We are excited by the growing use and impact of Talking Mats in CAMHS. With this in mind, we have updated our compilation of mental health blogs, and are pleased to share a new compilation with you. If you have used Talking Mats in a mental health setting and would like to share your experiences with us, please do get in touch at info@talkingmats.com – we would love to hear from you! 

You can also access the blogs listed above by clicking the following links:

The previous blog (read here) described the development of a set of symbols to prompt discussions around identity.  In this blog, the authors illustrate how the symbols can be used to support practitioners to consider their own ideas about identity and how this may influence the clinical relationship.

The completed resource was trialled with practitioners working in a variety of settings.

Feedback

‘It   help me understand and reflect on my own biases and how I am slowly working to be more aware of them and ask the right questions’

‘This Talking Mat  was an eye opener about my worries and anxieties around saying the wrong thing’

Overall practitioners reported that using the resource helped;

•             understanding and reflection on own biases and challenge default assumptions

•             consideration of wider aspects of identity that were not routinely thought about

•             holistic thinking by encouraging seeing clients in a wider context 

•             stimulate ideas about different questions to ask

•             provide a safe platform for staff to open up

•             address your own anxieties as a professional about getting it wrong and fear of ”putting your foot in it”.

It was also agreed that the resource could be used in diverse settings and not only within AAC.

Next steps

At the start of the process we were not sure where the discussions with the original project group would lead but the results of the pilot have shown that this Talking Mats identity resource is helpful for practitioners to mindfully reflect on their practice, allow unconscious bias to rise to the surface, consider all aspects of  their clients’ identity to develop their practice, contribute  to reducing inequalities and improving the responsiveness of services.

If you would like to know more about this resource and how it can support practitioners, please join Lois, Nikki and Lucia for an online webinar on

Tuesday 13^th August 2pm – 3.30pm

This week’s guest blog, the first of 2 from the authors (Lois Cameron, Nikky Steiner and Luccia Tullio), describes the development process of a set of symbols aimed at supporting practitioners to reflect on the role of identity within their practice. 

Every person has their own unique identity, just like they have their own unique fingerprint.

Identity is about how we see ourselves and how the world sees us.

Background

The Royal College of Speech and Language conference 2021 was titled ‘breaking barriers and building better.’  Professor Harsha Kathard from the University of Cape Town gave the keynote presentation and reflected on the key role understanding identity has in clinical practise, stating that ‘understanding identity is key to inclusion’.  Secondly, she stressed that if we want to develop  better services  and support then ‘Turning the gaze to reflect on our positionality is central to change’ .Ash R et al (2023) in their editorial for the British Medical Journal  highlight how interventions normally focus on single categories of social identity and ‘fail to account for the combinations of, or intersections between, the multiple social characteristic that define an individual’s place in society.’ They argue that ‘systems of care may consequently overlook overlapping systems of discrimination and disadvantage and exacerbate and conceal health inequities.’

The Development group

Following feedback from clinicians and people who use Alternative and Augmentative Communication (AAC) a working group was formed in March 2021 to explore the role of identity, diversity, equality and inclusion with in AAC practice. 

Communication Matters and AAC networks within the UK advertised the group and 12 people responded.  These people came from a range of organisations and had a range of lived experiences of diversity including people who use a communication aid to help them communicate. The work was funded by the Central London Community Health Trust and Talking Mats Ltd facilitated the meetings and the work

The group worked shaped the resource by reaching a consensus about the components of life that contributed to identity. In the end the group agreed on gender, sexuality, disability, race, neurodiversity, culture, family structure, voice, bilingualism, religion, mental health, personality, politics, intimacy, connecting with others and occupation. The process of developing the symbols was hugely helpful in unpicking what was actually meant by the various aspects e.g. voice. The original image for voice represented accents but the group discussion shaped the image to represent much more so the final image included a rainbow flag, a more general sound wave to represent tone, a Spanish word and an image to represent disability. As one group member said ‘my cerebral palsy is part of my identity. If I am having a voice I want to reflect that identity – I want a cerebral palsy voice’. Identity and the issues surrounding it can be emotive but the focus on the symbols helped contain the emotion and supported group members to listen to the perspective of others.

