As a group of Allied Health Professionals (AHPs) working in a secure hospital we recently embarked on a mini project using Talking Mats to check in with our service users with learning disabilities during Covid-19. We collated the evidence from our respective professional bodies (Royal College of Occupational Therapy, Royal College of Speech and Language Therapy, Chartered Society of Physiotherapists and British Dietetic Association) in terms of changes that people might experience if they’d had Covid-19 and produced a talking mat around these.  

It quickly dawned on us that we might be on to something here, and that creating an opportunity to ‘check in’ more broadly with our service users would serve a useful purpose, so we added some additional categories around changes to routine, psychological wellbeing and feeling safe.  

This was my colleagues’ first experience of using talking mats, and their faces when I turned up clutching my 99p actual doormat were a picture! I introduced them to the theory behind the mat and its presentation and harped on about the benefits in terms of attention, comprehension, non-threatening interaction, initiation and structuring narrative; they nodded supportively.  

We set off across our learning disability wards in multi-disciplinary pairs and all but a few of the service users agreed to have a chat with us. My colleagues commented that they were pleasantly surprised by the engagement and the amount and novelty of the information gained; we  identified things that the service users hadn’t told anyone because they hadn’t been asked that question!  

In talking to others we were asked why weren’t rolling this out in a partner secure hospital for people with mental health conditions? ‘no reason really, we just haven’t got there yet’ we answered. Then came the…. but we can just do it like a questionnaire with them. This question wasn’t, and in my experience isn’t ever ill meant. It comes from a place of naivety in relation to the presence of communication difficulties in people with mental health conditions and because of that, lack of exposure to different professional groups such as Speech and Language Therapy and the skills and approaches we have to offer. Skills in gaining and holding someone’s attention. Skills in decreasing pressure in communication situations. Skills in enabling time, space and ways in which people can initiate their thoughts.  

The Multi-Disciplinary Team (MDT) working around the project has enabled me to show others how talking mats can support their practice. It has enabled them to see how a very simple and non-threatening visual tool can open up conversations and lead to information that the service users hadn’t shared before, in a way that a face to face conversation doesn’t.  

Thanks to Jo Brackley, Clinical Lead, Speech and Language Therapy Secure Services at Cumbria, Northumberland Tyne and Wear NHS Foundation Trust for this inspiring blog – which demonstrates when we shift the way we listen and gather information from patients we get a different result and improve the quality of information and communication . If you or your team want to consider Talking Mats training then we can provide this for organisations . At the moment we can take a cohort through our online course together and then arrange a zoom call to discuss application to your work setting  – email info@talkingmats.com for more information.

It’s always great to see pictures of Talking Mats on social media.  The stories behind them, and the positive changes that can result for people keeps us motivated to share this powerful tool.

It is apparent however that not all pictures that are called Talking Mats are actually Talking Mats!  For example,

TOP SCALES   If the  top scale is Yes / No Or  a tick /cross

It is apparent from these mats that the questions are likely to be closed, and don’t provide a scale for reflection.  Closed questions can be leading and suggestive of a set answer the listener is seeking. e.g  ‘Did you enjoy your lunch?’  v. ‘How was your lunch?’

A yes/no, or a tick and cross at the top  are occasionally used with topics which appear to test understanding of rules, e.g acceptable and unacceptable behaviour in a classroom.   In that instance the listener facilitating the mat keeps the control and the power imbalance that exists in conversations for people with communication difficulties isn’t reduced.

The top scale used with each  topic is key to the mat working.  A Talking Mat could find out what the person thinks about the rules, and which ones they feel are good -not good or help -not help.   Our Foundation training includes how to match the top scale to the conversation. https://www.talkingmats.com/training/

TEACHING TALKING MATS   Some people with communication difficulties need to learn how to do Talking Mats.  Learning how to express a view can take time and has to be taught.  We  see pictures of what appear to be Teaching Mats. For example, starting with closed questions might be necessary to introduce the idea of preferences.

It is important that these Teaching Mats are not used as a true representation of a person’s view but seen as a step towards this skill- It can take time but great learning takes place along the way.

We have guidelines for working towards Talking Mats on our website:

Guidelines for working towards using Talking Mats – These guidelines are designed to support Talking Mats trained practitioners working with thinkers who may need to take extra steps to work towards using the Talking Mats framework

Supporting people to share what they think, and giving them the control to say when they are not happy with an aspect of their life, is within their legal rights.

‘To deny people their human rights is to challenge their very humanity’     Nelson Mandela

In the second of two blogs, we talk about how using Talking Mats Resources can help people have better conversations.   

