We’re always amazed to hear from people about the variety of topics they cover using Talking Mats –from how someone is managing their self care or domestic tasks, to arranging a wedding, or thinking about whats important at a funeral.

As a communication tool Talking Mats maximises a person’s capacity to reflect on a topic and express their view.   It gives confidence in decision making.

Here are some other topics we’ve heard about recently.

• As a conversation tool in class
• Pupil voice in school improvement plan
• Client contribution to meetings and review day placement
• Respite
• Operations e.g. gastrostomy
• Health
• Postural management
• Where to live
• Childs opinions in relation to GIRFEC
• Respite feedback/choices
• SW assessments
• Choices available within service
• Going somewhere new
• Transitions
• Problem solving ie horse riding, identifying the problem
• Eating and Drinking
• Keeping Safe
• Social Media

What do you want to talk about?  There is no limit!

We are very grateful to Marieke Lindenschot from the Netherlands for this great blog about finding out what activities children like and we look forward to hearing the next stage of her PhD.

For my PhD research in the Netherlands I use Talking Mats as a tool for my interviews with children. The children I interview vary in their communication abilities. Some are able to express their opinions and feelings very well, others are not able to communicate orally. As I was able to purchase the Talking Mats cards without text, I wrote down the words in Dutch in ‘children’s language’ on the cards.

Last week was an exciting week. I conducted the first pilot interviews with a boy of 12 years, a boy of 9 years and a girl of 8 years. They varied in their development. The first interview went great. The child could express which activities he liked, which he disliked and which were ‘so, so’ (in between like and dislike). With Talking Mats he could also tell me with whom he performed the activities and where. It was a fun way to get a lot of information in only 15 minutes! The child and his mother were very enthusiastic. He was able to tell a lot more then he usually does when he is asked about his activities! Unfortunately the other two interviews didn’t produce the same amount of information. The cognitive level of these children seemed too low to use Talking Mats. The boy didn’t understand the top scale ‘like’ and ‘dislike’, whereas the girl didn’t recognize the activities on the cards.
Overall we were very satisfied with these pilot interviews. The goal was to check if the interview guide with Talking Mats ‘worked’ and also to see for which developmental level this way of interviewing is possible. The pilot interviews gave a lot of information on these two goals. I am looking forward to the next interviews as Talking Mats showed to be a very helpful tool in finding out which activities children like.

Please send us any other examples of how you have used Talking Mats.

It was great to meet with Nikki Steiner, Principal Speech and Language Therapist with Central London Community Health Care Trust (CLCH), to evaluate the work that was commissioned by CLCH. The project started in the spring of 2016 and aimed to support a person-centred and inclusive approach to health planning and intervention using the Talking Mats framework.

Those words ‘person-centred’ and ‘inclusive’ are easy to say but much harder to implement. Our approach was threefold:

1. We provided 100 staff with the Talking Mats resources to use in their practice (both the original and digital versions).
2.  We ran 3 Enhanced Talking Mats training courses for those staff which involved two days training. The first day introduced the framework and built staff confidence in using the resource. The second day supported staff to reflect on their use of the Talking Mats in their work setting, and allowed them to think creatively about further application and development.
3. To sustain the capacity of CLCH to continue with the project we trained three accredited trainers. The plan is they will continue to build staff skills and training on an on-going basis and provide local leadership and expertise.

The evaluation framework that we are using looks at impact of this investment using the Kirkpatrick model of evaluation. This allowed us to evaluate:

1. Participants’ reaction to the training,
2. Participants’ learning – did they increase their knowledge skills and learning?
3. Transfer and application – did they apply their learning to the workplace?
4. Result – this was based on the impact that using the Talking Mats skills and resources had on the lives of people with communication disability

We had different measurements for each part of the model and these ranged from course feedback, a quiz, personal reflection and stories from people with communication difficulties. It is these that we are in the process of analysing so watch this space for the final report. Nikky said ‘This is such an exciting project that impacts on all the different client groups that we support’.

If you would like to discuss implementing Talking Mats at an organisational level then have a look at this link – Organisational Training

Many thanks to Cheryl Strutt for this lovely blog about how she developed and used an Aromatherapy Talking Mat with people with learning disability.