The whole iterative process of developing the resource and clarifying what the symbols should look like allowed the group to be clear about the individual meanings of abstract topics. This wider understanding was captured in a glossary to go alongside the symbols. For example, Identity has the following definition: Every person has their own unique identity, just like they have their own unique fingerprint. Lots of different characteristics make up our identity. This is what makes us different from other people. Sometimes we may share some of these characteristics with other groups of people, which can also be part of our identity.  Identity is about how we see ourselves and how the world sees us.

Equality, Diversity and Inclusion: a visual framework to support the exploration of Identity within practice.

The resource is seen as a support for constructive reflection by practitioners on identity and allows them to consider the different aspects of their patients’ lives that may impact on their interventions. The final Talking Mats symbols have the suggested top scale of ‘I considered a lot’, ‘I considered a bit’, ‘I have not considered yet ‘. It could be used individually or by a team as a group discussion tool. 

The glossary is included to allow practitioners to reflect on the wider meaning of the symbols and what the options capture.

As the resource uses the Talking Mats framework, it is recommended that practitioners have completed their Talking Mats foundation level training

If you are interested in completing Talking Mats Foundation Training, you can see the training options in our shop here.

References

Kashard H 2021 Keynote breaking barriers and building better The Royal College of Speech and Language conference.

Ash Routen, 1 Helen-Maria Lekas, 2 Julian Harrison, 3 Kamlesh Khunti1,2023 Interesectionality in health equity research BMJ 2003 https://www.bmj.com/content/383/bmj.p2953

Our thanks for this blog go to Deborah Little, Speech and Language Therapist; Clinical Lead for AAC & Total Communication (Children and Young People) NHS Dumfries and Galloway.

“Can we do a Talking Mat today Deborah?  This is the question I am asked as soon as I enter the Learning Centre in one of our local schools by an enthusiastic 8 year old who has been exploring what completing a Talking Mat (TM) is all about this term.  While we are in the early stage of this school’s TMs journey, the impact of embedding the approach into the fabric of how Children and Young People (CYP) are supported to communicate in school is already proving transformative.

Article 12 of The United Nations Convention on the Rights of the Child (UNCRC) guarantees children the right to express their views and opinions freely in all matters affecting them.  The responsibility of ensuring children experience this right is also underlined in NICE guidelines (2022) that state: “Education, health and social care practitioners should always: put the life goals and ambitions and preferences of the disabled child or young person with severe complex needs at the centre of planning and decision making.”

Working with my teaching colleagues within one Additional Support Needs (ASN) setting this year, we reflected on how effectively the CYP were able to give their views and how consistently these views were acted upon in meaningful ways.  We felt that this was an area we really wanted to improve upon and specifically we wanted to explore the following key questions in our minds:

• How can we support CYP’s understanding of their right to give their views and opinions?  We reflected that for some CYP, their experience of being able to do this was very limited and that their understanding of using a TM was not yet at a stage where they were able to represent their views.  We therefore wanted to prioritise finding out what helped these CYP to use TMs with understanding.
• How can we support CYP to know that they can tell us they aren’t happy about something?  We reflected that during ‘Emotions Works’ discussion times many of the CYP routinely shared that they felt ‘happy.’  It was rare for the CYP to talk about unhappy feelings.  We felt worried that the CYP often gave responses that they felt would be ‘right’ or pleasing to adults.
• How can we ensure we create a culture of prioritising time and space for CYP to share their views, opinions and ideas?  We thought about opportunities throughout the school week that would create space and motivation for the CYP to engage with TMs.  We wanted to achieve a feeling of TMs being integral to the everyday, as opposed to a sporadic ‘add on.’