Our first Resources blog (https://www.talkingmats.com/resources-with-training/) focused on the resource bundles which are available to purchase with our Foundation Training course.  This second blog focuses on the resources which are available to people who have completed our Foundation Training course. 

Remember that most of our resources are available in both low-tech, and digital, formats.   

Post-Training 

Once you have accessed one of our Foundation Training courses, you can purchase our resources at a reduced rate: 

1.    You can buy these in established sets using our post training order form, for example you may choose to buy a social care set, the secondary Children and Young people resource, or one of our Advanced sets (see 3. below). These sets all have 3 topics of conversation in them.

2.     New for 2020! – you can now buy individual topics of conversation from our ‘pick and mix’ selection, which includes topics  from our Health and Well-being Resource (also available as a bundle purchase with our Foundation Training course), as well as our Conversation Sets: 

 3. Our advanced sets, for example Keeping Safe and Thinking Ahead, are only available for those who have completed foundation training:

• Keeping Safe: Give people time to reflect on their lives and raise concerns using this resource. This can help you to explore sensitive issues in a non-threatening way by creating a listening space, simplifying abstract ideas, supporting thoughts while encouraging expression and decision making.

• Thinking Ahead: Support people to express their views and help them plan for end of life using this resource. It will also be helpful for many other people to consider future options in their lives.

We are also planning to add a ‘how was school today?‘ topic to our ‘pick and mix’ selection soon – so watch this space!

To find out how our resources could help you in your professional area of work/setting, check out these links here:  https://www.talkingmats.com/where-you-work/

For more information about these resources please contact the office on 01786 479511 or email info@talkingmats.com

Many thanks to Charlotte Phillips and Laura Douglas, SLTs at Blossom House School, New Malden, for this latest guest blog which looks at how Talking Mats are used for therapy goal setting within the context of a specialist school for children with SLCN.   Further information can be found on their RCSLT Poster Presentation (September 2019) here – AAC Poster RCSLT Conference September 2019

Goal setting can be a labyrinth to navigate! Do these goals reflect the pupil’s own views? Is there a discrepancy between staff and pupil ideas for goals? Are these goals motivating? Are the goals functional? Are pupils avoiding goals they would like to achieve for fear of failure? Add to this the language rich dialogue required in order to establish goals and similar to a maze you may encounter dead ends, twists, turns and a feeling of entrapment. How can we ensure we do not assume needs and that the goal setting process is collaborative and person-centered? Enter Talking Mats; a tool which enables you to make sense of the maze, like the lookout tower in the middle it allows you to have a clear view of how everything fits together. You’ll now find the goal of exiting is far easier!

How can Talking Mats help?

At Blossom House the Talking Mats framework is utilised at the beginning of therapy to support pupils with DLD and specific learning difficulties to identify areas of their strengths and needs and develop personally meaningful goals that are associated to these areas. Some of the pupils are competent verbal communicators within a social context but due to the emotive subjects they may be exploring they may not be able to access these skills within therapy. Talking Mats are also used to baseline students’ self-awareness alongside prompting pupil voice. Talking Mats are tangible and have low linguistic demands which allows students with kinaesthetic and/or visual learning style preferences, and communication needs to engage in these discussions.

Case Study This Talking Mat (using Widgit Symbols as options) was created with a student at the start of therapy whilst the therapist was building a therapeutic relationship. It helped a student who was reticent to share with a new adult to have a full conversation about things that he was happy with and those that were not happy. The mat options were chosen to include a) communication strengths and needs, b) school subjects and c) some areas the SLT knew were areas of strength. The function of this mat was threefold: to baseline the confidence the student felt about certain areas (with the aim to increase this over therapy), to assess his self-awareness of his strengths and needs and finally to act as a tool to help prioritise targets for therapy and develop relevant goals. The student’s self-awareness was accurate as he was able to rate known areas of strength e.g. singing, dancing and drama, as ‘happy’, whilst known areas of difficulty e.g. spelling were accurately labelled as ‘not happy’. Some of the areas of need that the student rated matched the SLT’s referral information as priorities for therapy from his teacher (starred) therefore these were used to go on to create joint goals with the student.

Next Steps

The school would now like to embed Talking Mats as a whole school approach. The first step will be Talking Mats forming a core part of School council meetings to ensure that every pupil has a voice. There will be consultation with SLTs around integrating Talking Mats into the Annual review pupil voice protocol and into therapy outcome measures. This will be facilitated through the use of the digital talking mats package which allows for staff to create mats with pupils on the move, with minimal resources. These can then be emailed to staff and pupils which makes this information practical for staff to use within the context of their extremely busy school day. The use of technology to facilitate self-advocacy is an interesting field which needs further investigation.

