What are social care outcomes and how do we measure them? The Adult Social Care Outcomes Toolkit (ASCOT) was developed over a number of years as a way of measuring user views on their social care. The ASCOT has been developed by researchers at PSSRU, University of Kent http://www.pssru.ac.uk/ascot/index.php

 There are eight domains of ‘social care-related quality of life’ included in the ASCOT. These include:

• Control over daily life
• Personal cleanliness and comfort
• Food and drink
• Personal safety
• Social participation and involvement
• Occupation
• Accommodation cleanliness and comfort
• Dignity

The measure has been tested with service users from different user groups and there are a number of different versions available, including an easy-read version.

Many people with who have communication difficulties are not able to provide views via interview alone.  Talking Mats is a communication tool that can be used with people who have communication difficulties. The mat consists of a set of symbols or pictures that are tailored to the subject you want to talk about.

The ASCOT Talking Mat: Tizard Centre’s Jill Bradshaw with Ann-Marie Towers and Nick Smith (both from PSSRU) have worked with the Talking Mats team at Stirling to develop three ASCOT Talking Mats.  These will enable people to give their views on:

• Where I Live.  This is a starter mat, designed to introduce people to the approach and for those people who might find more abstract concepts more challenging;
• My Care. People will be supported to give their views about whether aspects of their care are going well or not going well.
• Control over my Care. People will be given tools to think about how much choice they have over different aspects of their care.  The second and third mats have options for both basic and more abstract concepts.

The TM version of the ASCOT will enable researchers to investigate user views regarding social care outcomes.  By using this more inclusive methodology we will be able to engage with these seldom heard groups.  The use of symbols in combination with a structured approach will enable us to represent these participants’ own feelings/perspectives in the research, rather than us having to rely on the views of proxies.

Researchers at the University of Kent will be piloting the ASCOT Talking Mats with people with dementia and people with intellectual and developmental disabilities (learning disabilities).

Jill Bradshaw (Accredited trainer) Lecturer in Learning Disabilities, Tizard Centre, University of Kent

Ann-Marie Towers (Research Fellow) and Nick Smith (Research Officer). PSSRU, University of Kent

Background

Social workers are required to complete a detailed assessment of their client’s needs. It is recognised that it can be a challenge to ensure clients fully participate in the process if they have cognitive or communication difficulties. The City of Edinburgh Council were keen to explore if we could adapt their standardized assessment tool and make it into a Talking Mat framework. Several staff in the council are already skilled practitioners in Talking Mats so are familiar with the framework and use Talking Mats in their practice. They are enthusiastic about the benefits of using Talking Mats both in terms of how it increases participation of service users but also because in their view it makes interviews easier for staff to undertake.

Structuring Talking Mats assessment framework

In order to develop the bespoke Talking Mat we held a seminar to discuss the social work assessment tool and approach used. Six key staff attended the seminar, facilitated by two Talking Mats associates. The discussion at the seminar identified a structure that would enable us to construct a coherent visual conversation that would cover the issues required to complete the assessment, using mind mapping to support this process. It is also important to identify a top scale that matches the question you are asking and make sure the options you are including are neutral and not leading.

The structure that emerged from this discussion is a Talking Mat that enables people to explore their views on 3 topics

• their home
• their health and well being
• their community involvement

 Trialling the Talking Mats framework

Talking Mats then took the mind maps and developed these into symbol sets that were piloted by social work staff. At the end of the pilot a review was held and changes made which included alterations to

• the language used
• the symbols used
• the topic an option was included under
• making it clearer to staff when options were more abstract and required further explanation and or personalisation

Nicki Ewing from Edinburgh City Council who leads on the project says ‘ I am very excited that staff have a tool that can make assessment more meaningful for service users to participate in and makes it easier for staff to get good quality information’.

Next steps

We are thinking of holding a focus group for others that might be interested in using the framework for their practice if, you are interested please contact Lois  via the info@talkingmats.com email – call your email ‘social work focus group’.

Over the past  year we have been funded by the Scottish Government to develop a Talking Mat to enable adults  with Learning disabilities to raise issues of concern.  We have worked in close partnership with Survivor Scotland and Kingdom Abuse Survivors Project  .  Together we have developed and trialled a Talking Mat  . The final report for this project is here :Talking Mats and Survivor Scotland final Report

This year the Scottish Government recognised the value of using Talking Mats as a conversation framework to enable people with learning disability to reflect on their lives and express their views including raising  any areas of concern.  One of the key themes from the national Scottish strategy for people with learning difficulties ‘Keys to Life’ is to  keep people safe, but it was also recognised that the Talking Mat that had been designed could also help with other themes –

• Helping people with learning disabilities stay in control
• Shift the culture and ensure care is genuinely person centred
• Evidence that the views of people with learning disabilities have been taken into account
• Support people to cope with adversity and loss and enhance  resilience
• Address health inequalities and reduce early deaths

The Scottish Government has funded a 3 year project which we are calling Keeping Safe.