To answer these questions, we agreed on the following key change ideas to implement and evaluate:

Developing understanding of the Talking Mats process linked with familiar learning opportunities.

Dynamic Assessment is an approach familiar to those working with CYP who use Augmentative and Alternative Communication (AAC).  Adapting activities dynamically, being responsive to CYP’s progress, allows progressive skill enablement.  Together with teaching colleagues, we applied this thinking to helping the children use TMs with understanding.  If we had tried having a conversation using TM only a couple of times, our evaluation could have been that TMs wasn’t yet a tool we could use because for example, the CYP were putting all their symbols into the ‘I’m happy with this’ column only.  Instead, we thought “OK, that’s where the CYP are now, let’s give them opportunities to practise engaging with this new tool and time to develop using the approach with understanding.”  Put another way, we prioritised another key concept within the field of AAC: we Presumed Competence.  We believed that the CYP had the ability to share their thoughts, feelings and ideas if we introduced TMs gradually, linking with the activities above, that were tangible and familiar to the thinkers.

Consciously modelling that is OK to have negative feelings and opinions.

When a CYP is learning what might be possible in terms of communicating with AAC, best practise is for supporting adults to model the AAC.  This means, adults ‘use AAC to teach AAC.’  We show CYP that we highly value the AAC and want to use it too.  We use it in real situations, modelling vocabulary to help CYP understand the symbolic vocabulary and how they can begin to use it too.  When helping the CYP understand how TMs could help them express a wider range of emotions, we tried out using this approach. Now and again, supporting adults would share with the CYP how they were feeling about things using TMs and would include negative feelings. 

One CYP had a memorable response to my sharing that I was feeling “not happy” with my cat.  The CYP’s eyes widened and he became instantly animated, using his AAC to ask “cat..bad..what?”  I was able to explain that my cat had been scratching my carpets and I was feeling upset about this.  The CYP then used his AAC to say “cat…dig!”  He pointed at the ‘not happy’ symbol in the Talking Mats top scale, jointly sharing his attention to this symbol and understanding of what this meant with me.  The next week, we used TMs to ask this young person about a social group he had attended.  For the first time, we noticed him ‘swithering’ across his top scale while making his choices.  Also for the first time, I was confident that he shared his authentic feelings with me.  I reflected on the power of modelling and normalising feelings that are ‘not happy.’

So, where are we now?  The key themes from our findings after a year of using TMs as described above are:

In summary, using TMs in this setting has all supporting practitioners in agreement that it is not only important to listen to CYP when we know they might be having a tough time; we need to create space to listen all of the time, week to week, with authenticity and without agenda.  The principles regularly used within AAC practice of: modelling, presuming competence and dynamic assessment have been effective in supporting more children to be able to experience their UNCRC Article 12 Right, more of the time and with increased understanding and confidence.

References

• UN Convention on the Rights of the Child – UNICEF UK
• NICE Guidelines [NG213] (2022) Disabled Children and Young People up to age 25 with severe complex needs: integrated service delivery and organisation across health, social care and education.
• Emotion Works www.emotionsworks.org.uk
• Daneshfar, S and Moharami, M (2018) Dynamic Assessment in Vygotsky’s Socioculturaly Theory: Origins and Main Concepts.  Journal of Language Teaching and Research 9(3):600
• Donnellan, A (1984) The Criterion of the Least Dangerous Assumption.  Behavioural Disorders, 9 (2), 141-150
• Sennott, Light and McNaughton (2016) AAC Modelling Intervention Research Review.  Research and Practice for Persons with Severe Disabilties 41 (2)

Communication is a fundamental human right, yet many individuals with communication difficulties face daily challenges in expressing their thoughts, needs and feelings.  Augmentative and Alternative Communication (AAC) is a powerful tool that bridges this communication gap, and Talking Mats is one innovative approach that has proven highly effective in enhancing the lives of those who use AAC.

