Author Archives: Margo Mackay

Self-management for people with long term conditions

DTM Jean and David

Self-management for people with long term conditions (LTC) is now a key government strategy to encourage people to take responsibility for their own health, behaviour and well-being. Talking Mats received funding from The Health and Social Care Alliance Scotland to look how using the Digital Talking Mats (DTM) can help people with LTCs to manage their health and well-being and to recognise their own strengths and abilities.

The overall aim of our project was to empower people with different long term conditions, to manage their own health and well-being. Through using Digital Talking Mats (DTM) we hoped that participants would be able to have more control over their lives and have improved communication with families and professionals.

There were a total of 28 participants in this project living with one of three different long term health conditions – stroke, dementia and learning disability. Each participant had access to a tablet device and was given a personal DTM licence which gave them access to 13 topics in the Talking Mats Health and Well-being resource. We visited each participant at home and taught them how to use it and asked them to complete and send us at least 1 digital mat per week for 6 weeks on any topic they wished. The design of the digital Talking Mat allowed them to email their mats directly to the researchers. We visited each participant a second time to discuss on how easy it was to use the digital Talking Mats and their views on their completed mats. We asked those who wished to, to continue sending us completed mats beyond the initial 6 weeks. We visited them again in 6 months to discuss how they were managing.
15 participants completed all 6 mats and 12 participants continued to complete mats over the length of the project. Participants completed 235 digital mats across all 13 topics

There were 3 particularly significant findings

1. At 18 months the participants living with dementia actually felt their well-being had improved, despite dementia being a progressive illness.
2. For the participants living with stroke the results were even more striking as 95% felt things were going well at the end of the project in comparison with 47% at the beginning.
3. At the end of the project the percentage of people with learning disability who felt things were not going well had reduced from 19% to 10%. Furthermore the percentage of people indicating that they were not sure about their views had increased from 27% to 42%. There can be a tendency for people with learning disability when using Talking Mats, to express their views at either end of the mat and to rarely use the mid- point. However being able to use the unsure mid- point is noteworthy as it indicates that the participants in the project realised that they could express their views not only as black or white but could indicate that they were unsure. This awareness opens up the potential for people to express views more thoughtfully with opportunities for further exploration.

Here are three examples of how using the DTM supported people to self-manage situations in their lives. Click on image to enlarge.

DTM stories

As well as helping participants self-manage their long term conditions, an unexpected outcome of this project is that many people found that using the DTM helped them see the positive things in their life and not just the negative. It also highlighted that despite having a long term condition and, for many also a deteriorating one, that things were not getting worse.

Click here for full report including 6,12 and 18 month reports to the funders  20180717 Alliance full report

Click here for the summary report 20180717 Alliance Final Short Report

Click here for a video link of 2 participants

Moving from Primary to Secondary school – pupils share their views of transition

school

Moving from a primary school to secondary school can be a daunting prospect for children.
Whilst schools understand the need to prepare the children for the transition process, due to time constraints, the focus tends to be on group visits to the new school rather than one to one support for individual children.

The challenge therefore is to ensure that each child feels prepared for the transition and that they have the opportunity to talk about any worries they may have.

My sister is a head teacher of a small village school and was interested in finding out more about her pupil’s experience and thoughts about their impending move to secondary education.
With the permission of parents I offered a Talking Mats session to each child in the term prior to them leaving for secondary education. In total this was 8 children.
I used digital Talking Mats, choosing the “What I do and support” topic cards from the primary school pack.
The children were told that we were going to think about how each topic may be affected by moving up to secondary school. We used a happy/not happy top scale.

The level of engagement from the children first amazed me. They were all excited by the prospect of using the digital Talking Mat. All were familiar with iPad use and grasped the concept quickly.
They used the topic cards to think about areas such as playing, friends, helping in the house, looking after yourself, your safety and managing stress.
They all expressed worry about the transition process but for many it was not around areas that teachers or parents would have automatically considered. How they were going to get to and from the new school was a theme that concerned them, as well as getting up and getting ready to go to school in the morning. A large number of the children also explained that they had poor sleep due to either difficulty getting off to sleep or waking with worries. Some children also disclosed some concerns about family life.

I found that the diverse nature of the cards prompted the children to think about areas of their life that their teachers had not ordinarily thought about when considering the impact of transition.