If you are feeling inspired and would like to access Talking Mats training to enable you to introduce a similar approach in your school take a look here – 

https://www.talkingmats.com/training/foundation-training/

To find out more about our resources, including our Digital Talking Mats app, check out this link here – 

https://www.talkingmats.com/shop/

The Talking Mats Board is delighted to appoint Dr Jill Bradshaw from the Tizard Centre, University of Kent, to the position of honorary research associate. This is our first appointment of this kind. Talking Mats is an evidence-based framework and research is important to us – but that research needs to be much more diverse, and involve a much wider range of people.

Jill’s role will be to give the Talking Mats team:

• A sounding board for research ideas and proposals
• Advice and support on publishing articles
• Identify research gaps and advise on funding avenues

We are also very aware that a number of people are using Talking Mats as a research tool, and Jill will also help to develop a virtual research network to bring interested researchers together.  We are still exploring ways in which this could work, but it could involve an email network, virtual seminars and/or twitter chats. If you are interested in being included, and have completed our Talking Mats Foundation Training course, Jill would love to hear from you. Please email her on J.Bradshaw@kent.ac.uk – or email info@talkingmats.com and we will forward your interest to her.

Jill is really excited about this new post.  She says ‘We know that the voices of people who have communication challenges can be excluded from research. This is a great opportunity to work with others to think about how we can use Talking Mats creatively in research and to find ways of including views from a wider range of people’.

Lois Cameron

November 2019

In our latest blog, Rachel Woolcomb, Talking Mats OT Associate, discusses how Talking Mats can support Reflective Practice for Occupational Therapists.

Taking time out to stop and reflect on our practice can be a challenge. We convince ourselves there are more important things to do, people to see, targets to meet, and therefore we just don’t have the time.

However, I suggest, that with this mind set we are doing ourselves, and the people to whom we provide support and care, a disservice.

Clinical supervision has always been embedded in the culture of occupational therapy and at its best should create a safe and supportive environment in which reflective practice can take place.

Unfortunately, in practice, the reality can look different.

The more I have used Talking Mats to enable my clients to think and express their opinions, the more I have been convinced, that there is also great benefit to them being used within the clinical supervision process.

I want to thank the occupational therapists who agreed to explore this further with me. They used Talking Mats to think about their coping skills at work, or reflected on how their ability to learn and think, impacted their job role.

They were surprised how easy they found it to think about the full breadth of their working life and the impact this had on their wellbeing. As clinicians, we are great at looking after other people and ensuring that their health and wellbeing needs are met, however, we are not so great at caring for ourselves.

The latest TMOT resource provides more information about why and how, Talking Mats can be an effective tool in enabling a reflective thinking space for clinicians. Check it out here: TMOT3 Reflective practice

Give it a go… You are worth it!

To find out more about our Talking Mats resources, check out this link:

https://www.talkingmats.com/shop/

Talking Mats as a Thinking Tool

In the first of a series of blogs showcasing some of the fantastic presentations delivered during our Talking Mats is 21 event on 15th August 2019, our OT Associate Rachel Woolcomb shares her thoughts on thinking – and how Talking Mats can help:

Recently I have been giving some thought to the process of thinking!

Is thinking just a matter of the neural pathways in our brains manipulating information about ourselves and the world, to create an output or action? or is it more than that?

Can we overthink? Is being spontaneous under thinking? What about creative thinking?

At the Talking Mats is 21 celebrations I explored this subject and looked at how Talking Mats can be used effectively as a tool to support thinking.

My presentation – Talking Mats as a Thinking Tool – looked at the mechanics of thinking, and started to explore how as humans we don’t just learn facts but begin to understand and make sense of them within the context of our culture and environment.

Thinking is effortful and depending on the subject we need to think about can be complicated and demanding.

Using a Talking Mat creates the space to think, it helps to reduce other distractions and provides a structure for thinking. This means that the process of thinking becomes energy efficient as a Talking Mat enables the thinker to organise their thoughts and make connections that otherwise might not be identified or explored. The images used in the topic sets help with memory recall and are designed to expand a subject. This reduces the reliance on language and the need to express what we are thinking verbally.

The Talking Mat forms a visual picture of our thinking which is helpful for reflection and further exploration of the subject.

The final few slides in my presentation contain some quotes from occupational therapists who have used Talking Mats within their supervision sessions to enable them to think about their coping skills and strategies whist at work. I will soon be sharing a resource document on the use of Talking Mats as a reflective space for clinicians.