This project will

• Produce a new resource based on the feedback from earlier projects This has 3 topics of conversation . Firstly ,How people are feeling about their Health and well-being secondly, their relationships. For people who are able to think and express their views at a more abstract level  the resource has a third topic and gives them  space to reflect on their thoughts and feelings.

•  Train staff in the 14 health boards across Scotland to use Talking Mats and this resource specifically. This training will be provided jointly with KASP so staff can be supported to think through how they respond appropriately to any concerns that may arise
• Ensure that all health board areas have accredited trainers who will be able to lead ongoing training and sustain use of the resource

If you work with adults with learning disabilities in Scotland and would be like to be part of this exciting initiative please contact us at info@talkingmats.com.

We are launching our fantastic eating and drinking resource to support shared decision making. This has been co-produced with the help of  people with eating and drinking difficulties and a range of different professionals. The resource is designed to help people think about, discuss and make informed decisions about how to manage their eating and drinking more safely. People with eating and drinking difficulties should initially be assessed by a qualified Speech and Language Therapist and Dietitian who will recommend appropriate strategies to help them eat and drink safely. This resource is particularly useful in helping people understand the effect that their eating and drinking difficulties can have on their health. It also helps people talk about how they feel about recommended strategies.
When discussing eating and drinking, there are many issues to consider. We have provided symbols under three main topics to help present ideas in a structured way that reduces the likelihood that the person will be influenced.

Click on this image to see it more clearly.

Discussing these topics separately means that people can firstly consider how they feel about different meal times, where they eat and types of food and then think about the impact that their eating and drinking has on their health. It also allows people to have a conversation about some of the suggested strategies and how acceptable these are.

We have run seminars specifically on this new resource in London and Stirling

Contact info@talkingmats.com for further information if you wish to attend a seminar in the future.

Thanks to Andrea  McQueen from Australia for this lovely blog describing the Good Things Project which shows how good communication is central to active participation for people with intellectual disabilities

Across the world, many thousands of people with intellectual disabilities live in group homes. These are houses in the community shared by about four to six people with disabilities. Many of these people have communication difficulties of various sorts.
Communication is essential to many activities both within the home (e.g. making a shopping list, choosing what to watch on TV, letting your house mates know when you need some space) and beyond (e.g. developing and maintaining friendships; participation in education, employment and leisure). For many group home residents, participation in these activities relies on access to appropriate augmentative communication systems, and to trained staff who can support their use.
In twenty years working as a speech pathologist in Australia I have been in and out of a lot of group homes. Some do things better than others. Some value communication more than others. Some group home staff routinely use augmentative communication systems, such as Talking Mats, Key Word Sign and pictorial timetables. Unfortunately many do not. Each time I leave a group home, I ask myself the same question: “Could I live here?”
When I first came across the Roydon Street group home here in Melbourne I was impressed. This is a house where communication is respected, where people are listened to, and where genuine choices are offered. It’s not perfect, but it passes my simple test – it is a place where I could imagine living a good life.
I wanted to share the philosophies and practices of Roydon Street around the world. I hoped to influence other group homes to adopt the same simple strategies for their residents. So I sought funding and made a video – Good Things.
The Good Things video aims to show how simple communication strategies can contribute to a good quality of life for people with intellectual disabilities in group homes. It demonstrates how a culture of respect and autonomy can develop when staff understand how to listen to clients and support their communication methods. It shows what is possible in a sector that gets a lot of negative publicity.
Good Things was funded by the Victorian Department of Human Services, and the closed captions on the video were funded by the City of Bayside. The video is the result of a partnership of many agencies and individuals. Special thanks to the residents and staff at Roydon Street. Good Things was released on YouTube in March 2014, and to date has had more than 800 views in 17 countries (not quite keeping pace with Lady Gaga!). It’s a small project, but I hope it has made a difference. I know the team at Talking Mats shares the passion for improving the lives of people wherever they live, and I would love to hear from others with an interest in this area.
Click here to see the Good Things video
Andrea McQueen
Inner South Communication Service
Email: amcqueen@cbchs.org.au
Twitter: @aj_mcq

My name is Karin Torgny, I’m from Sweden. My background is in journalism and culture studies. I used to work in “The Development Centre for Double Exposure” for many years, and our mission was to improve and spread knowledge about violence against women with disabilities. My special interest during these years was AAC. Today I work for Unicef and in different projects on human rights issues.

A year ago I did my accredited Talking Mats training in Stirling, Scotland. Since then I have given my first course in using Talking Mats when talking about abuse and harm. It was a great experience and an opportunity to work with an enthusiastic group of women who were open and willing to communicate using symbols. They are all in an organisation working with girls/women with intellectual disability exposed to violence and oppression in the name of honour.