However, in the 25 years that Talking Mats has been developing resources we have never created one that specifically addresses the needs of AAC users.

 Until now!

The new resource, Supporting Communication with AAC and the online advanced training module, AAC will be launched at this year’s Communication Matters Conference 9^th-11^th September.

The idea

Ace Centre first contacted us in 2018 with the idea of developing a specific assessment resource that would allow the person considering using AAC to express their views about it; were they ready to use AAC, did it fit with their life and communication needs and how much support would be required? This could then inform decisions around referrals onto specialist AAC services.

Development

As with all Talking Mats resources, this one was piloted and discussed and changed until the final version was reached.  Thank you to all the practitioners and clients who gave their time and energy in that process. Thank you also to the Scottish Centre of Technology for the Communication Impaired who also collaborated on the resource and the module.

Outcome

 The outcome is a resource that can contribute to both assessments and reviews, and an Advanced online training module, both of which aim to put the AAC user at the heart of decision making about their communication.

Here is a brief outline of the resource and the module. 

Supporting Communication with AAC (card and digital resource)

Topics

 Your Communication

This topic considers the ‘How’, ‘Who’ and ‘Where’ of interactions and helps develop an understanding of the Thinkers communication needs.  It can be completed when you are getting to know the Thinker.

Joining in conversations

These topics are designed to help a Thinker explore how they feel about their AAC resource when it comes to joining in conversations and reflect the fact that an individual often uses a combination of communication modes to be effective. The three topic cards are: Verbal conversation, Paper support and Electronic Support.

How your AAC works

This topics explores different ways of accessing the  AAC device as well as the different features it has, incluing functions, appearance, sound, and access.

If you are trained in Talking Mats to Foundation level you can buy the resource from our website

AAC Advanced module

To access this course you must have already completed the Foundation Course.

The objective of this course is to ensure that AAC users are at the heart of decision making and that necessary adaptations are in place to support those conversations

The course is split into three different sections:

The Resource

Aim – to recognise the different topics and who they might be suitable for

Access

Aim – to recognise different positions, places and methods for a Thinker to access a Talking Mat

Communication Dynamics

Aim – to recognise the dynamics in a conversation, and appraise the process of using additional people during a Talking Mat

To successfully complete the course participants must pass the quiz and contribute to the forum telling us about their experience.

Courses will run from the 1^st of every month starting in November.

Talking Mats are delighted to share that we have been awarded funding to create a brand-new sensory resource for children and young people who have Speech, Language and Communication Needs (SLCN) and sensory integration/processing difficulties. The funding to create this resource has been awarded by the Communication Trust from the Communication Consortium Grants Programme – funded by The Rayners Special Educational Trust.  

The Communication Trust Consortium, a coalition of over 35 not-for-profit organisations, is hosted by ICAN. They harness collective expertise to support the workforce and commissioners to support all children and young people’s speech, language, and communication skills across the UK. 

This exciting year-long project will be led by Laura Holmes, our Lead Associate for Children and Young People. Laura has been part of the Talking Mats Team since 2016 and has over 20 years’ experience of working as a Speech and Language Therapist with children and young people, across a wide variety of settings in both NHS and independent sectors.  

New Sensory Resource 

This project will develop, pilot and launch a Talking Mats visual communication resource to tune into a child’s view of their sensory needs. It will enable children and young people who have speech, language, and communication needs (SLCN) and sensory difficulties to have a voice in their therapy assessment, planning and intervention.   

“Sensory integration” and “sensory processing” refer to the processes in the brain that allow us to take the signals from our senses, make sense of those signals and respond appropriately.  Children and young people with sensory processing/integration difficulties often have speech, language and communication difficulties, which may be linked to a diagnosis of autism (Green et al 2016); developmental language disorder (Simpson et al 2020); hearing impairment (Alkhamra et al 2020); or a history of trauma (Fraser et al 2017).   

