Author Archives: Margo Mackay

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

 

Advantages of GDPR !

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Apart from the necessity of fulfilling the requirements of the General Data Protection Regulation which has to be completed by 25th May, I have been pondering on other advantages of complying with the GDPR.

Here at Talking Mats we are all going through files, bagging up paper for shredding, deleting data files on our master computer and preparing text to send to all our customers and contacts to make sure we only hold information that is adequate and relevant.The first advantage for us is that it’s a good way to re-establish contact with people.

I’ve been given the task of going through all the research data and have ploughed through 16 drawers of research data starting in 1992!  Way back then I worked with a wonderful professor who was keen to hold onto all our raw data just in case we wanted to check or replicate anything. Its all been under lock and key but the time has come to bite the bullet and get rid of it.  I found this to be not only nostalgic but also emotional – all those fantastic participants who gave us their time and insights.

Its also been cathartic because as well as filling bags for shredding I am smashing up discs of video footage. We filmed lots of people with a range of communication difficulties using Talking Mats to compare with the same conversations without Talking Mats to analyse any differences. So… another big advantage is that I’ve destroyed all evidence of my dodgy hair cuts throughout the years!!

hairdresser

I counted 41 completed projects going from the very first one in 1992 which was a demographic survey of people who used AAC (Augmentative and Alternative Communication) systems in Scotland. In 1998 the Gannochy Trust funded the original project where Talking Mats was born Gannoch Final report. We then went on to carry out a wide range of projects which include working with people with Motor Neuron Disease, Stroke, Learning Disability, Children with Additional Support Needs, people living with Dementia to name but a few. The website contains the final reports on all our projects and in looking back at them I am also very proud of the good quality research the team here at Talking Mats has carried out.

Many others are now doing projects using Talking Mats but I leave it to them to organise their own GDPR and hope they also find the process worthwhile and rewarding and not just seen as a chore to be done.

Thinking Ahead: supporting people to plan for the future

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This new resource has been developed by Strathcarron Hospice and Talking Mats to help people with advanced illness or long term conditions to think ahead and plan for the future.

It consists of a booklet and 3 topic symbol sets: Affairs; Care/treatment; Personal values

3 topics
It can be used to help people have conversations about:
• the extent to which their personal affairs are sorted;
• what they would or would not consider about future treatments and care;
• what is going well/not going well in relation to their personal values

It is widely recognised that having discussions about end of life issues can enable people to remain in control for longer and help them to identify the care and support they need and want as they approach death. In spite of this, in Scotland:

  • 74% of people have not discussed what their wishes would be if they did not have long to live
  • 79% of people don’t have any written plans for their end of life care, financial wishes or funeral plans
  • Only 35% of people have written a Will

It can sometimes be difficult for people to start conversations about planning for end of life and people this is exacerbated if people have specific difficulties communicating their thoughts and feelings because of symptoms, fatigue and emotional factors. Before initiating this type of conversation it can be helpful to check the extent of a person’s understanding of their illness and whether or not they want to talk about the future.

The importance of having conversations and making plans for end of life has been highlighted as being relevant for people in the early stages of life limiting illness as well as for those nearing the end of life. There is evidence that people who have Advance or Anticipatory Care Plans in place are more likely to receive the care that they want and treatment can be less invasive. ACP is a process rather than a one-off conversation. It is acknowledged that ACP discussions should take place in appropriate settings with sufficient time to enable to people to consider and weigh up different options. ACP should also be developed in line with peoples’ personal values and goals (Sinuff Tasnim, et al.(2015) “Improving end-of-life communication and decision making: the development of a conceptual framework and quality indicators.” Journal of pain and symptom management 49.6 2015): 1070-1080).

Perhaps we should think about planning ahead whether or not we have advanced illness or long term conditions??

Training

To get the most out of the resource we run half day advanced training courses which will include the Thinking Ahead Resource. This course will be relevant to you if you:

  •  have attended a Talking Mats foundation training and are experienced in using Talking Mats with adults
  • want to extend your use of Talking Mats and consider its role and application to advance care planning
  • want to discuss sensitive topics around end of life care

 

Please contact us at 01786 479511 if you are interested in future dates.

Supporting families involved in the criminal justice system.


child thinking

Sally Kedge, Speech and Language Therapist from Trouble Talking New Zealand shares two powerful case examples of using Talking Mats with children and families caught up in the criminal justice system.

This week it was hot in New Zealand, so I sat under a tree in a school playground in the shade with an eight-year-old girl to do a Talking Mat. I’m a speech-language therapist engaged by the child protection agency who have guardianship of her. This doesn’t happen that often in NZ but the team involved with this girl and her brother realised that as well as dissociative behaviour related to the impact of trauma due to family violence exposure, there was also significant difficulty with language acquisition for both children. The mix of a trauma history and a language disorder was resulting in significant difficulty expressing emotions and explaining what had happened when behavioural outbursts happened.
Some of my work with this child has been to help the team understand how her language profiles impacts on her life, and to develop her language skills at school via a programme she carries out with a teacher-aide and a friend. My role has also involved helping her understand her own life story and to equip her to process this, as it hasn’t been a pretty ride so far.
At a multidisciplinary planning meeting for her and her sibling recently, the team were concerned to make sure the children had accurate information about when their father was going to be released from prison. Their mother has recently been released too but no one knows where she is currently. I suggested a Talking Mat might help us to find out what she knows at the moment about her parents and how she felt about the next few months, as there are likely to be some changes happening in her world. We wanted to give her accurate information so she didn’t need to fill in the gaps herself.
Using a Talking Mat helped me establish that currently this child feels many things in life are going well. This is good progress. However, we identified a few things that she felt were not going that well at school (‘in the middle’) and I was then able to talk to her teachers about preparing for the new school year starting in February. We figured out that she is looking forward to seeing her dad but doesn’t know when she will see him or where he is going. A conversation with her Social Worker and the drug rehabilitation residence has allowed me to put together some visuals and a timetable to show what is going to happen next. Dad can have these as well as her carer and others in her team.

