Monthly Archives: November 2018

Setting up an SLT service in prison

prison population

This 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 . HMP Berwyn is a large prison which opened in February 2017. To help you understand the challenges facing me when setting up this service in a new prison, I’ll tell you something about prisons, the people in prison, and the healthcare provision at HMP Berwyn.

In the UK the prison population is just growing and growing.  The graphic above  is taken from the Commons Library Briefing of April 2017 so that you can see the trend.  The number of people in the prison system as of April 2018 is 83,617.  The reoffending rate is about 30%.

From this data alone, we can see that something needs to change in order to reduce offending and re-offending.  Part of the ‘something which needs to change’ is considering offender rehabilitation / prison reform.  This led to the building of the UK’s newest prison – HMP Berwyn.

We tend to shorten the name of the prison to just ‘Berwyn’, so that is what I will call it in this short piece.   Berwyn has a focus on rehabilitation and treating people as individuals. We aim for the provision of high quality healthcare.  We have space for 2106 gentleman – which makes us quite a large facility.  We also give attention to the words which we use in our daily conversations – the clients are not called prisoners, but ‘men’, the cells are ‘rooms’, people are called by their first names, etc.

The healthcare provision is an integrated multidisciplinary team with a mix of professionals offering a range of skills.  It’s called the Health and Wellbeing Team as it offers holistic care to our clients.  I’m happy to say that this includes full time Speech and Language Therapy (SLT), which is where I come in.

Speech and Language Therapy is necessary in a prison setting as a significant proportion of people in the criminal justice system will have speech, language and communication needs.  Some research suggests that this may be as high as 91% (Brooks, 2011).  Many of these people will not have accessed SLT in the past, and will have developed their own strategies in hiding their difficulties.  This is why communication impairment is a hidden disability in this client group.  Alongside this, people in prison experience much worse mental and physical health compared with the general population.  There are more head injuries, more illnesses caused by drugs and alcohol, higher numbers of people with diagnosed mental illness and more people with conditions such as ADHD.  The prison population is aging, so we have all the illness which link with an aging population too, such as strokes, dementia, cancers.  You can see that as a service, we are going to be kept very busy!

We’ve got lots of plans for how to tackle some of the things which we want to do as an SLT service, but something which we have already achieved is using Talking Mats.

My first thought was how the men at Berwyn would respond to a conversation using a set of symbols and a doormat.  Needless to say, they took it to without question – even the toughest looking customers who had been ‘inside’ for many years happily sat down with me to chat using the tool.  Not only did they tolerate the Talking Mat, but they loved it – reporting that they were able to organise their thoughts and report their views more easily.

client report on needs at BerwynTo start with (and to ease clients into this way of sharing information) we tried Talking Mats about the problems faced by individuals at Berwyn.  The question was ‘what do you feel about ________ at Berwyn?’ with symbols for the experiences and situations that men face during the day.  It looked something like this: You can see that this gentleman was having some problems with his mental health, his computer in his room (which is necessary to book visits and make purchases), his memory and his weight.  Other aspects of his life were OK such as family contact and care from the doctor.

Some clients wanted to say more about emotions following completing the ‘problems’ Talking Mat.  We used a ‘me’/’not me’ visual scale and symbols to represent emotions.  This Talking Mat requires the client to have some emotional awareness skills so that they can recognise what they are feeling.  Not all of the clients are at this stage, and it is especially hard for depressed people to access their emotions vocabulary (Bryan,2013).

emotions Talking Mat

Here is an example of this Talking Mat.  This information could be used as a starting point to develop an emotions safety plan with an individual. After completing this Talking Mat with a 21 year old man who has a significant history of Adverse Childhood Events, he wanted to make his own Talking Mat about his life experiences.  This is a young man who finds expressing his emotions and past very difficult. I was quietly excited that he was prepared to share more information.  We have sat together and used the symbol software to make his symbols, and next week I will get to see what he is going to tell me.

And lastly, we have met some clients who have a diagnosis of an Autistic Spectrum Condition.  They had attracted this diagnosis during their teen or adult years, but had limited understanding of what Autism is or how it affects them on a personal basis.  Being in prison, they can’t Google to find out more as you and I might.

my auti

We have developed a Talking Mat which explores ‘what is Autism?’ and allows the client to learn while they report on what having autism feels like for them.  We hope to develop the responses on this Talking Mat into a person centred communication passport which can be shared to help all their communication partners.

