Many thanks to Tina Wood, Occupational Therapist at Therapy In Motion, for this great example of how Talking Mats can be used to explore thoughts and feelings both in present-day and in retrospect, to evidence positive outcomes from a change in educational placement. Tina’s use of colour coding and pie charts really helps to illustrate this.

Tina attended our Talking Mats Foundation training back in September 2016 and since then she has been using Talking Mats regularly in her work as an Independent Occupational Therapist.

In this example, Tina has used Talking Mats to enable Ben (name changed for anonymity, age 12½ years) to share his thoughts and feelings using the Talking Mats ‘Consulting Children and Young People’ resource packs – focusing on the topics ‘My Body and Skills’ and ‘What I do and Support’.

At the time of this Talking Mat, Ben had been accessing a new placement at a Pupil Referral Unit for the past 11 months (click on the picture below to see a clearer version).

As there was clearly a difference in how Ben felt things were going when he was attending his previous school, Tina decided to ask him to do a retrospective Talking Mat of how things were going for him 11 months ago in January 2018, when he started to feel “unwell”.

This enabled comparison with how he feels now in the “safe setting” of the Pupil Referral unit (click on picture to see a clearer version).

Tina then compiled the information from the above tables into pie charts, enabling a clear visual comparison between the two times/situations (click on picture to see a clearer version):

As can be seen from these charts, there had been a huge change in Ben’s perception of how he is coping with life in general and school in particular.

Tina recommended that this information needs to be considered along with the rest of Ben’s sensory needs (as reported in her full OT report) when deciding on what is the best educational setting for him after leaving the pupil referral unit.

We love this use of colour coding and pie charts to illustrate the information from Ben’s Talking Mats – to really ensure that Ben’s feelings and thoughts are seen and heard.

 If you would like to know more about accessing Talking Mats training – available across the UK and Ireland as well as online – please take a look here: https://www.talkingmats.com/training/

 If you have any examples of how you report/share information about completed Talking Mats we would be interested to hear about it! Just email laura@talkingmats.com

Thanks so much to all the practitioners who have sent us guest blogs about using Talking Mat in a Criminal Justice setting. Here are our top 5 – in no particular order!

1. Supporting Families in the Criminal Justice System: Sally Kedge, Speech and Language Therapist from Trouble Talking New Zealand shares two powerful case examples of using Talking Mats with children and families caught up in the criminal justice system. https://www.talkingmats.com/support-for-prisoners-families-experience-from-new-zealand/

2. Communication Needs within Youth Justice – Part 1: On 17^th April 2017, we organised a seminar to look at underlying issues and share good practice when addressing the communication needs of people in youth justice. We had representatives from: the Scottish government, the NHS; Third sector organisations working in youth justice, the police, social workers, professional bodies, universities and social work – from as far afield as New Zealand. The emphasis from the start was that understanding communication is key to improving service delivery. https://www.talkingmats.com/communication-needs-in-youth-justice/

3. Communication Needs within Youth Justice – Part 2: The afternoon session of our seminar on 17.04.17 continued the underlying theme that communication support needs are often hidden and many looked after children have support needs that remain unidentified. The outcome of the day was the establishment of a collaborative network. https://www.talkingmats.com/youth-justice-and-communication-needs-2/

4. Setting up a SLT Service in Prison: This inspiring blog by Jacqui Learoyd explores her role in setting up a speech and language therapy ( SLT )  service in a prison and her use of Talking Mats in that setting https://www.talkingmats.com/setting-up-an-slt-service-in-prison/

5. Has Talking Mats been used in Court? Two registered intermediaries talk about a couple of cases where Talking Mats was used as part of the achieving best evidence (ABE) interviews. https://www.talkingmats.com/talking-mats-used-court/

If you have been inspired and are not yet trained, come along to one of our Foundation training courses – for details see https://www.talkingmats.com/training/foundation-training/

We also offer online training if you are unable to access the training locations – for details see https://www.talkingmats.com/training/online-training/

  Improving communication with board games

Thanks to Karen MacKay from Focus Games for this new guest blog.

 Playing board games can deliver more benefits than just having fun with friends and family. In the workplace they help people to learn, collaborate and communicate, while they are having fun:

1. Breaking the ice

Ever attended an event or meeting where you didn’t know anyone? A board game helps everyone to become involved, talking and interacting, with each other – who doesn’t feel more comfortable, relaxed and happy to chat after playing a game together?

2. Learning through play

We learn through play when we are children, and it works just as well for adults too. Educational board games are a great way to learn from others, share experiences, ideas and gather new knowledge from the game itself. Plus you’ll be having fun – what’s not to love?

3. Developing social skills

Playing board games helps children learn to share, take turns, be a gracious loser and, for shyer children, to come out of their shell more. As adults, we continue to refine our social skills through games. They promote collaboration, communication, and teamwork, useful skills for us all!