Another child with a similar history also did a Talking Mat with me last week. My purpose was to help the team find out how he feels his current care situation is going. A very mixed picture emerged with some concerning cards placed in ‘not going well’. I asked the boy at the end if he knew anyone who could help him with those things and he said, ‘no one’. I was able to explain that I am one of the adults who need to figure out how to make life easier for him and I would talk to some other adults and come back to see him. The photo I took of the Talking Mat allowed me to follow up with the team and I took the photo back to the boy to explore further some of the ‘not going well’ cards. At this second visit, this boy initially did not want to speak at all, but he engaged fully in looking at the photo of the Talking Mat with me.

sally kedge blog
We used a scale of 1 – 5 (how much of a problem is this for you – 1 = not much, = 5 = really really bad) on a piece of paper that he could mark with a pen to explore the ‘not going well’ items in the photo. He picked out ‘mood’, ‘people coming to his house’ and ‘learning at school’ as ‘really really bad’. We agreed that these needed to get sorted out for him to make life easier and we agreed who I could talk to about these things. Once we got that agreed and written down, he initiated some conversation about less heavy topics and started playing. I’m now following up with the team. Easier said than done, but without the Talking Mat I don’t think we would have got his views so clearly.
Our Talking Trouble Aotearoa NZ team is involved with children, young people and adults involved with care and protection, justice, mental health and behaviour agencies. We have been very excited about the wide range of opportunities that Talking Mats has provided us and the professionals we work with to explore people’s views on their own situations, their preferences, and their well-being. This year we’ve been exploring how Talking Mats might be used in our contexts:
– in sexual assault health assessments undertaken by specialised health professionals
– for Social Workers in our Youth Justice and Care and Protection Communication Projects
– When finding out about how people feel about talking and understanding in legal contexts such as courts and Family Group Conferences when we are engaged as court-appointed Communication Assistants (equivalent to ‘intermediaries’),
– and in our own speech-language therapy assessments and interventions.
The social workers, paediatricians, teachers, lawyers and others we work with have also been excited about exploring how Talking Mats can assist in these contexts. We’re looking forward to more training from the Talking Mats team next year.

sallykedge@talkingtroublenz.org

Come and hear Sally speak at our Criminal Justice Seminar on the 17th of April 2018. Contact info@talkingmats.com  for more information.

Talking Mats in German

german app

We are delighted that ‘Talking Mats in German’ is now available in the Digital version and includes the latest technical and symbol upgrades. These upgrades are also now included in the English version.

Please click on this link to find out about all the upgrades.

We are very grateful to Prof Norina Lauer for sending us this blog which explains how ‘Talking Mats in German’ has been developed.

In 2016 Prof. Dr. Norina Lauer, a German professor for speech language therapy contacted Joan Murphy from Talking Mats because she was initially interested in the digital version for goal setting with people with aphasia. We found out that it would be interesting to have a German version of the app. So we started a project for translating Talking Mats into German. Prof. Dr. Norina Lauer managed the translation process. The project was financially supported by a German health insurance “BKK Dachverband” in cooperation with the German aphasia self-help organization “Bundesverband für die Rehabilitation der Aphasiker” (www.aphasiker.de). The translations were performed in a special scientific procedure to make sure that they match the English terms.

german app in action

What did we do?

Norina Lauer and her colleague Holger Grötzbach independently translated the English terms into German. Subsequently these translations were compared and the differing terms were discussed until a consensus was reached. The agreed translations were given to a professional translator who only got the German words and the corresponding pictures. She re-translated the terms into English and these re-translations were checked by Talking Mats if they were in accordance with the original English terms. For those terms that did not match, the process started again until all terms matched the original English terms (figure 1 shows the translation process). This process was performed for all topics of the app. So we have the complete Talking Mats app in German now.

Norina figure

Figure 1

So what’s next?

Norina Lauer completed the foundation training and the accredited training in 2017. In October 2017 she performed her first foundation training for 6 of her SLT students. One of these students will do her bachelor thesis about the German app version in 2018. Under accompanying consultation of Norina Lauer the student will perform two workshops for people with aphasia. In these workshops they will practice doing Talking Mats and afterwards evaluate the app concerning its content and practical use. For the evaluation we are planning a short questionnaire and a focus group.

It has been a delight to work with Norina and we look forward to hearing the results of her student’s project.

If you already have the Digital Talking Mats make sure you upgrade to get all the new features.  The German version with the upgraded is now available from the App store, Google Play (Free and Lite versions) or purchase the full version from our website .