As an occupational therapist it struck me that many of the children were expecting that with the change from primary to secondary there also came the added responsibility of having to look after themselves. For them the transition was not just about moving schools it was also about being more “grown up” and being less reliant on their parents for prompting their self care routine or accompanying them when outside.

At the end of the session a summary was agreed with each child and this was sent to both the teacher and the parent so that they could support the child with the issues they raised. The teachers remarked that even though each session had only lasted 20 minutes, and was facilitated by someone the child had never met before, it had managed to reveal a breadth of information about how each child was feeling, that they were not previously aware of.

In summary, the beauty of the Talking Mats approach is that it allows the thinker to explore a range of issues that are relevant to them and does not lead the listener down a path of asking questions they think to be relevant. This gave the child I worked with the opportunity to really say what was troubling them. They were not put off by the fact they have never met me before, they talked freely with the digital version of the Talking Mat being both a point of focus as well as in a format they enjoyed.
Whilst the theme of the sessions in this case was transition, I would commend teachers to consider using Talking Mats in schools to enable children of all ages to think and communicate their feelings on a wide range of topics.

Thanks again Rachel Woolcomb OT for a great practical example.

Intermediaries for Justice Conference


managing_expectations

It was great to be able to attend the Intermediaries for Justice Conference on the 9th May in City University London. From the very beginning there was a real buzz of excitement in the room. Intermediaries demonstrated throughout the day their commitment and passion for their job despite frequently working in difficult circumstances as well as having a role that is not always appreciated. They are employed by the crown, magistrates and family courts in England, Wales and Northern Ireland. Intermediaries support two way communication between personnel involved in the justice system  supporting  those previously judged incapable of giving clear and effective evidence to do so.

There was a real buzz from the outset at the conference. At times, it can be quite a lonely role being an intermediary. If you get the role right and put the appropriate communication scaffolds in place,  everyone communicates well – then some in the justice system find it hard to recognise that you have done anything at all! Baroness Newlove, the victims commissioner for England and Wales who was one of the key note speakers said ‘You need to see how intermediaries work to believe what they do ‘ Being a skilled communicator and being creative is the bedrock of intermediary practice. Baroness Newlove was clear that there needs to be greater access to registered intermediaries and but also there were clear management and long term support issues that need to be addressed by government.
The theme by various speakers throughout the day was the challenge of communication in the justice system. As one speaker put it ‘Justice is being delivered in a system designed in the 18th century which makes it difficult to fit the needs of the 21st century and ensure all have access to legal process ‘ Another speaker spoke of registered intermediaries levelling the playing field but there is still not equal access as defendants do not have automatic access to the scheme . As well as communication difficulties arising through the child’s age and or the person’s disability the issue of cultural communication was raised particularly in relation to gang culture
The conference loved meeting Oliver – the first dog in Europe trained to be court friendly and whose role is to support children to give evidence . Research in America has shown that stroking pets can help reduce fear and support children in court
Talking Mats is a communication framework that some intermediaries use . One said she could not do the role without Talking Mats and two intermediaries have described their use of them in two previous blogs . Click to read a blog by Nicola Lewis https://www.talkingmats.com/assisting-vulnerable-people-to-communicate/ and one by Catherine O’Neil https://www.talkingmats.com/talking-mats-used-court/ . So Talking Mats was delighted to be asked to the conference to have a stand and run a workshop. It was great to have Aileen O’Hagan with us and she talked through some case examples when she had used Talking Mats in her role as a intermediary. One example involved working with a young person with selective mutism where Aileen used Talking Mats to great effect to help prepare and plan for her witness interview . She created options around the optimum environment for the interview e.g. lightening, seating etc but also options around the mode of giving evidence . The witness wanted to write things down and wanted the intermediary to speak them out loud.
The day left me in no doubt that intermediaries are effective in enabling the voice of those who would not otherwise be heard, be heard. I remain concerned and puzzled as to why Scotland does not have the scheme. We do have appropriate adults but this role does not have the legal standing nor the training and qualification demands of the registered intermediary scheme and in practice the focus of the work is different . I hope this situation will change.
The intermediaries for justice organisation have now established themselves as a charity and if you want to find more about their work then visit http://www.intermediaries-for-justice.org.
If you are an intermediary and have found Talking Mats helpful then we would love to hear form you. We are always up for more guest blogs so please get in touch

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