As part of the Right to Speak initiative Talking Mats was funded to develop ‘Promoting Inclusion and Participation’: an online learning resource for staff working with children and young people who use Alternative Augmentative Communication (AAC).  We have been delighted to work with NHS Education Scotland on developing this free resource and also have really enjoyed working in partnership with the learning and development consultancy: Forum Interactive.

The complexity of care for children and young people who use Alternative and Augmentative Communication (AAC) is multifaceted. Ensuring that goals are centred on the young person and family’s needs is a constant challenge to practitioners. There are several resources that focus on developing the technical skills of developing AAC but there is a scarcity of resources that focus on the impact of AAC on the child’s day to day life.

Promoting Inclusion and Participation is based on an earlier project which determined the key indicators of a quality AAC service from the perspective of AAC users and their families.

Promoting Inclusion and Participation uses the following frameworks to help practitioners structure their decision making:

1. International Classification of Functioning, Disability and Health – Children and Young People (ICF-CY)
2. Janice Light’s Communicative Competencies (2014)
3. GIRFEC (Getting It Right For Every Child) wellbeing indicators

These are brought to life in a series of DVD vignettes which tell the stories from the perspective of the child, their families and schools. It poses the practitioners’ questions that allow them to reflect on the impact of AAC on the child’s day to day life. The resource is designed to be used for group discussion. The feedback from the expert practitioners that reviewed the material suggest that the DVD and resulting questions can enable AAC practitioners to have  a rich discussion about best practice and how to time educational and therapeutic input to achieve holistic outcomes.

This on-line resource will help practitioners:

1. Understand the role that collaboration and involvement play in delivering wellbeing outcomes for children who use AAC.
2. Apply a holistic approach and outcomes focused approach to assessment, implementation and review which places the child at the centre.
3. Recognise that as the child develops and changes, so the level of different team member’s involvement will ebb and flow.

Download the resource here. It takes a little time to download so be patient !

We would be delighted to receive feedback of how it is being used.

Ref

Light J , Mcnaughton D, Communicative Competence for Individuals who require Augmentative and Alternative Communication: A New Definition for a New Era of Communication? Augmentative and Alternative Communication, 2014; 30(1): 1–18

Handing over control of communication seems to be the most difficult of all the skills we need to have when we are taking part in communicative exchanges. Just how difficult this is, even for skilled communicators, can be clearly seen when people are using Talking Mats. Handing over control of communication is one of the fundamental principles of the talking mats framework. If the person has the physical skills, the facilitator physically hands over this control by handing the person the symbol (and of course other approaches are used when the person does not have the physical skills). The ‘thinker’ (the person who is doing the Talking Mat) then places the symbol on the Talking Mat, under one of the points on the pre-agreed top-scale, having been asked an open question e.g. how do you feel about …….?
When facilitators are learning about this approach, they seem to find it easier to ask open questions, slightly harder to stick to the agreed top scale but really difficult to hand over all of that control. As part of the training, participants film themselves using Talking Mats with someone. We use that clip to reflect on the facilitators’ skills, by taking about things that we liked and then reflecting on ‘it would have been good if…….’
The video clips work really well as participants can see themselves making the errors of retaining control in small (but nonetheless significant ways) e.g.
• Having the mat facing themselves rather than the ‘thinker’
• Moving the symbols after they have been placed by the ‘thinker’ to tidy them up/to make it easier for facilitator to see them
• Forgetting to give a neutral response where ever the symbols are placed (even if the facilitator thinks that the symbol has been ‘misplaced’)
• Telling people that they must place the symbols in rows underneath one another
• Not letting people use the top-scale creatively e.g. by placing the symbols at specific points between the top-scale e.g. to represent unsure but I am more happy with it than not.

The great thing about the Talking Mats training is that participants noticed these things that they were doing and will be working hard at noticing and doing them less in future.

We find it hard to give up control and find it hard to notice the things we do to retain this control, even when we are working within the talking mats framework. This is a framework where we are ‘symbolically’ handing over that control in the form of giving someone a symbol and so have a very obvious reminder of whose turn it is. How many ways then must we do it in everyday conversations and never notice? After all, in every day conversations, there are typically much less obvious reminders of whose turn it is and who should be in control.

Many thanks to Dr Jill Bradshaw, Lecturer in Learning Disabilities/Consultancy Development Manager, Tizard Centre, University of Kent for this thoughtful blog.