I am an Aromatherapist who works with adults who have a learning disability and often additional communication difficulties. As part of a recent service review I wanted to develop patient involvement. Talking Mats (TM) was suggested as a possible option to support patient feedback. I decided to look into this tool further and access training. During my TMs training I was supported to develop my specific Aromatherapy TM. The main aim behind this initiative was to adopt a system that could identify how each patient felt about the service and identify if there were areas where changes or improvements could be made. I wanted to work closely, alongside each patient, in order to learn how they really felt about their Aromatherapy treatments, their likes/dislikes etc. and to give them a sense of ownership of their sessions. It’s all about giving individuals with a communication difficulty a voice that can be heard.

The Aromatherapy TM supported patients to understand what is involved in an aromatherapy session and has been effective in helping them to personalise their session.

I used the Aromatherapy TM within the patient’s first session and following their last session, taking a photograph of the completed mats as evidence. The TM is an excellent way of offering a range of different types of massage experience and the patient can select their preferences. I found it an excellent way, to obtain valuable feedback on patient experience. One patient with a severe learning disability and autism was able through the use of symbols, to indicate his dislike for the music being played during his Aromatherapy session. He has no verbal means of communication and feedback like this would not have been achieved if the Aromatherapy TM wasn’t used. Through the implementation of the TM I now have evidence of patient centred practice, in relation to the therapeutic value of the Aromatherapy Service. The Aromatherapy TM supported patients to understand what is involved in an aromatherapy session and has been effective in helping them to personalise their session.

Since the implementation of the Aromatherapy TM, patient feedback is now at the heart of the Service. The patient is now able to openly give comments, make choices on their treatment plan, which in turn is making their attendance at the department, a very pleasurable one and it’s very personal to the individual. Another patient who said that he wasn’t able to read or write, was able to explain what the symbols meant and chose the symbol for happy. He went on to indicate his preferences stating ‘I like foot-spa and a foot massage.’ Prior to using the TMs, I was often reliant on observing the patient’s body language to assess their level of enjoyment and gain feedback. The Aromatherapy TM now allows for a more accurate method of evaluating interventions. I am so enthusiastic about the increased level of patient involvement and the willingness of the patients to become involved in this activity. This project clearly demonstrates the value of involvement, leading to improved partnership working and better experiences.

Cheryl Strutt, Aromatherapist, Cheryl.strutt@belfasttrust.hscni.net

We are very grateful to Mary Walsh, Senior Speech and Language Therapist at St Mary’s Hospital in Dublin, for her Blog ;Does he like fairy cakes? ‘ It has been taken from her report on a project which looked at how speech and language therapists can facilitate the involvement of people with dementia to become more active participants in the decision making process around dysphagia management at the end stage of dementia. The project was funded by the Irish Hospice Foundation Changing Minds Programme

 The project aims were:

1. To improve person centred care in relation to residents’ food and drink preferences and dislikes
2. To actively involve the residents of the dementia specific unit in the decision making process around their dysphagia (swallowing) management particularly at the end stage of their lives.

In order to find out the food and drink preferences and dislikes of the residents, the team carried out staff questionnaires and family questionnaires. They found that, although these were useful in getting a quick overview, there were a lot of unanswered questions.

The team also used Talking Mats and found it to be a powerful way to explore the residents’ food and drinks preferences and dislikes when used with suitable candidates. Participants appeared to really enjoy the experience including looking at pictures of the completed mats afterwards. This may be because they felt heard, that their views mattered and/or that they felt empowered. The information was important for current Dysphagia management, and also as an advanced directive in the documented evidence of the residents’ wishes in the recorded pictures of completed mats.

 Brief Case Study:  Does he like fairy cakes?

Talking Mats was used with a gentleman who may have been assumed to be unsuitable to use Talking Mats as he was assessed as having late stage dementia. However, this man engaged readily in the Talking Mats interview and appeared to be happy to have his views recorded. Also, there was a much higher level of correlation than variance with Talking Mats and both the staff questionnaire and the family questionnaire thus further indicating that he was a suitable candidate. ‘Fairy cakes’ was something that this resident reportedly liked in both the staff questionnaire and the family questionnaire. However, the gentleman indicated twice on Talking Mats that he disliked fairy cakes.