This work is important as sensory assessments can typically involve a mixture of formal and informal questionnaires and checklists which are carried out with Parents/Carers, Education Staff, and may also involve observations of the child in their environment. The issue is that Child Voice is not always routinely, or effectively, included in these assessments, or in subsequent planning and intervention – however the Royal College of Occupational Therapists recommends that ‘person-centred goals/outcomes must be established prior to intervention’ (RCOT, Informed View: Sensory Integration and Sensory-Based Assessments 2021). This also links with the current SEND system in England and GIRFEC in Scotland, both of which also emphasise the importance of child voice throughout assessment, planning and intervention processes. 

We plan to work with experienced Talking Mats OT and SLT practitioners working with children and young people who have SLCN and sensory needs, to co-create this resource.  

Get Involved 

If you, or someone you know, works with children who have a diagnosis of SLCN and sensory needs, and is an experienced Talking Mats practitioner, please share the news about this project. 

If this applies to the work that you do, and you would be interested in taking part in this project, please follow this link to express your interest: Communication Trust Project.   
Expressions of Interest should be submitted by Friday 23/09/22. 

Stay Connected 

For more information about Talking Mats, please visit our website www.talkingmats.com or follow us on social media to keep up to date with all our news! 

Our new digital platform with enhanced features

Talking mats have been researched and developed over a period of more than 20 years. Initially Talking Mats developed as a paper based communication framework but there was always much interest in having it as a digital resource so our first digital Talking Mats platform was released in 2012.  

In the years since its release the Talking Mats digital platform has helped thousands of people who otherwise would find it challenging to express how they feel, but with the discontinuation of Flash player the opportunity to create a new web-app presented itself. We are delighted to say that it is here! Combining it with the new website means that we are able to include many of the features that our customers have wanted, including the ability to:

• Add and save photos
• Personalise conversations by adding symbols from other sets
• Create and save your own personalised mats ( provided you are foundation trained )
• Think through and order your Talking Mats conversation
• Change and select an appropriate Top Scale
• File your thinker’s mat in an easy to retrieve manner
• Easily carry out remote Talking Mats conversations

Our Digital Support Officer, Mark, is here to take you through the headlines of the new app, as well as some useful information for existing users.

In a nutshell

The new Digital Talking Mats (DTM) is a subscription-based web app which is access via our new look website www.talkingmats.com. It contains all the Talking Mats resources currently available to purchase to ensure that it can be used in as many different contexts to help as many different people as possible.

The subscriptions

We wanted to ensure that there was a DTM subscription for everyone. To that end, there are three different levels of individual subscription (starter, enhanced, complete) which can be renewed on a monthly or annual basis. There is also a licence specifically for organisations which offers the chance to have multiple users tied to an organisation, all at ‘complete’ level.

Once you have signed up for a subscription, you can easily see the details in the ‘subscriptions’ section of your account.

Existing Digital Talking Mats customers

If you had access to version 1 of the digital Talking Mats please keep an eye on your inbox as you will be getting an email giving you access to the new version . If you do not receive such an email please get In touch with us.

App Features and How to Use Them

Once you have subscribed and accessed the app, there is immediately a helpful video which tells you all you need to know about how to use the app. This includes setting up a new thinker, creating a new Talking Mat with the symbols of your choice, and how to view snapshots of previous sessions you have carried out.

Technical Tips

Browsers

All browsers are equal, but some are more equal than others. Our app is optimised for Google Chrome, but will also work on Firefox and Microsoft Edge. Internet explorer is not supported. It is a good idea to make sure your browser is as up to date as possible for the best user experience. Mor detailed information on browser compatibility is available here

Offline Functionality

We recognise that internet is not always available in homes, schools or many other places, and so it is very important to us that the app works offline. Unfortunately due to the fact it is till relatively fresh, the app will not work offline yet, but rest assured this feature is in the pipeline. One option in the meantime is to use a device that can hotspot (most smartphones will have this feature) and carry out a Talking Mat online.