 If you like the idea of improving your communication skills using a board game, The Communication Game is your ideal tool. Effective communication allows everyone the opportunity to express themselves clearly. In health and social care, effective communication is vital to ensure individuals receive safe and appropriate care.

For many people who have communication support needs, accessing health and social care and other public services is a challenge. We partnered with Talking Mats who worked with us and a group of people with communication support needs to develop and test The Communication Game. Initial development was funded by NHS Education For Scotland, and The Communication Game was born as an engaging way to help us all to reflect and develop our own and our teams communication, and thus improve the quality and safety of services.

The Communication Game is designed to help anyone working in health and social care to improve how they communicate, particularly with people who have communication support needs. Playing the game will help you think about the barriers to effective communication; and things you can do to ensure you communicate well with others. It is being used by many groups across the country including allied health professionals, nurses, charities, voluntary and community groups, nursing/care home staff and students studying nursing, speech and language therapy, social care and more.

The Communication Game uses questions to help build knowledge, scenarios to help you see the issues people face when communicating, and activities to help you practise different ways of communicating. It is a 1-hour training session for up to 10 people that you can use over, and over again with different groups.

The game is available from Focus Games and you can learn more and order at www.communicationgame.co.uk

Addressing the communication needs of people in youth justice is key to improving lives. The lack of attention to this is costly. On the 17^th of April, we organised a seminar to look at the underlying issues and share good practice.

We were delighted with the collaborative mix of people attending. We had representatives from: the Scottish government, the NHS; Third sector organisations working in youth justice, the police, social workers, professional bodies, universities and social work.

Our thanks to Professor Richard Simpson for chairing the day and setting the tone by emphasising from the start  that understanding communication is key to improving service delivery. Following his introduction a series of excellent and stimulating presentations took place creating a fusion of ideas and practice from Scotland and New Zealand.

• Kim Hartley Kean, head of the Royal College of Speech and language therapy  Scotland office highlighted the current position in Scotland
• Sally Kedge and Alayne Mckee described the approach adopted by their organisation Talking Trouble in New Zealand.
• Jane Macer the therapeutic service co-ordinator from Starley Hall Fife described an whole system approach to embedding good communication practice within an organisation
• Yvonne McKeown and Sandra Polding Speech and Language Therapists working with young people in a NHS inpatient psychiatric unit in Glasgow shared some case examples.

In different ways the speakers brought up very similar themes:

1. Communication can be treated glibly. There is a lack of understanding of what communication difficulties are and of the impact that they have on the lives of young people. These difficulties are often hidden and take time to identify. Lack of identification can have a huge impact on the future lives of young people.
2. Finding ways to hear the young person’s voice is key both for the young person but also for organisations in order to deliver appropriate and effective care.
3. Recognition of the intergenerational cycle and the importance of getting care and support correct so we break patterns and enable change.
4. Providing collaborative solutions and understanding the breadth of communication will help services improve. However, given services often don’t know what they don’t know in terms of the impact of communication difficulties we have to find ways to express those solutions in language that those services can relate to and understand. Listening to organisations and exploring their processes by analysing the communicative demands of each stage can be a helpful way to start.
5. Moving forward it is important to knock on open doors i.e. work with people who are receptive to recognising the impact of communication difficulties on young people and their lives but also find the strategic influencers who are sympathetic, in the words of our New Zealand colleagues ‘the aunts and uncles in the field’ who can help to promote the issue and raise awareness at a National level.
6. You can’t explore the issue of trauma and adverse childhood experiences without certain precursor, building blocks being in place. This takes time and requires a constancy of approach.
7. The importance of inclusive, visual tools becoming common place so that they are not used in isolation and in a vacuum.
8. The challenge of supporting and nurturing a young person’s inner voice when they have significant difficulties with language.
9. Lack of understanding of communication difficulties may lead to services responding to internalized behaviours that can lead to a fork in life; one way can send the young person down a route of offending behaviour services and the other mental health services.
10. The solutions lie in partnership and collaboration between professions and services.

There were lots of creative ways of using Talking Mats that were shared. A couple of examples that stand out were

• Using Talking Mats with social workers to help them unpick what they already know about a young person’s language and communication. This approach helped them think about all the different aspects that contribute to communication and where the young person’s strengths and weaknesses lay e.g. non verbal communication , humour , word finding , understanding complex information, understanding simple information etc .
• Using Talking Mats to support a psychiatric assessment of a young person. One person used his Talking Mat to say he was hearing voices something he was unable to disclose verbally. In this case this enabled an accurate mental state assessment and non-custodial sentence.

I will leave the last word to a young man living in an inpatient unit to support his mental health, his words about communication difficulties are ‘They make you more vulnerable when bad stuff happens’ how true that is and this is why it is important we work together to improve services .

Next steps The community justice network met in the afternoon and were challenged to think about the opportunities and barriers in developing services – read the for blog that covers the afternoon ……… If you missed the seminar and want to join a multiagency network to discuss this and help take this forward in Scotland then please let us know .