 A number of actions are proposed in the report including :

1. Continue to use Talking Mats as appropriate in the dementia specific residential unit and the rehabilitation wards of St. Mary’s Hospital.
2. Inform the multi-disciplinary team of the merits of Talking Mats. This tool can also be used to explore other important issues for suitable residents/ patients on a case by case basis.

Conclusion:

It is essential to challenge our assumptions in our dealings with people with dementia. Truly person centred care takes time and patience where assumptions are challenged. Also, it is essential to listen to what residents tell us verbally, or through a supported communication system such as Talking Mats or non-verbally through tone of voice, facial expressions or gestures, and to act according to what is being communicated.

To read the full report please contact Mary Walsh at mary.walsh6@hse.ie To find out more about a Talking Mats resource that specifically focuses on finding out views on eating and drinking then please click here 

Many thanks to Shirley Rush Health Facilitator at Belfast Health and Social Care Trust for this great blog about using TM as a ‘weigh to health’.

Following my Talking Mats (TM) training I had the opportunity, as a health facilitator, to use TM in an adapted ‘Weigh to Health’ course. This course encouraged people with learning disabilities to make small changes to their lifestyle and to educate them on the effects of obesity and their health.

Prior to commencing the group work we met with each person and completed a Talking Mat. The topic was to explore “Important things to lose weight”, we used a wide range of symbols and included physical activity, health conditions and appearance. Clients also requested additional symbols were added including alcohol, cycling and mood, which made the mat individual to them.

A photograph was taken of the completed TM to act as a record of what was important to them. On completion of the group the TM was repeated with each person using the same topic and symbols and the mat was again photographed. When we compared the TMs it showed that all the client’s knowledge and understanding of the effects of obesity and the health benefits associated with weight loss had increased.
“it done me good, helped me to lose weight by talking about my health and the need to lose weight to look after my heart”

The use of the talking mat was a valuable resource, it allowed each client to make an informed choice about participating in the group work. One client said he felt he had been listened too and “it done me good, helped me to lose weight by talking about my health and the need to lose weight to look after my heart”. By using TM in this way we have been able to use this information to demonstrate outcomes and it shows the information was presented at a level of understanding suitable for the client group. On an easy read questionnaire about the course all the clients agreed that doing the TM was useful, one person wrote “loved doing the mat”.

If you want to get more information from Shirley contact her at Shirley.rush@belfasttrust.hscni.ne

We have received a number of requests to create a guide to adding your own images and creating submats with Digital Talking Mats and this blog will show you how.

One of the features of Talking Mats is that we have developed a number of different symbol resources based on our research and clinical practice which cover a wide range of topics.
However, sometimes you may want to personalise what is being communicated about by adding your own images. You may also want to create a submat to explore an existing topic in more detail or you may want to create a completely new topic. In our training courses we explain how to do this when using the original Talking Mats.

However more and more people are now using the digital version of Talking Mats. In a previous blog we described how to add your own photos to the Digital Talking Mats.

We have now made a guide to help those who have the digital version to both add their own images and to create a submat with an example of a sub-mat with the topic “office”.

Download the following pdf to find out how to do it. dtm-a-guide-how-to-add-photos

We would love to hear any stories about making your own digital submats

Castle Hill High School has seen the benefits of using Talking Mats to let pupils have their say and be involved in planning outcomes. Jenna McCammon, Speech and Language Therapist & Rebecca Highton, Speech and Language Therapy Assistant, Stockport NHS Foundation Trust explain how they are using Talking Mats at Castle Hill High School.

Talking Mats has been beneficial in supporting young people with communication difficulties in school.

