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

It’s not necessary to use every symbol in each topic set to have a successful conversation. The Talking Mats symbol sets have a range of options, some concrete and some abstract (more difficult for some to understand)  You don’t need to use every symbol in your set!

People have found the Work/Education set in the Health and Wellbeing resource useful around times of transition from senior school or when finishing college. It is  also valuable as a tool to support a person’s thinking during the process of applying for jobs.  The symbols support these 2 aspects of work and education and are taken from the WHO ICF section on Major life areas[1].  For more information here’s a link to an earlier blog about the ICF. http://www.talkingmats.com/whats-health-well-resource/

When asking someone to think about different kinds of work, suggested top scales are  like/not like or important/not important.  The choice is dependent on what you want to find out and what level of understanding the thinker has.

If the person is then pursuing options, there are different symbols to cover the aspects involved in this. e.g. application and interview.  A different top scale  managing /not managing ensures useful information is gained.

Each topic set can be broken down into what matters to that person at that moment in time, and using different top scales results in getting different information.

This set is available to purchase in both digital form and symbol cards www.talkingmats.com

[1] ICF International Classification of Functioning, Disability and Health –World Health Organization p164-167

This story, which highlights the importance of finding out what really matters to people, was shared by one of the staff attending the second day of an enhanced Talking Mats training course. She works in a NHS facility for people assessed as needing hospital-based continuing care.

I was working with Bill (not his real name) who is a man with severe cognitive impairment resulting from a head injury and stroke. He was very angry and agitated and we couldn’t work out what was wrong. At times he was physically aggressive when we couldn’t understand him.

One day he drew a picture of a rabbit and was very insistent about it but we didn’t know what it meant. We contacted his sister about him being angry about a rabbit. She asked around to other family members and friends but no one could think what it meant.

Bill continued to draw a rabbit and then other pictures including money and TV  so I made an improvised Talking Mat using his drawings as the options and began trying to find out what really mattered to him. I gradually connected that the TV was about about programme called Dickinson’s Real Deal (a TV programme about antiques) and that in the past Bill had had an ornament of a rabbit which he thought was worth a lot of money.

We phoned his sister again about a possible rabbit ornament and she then remembered that he had collected figurines in the past. She finally discovered the rabbit in her garage.

Once we were able to reassure Bill that his rabbit was safe his frustration lessened,he was much less angry and became more settled.

This lovely story shows us how important it is to never assume that someone is just ‘being difficult’  but that if we can try to find out what really matters to them we can make a huge difference to their lives and ours.

This is the second in a two part discussion on decision making and determining capacity, this time looking at how Talking Mats can help. Click here for the previous blog

Where Talking Mats comes into play is by allowing people to consider each option around a decision and then make their decision when they place the symbol under the appropriate top scale. We have found that many people, who would otherwise be judged not to have capacity, can show that they can indeed understand and express their views so that they can be acted upon. Equally our work so far indicates that if someone cannot use Talking Mats this may be an indication that they do not have capacity for that particular decision.

Talking Mats supports the four criteria which are required in determining mental capacity. The table below lists some of the elements which Talking Mats provides to support each of the 4 criteria.

(Click on the image to enlarge)

Are these 4 criteria applicable and helpful in your setting?

Thanks to Natalie Leader, one of our Accredited Trainers from Hobart, Australia for this blog reflecting on her experience of doing the online Foundation training.

The beauty of online training is that no matter where you are or what time zone you’re in, there are options. This is really brought to bear when living in a rural or remote area, such as here in Southern Tasmania.No matter how much those of us here in beautiful Tassie brag about what an awesome place it is to visit, there are limits as to which training organisations will provide professional development sessions here, and how often.

I missed an opportunity to attend Talking Mats Foundation training by a few months so registered to do the online training instead.

My experience with the Talking Mats online training platform was that the organisers were responsive and positive, and the content offered variety, with steady monitoring of progress. Amongst the easy navigation and helpful resources you also participate in discussion forums. As one who doesn’t often participate on line, I found them encouraging and helpful, It was also interesting to read people’s descriptions of different ways that Talking Mats can be used.
Doing the modules in sequence (and with some time in between) worked well for me, as I reflected more deeply on the role of the listener and the qualities I needed to foster in my practice, such as observation, pacing and neutrality.Fostering those qualities and being guided by principles such as self-determination is now an ongoing goal for me.

