Laura’s 4 year old twin boys are just about to start school and she was finding it difficult to have a proper chat with them about how they are feeling. She wanted to think about how best to help them prepare for the transition from nursery so used Talking Mats.
We have done lots of ‘practice mats’ over the past few months – focusing on topics such as ‘food’, ‘animals, and ‘toys/games’, so I knew that the boys were both familiar with Talking Mats before I introduced the more emotive topic of ‘School’.
P was first to have a go at being a ‘Thinker’, with me as the ‘Listener’. We used the Top Scale ‘Happy about/ Not Sure/ Not Happy About’. P thought very hard about placing each option. It helped to have the pictures and mat to focus on rather than just me firing questions at him.
My use of open questions such as ‘How do you feel about playing at your school?’ meant that he often made additional comments such as going on to talk about the toys he had played with during his settling-in session. Some options did need more explanation, for example with ‘eating’ we talked about eating snack at playtime and having a school dinner at lunchtime. Abstract concepts such as ‘trying new things’ also required further explanation. This included relating the concept to real-life situations such as trying to ride a bike and starting swimming lessons.
P’s finished mat gives us a clear indication of his feelings about school. The ‘check and change’ stage was very useful as P changed his mind about ‘uniform’ which he had originally placed under ‘Not Happy About’ – he said that actually he is happy because he will look smart in his new uniform!
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.
Involving people with a learning disability in service evaluation is both essential and challenging.
Maria Lavery speech and language therapist, and her colleagues in North and South Lanarkshire are using Talking Mats to get feedback about the service they deliver for people with a learning disability . They want to find out about what people feel they do well, and what could be done differently. In addition they have placed a suggestion box at the entrance to their building, but want to involve everyone who is connected with their service – clients, family, carers various multi-agency colleagues and are carrying the review out over a 6 month period.
The analysis and learning will be used to inform the Speech & Language Therapy work plan and support the future direction of the service.
Talking Mats has been used successfully to evaluate Augmentative and Alternative Communication services and the resource for this is available on our website http://www.talkingmats.com/wp-content/uploads/2013/09/AAC-service-Evaluation-script-and-symbols.pdf
We are currently working to develop a Talking Mats resource to support conversations relating to Advance Care Planning (ACP) with staff and patients from Strathcarron Hospice. People who use hospices often have specific difficulties communicating their thoughts and feelings because of advanced illness and emotional factors.
Sixteen staff from the multidisciplinary team at Strathcarron Hospice were trained to use Talking Mats by Sally Boa who is Head of Education, Research and Practice Development at Strathcarron Hospice and also one of our accredited trainers.The staff trained used it successfully with patients in the hospice and found that they could use it with a range of patients for a variety of purposes: getting to know someone; identifying goals; discharge planning.
A sub-group of staff attended a workshop with members of the Talking Mats team to discuss the potential use of Talking Mats to support conversations relating to ACP. Topics and options were agreed. These were then presented to a wider forum of staff from Highland Hospice for validation and checking. Three main topics to support ACP conversations were identified: Affairs; Care and Personal Values. New symbols are being developed and the resource will be trialled with a range of patients in the hospice setting.
Our hope is that Talking Mats can be used by trained staff in a hospice setting to support people to express their views and help them plan for the end of life and that it will also be helpful for many other people to consider future options in their lives.
We will write an update once the new resource has been completed.