The Talking Mats funeral resource

Talking about death, loss and funeral planning is something many of us find difficult and challenging.  Talking Mats has won funding from the Big Lottery Awards for All to develop a resource that will allow someone to plan their own funeral or be involved in the planning of a loved one’s funeral.

The inspiration

Gillian Robertson who is a celebrant, retired headteacher of a special school and a Talking Mats Licence trainer is the instigator and driver behind this project. She said her inspiration came from being asked to do a funeral of a Dad with two daughters one of whom had additional support needs.

‘When planning his funeral, I spoke mainly to her sister and her mum. They had decided not to tell the other sister the date of the funeral. I had a stomach-churning feeling, this didn’t seem right, but it was not my decision. I had no materials I could offer the family to help make sure their sister was included. It came to the day of the service. To my surprise, the sister was there with her support worker. I was able to have a nice chat with her before the service. When it came to the Committal, she waved goodbye to her dad. I think her mum and sister were a little embarrassed, but I was so glad she was there. She nearly missed the chance to be able to say goodbye or get the closure that other people get from a funeral.’

Development

An effective Talking Mats resource needs a structure that supports the conversation you want to have.  Developing this structure benefits from different perspectives.  In order to gain these perspectives two different focus groups were set up;

1. Celebrants and funeral staff
2. People with learning disabilities and their support staff

Discussions led to 3 main topics being identified.  Symbols were designed and tested, and the resource further adapted in response to feedback

Final testing phase

The Funeral Resource is now in its final phase of testing where and experienced Talking Mats practitioners are required to use it and feedback results.  You will be sent the resource and asked to feedback your experience via Survey Monkey.  Funerals are very culturally specific and this set may not work for all cultures and faiths.  Knowing the limitations will help the development of guidance to go along with the resource.  Testers who can use the resource in diverse settings are particularly welcome. 

If you think you could use the resource at least twice between now and the 17^th of February 2023 please email lois@talkingmats.com describing the client group you work with, your role and the cultures and faiths you might use the resource with.  Up to 8 people will be selected for this next test phase.

In her final blog, April Dobson describes how the training and implementation of Talking Mats across Services led to the decision to use the approach in Hallmark’s annual survey and what was discovered.

For those of us who work in social care settings, there is a requirement to carry out an annual survey each year to determine how people who use the service feel about it.  People with communication difficulties often find the various questionnaires lengthy and confusing and it falls to a third party to answer on their behalf.

Following the Talking Mats training and implementation across the service, Hallmark Homes decided to use this approach as part of the 2022 Survey. 

How did we do it?

• We selected 12 questions that were concrete in nature and reworded them to follow the Talking Mats principles and guidance. 
• Practitioners were given specific symbols, a precise question and a consistent top scale – Happy/Unsure/Not Happy.

What did we learn?

We ran follow-up focus groups to explore the benefits and challenges.

• Both focus groups reported that using Talking Mats was an inclusive practice.  
• Talking Mats discussion often act as a prompt for exploration of specific topics through TM sub-mats to support care and wellbeing (for example weight loss).
• Talking Mats is helpful for people whose first language is not English.
• Talking Mats can help build trust as people feel as though they are being heard and what they say is being acted upon.
• Talking Mats practitioners learned how to tailor the approach to ensure more of our residents can have a say about very local issues.
• Some of the questions need to be reworded.
• Talking Mats should be considered in instances where behaviour may actually be an expression of unmet needs.
• Using Talking Mats  did not work for everyone.  Selection of residents is key, and in the pre-work leading up to the annual survey next year consideration should be given to reminding practitioners of the circles model, and guidance/learning from this year.  This may take the form of pre-survey group meetings on teams.

Although residents who gave their feedback via Talking Mats had a lower rate of positive responses when compared to those who used the traditional method, this is valuable information for Hallmark.  The feedback about using Talking Mats in this way was positive;

I really believe this gives a way to hear everybody’s voice you know ……We all sit here with our preconceptions but actually this isn’t about us. This is about us hearing the voice of our residents that wouldn’t have been heard if we hadn’t of used TM as part of the survey.

(Hallmark Regional dementia practitioner)

there are always elements we want to do better and we want to improve. And this is the first iteration (of using TM for the annual survey), of course. But for the first time, I thought, I can say here hand and heart that we’re getting the true representation or a wider representation across our homes and to a point……… We’re better equipped to say what we need to be doing.