A Talking Mats approach has been used to support a pupil who presents with selective mutism. He started refusing to engage in lessons and activities, so school wanted to find out what he enjoys doing and how best to support him. Talking Mats allowed the speech and language therapy team to find out about his likes and dislikes at school, along with the reasons why he was refusing to engage in certain lessons. The sessions allowed the speech and language therapy assistant to build rapport with the pupil through finding out what he enjoys both in and outside of school, and the pupil communicated verbally during one of the sessions for the first time since his change in behaviour. The speech and language therapy assistant took pictures of the finished piece of work and asked permission from the pupil to share this with school staff. The speech and language therapy assistant was able to feed back the outcomes with staff and with other professionals during TAC meetings. Staff and other professionals would then request if the speech and language therapy assistant could obtain more information from the pupil, when needed, using Talking Mats.
Safeguarding – A possible safeguarding issue was suggested by a pupil during a therapy. The pupil has significant communication difficulties and so the information she was able to provide was very limited. The safeguarding officer in school requested if the speech and language therapy team could try to find out more. This was done us using Talking Mats, which allowed the pupil to share more information about the issue which was then shared with the safeguarding officer.
Motivational Interviewing is a tool used by the speech and language therapy team, both when assessing a new referral and when completing a review assessment in order to set new therapy targets. It is an opportunity for the young person to express their opinion, and can also be used to determine how much insight they have regarding their communication abilities. This is usually done verbally using a 10-point scale, however Talking Mats has been used by the speech and language therapist when assessing pupils with limited verbal ability. This allows these pupils to voice their views and have a say in their therapy planning. The findings from the Talking Mats motivational interviews then contribute to writing EHCP Reports for the pupil and are used to inform the decision-making process regarding their therapy goals.

Thanks to Jemma and Rebecca for sending these great examples. Change happens when we give young people a listening space.

Talking Mats considers both health and social aspects when it is used to include people in their care planning.  Lots of interesting comments are made by course participants on the forum in our online training course.  Annemarie, who works as an agency carer visiting clients in their own homes posted her thoughts about the social model of disability

 Remembering the person behind the condition

In my experience, society is fixated on the medical model, the ‘what’s wrong’ approach. Whilst the medical model is clearly a valuable and required tool, it often leads to labels that individuals are then lumbered with, such as, ‘she has dementia’, ‘she is visually impaired’, ‘he’s deaf’ or has a ‘leaning disability’. Taking this approach overlooks the person behind the ‘condition’ and so can restrict inclusion.  One example could be an individual with dementia being unable to make everyday choices about seemingly mundane issues such as what to wear that day. Using a medical model, a carer may be aware of the clients difficulties and make choices for them, whereas using the social model approach enables the carer to see beyond the condition and fully include the client, allowing them to be part of the decision making process for themselves. A second example could be a person with a communication disorder such as Asperger’s Syndrome. Access to work could be severely restricted using a medical model as the pragmatic manifestation of this condition may well exclude a person from seeking certain types of employment. Promoting the use of a social model would ensure work colleagues understood the possible limitations of the condition and ensure adequate support networks were in place. The social model attempts to embrace a person’s difference and raises awareness within society of individual needs that will facilitate inclusion into all aspects of life.

The WHO ICF -World Health Organisation International Classification Framework of Functioning, Disability and Health (2001, 2007b) aims to merge the medical and social model, encouraging professionals to think not only of the persons health condition and resulting impairment, but the impact this has on the persons participation and activities.  It captures the full complexity of people’s lives, including environmental and social factors and can be applied over different cultures

The Talking Mats Health and Well- being resource is based on the WHO ICF and supports a person to reflect and express their view on various aspects of their lives.  Using the Health and Well being  resource supports workers to remember the person behind the condition.

We are delighted to have received funding from Life Changes Trust to work with Patient Opinion to help improve the access to their website by developing a Talking Mats to enable people to tell their stories.

Like Talking Mats, Patient Opinion is a Social Enterprise and has an excellent independent website https://www.patientopinion.org.uk/  that enables people to share their experiences of UK health services, good or bad. They then pass the stories to the right people so that they can learn from them.

The project we are working on is focusing on people with dementia but in the long run we hope that lots of people will benefit.  It will bring our two innovative technologies together marrying the expertise of the Patient Opinion website with that of the Digital Talking Mats.

Our aim is that people affected by dementia can use their own voice to share their experiences and make real differences to relationships, services and culture, just as many others are already doing across health and care. We also hope that this work will empower others with communication or cognitive difficulties to share their experiences and be heard in an open and transparent way.

This ground breaking work is being funded and supported by Life Changes Trust, People Affected by Dementia programme. The Big Lottery funded programme is committed to working with people living with dementia and those who care for them, investing resources so that individuals are more able to face the challenges before them, and can exercise more choice and control in their own lives.

We expect the project to take 18 months to complete and have already run focus groups with people with dementia, family members and expert practitioners to plan the new symbols. We are now working with the technical experts to create the website interface which we will then pilot with people with dementia.

Watch this space for more updates…..