Category Archives: Autism

Setting up an SLT service in prison

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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

Care Opinion’s Picture Supported Stories

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Talking Mats were delighted to be involved in the launch of Care Opinion’s Picture Supported stories at the Life Changes Trust Gathering in Perth Scotland this week. We have been working with Care Opinion for the past two years to develop this feature.  This earlier Talking Mats blog describes the development process and this recent Care Opinion blog gives some examples of the feature in use.

However, in this blog,  I want to reflect on two events I went to within a short space of time; the gathering in Perth on Monday and the Royal College of Speech and Language  Therapists study day the previous thursday in Stirling . It felt to me like my two worlds colliding or maybe it was just my stars aligning ! At the RCSLT study there was a session on the public perception of Speech and Language therapy and how there is still much work to do in changing the myths that are spun and repeated about what Speech and Language therapists actually do . For as John F Kennedy said in 1962 ‘ the great enemy of truth is very often not the lie but the myth , persistent, persuasive and unrealistic ´ The  National  Allied Health Professional  children’s lead, Pauline  Beirne suggested to the study day that Care Opinion is a great web site for encouraging that sharing of stories. Then, strangely when I got back into the office there was a story waiting for me in my in box all about the positive experience of a parent involved in a Hanen programme in NHS Lanarkshire  which reinforced that very message.

We know people relate to stories, stories resonate and have impact, they are easy to remember .  Our drive in working in partnership with Care opinion was to support more people to tell their health and care stories  by increasing accessibility . It was designed with and for people with dementia   through funding from Life Changes Trust but anyone can use it and they are! It is great to see the stories coming in.

Through stories let’s celebrate the good, develop and improve practice and let’s use stories to challenge myths and educate. So use Care Opinion and try out the  picture supported stories to share your experiences , tell other people ,spread the word and the picture supported story feature  !

Talking Mats – 2 learning opportunities for February

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Do you want to introduce Talking Mats to people with a communication disability and autism, but know they will need support to learn it?

We are holding a 2 hour seminar on the 1st of February in Stirling to share ways of supporting people with autism to learn to use Talking Mats and express their thoughts.Twilight ASD Seminar

 

Do you want to help people think about the future and what they might want to have in place at end of life?  Talking Mats and Strathcarron Hospice have developed a powerful new resource to support these sensitive conversations and an advanced course is being held in Stirling on the 21st February   and in London 27th of March http://www.talkingmats.com/training/specialist-seminars/

3 topics

 

These opportunities are only open to people who have attended Foundation training

Talking Mats & ASD – developing social communication.

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Talking Mats and Autism- Have you sometimes tried it and it didn’t work?

There is a growing interest in teaching TM to people with ASD. We know that some important adaptations might be required to make this a meaningful experience, and are keen to share our learning so far.

Being asked for thoughts or views can be difficult for some people with communication difficulties.  In particular, there is a group of people with autism where some of the core principles of Talking Mats have to be taught in stages.   Some thinkers will just ‘get it’ and find it a valuable tool for sharing their thoughts and for supporting decision making.  For others there may have to be adaptations and /or  specific teaching e.g. the vocabulary of the top scale.  We heard recently of a student in a specialist centre who couldn’t use Talking Mats.  However the staff would include him in groups where it was used and make sure he was around others doing Mats.  After a few years, he did learn the principles and go on to use it effectively.

We have gathered ideas and knowledge from practitioners working in the field of autism and included these on our web-site under Free Stuff on Communication Disability.  ASD guidelines  It’s important that these guidelines grow and adapt as we learn more about using TM with an even wider range of people.

We’ve arranged a twilight session here at Stirling on the 1st of February 2018  to bring together practitioners working in the field of autism to extend our knowledge and encourage a staged approach to effective use of Talking Mats.
We’re delighted that Ruth Chalmers, Principal Teacher for Autism Spectrum Info and Support Team (ASIST) in Fife will be joining us to talk about developing social communication skills using Talking Mats. There will be time for small group chat so bring along a case you want to discuss.
Please share the attached flier 201802 AsD seminar with your network and we hope you can join us

Please come along and   If you are interested in attending this twilight session 4.00pm to 6.00 pm (cost £20.00),  please notify us at info@talkingmats.com

Work with children and young people? TOP 10 TM blogs

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Huge thanks to all the practitioners who have sent us guest blogs. We selected our 10 favourite guest blogs…in no particular order!

  1.  Talking Mats to support children who stammer Kirsten Taylor, Speech and Language Therapist tells a moving story about how finding out what was upsetting a boy with a stammer helped to implement change.
  2. Hearing the voice of the child Emma Atkiss, Senior Educational Psychologist, shares her findings from the Wigan Pathfinder project reporting that using a Talking Mat helps to meet the 5 criteria of Shier’s model of participation.
  3. Talking Mats for capacity assessments in people with ASD/LD Ruth Spilman, Senior SLT from The Cambian Group, shares practical tips on assessing capacity.
  4. Castle hill school supports pupil voice Jenna McCammon, SLT and Rebecca Highton, SLT Assistant, tell 3 inspiring stories using TMs in: selective mutism; safeguarding and motivational interviewing.
  5. Supporting Looked After Children to have their say Karen Wilson, Principal Teacher for children with additional support needs in a mainstream secondary school  shares her experience of using TMs to give young people a stronger voice in making decisions affecting them.
  6. Hearing the voices of Looked After Children Rachel Clemow, Head Teacher and Donna Wood, Education Support Worker, report that Talking Mats has enabled children to express their thoughts and views in a safe, neutral environment.
  7. Talking Mats and Mental Health  Carla Innes, Clinical Psychologist for learning disability from Healthy Young minds Stockport talks about the impact of TM training on the whole team.
  8. Mummy I don’t want to go to nursery today read about how using a Talking Mat might shed some light on why a 4 year old was upset at the thought of going to nursery.
  9. How do you feel about starting school? The story of 4 year old twins and their thoughts about starting school.
  10. Sibling Attitudes Prof Juan Bornman from Pretoria in South Africa publishes a report on a study carried out with 27 typically developing children who have a younger sibling with a severe speech and language disability.

If you have been inspired and are not yet trained to use Talking Mats – come along to one of our training courses.