(Hallmark Director)

Thank you to April for these fascinating blogs and for being such a strong advocate for Talking Mats. If you would to chat about anything raised by these blogs or find out how Talking Mats could benefit your service please get in touch via info@talkingmats.com. Read April’s blogs on why and how she embedded Talking Mats in Hallmark Home Part 1, Part 2

In her 2nd blog April Dobson describes how Talking Mats has been implemented across Hallmark Care Homes

Many of our organisational processes across our services have become richer and more inclusive as a result of introducing Talking Mat.  Here are some ways we have embedded TM within areas of our work; 

• Accessible information standard; the use of TM is included as a recommendation in our organisational standard and policy 

• New residents; Hallmark’s Dementia Care Managers use TM where appropriate to support people with dementia and/or communication difficulties to transition into the care home environment, and to support with care planning 
• Care planning; used to gather information from the person to support their care plan 
• Internal compliance monitoring and reporting; TM is part of our compliance team’s standard approach and they conduct TMs at part of every compliance audit 
• Supporting people living with dementia who express unmet needs through behaviour; TM is used as part of a range of different methods to explore the reasons behind need 
• To support wellbeing and lifestyles/activities choices and opportunities; TM is used by our lifestyles teams and evidence of use is required as part of our annual lifestyles audit 

• Internal ‘Outstanding Pathways’ accreditation; Homes choosing to complete a Hallmark outstanding pathway in ‘resident involvement’ are required to show evidence of the use of TM in order to successfully meet the criteria (through photos, written care plans etc).  This could be in connection with a planned refurbishment for example, or discussions about mealtimes etc 
• Project/research evaluation; Hallmark’s Researcher in Residence includes the use of TM as part of a range of evaluation methods for all internal and external projects or research involving people living with dementia, and for those with communication difficulties.  External partner researchers also receive training in the use of TM from our licensed trainer. 

Since the introduction of TM, I’ve been delighted to see our trained practitioners using the resource to ‘talk’ on an individual basis about a range of topics with people living in Hallmark Care Homes, and the best way to tell you about this is to give you a few examples.  I’ve used the words of our team members to describe what happened in each case.  Whenever a TM is used the listener completes a short description of the mat with a photo and any actions using a template we developed.  This is then included in the resident’s care plan record and reviewed regularly; 

Example 1 

E lives in the Residential Community and has dementia. E has a level of anxiety/distress over knowing she “lived” in a care home and becomes particularly anxious around a particular time in the evenings. She becomes flustered and can panic when she can’t communicate what she wants to say. 

 I used the Talking Mat to see how she felt about her time here as well as encouraging her to express herself.  It helped her focus on one topic at a time and not become overwhelmed by her feelings. One theme that emerged was that E did not feel listened to by the care home team or her family. On reflection, I recalled overhearing an interaction with her son and her, where he repeatedly told E that she “lives here now” and “can’t go home”, and I remember spending time with her after this visit as it caused her so much upset. Following our work with a mat was able to share E’s opinions with the team and have been working with the family on ways to ensure E feels valued and listened to. We plan to redo the mat regularly. 

. 

Example 2 

We did one with a new resident which I feel was very successful – it linked in to her religion and we found out that she was feeling out of touch with her faith as part of a general mat and then completed a sub mat around just this area – for example does she want a Bible in her room or visits from Jehovah Witnesses.. it was really important because actually the team got to know her through the talking mat and we had back quality time ……It’s about trust as well. She came from the hospital  she was anxious and she was worried as she’d had two operations. 

Example 3 

.. talking mat has been an amazing tool as it enabled me to dive deeper and get to know a resident whom the team had reported that often they had a ‘hard time’ assisting with personal care needs. The Talking mat session was brilliant as the lady was able to communicate that in – fact she will not want any assistance with toileting needs as she felt she was independent. The team are now using the approach of offering their assistance rather than telling her it’s time for a wash and this has been far more successful.  

Example 4

one lady just didn’t want to go to the dining room for meals so I tried a mat to find out why she would only eat in her room. We weren’t even talking about it but she kept rubbing her leg during the mat, so I quickly stopped the mat we were doing and got out some symbols showing different parts of the body.  I used a different top scale to try and find out if she had pain.  It turned out that she wasn’t going to the dining room as it really hurt her to walk there.  I spoke to the team and they made a GP referral for pain relief which has now made a massive difference to her.  I don’t think we would have picked this up without the talking mat. 