We are grateful to Nicola King SLT, who describes how she and colleagues use Talking Mats not only to gain feedback from parents about the therapy process, but also about the parent’s understanding of the child’s diagnosis and its impact.
The options to start the discussion are included in the mind map below. Click on image to enlarge.

Issues raised by one parent were
1) Information given to me –unsure . The mum went on to say ‘I’m worried/ frightened. I don’t want to ask too much as I’m frightened as to t he answers
2) My child’s progress –unsure. The mum offered ‘I’m inpatient’

Nicola commented –‘These were huge issues and each response gave me a chance to explore what she was thinking and meaning. For the first time this mum offered her fears about ASD and ADHD. She enjoyed the Talking Mats process and after the interaction agreed for the first time to an onward referral which ensured support was in place for her son starting school.
The Talking Mats format was a brilliant way to have that ‘difficult conversation’ ‘

One of the many ‘non-traditional’ uses of Talking Mats has been the work that has been undertaken with university students (both undergraduate & post graduate) at the University of Stirling. Since 2008, staff in the Career Development Centre at the University have been trained to use Talking Mats as a tool to help students to articulate their career thinking and planning.
We have established from our research and trialling of a range of topic cards that students respond well to the process. While the majority of the students we work with have no speech or language difficulties, the process of TM enables students to articulate their thoughts and to feel more at ease to raise particular issues. It can be very hard for students to talk openly about financial worries, academic issues, or career anxiety. TM gives a platform for this to be done in a non-threatening way and quickly allows the Careers Adviser to see where the student is ‘at’ in their thinking. This then allows the adviser to work more efficiently & effectively to support the student to develop their career plans /strategy.
Staff feedback would indicate that they enjoy working with TM in both one to one and group settings with students. There are many perceived advantages to using TM but one of the main ones is that it can make better use of the time available and that it can be a good way to see quickly where the key issues are that need to be addressed. TM also fits well with current Career Guidance Theory, allowing the student to narrate the ‘story’ and arrive at their own solutions to the ‘problem’ under discussion.
There are of course some students who do have additional learning needs and TM is again an ideal tool. In particular, students with dyslexia and dyspraxia comment positively that the visual aspect of the cards allows them to process the information and structure their thinking in a clearer way that just talking to a careers adviser can.
International students who sometimes have poor English language skills respond well to using TM as it allows us to get a clearer picture of the students thinking than sometimes is the case from a more ‘traditional’ discussion
Action Planning and Goal setting are a big part of the Career Management process and TM is a really useful tool to ‘kick-start’ this process for students. The visual impact is powerful and enables students to see clearly what they are considering and the cards allow the students to physically move the cards to help them to decide how to move forward in their thinking and planning. Students consistently comment that they appreciated the opportunity to see clearly the issues that they are considering and allow them to move forward.

Many thanks to Elaine Watson, Careers Adviser, University of Stirling and one of our accredited trainers for this stimulating description of how she is implementingTalking Mats

It is recognised that it is difficult for people with communication disability to give feedback to health service staff.  The group that developed the Making communication even better resource decided that mystery shopping would be a good way to find out whether health  staff were supporting their communication and enabling them to access the services that they require and are entitled to. Funding was sought and gained from NHS Education Scotland for a small mystery shopping project.

20 people  with communication disability were involved in the project which was coordinated by Talking Mats Limited and the Stroke Association Scotland. There were different aspects of the project – making phone calls, face to face visits and recounting personal experience .  It covered the 14 Health boards in Scotland.  The project report was named ‘Through a Different Door’ as this reflected the overall findings that people had highly varied experiences of interactions with health service staff ranging from the excellent and supportive to  poor which had the further  risk of endangering patient safety . Click here to read the final reports

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.

