Monthly Archives: May 2018

Learning Conversations – How do I feel about what I do and the support I get?

being_involved_in_decisions

Thanks to Laura Holmes for this blog about the support she gets from Talking Mats for ‘Learning Conversations’ with the children she works with.

I use Talking Mats for a variety of purposes in my role as a Speech and Language Therapist (SLT) for NHS Stockport Children’s Therapy Services Team, working with children with speech, language and communication needs (SLCN) in mainstream primary schools.

The introduction of the SEND Reforms in 2014 and SEND Code of Practice (January 2015) firmly places children and young people at the centre of the planning process – ‘No Decision About Me, Without Me’.  The following principles underpin the reforms,

  • Support for children and young people with SEND should be based on an understanding of their views, wishes and feelings.
  • Wherever possible, children, young people and their parents should participate in decision making, and should be supported to participate.
  • Support should help children and young people achieve the best possible outcomes, and prepare them for adulthood.  (Howe C., et al 2016)

One of the main advantages of the Talking Mats approach is that it has enabled me to have ‘learning conversations’ with some of the children I work with.  These learning conversations support children to participate meaningfully in decision-making in terms of setting SLT targets based on their views, wishes and feelings, which are then incorporated/ linked into their SEN/ Education, Health and Care Plans.

I usually introduce the Talking Mats approach using ‘practice’ mats focusing on familiar topics such as animals, food, activities.  Once a child is using the mats to clearly indicate their views/feelings on these familiar topics, I introduce topics such as ‘My Body and Skills’ and ‘What I do and Support’, using the Talking Mats ‘Consulting Children and Young People – Primary’ resource, to support a learning conversation. I use original and/or digital versions depending on what each child responds best to.  Here is an example of a mat focusing on the topic ‘What I Do and Support’, using the topline question ‘Happy About/ Not Sure/ Not Happy About’:

Laura's blog

 

Using the Talking Mats approach as a basis for this learning conversation enabled me to learn about B’s views and feelings regarding the things he does and the support he currently receives.  This approach also provided me with a deeper understanding of how he felt about these skills, as he was noticeably more communicative when we had the mat to focus on rather than answering direct questions.

At the end of the session we discussed what B would like to work on in particular.  B shared that he wanted to work on asking for help, and making choices.  These two targets were then set in his updated therapy plan, which also included recommendations in terms of supporting B to follow routines in school, for example through increasing use of visual supports and strategies, and also in terms of providing opportunities for B to try new things in school with an appropriate level of support and guidance.  It will be useful to carry out follow-up learning conversations using sub-mats – for example, submatting ‘routines’ (once the recommended supports and strategies are in place) using the topline question ‘what helps/not sure/ what does not help’, will enable B to share what he feels works best for him.

Using the Talking Mats approach has often taken a child’s therapy ‘journey’ down unexpected paths as the mats have sometimes revealed areas of difficulty and/or challenges for that child which were not previously apparent or identified.   These areas would not have been targeted otherwise, indicating the power of Talking Mats to empower and enable the children I work with to participate in their own therapy planning.

References:

Howe C., et al. (2016)
Guidance for Speech and Language Therapists on their roles and responsibilities under the Children and Families Act 2014 and associated Code of Practice
Royal College of Speech and Language Therapists Position Paper. RCSLT: London

For further information about Talking Mats training options click here

 

 

 

Connecting people, connecting support

Alsion McKean 1

Many thanks to Elaine Hunter, National Allied Health Professions Consultant with Alzheimer Scotland for this blog

Background

Connecting People, Connecting Support is a new policy document in Scotland and shares  how allied health professionals (AHPs) in Scotland can support people with dementia, their families and carers to live positive, fulfilling and independent lives for as long as possible.

The policy document presents an evidence-informed case to support a biopsychosocial approach to practice for ALL AHPs in Scotland when working with people living with dementia – what we call the AHP approach. The fundamental understanding driving the AHP approach is that people living with dementia CAN benefit from AHP-led interventions.   In this week’s blog we are sharing the AHP contribution to maximising psychological wellbeing.

 Alsion McKean 2

Maximising Psychological Wellbeing

What do we mean by psychological wellbeing?

The central importance of finding ways to communicate (verbal and non-verbal) that work for each individual and which make meaningful connections that may have wide-ranging benefits in relation to overall wellbeing and quality of life is recognised. Psychological interventions of different intensities are reflected to promote emotional health and psychological wellbeing, with the provision of psychological interventions for depression, anxiety, and expressions of stress and distress. This element builds on established AHP psychological interventions and therapies.

