In Stockport we have a termly ‘Voice of the Child/Young Person’ Champions Network meeting during which professionals working in health, education and social care settings across the area meet to discuss real-life examples and to share information and strategies – during the last meeting in October 2018, we discussed using Talking Mats to support police interviewing.

Louise Tickle, Specialist Learning Disability Nurse from the Children’s Learning Disability Team at Stockport NHS Foundation Trust, shared a great example of using Talking Mats to support a child she was working with to share information about a serious safeguarding concern. Louise had been asked by the police to carry out a Talking Mats session with the child as they were aware that she was already using this approach. Louise led the session and was supported by the child’s school SENCO, who had also been Talking Mats trained. The aim was to explore a disclosure which the child had previously made.

Louise shared some great tips about using Talking Mats during an investigation phase:

• Introduce the Talking Mat with a familiar topic, then move on to the main topic/ area of concern
• Watch out for non-verbal cues – initially, the child appeared to be happy and relaxed during the interview, however the child’s non-verbal communication visibly changed when the topic changed. It is easier to pick up on these non-verbal cues if you are able to video the session.
• Have another Talking Mats trained observer present if possible to support and evaluate the session with you.
•  Make sure you use terminology that the child is familiar with, and use language that the child would use themselves e.g. when describing body parts.

Talking Mats are often used by people working within the justice system, including registered intermediaries – here is the link to one of our previous blog posts for more information: https://www.talkingmats.com/talking-mats-used-court/.

In this work you must be clear about the different stages of safeguarding and follow the procedures within your organisation. Disclosure and investigation are two different phases. The Keeping Safe resource has been trialled and tested to support people to raise concerns. https://www.talkingmats.com/keeping-safe-a-new-talking-mats-resource-available-to-purchase/ . When a disclosure moves to the investigation phase you may have to personalize the mat to fit the situation but what is key is that you keep the options open and non-leading.

For further information about accessing one of our Talking Mats Foundation Training Courses across the UK, and our ‘Keeping Safe’ Advanced course, see our training options here https://www.talkingmats.com/training/

Self-management for people with long term conditions (LTC) is now a key government strategy to encourage people to take responsibility for their own health, behaviour and well-being. Talking Mats received funding from The Health and Social Care Alliance Scotland to look how using the Digital Talking Mats (DTM) can help people with LTCs to manage their health and well-being and to recognise their own strengths and abilities.

The overall aim of our project was to empower people with different long term conditions, to manage their own health and well-being. Through using Digital Talking Mats (DTM) we hoped that participants would be able to have more control over their lives and have improved communication with families and professionals.

There were a total of 28 participants in this project living with one of three different long term health conditions – stroke, dementia and learning disability. Each participant had access to a tablet device and was given a personal DTM licence which gave them access to 13 topics in the Talking Mats Health and Well-being resource. We visited each participant at home and taught them how to use it and asked them to complete and send us at least 1 digital mat per week for 6 weeks on any topic they wished. The design of the digital Talking Mat allowed them to email their mats directly to the researchers. We visited each participant a second time to discuss on how easy it was to use the digital Talking Mats and their views on their completed mats. We asked those who wished to, to continue sending us completed mats beyond the initial 6 weeks. We visited them again in 6 months to discuss how they were managing.
15 participants completed all 6 mats and 12 participants continued to complete mats over the length of the project. Participants completed 235 digital mats across all 13 topics

There were 3 particularly significant findings

1. At 18 months the participants living with dementia actually felt their well-being had improved, despite dementia being a progressive illness.
2. For the participants living with stroke the results were even more striking as 95% felt things were going well at the end of the project in comparison with 47% at the beginning.
3. At the end of the project the percentage of people with learning disability who felt things were not going well had reduced from 19% to 10%. Furthermore the percentage of people indicating that they were not sure about their views had increased from 27% to 42%. There can be a tendency for people with learning disability when using Talking Mats, to express their views at either end of the mat and to rarely use the mid- point. However being able to use the unsure mid- point is noteworthy as it indicates that the participants in the project realised that they could express their views not only as black or white but could indicate that they were unsure. This awareness opens up the potential for people to express views more thoughtfully with opportunities for further exploration.

Here are three examples of how using the DTM supported people to self-manage situations in their lives. Click on image to enlarge.

As well as helping participants self-manage their long term conditions, an unexpected outcome of this project is that many people found that using the DTM helped them see the positive things in their life and not just the negative. It also highlighted that despite having a long term condition and, for many also a deteriorating one, that things were not getting worse.