Thanks to Lauren Pettit for this thought provoking blog about using Talking Mats in a rehabilitation setting in South Africa to compare goals of adults with aphasia, their Speech and Language Therapists and their significant others.
I am a Speech-Language Therapist in Johannesburg, South Africa and I work in neuro rehabilitation for people who have had a stroke or head injury. Over the past few years, I have been inspired to learn more about implementing communication modes to assist people to participate effectively in various communication interactions.
Talking Mats™ is such a wonderful tool that enables people to communicate so many things, from their needs and desires, to engaging in higher level conversations. I have seen the benefits of this tool used in a rehabilitative setting. I recently completed my dissertation with the Centre for Augmentative and Alternative Communication (CAAC) at the University of Pretoria, in South Africa.
The study included adults with aphasia who were still attending therapy at least 6 months after their stroke and were working on activities and tasks in various therapies, for example: Occupational Therapy, Physiotherapy, Speech-Language Therapy, therapies. I wanted to understand what was important for them to work on in rehabilitation to improve in various areas of life. Some of the adults with aphasia had very little or no speech, others had difficulty expressing themselves and finding the appropriate words to use in a phrase or sentence. Talking Mats™ was therefore used to assist them to rate important life areas. The life areas (activities and participation domains) were identified by the International Classification of Functioning, Health and Disability (ICF). This classification system was created by the World Health Organisation (WHO) and may guide therapy assessment and management. The areas were depicted as symbols with a supplemented written word on each card. These nine cards were: Domestic Life, Relationships, Work and Education, Leisure or Spare time, Self Care, Learning and Thinking, Coping, Communication, and Mobility. The adults with aphasia were asked what was important to them to work on in rehabilitation. The adult with aphasia could place the card under Yes, Maybe or No on the velcro mat and provide a comment if he/she wished or was able to. The Speech-Language Therapists who worked with the adults with aphasia and their significant others (a family member/friend or carer, who knew the person well) were also included in the study. They were asked to identify which areas they thought were important for the adult with aphasia to still work on in therapy.

(Click on graphs to see clearly)

It was very interesting to see varied opinions in the results. Six of the areas received similar ratings from all the participants and Communication was highlighted as an important area to work on by all. There were statistical differences found for the following domains: Work and Education, Leisure or spare time and Self Care. The adults with aphasia wanted to work on Leisure or Spare time and Self Care, however, Work and Education was not important to them to work on in rehabilitation, whereas the Speech-Language Therapists rated Work and Education as important for the adults with aphasia to work on. Significant others did not rate these domains as important.
This study gave a glimpse into how some rehabilitation teams are currently communicating and working together and that very often, the people who have difficulties expressing themselves are perhaps not always given the time and space to understand the therapy plan and identify and communicate their individual therapy needs. This needs to be explored further. Talking Mats™ provided a structure and gave the adults with aphasia a ‘voice’ and the opportunity to engage in this complex communicative interaction. I am in the process of sharing the results from the study with the participants. I have encouraged them to sit together in their teams and identify areas that could currently be focussed on in their therapy. Many participants were eager to discuss the results after the interviews were conducted and were interested in the concept of prioritising their rehabilitation needs. I hope they see their participation in this study as the opportunity to further engage in their rehabilitation needs and that it gives them the confidence to participate more fully in many other areas of their lives that they identified as important.
I would so appreciate your thoughts and input. Please respond to Lauren lolpettit@gmail.com

Thanks to Fiona Kane from the Alzheimer’s Resource Centre in Clydebank for sharing this lovely story about a visit to a man who had had a stroke. He was able to explain his views and take part in self management without realising it!

“Two of us visited a man who has aphasia. His wife is really struggling to communicate with him. She had been unable to attend the Talking Mats family training. I suggested the Talking Mats and they both agreed to try it out. I thought I would share it with you.

When we arrived the man was snoozing in the chair. He was extremely apprehensive when we first introduced the Talking Mats. However he quickly became very animated and we were able to tune into what he was saying.

A. asked him about gardening and he said he didn’t like gardening. He then invited us out to see his garden, was able to show us where he fell cutting a high hedge and indicated this was the reason why he had stopped working in the garden.

 He told us he didn’t like religion and this was because his Mum was so strict with religion when he was younger.

 He told us he really enjoyed photography and missed that. His wife is now going to buy a digital camera to help him continue with this.

 He also told us that he enjoys listening to the radio but not radio 4 as there is no music.

 His wife was absolutely amazed with the information her husband was able to communicate through the mats and he was able to express how much he enjoyed doing it. He was very animated and walked us out to the door. 

It was a really amazing experience for both of us!”

Many thanks to Helen Paterson, one of our accredited trainers for this fascinating blog.