For the future, we want to explore in more depth how we can use TM to support DoLS assessments, safeguarding concerns, and best interest decision making. 

As we head into World Alzheimer Month, April Dobson, Head of Dementia Care and Wellbeing at Hallmark Care Homes, shares how she introduced Talking Mats and the impact it has had. This is the first of 3 blogs.

These are the things I missed over the past couple of years

• the chat with the person in the shop
• the coffee and natter with a friend
• the catching up with family news

A big gaping hole was left in my life and I found myself wondering if that’s how someone with communication difficulties feels every single day

Over the years I have observed frustration and sadness in the person with dementia born out of not being able to be heard, and withdrawal and isolation in part due to not being part of a conversation, not having a connection.  This frustration is reflected in carers and family members when they talk about communicating.  They worry that they might be doing something wrong when their efforts don’t get the response they hoped for, and sometimes just stop trying to make a connection because it’s simply too difficult.

I believed there must be a way to hear these voices.  My research lead me to believe Talking Mats could be a game changer for Hallmark and I became a Licenced Trainer in 2021. I proposed the following implementation;

• Training 2 key staff members per home
• Training Regional teams
• Using Talking Mats to support information gathering in our annual survey.  Up until now the views of people living with dementia around their care had not been captured. More about this in a follow-on blog.

The Board at Hallmark were as enthusiastic as I was and our Executive Leadership Team also completed their Foundation Training.

Despite a return to lock down, I managed to follow my plan for face to face training (more or less).  As of July 2022, I am really proud to report that Hallmark Care Homes has a total of 52 qualified Talking Mats practitioners within the team.  What’s more, all 52 are just as excited as I am; here’s just one example of that from a member of the care team;

“The talking mats allowed us to be able to stay on the conversation by pictures and by keeping things on the mat to refer to…. And it was a really nice one to one time as well and their whole demeanour afterwards was amazing, completely different, really calm, really engaged, really alert. So yeah, we did notice the significant difference after doing that. And it was, it was a nice protected bit of time, to spend with them somewhere quiet”.

It is early days but I feel we have the foundations of something really special and important in place.  Conversations are happening; there’s no pressure to talk – everyone has the options of being vocal or being quiet – but our skilled, trained team members are able to gently guide a conversation if necessary, taking cues from subtle body language or nuanced expressions.

This project has connected people; Hallmark residents, team members and families and I’ll tell you more about the impact that Talking mats has had in the next blog.

Talking Mats will be attending the Alzheimer Scotland conference on the 5th of September, come and say hello

We are delighted to have received funding from the Scottish government’s neurological framework to work with Strathcarron hospice and the Scottish Centre for Simulation to use the Talking Mats ‘thinking ahead’ resource to support effective  end-of-life planning. 

This project aims to help people think about and talk about their priorities and plans, should their health deteriorate. All too often, conversations about priorities and preferences for end-of-life care are put off. As a result, decisions are made during a crisis. At these times it is difficult to find out and include the views of the person and what matters to them, resulting in unwanted treatments and hospital admissions.

We have received funding from the Scottish Government’s Neurological Framework fund to train 18 people who work with people with neurological conditions to use the “Thinking Ahead’ Talking Mats resource.

We are hoping to work with 18 people from nine organisations who normally support people who have neurological conditions to think about and make plans for the future.

What will taking part involve?   

This practice development project involves three parts: training; using the Thinking Ahead resource with people with neurological conditions and taking part in an evaluation.

Most of the places have already been allocated however there 3 or 4 places left that you can apply for if

• You work in Scotland
• Your work with people with long term neurological conditions and or or you work in palliative care settings where some of your work is in this area
• You can commit to undertaking and contributing to  the various stages of the project within the stages

Your commitment – training and resources

• Attend the training will be in two parts. The first part, for those with little or no previous experience of Talking mats will be a half day on-line session on the 12^th Sept 10-1.00pm  The second session will be face to face (at Strathcarron Hospice) and will be run jointly with the Scottish Simulation Centre. These will be smaller group sessions and you will have to attend one session from 10- 4.00  on either the 26^th Sept , 30^th Sept or the 28^th Oct.  of There will be some reflective practice work to do between sessions one and two. Whilst there is no cost for the training and resources, participants will need to fund their own travel to the venue.
• All the Thinking Ahead resources will be provided, including card-based resources and access to the digital Talking Mats.
• Training will take place in September 2022, dates to be confirmed.
• If you have already completed the Foundation Talking Mats course, you may be able to just attend the second session.