Click here for full report including 6,12 and 18 month reports to the funders  20180717 Alliance full report

Click here for the summary report 20180717 Alliance Final Short Report

Click here for a video link of 2 participants

Talking Mats were delighted to be involved in the launch of Care Opinion’s Picture Supported stories at the Life Changes Trust Gathering in Perth Scotland this week. We have been working with Care Opinion for the past two years to develop this feature.  This earlier Talking Mats blog describes the development process and this recent Care Opinion blog gives some examples of the feature in use.

However, in this blog,  I want to reflect on two events I went to within a short space of time; the gathering in Perth on Monday and the Royal College of Speech and Language  Therapists study day the previous thursday in Stirling . It felt to me like my two worlds colliding or maybe it was just my stars aligning ! At the RCSLT study there was a session on the public perception of Speech and Language therapy and how there is still much work to do in changing the myths that are spun and repeated about what Speech and Language therapists actually do . For as John F Kennedy said in 1962 ‘ the great enemy of truth is very often not the lie but the myth , persistent, persuasive and unrealistic ´ The  National  Allied Health Professional  children’s lead, Pauline  Beirne suggested to the study day that Care Opinion is a great web site for encouraging that sharing of stories. Then, strangely when I got back into the office there was a story waiting for me in my in box all about the positive experience of a parent involved in a Hanen programme in NHS Lanarkshire  which reinforced that very message.

We know people relate to stories, stories resonate and have impact, they are easy to remember .  Our drive in working in partnership with Care opinion was to support more people to tell their health and care stories  by increasing accessibility . It was designed with and for people with dementia   through funding from Life Changes Trust but anyone can use it and they are! It is great to see the stories coming in.

Through stories let’s celebrate the good, develop and improve practice and let’s use stories to challenge myths and educate. So use Care Opinion and try out the  picture supported stories to share your experiences , tell other people ,spread the word and the picture supported story feature  !

 ‘For every pound invested in the Talking Mats Keeping Safe resource and training there is a potential saving to services of £23.00’ .This was the findings of a cost benefit analysis carried out during the development phase of the Keeping Safe Talking Mat resource.  A Cost-benefit analysis demonstrates the overall economic value of an intervention with numbers and evidence.

 The Keeping Safe resource

The Keeping Safe resource is a visual framework that has been developed and trialled over 6 years in partnership and with funding from various organisations e.g. Survivor Scotland, Scottish government , Kingdome Abuse survivors project and NHS Fife

The Keeping Safe resource provides:

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

A reflective practice training was developed and  provided to over 700 staff to allow staff become familiar and confident with using the the resource

Findings of the cost benefit intervention

There is a significant financial advantage to services using Talking Mats. Analysis of six scenarios found that for each pound invested in the Keeping Safe training there is a potential saving to public services of £23.00. In learning disability services it is easy for costs to accelerate quickly. If services don’t respond effectively, challenging behaviours can escalate and relationships and placements are at increased risk of breakdown. Talking Mats can help provide staff with a comprehensive and accessible framework to help them listen to people who can find it difficult to articulate what is really going on for them e.g. issues of pain, relationships or levels of support. In this project 89% of Talking Mats resulted in staff learning new information about the person they were working with, even when they thought they knew them well.  The Talking Mats framework provides a way to turn these points of views into actions that can be monitored and reviewed. It is these early interventions that not only save money but improve quality of life.

Cost benefit Process

With support from Inspiring Scotland a cost benefit analysis was done that examined the cost of the Talking Mats intervention and any resulting actions. 6 cases were chosen from over 100 detailed descriptions of how practitioners working with people with learning disabilities had used the resource.  These descriptions  represented a cross spectrum of  people with learning disabilities in Scotland in terms of living situations e.g. living at home , in supported settings and an inpatients facility . They were also chosen to represent the comorbid conditions that often exist with learning disability e.g. autism, mental health and cerebral palsy. An alternative scenario was created and tested with critical friends as to the likelihood of what might have happened without the Talking Mats intervention. All the scenarios that were developed are  available here 20180110 scenarios cost benefit   The primary source of financial information and the subsequent calculations  was the Unit Costs of Health and Social Care produced by the Personal Social Services Research Unit (PSSRU) 2015/16 . This contains detailed cost estimates for a range of services such as care placements, NHS services, social work, mental health, and family interventions. This analysis can only be illustrative as assumptions are subjective.

The findings from our final report 160512 Keeping Safe report 2013-2016 showed that effective use of the resource   not only led to  improvements to quality of life for individuals but that it can save services money. Book a place on our  webinar and get the Keeping Safe  resource 20180122 Keeping Safe Webinar  or if face to face discussion is more your thing attend the advanced course in April 2018 – you get the resource with that booking too!

Thanks to Rosie Murray for this great blog describing how she used a collaborative Talking Mats ‘Wall’ to help students comment on how different activities inside and outside college make them feel.