For further details about our Talking Mats is 21 event and presentations check out our recent blog – https://www.talkingmats.com/amazing-talking-mats-is-21-day/ 

If you are interested in accessing Talking Mats training, follow this link for more details of the options we can offer –  https://www.talkingmats.com/training/

Watch this space for more information from the presentations delivered at our #TMis21 Event!

Rachel Woolcomb, our Talking Mats OT Associate, shares a recent personal experience where she used Talking Mats to support a difficult conversation:

The vision of Talking Mats is to improve the lives of people with communications difficulties. I have been reflecting recently on the definition of ‘communication difficulties.’

When I first heard about, and started to use Talking Mats 10 years ago, my perception was that it was fantastic for those that could not speak but I must admit I didn’t really consider using it with people who, such as myself, could use their voice to communicate.

Over the years as my understanding has developed, and I have looked further into the use of Talking Mats as a ‘thinking tool’ I have come to a different conclusion.

I would like to suggest that at some points in our lives, each one of us is likely to experience a communication difficulty. I don’t mean that we cannot physically speak, but that we cannot express what we really want to say in words. Perhaps a topic is too difficult to talk about with someone so we don’t bother, or we are overwhelmed by the subject that we don’t really know where to start.

One such subject is that of death and dying.

We know it will happen to us all one day but to talk openly with loved ones, is for some reason, too much to comprehend, too emotive, or considered bleak.

I am very fortunate enough to have grandparents in their 90’s however the conversation about their wishes for the future goes unspoken. It is a challenge for my parents to raise the issue therefore it remains the big unknown.

This is a common problem. In 2009, The National Council for Palliative Care wanted to address this issue and set up the Dying Matters Coalition in England and Wales, to help people talk more openly about dying, death and bereavement and to make plans for the end of life.

Talking Mats have produced a set of topic cards called ‘Thinking Ahead.’ https://www.talkingmats.com/product/thinking-ahead/

These were created in consultation with Strathcarron hospice to help people with advanced illness or long term conditions to think ahead and plan for the future. The three topics in the set are: Affairs, Care and Treatment and Personal Values.

My Mum was interested in my role with Talking Mats and wanted to understand what it was all about. We had already started to talk about the challenges of having difficult conversations, especially about death, and therefore over a drink, in a relaxed coffee shop, we embarked on a journey of discovery using a Talking Mat. My Mum as the Thinker and myself as the Listener .

She used the Talking Mat to help her think about things she had not considered and was able to make plans about what she wanted to do next. I heard her wishes and her thoughts, on why certain things were important to her. It was a very special time, facilitated by a Talking Mat.

My challenge to you as readers of this blog is to ask yourself ‘what do I have difficulty talking about’ – A Talking Mat just might be the answer!

Another resource you might find helpful is ‘Let’s Talk about Death and Dying’ –  www.ageuk.org.uk

Rachel will be running a ‘Talking Mats as a Thinking Tool’ workshop at our Talking Mats is 21 Event is in Stirling on Thursday 15th August 2019. Dr Sally Boa from Strathcarron Hospice will also be running a ‘Talking Mats in End of Life Care’ workshop at this event. Thanks to funding from NHS Forth Valley endowment committee the event is free but you do need to book your space https://www.eventbrite.co.uk/e/talking-mats-is-21-tickets-62362171935

You can come to the morning only, afternoon only or come for the whole day.

If you can’t come to our event watch out for out blogs and social media celebrating the reach of Talking Mats for 21 days before the 15^th of August.  Please join in with your contributions using the hashtag #TMis21. For 21 days after our event we will be having a special Birthday offer! Watch this space, more to follow …….

At Talking Mats, we offer a range of training models https://www.talkingmats.com/training/ that are tailored to suit individual teams and/or organisations and that help them develop their services to people with communication disability.

The one which best supports participants to embed Talking Mats in their practice /organisation is the Enhanced Talking Mats training https://www.talkingmats.com/training/bespoke-training-for-organisations/. This course is run over 2 days with the second day usually 4 months later supporting staff reflect, refresh and extend the implementation of Talking Mats with their clients. It includes an evaluation of the participants’ views of their interaction with ‘thinkers’ before and after the Talking Mats training. Participants are asked to complete a short questionnaire designed by the Talking Mats team on Survey Monkey prior to the first training day.

In November 2018 Joan Murphy ran the first day of an enhanced course in Welshpool, North Powys for 12 NHS staff including (Click to enlarge):

Over the next few months participants were asked to use Talking Mats and bring case studies to the follow up day. They were also asked to complete the survey before the second day which was held in March 2019.