Using the Thinking ahead resource:

• You will be expected to use the Thinking Ahead resource with four people living with neurological conditions and report their experiences through a questionnaire. This work can happen over a 4-5 month period.

Evaluation:

• In addition to completing questionnaires after each Talking Mats session, staff will be invited to attend a focus group. This will be face to face or remote, depending on what is most practical for staff. Focus groups will take place in February/March 2023.

 Sustainability:

• There will be an opportunity for organisations to apply for one member of their staff to become a licenced Talking Mats trainer. This will enable the member of staff to continue to develop skills within your organisation. Overall, there are three funded places available on this scheme through this funding. More information will be provided towards the end of the project.

Apply to be involved

If you would like to apply for this opportunity, then please email lois@talkingmats.com by the 30^th August and say

• Why you want this opportunity
• Your profession
• Where you are based
• Whether

Selection will be based on ensuring a wide range of professions , geographical cover and appropriate caseload for the project

We are delighted to be attending the Looked After Children Conference in Manchester on the 8th of December 2022. Many Looked After Children and Young People have communication needs, which can make it difficult for them to have a voice and express their views and feelings.

This flyer shows how Talking Mats can help Children and Young People with communication needs to share their views and feelings, in line with the Lundy Model of Participation and UNCRC Article 12, which underpins our training and approach:

If you are attending this conference, come and visit Laura at our Talking Mats stand to find out more.  Laura is our Lead Associate for Children and Young People, and also works as a Speech and Language Therapist with Cared-For children and young people, using Talking Mats as an integral part of her assessment and intervention process.

To find out more about the range and impact of communication needs of Looked After Children, check out this information from the Royal College of Speech and Language Therapists.

It’s that time of year when fancy clothes are aired, proud parents clutch tissues and little funny black hats are thrown sky high!  Congratulations to all students graduating this year, and to students moving successfully into your next year of learning.

A recent Twitter conversation asked what therapy tools / approaches practitioners thought should be included in Speech and Language Therapy courses.  Talking Mats popped up frequently and whilst we are keen to have as many practitioners as possible, across all professions trained in and using Talking Mats we understand the RCLST’s point that it is difficult for courses to cover every approach to therapy. 

However, as a student (and new graduate) on any course – Social Work, Occupational Therapy, Educational Psychology to name a few, you can still add Talking Mats to your toolkit as you progress through your training and enter the workplace by taking advantage of our Summer Sale for Online Foundation Training on our July and August course:

Students and New Graduates

50% discount

Follow this link: https://www.talkingmats.com/shop/

And use the codes:         26^th July code: studentjul50

                                        23^rd August code: studentaug50

Spaces are limited to 10 places per course so spread the word and sign up quickly!

Rosie Murray trained in Talking Mats as a student and is now using it in her role as a Speech and Language Therapist in a college for young adults with autism, learning disabilities and SEBD.  She has also gone on to become a Talking Mats Licenced Trainer. Read her blog here: https://www.talkingmats.com/talking-mats-collaborative-wall/

Download and print top scales.

For users of Talking Mats getting your top scales right is a key part of the process.  The sight of Matty with thumbs up / thumbs down / shrugging is a familiar one.  It is our ‘go to’ top scale image, attached to our symbols in every resource you order.  However, since the launch of our new digital resource where there is a choice of 16 top scales our TM community has been asking for the equivalent in card format. 

 So here it is:

If you are trained and have an account on the website you can download and print 16 different top scales to suit the conversations you are having and the thinkers you are having them with.

Before you all rush off to print, laminate and chop it is probably worth pausing to think about the top scale and how important it is in the Talking Mats framework.  Making sure the top scale matches the question is vital to the conversation; for example if your topic is Self Care and the purpose is to find out if anything is causing a problem it is more appropriate to ask if someone is ‘managing / not managing’ rather than whether the task is ‘very important / not important’.  The focus of the conversation becomes whether or not the Thinker can carry out the activity allowing for practical steps to be put in place to support them. 