We keep thinking about ‘what next?’ with the clients and the SLT service, and we continue to develop symbol sets for more Talking Mats conversations.  Often we are being led by the clients in terms of what they need in Talking Mat form.

We have strong links in the wider team, so will be doing more Talking Mats work with psychology, substance misuse and nursing colleagues.  We hope to access the Talking Mats Accredited Training and expand the number of people using Talking Mats to include Offender Managers and Prison Officers.  Alongside this we are developing healthcare pathways for clinical work such as end of life care, so will be applying the Talking Mats methodology to advanced care planning.  There’s a lot to do!

Postscript 

If any of you want you to link with Jacqui to discuss this further please let us know and we will link you with her. If you want to become confident and skilled at using Talking Mats then please come on a training  We also have an online course

References

Brooks, V., 2011. Report outlining the findings of a 13 month pilot project examining the effectiveness of speech and language therapy for young people known to Exeter, East and Mid Devon Youth Offending Team. East and Mid Devon Youth Offending Team.

Bryan, K. (2013). Psychiatric disorders and communication. In L. Cummings (Ed.), The Cambridge Handbook of Communication Disorders (Cambridge Handbooks in Language and Linguistics). Cambridge: Cambridge University Press. doi:10.1017/CBO9781139108683.020

Let pictures talk

german app in action

Grateful thanks to Prof. Dr. Norina Lauer, OTH Regensburg – University of Applied Sciences, Germany for this blog.

At the conference of the German Society for Aphasia Research and Treatment (GAB) from the 1st to the 3rd of November Franziska Rau presented a poster – Let pictures talk – about her bachelor thesis on Talking Mats.

2018 TalkingMats – Germany

Speech and language therapists from German-speaking countries meet at this conference to present their latest research findings. This year’s theme was ” Aphasia Therapy Digital”.
The presented bachelor thesis about Talking Mats was performed at the HAN University of Applied Sciences, Netherlands, and was written by Franziska Rau together with Karoline Bitter and Lara Stobrawe. The students asked 29 people with aphasia and 63 people without aphasia for how representative they rated the images and terms used in the Communication section of the Digital Talking Mats Health & Well-being resource. While the healthy persons judged many items as not clear enough, the people with aphasia estimated significantly more pictures and names as appropriate. For this purpose, various reasons have been discussed, such as the possibility that the persons with aphasia directly perceived the pictures and terms as aids, while healthy persons judged more critically on the basis of the task. But also problems of concentration or comprehension in people with aphasia would be causally conceivable. This should be examined in further studies.
The poster was presented as part of a poster session and was well received by the audience. Thanks to Franziska, Karoline and Lara for their great study and to Holger Grötzbach, Janine Coopmans and Xaver Koch who supported the students.

We are always happy to receive projects and posters from anyone studying how Talking Mats can be used

Talking Mats for parents

Corporate_logo_CMYK_BLUE

We were delighted to get funding from the Big Lottery to deliver a Talking Mats training to parents and carers in Perth, Scotland.  The feedback from this pilot group, (who have primary school aged children with speech, language and communication needs), will be used to develop a training course specifically for parents and carers,  and design a Talking Mats resource for families to use at home.

We don’t yet know what the training and resource will be like.  This will be designed with the parents when they have completed the training.  Will it be a set for the digital app, or a mat and cards?  Will the training be online or a face to face course?   Exciting!

We will then apply for further funding to develop this and make it accessible to more families.

Talking Mats helps people have better conversations.  Some parents are already using Talking Mats at home to have a conversation, to support their son or daughter to express how they feel about a topic or say when somethings wrong.   Here’s a link to a blog about how Talking Mats helped a parent find out why her 4 year old daughter  was getting upset at the thought of going to nursery https://www.talkingmats.com/mummy-i-dont-want-to-go-to-nursery-today/

We’re always keen to hear what topics would be useful to explore with children and young people with communication difficulties.  Get in touch with your ideas via Facebook, Twitter @TalkingMats or info@talkingmats.com