I think Talking Mats is a good tool when approaching difficult subjects and I hope to run more courses like this in Sweden in the future. Lately I was interviewed on the Swedish Radio and talked about the use and possibilities with Talking Mats when someone is exposed to harm and abuse.

For those who know Swedish (!), here is a link to that program, http://t.sr.se/1mxZv9W

I am also curious if someone else is doing something similar. If so I would be interested to know more. Send an e-mail to: karin.torgny@gmail.com

Have a look at how Talking Mats has been used in Scotland to support people with a learning disability to disclose issues of concern: Survivor Scotland

Talking Mats has adopted day 69 of the justice for LB Campaign. This campaign was started was after Connor Sparrowhawk drowned in the bath whilst staying in  an assessment treatment unit .  In the words of his mum Connor was ‘a beautiful, hilarious and loved beyond words dude’.  So, after decades of trying to improve services for people with learning disability, closing the long stay hospitals, bringing in person centred approaches, we are left in 2014 with huge inequalities in the health and life opportunities  for people with learning disability and life’s like Connor are cut short in such a shocking, unnecessary and untimely manner.

How many more tragic deaths are we going to see before residential services for people with learning disability are going to change?  We need to see at the heart of  service culture an ability to really listen , put the views of the patient at the heart of planning and see the families as key partners. Sometimes I think people see listening as a ‘soft issue’. Other things get measured but does the quality of listening ever get measured? It should because in my view it is a critical patient safety issue.

Over the last few years I have had the privileged of working with a diverse group of people with a range of communication support needs. They have developed an interactive workbook for NHS Education Scotland. They share their experiences of contact with services to help staff understand how to improve communication and listening skills. They created 10 vision statements for staff of the things that were key to them. They told powerful personal stories to illustrate those statements. The stories illustrate both good and bad practice. You can download the free resource at http://goo.gl/QdOOev .

Listening to people what strikes me time and time again is the lottery of service delivery. There are some great stories where people have received quality treatment and interaction but that is not universal for there are stories where you are left questioning the compassion and humanity of staff in so called ‘caring’ roles. The question for all of us is how we shift the culture so that we can all experience a person centred and listening health service. I hope the energy and impetus of #107 campaign ignites the flame of change so that ‘all dudes’ gets a safe and quality service. If you want to join the campaign then please follow @justiceforLB .

Teens are comfortable using communication tools in the form of social media. They can feel less comfortable with direct communication and often find it hard to put their feelings into words. Using a Talking Mat when talking to teenagers provides a communication tool which takes the focus off face to face interaction. It gives a thinking space to help them to express their feelings. It also allows you to have a balanced conversation because it talks about the positive things in daily life as well as the opportunity to talk about difficult things.
Tina is a 13 year old girl who initially had coped well with the transition to High School but in February had started to refuse to come to school. She was unable to explain what the problem was and when asked about the reason for her absence, would say “ I hate school”.
The “Consulting children and Young people -secondary resource” was used to consult with Tina. She was presented with some of the options from “My body and Skills” to think about how she was feeling. Tina used the top scale Happy(Things are going well and Not happy (things are not going well).
During the Talking Mats interview she opened up about how she felt about travelling to school (she hated going on the school bus and felt embarrassed) She clearly identified the fact that she has specific learning needs as she has difficulty understanding and concentrating in class and often falls behind with her written work. Attending her maths class was particularly difficult and she did her best to avoid going. She also talked about her difficulty with talking to adults and also to her peers. Often she feels excluded in conversations as although she is listening, she doesn’t always understand what they are discussing and doesn’t know what to say. She has a problem with sleeping and feels her mood is low a lot of the time. She also commented that she can feel extremely angry and this has a negative effect on her behaviour. On the positive side, she loves to read and feels happy about her diet and her weight.

Helping Tina to grade her feelings about specific issues helped to identify what needed to be done in the first instance to get her back to school.
Alternative travel arrangements were put in place, extra support provided for her in class and from the learning support base.
She is attending school again and the pupil support team are gathering together the appropriate “team around the child” to explore her difficulties further.

Find out more about how to use Talking Mats by signing up for a training course at Talking Mats.

Using Talking Mats with Tony, a 53 year old man with learning disability and dementia. A guest blog by Rebecca Leighton  Specialist Speech and Language Therapist and Consultant for elenbi-uk 

“When I change I will be different” 

Tony was referred to me for Speech and Language Therapy around 6 months after being diagnosed with mixed dementia.  Dementia was having many effects on him but a key impact was communication difficulties: one of these difficulties was dysarthria (for him, this meant slow, slurred, effortful speech and difficulty maintaining enough breath support to finish his sentences) and  another word-finding problems (difficulty remembering and producing the words he wanted to say – like the “tip of your tongue” phenomenon we all get from time to time, but occurring in most of Tony’s sentences).  These two communication difficulties combined made talking very tiring and frustrating for him.

