an area we really wanted to improve upon and specifically we wanted to explore the following key questions in our minds:

• How can we support CYP’s understanding of their right to give their views and opinions?  We reflected that for some CYP, their experience of being able to do this was very limited and that their understanding of using a TM was not yet at a stage where they were able to represent their views.  We therefore wanted to prioritise finding out what helped these CYP to use TMs with understanding.
• How can we support CYP to know that they can tell us they aren’t happy about something?  We reflected that during ‘Emotions Works’ discussion times many of the CYP routinely shared that they felt ‘happy.’  It was rare for the CYP to talk about unhappy feelings.  We felt worried that the CYP often gave responses that they felt would be ‘right’ or pleasing to adults.
• How can we ensure we create a culture of prioritising time and space for CYP to share their views, opinions and ideas?  We thought about opportunities throughout the school week that would create space and motivation for the CYP to engage with TMs.  We wanted to achieve a feeling of TMs being integral to the everyday, as opposed to a sporadic ‘add on.’

To answer these questions, we agreed on the following key change ideas to implement and evaluate:

Developing understanding of the Talking Mats process linked with familiar learning opportunities.

Dynamic Assessment is an approach familiar to those working with CYP who use Augmentative and Alternative Communication (AAC).  Adapting activities dynamically, being responsive to CYP’s progress, allows progressive skill enablement.  Together with teaching colleagues, we applied this thinking to helping the children use TMs with understanding.  If we had tried having a conversation using TM only a couple of times, our evaluation could have been that TMs wasn’t yet a tool we could use because for example, the CYP were putting all their symbols into the ‘I’m happy with this’ column only.  Instead, we thought “OK, that’s where the CYP are now, let’s give them opportunities to practise engaging with this new tool and time to develop using the approach with understanding.”  Put another way, we prioritised another key concept within the field of AAC: we Presumed Competence.  We believed that the CYP had the ability to share their thoughts, feelings and ideas if we introduced TMs gradually, linking with the activities above, that were tangible and familiar to the thinkers.

Consciously modelling that is OK to have negative feelings and opinions.

When a CYP is learning what might be possible in terms of communicating with AAC, best practise is for supporting adults to model the AAC.  This means, adults ‘use AAC to teach AAC.’  We show CYP that we highly value the AAC and want to use it too.  We use it in real situations, modelling vocabulary to help CYP understand the symbolic vocabulary and how they can begin to use it too.  When helping the CYP understand how TMs could help them express a wider range of emotions, we tried out using this approach. Now and again, supporting adults would share with the CYP how they were feeling about things using TMs and would include negative feelings. 

One CYP had a memorable response to my sharing that I was feeling “not happy” with my cat.  The CYP’s eyes widened and he became instantly animated, using his AAC to ask “cat..bad..what?”  I was able to explain that my cat had been scratching my carpets and I was feeling upset about this.  The CYP then used his AAC to say “cat…dig!”  He pointed at the ‘not happy’ symbol in the Talking Mats top scale, jointly sharing his attention to this symbol and understanding of what this meant with me.  The next week, we used TMs to ask this young person about a social group he had attended.  For the first time, we noticed him ‘swithering’ across his top scale while making his choices.  Also for the first time, I was confident that he shared his authentic feelings with me.  I reflected on the power of modelling and normalising feelings that are ‘not happy.’

So, where are we now?  The key themes from our findings after a year of using TMs as described above are:

In summary, using TMs in this setting has all supporting practitioners in agreement that it is not only important to listen to CYP when we know they might be having a tough time; we need to create space to listen all of the time, week to week, with authenticity and without agenda.  The principles regularly used within AAC practice of: modelling, presuming competence and dynamic assessment have been effective in supporting more children to be able to experience their UNCRC Article 12 Right, more of the time and with increased understanding and confidence.

References

• UN Convention on the Rights of the Child – UNICEF UK
• NICE Guidelines [NG213] (2022) Disabled Children and Young People up to age 25 with severe complex needs: integrated service delivery and organisation across health, social care and education.
• Emotion Works www.emotionsworks.org.uk
• Daneshfar, S and Moharami, M (2018) Dynamic Assessment in Vygotsky’s Socioculturaly Theory: Origins and Main Concepts.  Journal of Language Teaching and Research 9(3):600
• Donnellan, A (1984) The Criterion of the Least Dangerous Assumption.  Behavioural Disorders, 9 (2), 141-150
• Sennott, Light and McNaughton (2016) AAC Modelling Intervention Research Review.  Research and Practice for Persons with Severe Disabilties 41 (2)