I have now introduced Talking Mats into my practice and have taken the next step of becoming an Accredited Trainer.

Becoming an accredited trainer involved attending a 2-day workshop in Melbourne for face-to-face training and assessment from Lois and Nicki from Talking Mats Ltd, Stirling, Scotland. As if having excellent trainers was not enough, there was the added bonus of a roomful of like-minded practitioners, all sharing their skills and experiences with Talking Mats. Because each person’s work setting was unique, our group had a rich and diverse array of perspectives on implementation of Talking Mats training and techniques.
So, now I’m making preparations for delivering my first training workshop, sharing Talking Mats with my colleagues. I actually don’t have the jitters (except regarding the IT!) And, I’m confident that Talking Mats will speak for itself. Perhaps I may have appeased the IT deities by taking a giant leap from my former self and participating in a blog, so that side of things will run smoothly!

Good luck with the training Natalie!

This month we have online course participants from Singapore, Canada, Ireland and the UK. Register now for our next online training starting on the 5th of September.

Laura’s 4 year old twin boys are just about to start school and she was finding it difficult to have  a proper chat with them about how they are feeling. She wanted to think about how best to help them prepare for the transition from nursery so used Talking Mats.

We have done lots of ‘practice mats’ over the past few months – focusing on topics such as ‘food’, ‘animals, and ‘toys/games’, so I knew that the boys were both familiar with Talking Mats  before I introduced the more emotive topic of ‘School’.
P was first to have a go at being a ‘Thinker’, with me as the ‘Listener’. We used the Top Scale ‘Happy about/ Not Sure/ Not Happy About’. P thought very hard about placing each option. It helped to have the pictures and mat to focus on rather than just me firing questions at him.

My use of open questions such as ‘How do you feel about playing at your school?’ meant that he often made additional comments such as going on to talk about the toys he had played with during his settling-in session. Some options did need more explanation, for example with ‘eating’ we talked about eating snack at playtime and having a school dinner at lunchtime. Abstract concepts such as ‘trying new things’ also required further explanation. This included relating the concept to real-life situations such as trying to ride a bike and starting swimming lessons.
P’s finished mat gives us a clear indication of his feelings about school. The ‘check and change’ stage was very useful as P changed his mind about ‘uniform’ which he had originally placed under ‘Not Happy About’ – he said that actually he is happy because he will look smart in his new uniform!

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The Talking Mats  Keeping Safe Learning Disability projects ends but a resource that promotes safeguarding and well-being  continues.

The Keeping Safe Talking Mat provides a structured framework to ask someone ’How’s your life going?  We are grateful to the Scottish Government Keys to Life monies for funding the trials. Impact of use of the resource was gained by practitioners sending in examples of their use of Keeping Safe, and the outcomes and actions from the Mats were themed.

The resource has been shown as a helpful way to

• discuss new information (89%). Staff frequently commented that using the Mats revealed things they had not known previously.
• discuss and resolve fears (84%) . It provided a framework that was supportive for those more difficult and or sensitive conversations e.g.’ Usually when she expresses her feelings she can get either upset or angry. She did not get upset or angry at any point through doing the Talking Mats, although the subject and things she was saying was at times difficult issues.’
• support thinking (89%) ‘It helps with memory and attention as she has something visual to keep her focused.’

As of June 2017, 609 people who work with adults with a learning disability in Scotland have the Talking Mats Keeping Safe Resource and are trained to use it. This includes a wide range of professions : clinical psychologists, social workers, advocacy workers, community nurses, support workers and allied health professionals.  21 people extended their training to become trainers themselves, and are now training people to use Talking Mats and the Keeping Safe resource in their geographical area.

Initially many staff thought using the resource would take too much time but in fact were really surprised to find how much quality information they got in a short space of time.  A cost benefit analysis demonstrated that using the Keeping Safe resource is cost effective for organisations i.e. for every £1.00 an organisation spends on the training and the resource, the potential financial benefit to the organisation is £23.00. We believe this is because the Mats create a powerful listening space and so that issues can be addressed timeously and not spiral out of control. This has not only a financial benefit but also a return in terms of an individual’s well-being and access to local non specialist services.