The midpoint of all top scales is included as we find it allows for indecision, an everyday part of the process of making decisions and forming opinions.  Some people do struggle with too much choice however, and the top scale can be presented with just the 2 opposing points on the scale. 

The printout includes top scales for our Advanced sets; ‘This is Me / This is not Me’, (Keeping Safe), ‘Sorted / Not Sorted’ (Thinking Ahead), and ‘Safe / Not Safe’ for our new Youth Justice resource, as well as options without thumbs and one that uses stars instead of Matty.

We know this new print out will be very useful to many of you when you plan your Talking Mats sessions and if you have any other top scales that you think could be added please let us know!

The printable top scales document can be found in the Shop if you are Talking Mats trained and you log into your account on the website

www.talkingmats.com

Read more about Top Scales https://www.talkingmats.com/when-is-a-talking-mat-not-a-talking-mat/

We are delighted to speak at the 7^th World Capacity Congress on Adult Capacity on the 7^th of June 2022 about Talking Mats and Capacity. Talking Mats facilitates a balanced conversation that can help redress the power imbalance within capacity conversations. This is particularly key where people have communication and or cognitive difficulties, too often poor communication skills are conflated with lack of capacity.

Self – determination is enshrined in law. The fundamental principle we need to remember is that a person is deemed to have capacity to make decisions about their own lives unless assessed otherwise.

This photo shows how Talking Mats helps with determines capacity by supporting people to:  

• Understand relevant information
• Retain information
• Weigh up information
• Communicate views and wishes

On the 8^th of June, Lois’ speaks about Talking Mats specifically supported health decisions in podiatry using a specifically designed podiatry Talking Mats developed jointly with NHS Fife .

Click here to download

In the 2nd blog about our new resource, Licenced Trainer Fiona Taylor tells us about its development.

I am Fiona Taylor, Speech and Language Therapy Service Lead in Salford and also the Greater Manchester SLT Youth Justice Lead. I have been part of a group of Youth Justice practitioners who have worked with Talking Mats to develop a Youth Justice resource and below is the story of our journey.

Within Greater Manchester we have Speech and Language Therapists working within seven of the nine Youth Justice Services (YJS). Since April 2019, we have received funding from NHS England to support and enhance the Speech and Language Therapy service in this area. We wanted to explore training packages and materials which would support YJS staff to have conversations about a wide variety of topics related to the young person’s offending. An approach was needed that the young people would not find confronting and that would take into account the language and learning needs of many the young people (RCSLT Justice Evidence Base, 2017). We felt that Talking Mats would allow this approach as it could be incorporated into every day practice. Discussions with Talking Mats developed into collaborating on a specific set of Youth Justice cards to support this population.

In February 2020, 23 staff from the nine Greater Manchester Youth Justice Services attended a one day Talking Mats training course with Margo and Laura. Then in March 2020, a focus group met again with Margo and Laura to develop a set of bespoke Talking Mat cards for use within Youth Justice. We spent time as a whole group discussing areas we felt were key for YJS practitioners and then split into three groups to further develop these ideas.

From this, three sets of cards were developed focusing on the young person’s:

• Safety (Places and Spaces), to open discussions around areas where the young person felt safe/unsafe which could also support an understanding of wider antisocial behaviour.
• Relationships, with the aim that this would support assessments around sexually harmful behaviour.
• Youth Justice Experience, to ensure user voice was captured and to support service improvement.

The COVID pandemic has meant that the pilot phase for the resource set has taken longer than originally planned. Throughout the planning phase we have met regularly with Talking Mats to provide feedback on how we as practitioners have found the sets and how the young people have responded. YJS staff have reported that the packs have helped open up conversations about difficult topics, including those related to Covid. Staff have also been able to provide case studies to show how the information shared from the mat has supported the young person during their time working with the youth justice services.

Working with Talking Mats has allowed us to develop a resource set for use within a previously unmet area for Youth Justice practitioners, including SLTs. The cards provide an evidence based, structured approach to support the young people we work with and enable them to express their views and feelings and to have their voices heard and responded to. This has supported us as practitioners to develop relationships and to better tailor support and interventions to that young person. We hope that you enjoy using the cards and we look forward to hearing how they have been used.