The following graphs show the comparison of the pre- and post- training evaluations. (Double click to enlarge the figures):

Figure 1 Pre talking Mats training – November 2018

Figure 2 Post Talking Mats training – March 2019

In addition, participants were asked to add any comments. Here are a sample of them:

It allowed me to identify areas that mattered most to the person in terms of what they wanted to work on in therapy. It showed me that what I thought was the most severe aspect wasn’t always what was having the biggest impact. 

• Now have understanding of hobbies/likes to interact with on the ward to engage in therapy and reduce anxiety/boredom. 
• Brought up something important to them which probably would not have surfaced without TM. 
• Used to make patient-centred goals as opposed to goals set with family therapist. 

In conclusion, if any organisations are looking for Talking Mats training, we would encourage them to consider booking the enhanced course to support them to use Talking Mats to its best effect.

Our Talking Mats is 21 Event is in Stirling on Thursday 15th August 2019.  Thanks to funding from NHS Forth Valley endowment committee the event is free but you do need to book your space https://www.eventbrite.co.uk/e/talking-mats-is-21-tickets-62362171935

You can come to the morning only, afternoon only or come for the whole day.

If you can’t come to our event watch out for out blogs and social media celebrating the reach of Talking Mats for 21 days before the 15^th of August.  Please join in with your contributions using the hashtag #TMis21. For 21 days after our event we will be having a special Birthday offer! Watch this space, more to follow …….

Last week, Laura Holmes, our NW England Associate, had the pleasure of interviewing our inspirational Founder, Joan Murphy. Joan will be retiring after our Talking Mats 21 event on 15^th August 2019 and so this was a great opportunity to find out more about her Talking Mats experiences:

Are there any stand-out moments for you, from your Talking Mats time?

Talking Mats are now used in many countries across the world and it has been great to have the chance to travel widely. One particular moment which stands out for me was during one of two trips I made to China with Sally Boa. I was asked to demonstrate Talking Mats with a man who was in hospital having had a stroke. He had no speech and was using a wheelchair. I used Talking Mats to find out what the man felt he could/ couldn’t do. The man shared that he felt he could walk. I had to present the symbol three times as the family members and medical staff watching were adamant that the man could not walk. On the third time, the man pushed the table, moved his wheelchair back then stood up and walked around the room. His family and medical team were completely shocked and realised that no-one had actually thought to ask him if he could walk. This was a massive turning point both for the man – and also for his family and medical team, who could now see the power of using a Talking Mat.

Have you done any Talking Mats yourself that helped you to make an important decision for you or your family?

Absolutely – quite a few! My husband and I both used Talking Mats for our Power of Attorneys and shared them with our lawyer and grown-up children. My husband and I also used Talking Mats to talk about the Scottish Referendum as we had opposing views – it really helped as it made us listen to each other without interrupting. We then went on to use the mats as part of a presentation. Various members of my family have used mats to explore personal issues and decisions 

What are the top tips you have gained from your Talking Mats journey – from working in the NHS and then more recently as a social enterprise?

You have to have humour. And be able to listen. It has been essential to be able to work in partnership with Lois and the other Talking Mats team members. The team are such nice people to work with and we have lots of laughs. Setting up as social enterprise was vital for Talking Mats – in terms of having the freedom to be creative. It felt as though someone had a big rubber band which was able to be released. It was a huge risk and there have been lots of leaps of faith along the way.

Do you have any top tips for people using Talking Mats in the Listener role?

Be quiet – and Listen! It’s also important to feel relaxed and to have a sense of humour whilst using it. A Talking Mat is not a test – it is serious, and can be used to explore difficult issues, but it should be fun.

Talking Mats is a low-tech AAC system – do you think it has a place in the modern world?

It is absolutely crucial! Low-tech resources are fundamental in terms of being able to have and develop conversation skills and social closeness.

What do you want for Talking Mats in the next 10 years?

World Domination! Talking Mats has the potential to be used everywhere in the world, by everyone. However I would like to see Talking Mats continue to have a small core team, but increasing Licensed Trainers across both the UK and the rest of the world.

Our Talking Mats is 21 Event is in Stirling on Thursday 15th August 2019.  Thanks to funding from NHS Forth Valley endowment committee the event is free but you do need to book your space https://www.eventbrite.co.uk/e/talking-mats-is-21-tickets-62362171935

You can come to the morning only, afternoon only or come for the whole day.

If you can’t come to our event watch out for out blogs and social media celebrating the reach of Talking Mats for 21 days before the 15^th of August.  Please join in with your contributions using the hashtag #TMis21. For 21 days after our event we will be having a special Birthday offer! Watch this space, more to follow …….