When I first met Tony, one of my aims was to find out what he wanted to achieve with Speech and Language Therapy.  We discussed this but it was tiring for Tony and it became clear very quickly that using words alone was not helpful.  It also became clear in that first session that although Tony was concerned about his speech, he was more concerned about his future and other areas of his life. He was worried about how he would enjoy life with dementia. He knew he would get worse and he wanted to know how he and his family would cope with that.  Tony said “When I change I will be different. What will I do with myself?”

I introduced Talking Mats to Tony at our next session, suggesting that it would be a way of exploring what he was worried about in terms of his overall health and wellbeing and also  what he might want from Speech and Language Therapy.  We did four Mats over the course of two sessions:

Mat 1: Starter topic (food). Tony managed a three-point scale easily (“like” “dislike” and “not sure”) and told me “This is alright, its easy. I can talk if I want. But I don’t have to.”

Mat 2: “My worries”.  Tony used a three point scale to indicate whether he was “not worried”, “a bit worried” or “very worried” about a range of aspects of his life and future.  We found that Tony’s main worry was what he would do with his time as his dementia progressed.

Mat 3: “Activities with dementia” – a sub-mat based on Tony’s main worry identified in Mat 2. This was done jointly with his advisor, Sabira, from his local dementia support service, who planned the mat with me to ensure it covered all the options Tony had available to him locally. The mat revealed that Tony was already attending a well-being café but wanted to try other well-being cafes too, to meet more people.  He was keen to try the singing group and also felt that his family needed support.  Sabira commented that she thought Talking Mats should be used more with people with dementia and she intended to explore this within her own service.

Mat 4: “What I want help with from Speech and Language Therapy”.  Again we used a three point scale, this time to indicate “yes”, “no” and “maybe” to possible goals for Tony. Options included assessment, therapy and advice. We chatted around each topic, giving Tony more information on each possibility and discussing if and how it could benefit him. Tony made informed choices around each option, and made the decision to start by creating a Life Story.

With Talking Mats, Tony has been able to give his full views on some very difficult topics for him. He has done so in a way which has reduced the demand on his speech, which made the discussion easier and less tiring for him. He has taken control of his Speech and Language Therapy care and has made informed decisions about his therapy goals.  Perhaps more importantly he has taken control of his future and made informed choices about what he wants for himself and his family for the rest of his life.

Talking Mats could be used by many services for people with dementia.  Imagine how empowered people with dementia would be, for example, if their social worker or dementia adviser were able to use Talking Mats with them to identify their needs and wishes and help them choose what they want for their present and future. What better way to involve people in their own care?

The only caveat? Get in there early. Empower people to tell their story while they are still able to use pictures and words to do so.  Dementia can steal these skills, burdening families with making decisions on behalf of their loved ones.  As a daughter, mother, wife and sister myself, I know I would feel much more at ease with making a decision for my relative with prior knowledge of what they themselves would have wanted. Talking Mats is one way of finding that out.

The Health and Well-being resource is based on the WHO International Classification of Functioning, Disability and Health (ICF) which is a framework which covers almost every aspect of daily life and can be applied over different cultures (WHO 2001).

Use of the WHO ICF helps professionals to think holistically about the people they are working with. We have produced four sets of symbols, based on WHO ICF, to help people express their views about different aspects of their lives. These cover 13 topics:

You can use the symbols in different ways, depending on the cognitive abilities of the person you are working with. For example, if you are working with someone who can understand abstract concepts, you could start with the 13 main health and well-being symbols. Your top scale might be ‘managing’ and ‘not managing’. Here is an example of a mat completed by Duncan who had a stroke which affected his ability to communicate through speech:

Using these symbols as a starting point, Duncan could tell us that his main concerns related to worries about his health, expressive communication and work. From here, we did ‘sub mats’ to help Duncan identify the specific areas he wanted to work on/explore.

Here is the mat Duncan completed in relation to his health:

Having done this mat with Duncan, it became clear that he was worried about various aspects of his health, particularly the risk of having another stroke. The wider team were able to give him and his wife information about stroke prevention. Other mats were also completed, exploring expressive communication, work and education and higher level communication (which is included in the ‘learning and thinking’ topic, and covers written communication as well as memory and concentration). Using the Health and Well-being symbols, we were able to work with Duncan to help him identify the main issues that he wanted to work on and then work towards more specific rehabilitation goals. Duncan had copies of all the mats he had completed and found it useful to refer to them over the months. This helped everybody stay on track in relation to his goals and he was also able to track his progress over time.

Have a look at our Health and Well-being resource on our website. It is available both as an original Talking Mat with a physical mat and symbol cards or as a  digital version  as part of The Talking Mats pro subscription