As a student, I trained in the Talking Mats approach, after finding it incredibly useful in clinical placements. I am now a speech and language therapist at St John’s College in Brighton. This is a college for young adults with autism, learning disabilities and SEBD. Our learners have a wide range of communicative needs and cognitive abilities. I was approached by our nursing team in the lead up to world mental health awareness day, as they were organising a ‘tea and talk’ session for our learners of all abilities.

We organised a range of activities, such as symbolised conversation starters. However, we felt we needed something to allow our less verbal learners to make their voices heard. I thought back to my training, and remembered Joan Murphy talking about large, collaborative Talking Mats – or ‘talking walls’. We discussed this idea, and felt it would be a great way for students to feedback on how different activities inside and outside college make them feel.
It took some considerable planning. Due to the emotional needs of some students, our top scale required us to avoid words that were too upsetting for individuals. In the end we settled on ‘good’ (with a widget ‘calm’ symbol) and ‘worried’. We also wanted it to provide a genuine opinion, so although we considered including activity options that were clearly negative, e.g. ‘fire alarms’, we took the opportunity to show our learners that we all have different opinions on things, and that this is good. We hypothesised that because of this, learners would be skewed towards giving positive opinions, and this informed the order of presentation of the top scale and the activities themselves.
On the day, we had 15 different activities to give an opinion on, each with different border colours for differentiation, and of course blank tiles so our learner’s could come with their own activities. Students were encouraged to write their name on the back of a chosen activity, and a consistent script was used to present the wall to each learner. Makaton signing was used alongside the script to support understanding.

Everyone loved the wall!

Learners of all abilities offered their opinion, and it generated discussion between learners of differing abilities. It signposted staff to particular likes and dislikes of learners, and showcased the power of talking mats to all staff. For example, one of our learners is a cheerful young man, who uses minimal verbal utterances to communicate. When the board was presented to him, he very clearly selected ‘talking’ as an activity, and clearly indicated that it makes him worried. This has allowed us to reflect as a staff team about how we can support him to communicate with minimal anxiety.
Learners too took away some important lessons from using the wall. They saw that while some activities are VERY popular (e.g. computer time), some are quite polarised, e.g. animals. This highlights the important issue of mutually respecting each others differences. Since the event, staff have discussed ideas they have on how to utilise this tool. We are considering how we could use Talking Mats as a tool in our peer mentoring sessions between learners of higher and lower verbal ability, as we feel it would be beneficial for both mentee and mentor. We are looking forward to using Talking Mats as a flexible tool for the college in the future.

Please let us know of any other innovative ways of using Talking Mats!

The Talking Mats  Keeping Safe Learning Disability projects ends but a resource that promotes safeguarding and well-being  continues.

The Keeping Safe Talking Mat provides a structured framework to ask someone ’How’s your life going?  We are grateful to the Scottish Government Keys to Life monies for funding the trials. Impact of use of the resource was gained by practitioners sending in examples of their use of Keeping Safe, and the outcomes and actions from the Mats were themed.

The resource has been shown as a helpful way to

• discuss new information (89%). Staff frequently commented that using the Mats revealed things they had not known previously.
• discuss and resolve fears (84%) . It provided a framework that was supportive for those more difficult and or sensitive conversations e.g.’ Usually when she expresses her feelings she can get either upset or angry. She did not get upset or angry at any point through doing the Talking Mats, although the subject and things she was saying was at times difficult issues.’
• support thinking (89%) ‘It helps with memory and attention as she has something visual to keep her focused.’

As of June 2017, 609 people who work with adults with a learning disability in Scotland have the Talking Mats Keeping Safe Resource and are trained to use it. This includes a wide range of professions : clinical psychologists, social workers, advocacy workers, community nurses, support workers and allied health professionals.  21 people extended their training to become trainers themselves, and are now training people to use Talking Mats and the Keeping Safe resource in their geographical area.

Initially many staff thought using the resource would take too much time but in fact were really surprised to find how much quality information they got in a short space of time.  A cost benefit analysis demonstrated that using the Keeping Safe resource is cost effective for organisations i.e. for every £1.00 an organisation spends on the training and the resource, the potential financial benefit to the organisation is £23.00. We believe this is because the Mats create a powerful listening space and so that issues can be addressed timeously and not spiral out of control. This has not only a financial benefit but also a return in terms of an individual’s well-being and access to local non specialist services.

Although this resource was developed with adults with a learning disability, several people have reported  that they have found it useful with other client groups e.g. adults with acquired neurological disorders and young people particularly with mental health issues .

If you want to read in more detail about the design process behind the resource then please read this journal article published in the Tizard Learning Disability Review  More Than Pictures TLDR 2017

Involving people with a learning disability in service evaluation is both essential and challenging.