Now that Talking Mats is accessible in a digital format, the Talking Mats team are often asked ‘Can it be used on an eye gaze device?’ . Of course, for those who use eye pointing reliably, they can use a standard Talking Mat, but there are those individuals with whom we work with who may want to use their eye gaze device to use a Talking Mat, and who find the digital format more accessible. We would suggest that this is only done with a client who is already familiar with eye gaze , due to the extra effort required both to use eye gaze and to make decisions when using a mat. There are many other access methods with which you could use and access Talking Mats Pro, such as a head mouse, chin joystick or touch screen, but for this blog we will focus upon eye gaze. Here’s how we made it possible, and I am sure there may be other ways which we would love to hear about!

1. To use Talking Mats Pro directly using eye gaze the person really needs to be calibrated on a device, and they require a level of calibration that is good enough that they are able to access a mouse emulator or Gaze selection on Tobii.
2. You must ensure that the mouse emulation or Gaze selection features are set up and the person understands what the features are and what they mean e.g: left click, drag and double click.
3. Open up Talking Mats pro on your account.
4. You will need to select the topic, topscales and symbols for your client, as this will make it easier with less work for your client, although this is something you would do anyway as the person facilitating the mat.
5. Now go through the question and the topscales as you usually would and explain them to your client.
6. Select the first symbol and place it on the mat where they can see it.

This is where the 2 systems differ:

Mouse emulation: In mouse emulation mode, the user is emulating and controlling a mouse pointer on the screen. This function is available with software such as: Tobii Gaze Interaction in Mouse Emulation Mode (shown above), Alea Intelligaze, Eye Tribe with Dwell Clicker, Tellus 4 with TM4 eye tech, or the Windows App within the Sensory Software’s The Grid 2 FastTalker2 user.

1. Client first needs to open the mouse function menu by fixing his or her gaze on the small grey icon which will open the mouse menu.
2. Client then fixates gaze to select the drag function (shown above)
3. Then the client will select the symbol s/he wants to move by fixating on it.
4. Once fixated, they symbol will ‘drag’ around the screen with the clients gaze. 5
5. They will then fixate on a point to ‘drop’ it.

See Video

Gaze selection (Tobii):

With Gaze selection (Tobii only) the user can control a Windows desktop with a two step selection method. The first step involves selecting the desired task from the taskbar on the right of the screen. The person looks at it until it changes to white. The person then looks at the part of the screen where they want the task to take place.

1. The client clicks selects drag function at the top of the Menu
2. They then look at the symbol 3
3. They then look where they wish to place the symbol.

This does require some more thinking on the side of the client as they need to look to where they want it to go and they are not just dragging it as they are in mouse emulation mode.

See video

For individuals who do not have a calibration good enough to use mouse emulation or gaze selection, it is a little more complex. A Talking Mat could be emulated from software such as The Grid 2 or Communicator, but it would not involve the software from Talking Mats Pro or dragging of symbols and moving them to where the person wants them to go.

Thanks to Helen Beltran for this thought provoking blog.

I am an Accredited Talking Mats Trainer and have just finished a great week of training in my local area, Inverclyde, Scotland. This was the first time I had given out symbol sets to everyone who completed the training. What difference did it make?

Everyone was able to see the symbol sets during the training and was really positive about the images and the design. I was concerned at the time that this would stop them really engaging with the process and individualising their mat. I was so pleased when they came back with videos that showed that they had selected the most appropriate options for their communication partner, they had removed those that were too abstract, they had thought about using photos, they had added symbols they had produced themselves. They had made the resources their own!

We talked about this as a group and all the participants felt that the symbol sets were going to allow them to get going with Talking Mats. They would then develop their bank of symbols, by making their own and buying further packs. Some participants told us that they felt having the symbol sets was allowing them to bring supportive colleagues on board who had not yet done the training and was combatting the negative attitudes of the vocal few who had the ‘not more work for us to do’ attitude!

They left with their symbol sets – full of ideas, not just about Talking Mats but about offering choice, hearing the individual’s voice, reducing vulnerability, relationship building and empowerment.

It has often struck me that some people are very much at home making picture resources and making their communication more visual, while others find it a real challenge. Is it reasonable for us to expect everyone to produce their own resources from scratch? Is the barrier to the use of visual communication the making of the resources, rather than the motivation to use them? On the other hand, is the making of the resources the only way to make sure that the supports meet the individual’s needs? What about the costs involved in buying in? Do those who are embracing visual communication need help with resources in order to spread good practice?

Food for thought?