App Navigation

When you are navigating from page to page in the app, it is actually creating overlays on a single web page. This means that when you are in the app, if you press the ‘back’ button on your browser, it will take you out of the app completely.

If you have any questions about the Digital Talking Mats platform or you are interested in learning more, you can get I touch with Mark at mark@talkingmats.com.

On Wednesday November 10^th we held a colloquium with the University of Edinburgh and NHS fife to report on the findings of the research that was funded with the Burdett foundation . The easy-read version of this report can be found here.

48 people attended the online event on Wednesday and engaged in some very thoughtful discussion and reflection on communication in forensic settings. There was much to think about including whether ethos and values align with self-determination , how to get communication taken seriously by staff who are often under huge pressure. Consideration of  where power lies in an organisation and an acknowledgment that  in order to share power staff themselves need to feel they have power.

The recognition that in the promotion of shared decision making, you increase the risk of people taking what others may see as unwise decisions. The need to support the capacity of people to be involved in decision making early on and in the smaller decisions of life and not leaving including them to a crisis.

The importance of further research in his area and that small clinically driven research projects have an important role to play in addition to ones funded by bigger grants. There is much to digest and we are hoping to keep the conversation going.

If you would like to see for yourself the research presented and the topics discussed at the colloquium you can watch the recording of the Zoom session here.

If you want to attend foundation Talking Mats training please find out more here. if you have completed your foundation training please consider attending the Keeping Safe advanced online module which includes the Keeping Safe resource . If you have the Keeping Safe resource please download the new Being Included bolt on to use with it.

During May we are hosting 3 one hour webinars which will demonstrate the new digital Talking Mats that is currently being developed for us by our technical partners MTC.  

The webinar will focus on demonstrating its new features including: 

• technical specification for use
• the range of symbols sets availableincluding Keeping Safe, Thinking Ahead, Health and Housing and the Leisure subsets of Sports and Out and About  
• how to add your own photos 
• how to make sub mats ,
• how to useit to support effective remote  conversations  
• how to file restore and retrieve individual mats. 

The migration from our current system to this will be explained as well as how to purchase and use if you are a new user. 

Please note this is not a Talking Mats training. 

Choose a webinar that suits your time zone and work pattern and book a place. All times are GMT 

• SOLD OUTTuesday 11^th May 9.30 -10.30 am   SOLD OUT 
• Monday 17^th00-5.00 pm 
• Thursday 27^thMay 1-2.00 pm  

All webinars are free and we would love to see you to show you  he new digital Talking Mats  

I stole the lyrics and altered them slightly, but this is the song line that has kept popping into my head over the past few weeks as we find ourselves hurtling through the different phases of lockdown easing. The rules and recommendations that have guided our lives for the past 3 months or so are changing rapidly and change can be difficult.  Communicating how we feel about change and life in general can be difficult.

We have seen creative uses of our resources and have really enjoyed learning how they have helped young people and adults express how they coped throughout lockdown and beyond.  Kirsten Lamb’s guest blog about Returning to School After Lockdown is just one example of how the TM framework was invaluable in gaining the opinions of young people as they adapted to ongoing changes over which they had little or no control.
https://www.talkingmats.com/returning-to-school-after-lockdown/

Another Talking Mats practitioner recently tweeted this mat that she did with a college student, showing how Talking Mats helped structure thinking about how life was going.

We felt a single resource was needed to help kick start a conversation around Life (but not as we know it; I am sure that’s a song too) looking at the following themes:

• Family / Friends / Bubbles / Social Distancing
• Health
• Mood / Emotion
• Sleep
• Exercise
• Work
• School / College
• Activities
• Shopping
• Routine

As with every Talking Mat you can change the top scale to be more or less concrete, you can use blanks to add in things that we haven’t included, you can leave things out that aren’t relevant.  Download your free printable pdf here: LOCKDOWN SET

We look forward to hearing stories from our Talking Mats Community on how you helped others express themselves (definitely another song!)