Maria Lavery speech and language therapist, and her colleagues in North and South Lanarkshire are using Talking Mats to get feedback about the service they deliver for people with a learning disability . They want to find out about what people feel they do well,  and what could be done differently.  In addition they have placed a suggestion box at the entrance to their building, but want to  involve everyone who is connected with their service – clients,  family,  carers   various multi-agency colleagues and are carrying the review out over a 6 month period.

The analysis and learning will be used to inform the Speech & Language Therapy work plan and support the future direction of the service.

Talking Mats has been used successfully to evaluate Augmentative and Alternative Communication services and the resource for this is available on our website http://www.talkingmats.com/wp-content/uploads/2013/09/AAC-service-Evaluation-script-and-symbols.pdf

This is a fabulous film that really shows Talking Mats in action and how it supports and promotes involvement on so many levels.

Talking Mats and the National Involvement Network (NIN) have been working together for the past year  to enable the NIN members to develop a Talking Mat and to use that Mat to listen to the experiences of people with learning disabilities . It has been a great project and we wrote up the experience of running the training in two earlier blogs.

The first blog described how we worked with the group to develop  a Talking Mat to link with the NIN’s charter for involvement . The second how we developed and delivered a Talking Mats training course to meet the needs of the NIN members all of whom have learning disabilities

The group then set off to carry out their Talking Mats conversations supported by staff from their respective organisations and or ARC Scotland. The group decided they wanted to make a film about their experiences of using Talking Mats and ARC Scotland  supported them to do this . Rhona and I were delighted when we got this link to the film all about their experiences of using Talking Mats. We really enjoyed watching it and we are sure you will to. https://www.youtube.com/watch?v=0BTlYuqLBXs

Five short stories from our recent accredited training course in Stirling.

1. A looked after child was unhappy but no one knew specifically why. Using the Talking Mats, she indicated that she was upset by the weekly phone call with her mother because it always happened when it was her playing time. The time of the call was moved to just before her bedtime but this resulted in bad dreams. The time of the call was finally moved to Saturday afternoon which helped her settle and reduced her distress.
2. Talking Mats was used with an Iraqi boy who had come to England via Libya, Italy and the jungle camp at Calais. When he picked the symbol of a waiting room he indicated that despite all she had been through he really liked this because it reminded him of all the children in his family and made him happy.
3. A 76-year-old man with a learning disability disclosed that he had been attacked and suffocated by his upstairs neighbour one week previously. It was only when he used the Talking Mats that he disclosed to anyone what had happened.
4. A lecturer usually used quantifying measuring with her students to find out how they were managing their studies. Instead she used Talking Mats to find out how they were coping with their work life balance. One student told her that she was managing fine except that her pet rabbits always escape under the bed and it takes her a long time to get them back out so she does not let them out very often!
5. Talking Mats was used with a man who had had a stroke and had to go into residential care because his family could no longer look after him. They were very worried that he was unhappy with the new care set up. He was able to show with the Talking Mats that he was happy about everything except that he was not given enough time when he went to the toilet. Once the staff realised this they then gave him more time which resolved the situation and reassured his family.

Please send us your Talking Mats stories – we love hearing them.

We are now half way through our project, funded by The Health and Social Care ALLIANCE Scotland, whose overall aim is to empower people with a range of long term conditions, with and without additional communication difficulties, to self-manage their own health and well-being by using Digital Talking Mats.

Participants

We have carried out all the initial visits and 16 follow-up visits and participants are sending in their completed mats, choosing whichever topics they want from the digital Health and Well-being resource. At the time of writing this blog we have received 137 completed mats.

We have received very positive feedback with many examples of how people are using the Digital Talking Mats to self-manage.

Here are 3 examples:

One participant with learning disability has diabetes. Through using the Digital Talking Mats she has stopped buying takeaways every night and is now buying M&S ‘Balanced for You’ meals. This is a huge step forward for her as she refused to discuss healthier eating before.

A man with early onset dementia has identified that he used to enjoy singing and has decided for the first time in his life to join a choir. This is not something that had come up in conversation before. Despite the diagnosis of dementia he has realised that he is still keen to try new things.

 

 

The wife of a man with severe aphasia said ‘This (Leisure away) has highlighted how few things he can do away from home. We discussed this but can’t see how we can change the situation.’ However at the second visit he used the same mat and indicated that he had been thinking about his mobility and was about to start swimming and a fitness class.

We already have an increased awareness of the meaning of self-management as we observe how participants are using the Digital Talking Mats to think about their situation, state their own views and share them with carers/support workers. We are also noticing that there is a shift in some relationships as the carers/support workers realise that the person with the long term conditions can make decisions and express their own views rather than having decisions made for them.