Elaine Hunter 3Click on box to enlarge

Why is psychological wellbeing important?

 People with most types of dementia will at times struggle to find the right words or follow a conversation.

  1. Communication difficulty can be exhausting for the person, families and carers
  2. We know that people can often find it difficult to talk about dementia and many people living with dementia experience social isolation
  3. Dementia can have a profound psychological impact and may be linked to feelings of anxiety and depression.
  4. A non-pharmacological therapeutic approach is advocated for the treatment of psychological symptoms and a person-centred stepped-care model of support.

 3 ways allied health professionals CAN maximise psychological wellbeing?  

 1. Maintain and maximise communication

AHPs are aware that optimum communication occurs in environments that are comfortable, where a person can feel relaxed and safe, and when the AHP-led intervention is tailored and individualised. AHPs have experience in training others in conversation skills and cuing strategies, identifying key elements for effective everyday communication and supporting opportunities to practice communication strategies in a social context, helping the person to gain confidence in the interaction. Speech and language therapists can provide personalised communication advice (aimed at, for example, developing communication passports, assessing communication networks and maximising communication opportunities) that is shared with family members to facilitate their communication skills. Where language difficulties present as a primary feature of the dementia, as in primary progressive aphasia, speech and language therapists will carry out assessments to identify specific communication impairments and abilities. Their findings will contribute to the diagnosis and be used to plan therapy and strategies.

 2. Psychological interventions

AHP core psychological skills are unique to each profession and vary according to their undergraduate education and postgraduate development activity. AHP interventions to maximise psychological wellbeing require excellent communication skills and the ability to integrate psychological interventions and psychological therapies into core AHP practice.  A number of approaches based on the psychological understanding of dementia and its effects, including reminiscence approaches, life-story work, anxiety management, and engaging in everyday occupations and activities, will be core to AHPs’ day-to-day practice.

With additional enhanced training opportunities, psychological interventions can also become core to AHP roles and integral to a team approach to a stepped-care model of assessment and intervention. Psychological interventions include motivational interviewing, behavioural activation, mindfulness based cognitive therapy, cognitive stimulation therapy, cognitive rehabilitation and cognitive behavioural therapy. Specific psychological interventions providing individualised, formulation-led interventions in response to stress and distress in dementia, ranging from low-intensity to specialist interventions, can also be within AHP remits.

 3.Psychological therapies

Psychological therapies are highly specialised psychological interventions that include the established AHP disciplines of art psychotherapy and music therapy.

Art psychotherapy creates opportunities for verbal and non-verbal communication by using art to enable people to feel connected to a sense of self, other people and the environment around them. It can support people living with dementia by reducing anxiety and increasing coping skills (Safer & Press, 2011), depending on how interested the person is in art activities, art materials and how they feel about one-to-one or group activities. Art psychotherapy can be particularly helpful for people who find it hard to express their thoughts and feelings verbally, enabling self-expression and enhancing sense of self and personhood.

Music therapy builds on people’s ability to respond to music to develop a therapeutic relationship and facilitate positive changes in emotional wellbeing and communication through engagement in live musical interactions. It has a robust evidence base as an effective, non-pharmacological intervention that can significantly improve and support the mood, alertness and engagement of people with dementia, reduce the use of medication, and help to manage and reduce agitation, isolation, depression and anxiety (Ridder et al., 2013).

These art-based therapies are particularly helpful when people find their emotions are too confusing to express verbally, when verbal communication is difficult or when words are not enough.

Supervision for the AHP professions is integral to all of the interventions.

On reflection

Thank you for taking the time to read this blog and we would like to know

  • As an AHP, how do you currently support people living with dementia to maximise the persons psychological wellbeing?
  • As person living with dementia, what support would you like to receive from allied health professionals to maximise your psychological wellbeing?
  • As family carer, what support would you like to receive from allied health professionals to maximise your psychological wellbeing?

We look forward to hearing from you.

Email me at EHunter@Alzscot.org

References

There are references supporting this text which you will find in the original policy document and can be viewed here  https://www.alzscot.org/assets/0002/7356/AHP_Report_2017_WEB.pdf with all the evidence informing the policy available at www.alzscot.org/ahp