Click to read the excellent presentations from the seminar

• CJSCENTalkMatsPresentation170418
• Talking Mats presentation 17 April 2018 Sally Kedge Alayne McKee TTANZ final
• TM seminar 04-18
• Talking Mats & Justice CEN April 2018 Draft

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  !

This story, which highlights the importance of finding out what really matters to people, was shared by one of the staff attending the second day of an enhanced Talking Mats training course. She works in a NHS facility for people assessed as needing hospital-based continuing care.

I was working with Bill (not his real name) who is a man with severe cognitive impairment resulting from a head injury and stroke. He was very angry and agitated and we couldn’t work out what was wrong. At times he was physically aggressive when we couldn’t understand him.

One day he drew a picture of a rabbit and was very insistent about it but we didn’t know what it meant. We contacted his sister about him being angry about a rabbit. She asked around to other family members and friends but no one could think what it meant.

Bill continued to draw a rabbit and then other pictures including money and TV  so I made an improvised Talking Mat using his drawings as the options and began trying to find out what really mattered to him. I gradually connected that the TV was about about programme called Dickinson’s Real Deal (a TV programme about antiques) and that in the past Bill had had an ornament of a rabbit which he thought was worth a lot of money.

We phoned his sister again about a possible rabbit ornament and she then remembered that he had collected figurines in the past. She finally discovered the rabbit in her garage.

Once we were able to reassure Bill that his rabbit was safe his frustration lessened,he was much less angry and became more settled.

This lovely story shows us how important it is to never assume that someone is just ‘being difficult’  but that if we can try to find out what really matters to them we can make a huge difference to their lives and ours.

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

When considering someone’s mental capacity its is important to bear in mind that the right to self-determination is enshrined in law.

In 1948 Eleanor Roosevelt, as the chair of the United Nations Human Rights Commission, was the driving force in creating the Universal Declaration of Human Rights Act (1948).

Since 1948 there have been laws passed in many countries stating that people with communication disabilities should have equal rights, including and specifically in the complex area of mental capacity. In the United States the Federal Law that covers this is the Americans with Disabilities Act of 1990 . In the UK the key Acts of Parliament are the Mental Capacity Act (2005) England and Wales  and the Adults with Incapacity Scotland Act (2000).

The UK Acts specifically focus on mental capacity and say that every adult has the right to make decisions unless proved otherwise and that each individual has a different capacity to make decisions about different aspects of their life. In addition they state that we must assume that someone has Capacity unless it is established that the person has substantial difficulty in one or more of the following criteria in the following diagram.

There are a number of important expectations behind these Acts which are particularly significant for people with communication difficulties.

• Everyone should be supported to make their own decisions (including Augmentative and Alternative Communication methods)
• Adults should be encouraged to make use of their skills and to learn new ones where that would be helpful
• Information to support understanding needs to be given in a way that is appropriate to his/her circumstances (using simple language, visual aids or any other means).
• People are entitled to make their decision – this is not about what we think is good or bad
• Judgements on capacity:
  • cannot be based on age, behaviour or disability
  • need to be made decision by decision – (so not being able to make more complicated decisions does not apply to all decisions)
  • cannot be based on past experience of decisions – they need to focused on the here and now
  • must take into account the adults socio-cultural circumstances wherever relevant
  • where a person is able to retain the information relevant to a decision for a short period only, this should not prevent him or her from being regarded as able to make the decision
• If someone is judged to lack capacity then decisions must be in their best interest and any measures taken on their behalf are to be the least restrictive to the person
• It is important to assess people when they are in the best state to make the decision

Please let us know how you deal with self-determination and capacity issues where you work.

In a future post I will explain how Talking Mats can help support decision making and the identification of Capacity.

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.

The Keeping Safe Talking Mat resource provides a structured framework to ask someone ’How’s your life going?  It has 3 topics: Your Well-being;  Relationships; Thoughts and Feelings

Do you find it difficult discussing feelings with people who have limited understanding?

Do you have limited time to discuss sensitive issues with people?

Do you want to find out any issues which may be slowing recovery or preventing someone moving forward in life?

A cost benefit analysis demonstrated that using the Keeping Safe resource to create a listening space for people to think and share how their lives are going, is cost effective for organisations.

The design of the resource is described in the Tizard Learning Disability Review More Than Pictures TLDR 2017

It has been trialled and tested with people with learning disabilities throughout Scotland, but has also been used effectively with a range of people who find it difficult to discuss their life e.g. Young people with mental health condition.

It  has been shown as a helpful way to

•      discuss new information (89%),
•      discuss and resolve fears (84%)
•      support thinking (89%)

This poster gives an overview of the project KS 2nd Poster (click to enlarge)

The Thoughts and Feelings topic uses a different top scale and this resource is best used by people who have completed Talking Mats Foundation Training.  If you want to buy it (£55.00 +VAT)  contact the office  www.talkingmats.com   tel. (+44) 01786 479511