Although this resource was developed with adults with a learning disability, several people have reported  that they have found it useful with other client groups e.g. adults with acquired neurological disorders and young people particularly with mental health issues .

If you want to read in more detail about the design process behind the resource then please read this journal article published in the Tizard Learning Disability Review  More Than Pictures TLDR 2017

When considering someone’s mental capacity its is important to bear in mind that the right to self-determination is enshrined in law.

In 1948 Eleanor Roosevelt, as the chair of the United Nations Human Rights Commission, was the driving force in creating the Universal Declaration of Human Rights Act (1948).

Since 1948 there have been laws passed in many countries stating that people with communication disabilities should have equal rights, including and specifically in the complex area of mental capacity. In the United States the Federal Law that covers this is the Americans with Disabilities Act of 1990 . In the UK the key Acts of Parliament are the Mental Capacity Act (2005) England and Wales  and the Adults with Incapacity Scotland Act (2000).

The UK Acts specifically focus on mental capacity and say that every adult has the right to make decisions unless proved otherwise and that each individual has a different capacity to make decisions about different aspects of their life. In addition they state that we must assume that someone has Capacity unless it is established that the person has substantial difficulty in one or more of the following criteria in the following diagram.

There are a number of important expectations behind these Acts which are particularly significant for people with communication difficulties.

• Everyone should be supported to make their own decisions (including Augmentative and Alternative Communication methods)
• Adults should be encouraged to make use of their skills and to learn new ones where that would be helpful
• Information to support understanding needs to be given in a way that is appropriate to his/her circumstances (using simple language, visual aids or any other means).
• People are entitled to make their decision – this is not about what we think is good or bad
• Judgements on capacity:
  • cannot be based on age, behaviour or disability
  • need to be made decision by decision – (so not being able to make more complicated decisions does not apply to all decisions)
  • cannot be based on past experience of decisions – they need to focused on the here and now
  • must take into account the adults socio-cultural circumstances wherever relevant
  • where a person is able to retain the information relevant to a decision for a short period only, this should not prevent him or her from being regarded as able to make the decision
• If someone is judged to lack capacity then decisions must be in their best interest and any measures taken on their behalf are to be the least restrictive to the person
• It is important to assess people when they are in the best state to make the decision

Please let us know how you deal with self-determination and capacity issues where you work.

In a future post I will explain how Talking Mats can help support decision making and the identification of Capacity.

Involving people with a learning disability in service evaluation is both essential and challenging.

Maria Lavery speech and language therapist, and her colleagues in North and South Lanarkshire are using Talking Mats to get feedback about the service they deliver for people with a learning disability . They want to find out about what people feel they do well,  and what could be done differently.  In addition they have placed a suggestion box at the entrance to their building, but want to  involve everyone who is connected with their service – clients,  family,  carers   various multi-agency colleagues and are carrying the review out over a 6 month period.

The analysis and learning will be used to inform the Speech & Language Therapy work plan and support the future direction of the service.

Talking Mats has been used successfully to evaluate Augmentative and Alternative Communication services and the resource for this is available on our website http://www.talkingmats.com/wp-content/uploads/2013/09/AAC-service-Evaluation-script-and-symbols.pdf

We are currently working to develop a Talking Mats resource to support conversations relating to Advance Care Planning (ACP) with staff and patients from Strathcarron Hospice. People who use hospices often have specific difficulties communicating their thoughts and feelings because of advanced illness and emotional factors.

Sixteen staff from the multidisciplinary team at Strathcarron Hospice were trained to use Talking Mats by Sally Boa who is Head of Education, Research and Practice Development at Strathcarron Hospice and also one of our accredited trainers.The staff trained used it successfully with patients in the hospice and found that they could use it with a range of patients for a variety of purposes: getting to know someone; identifying goals; discharge planning.

A sub-group of staff attended a workshop with members of the Talking Mats team to discuss the potential use of Talking Mats to support conversations relating to ACP. Topics and options were agreed. These were then presented to a wider forum of staff from Highland Hospice for validation and checking. Three main topics to support ACP conversations were identified: Affairs; Care and Personal Values. New symbols are being developed and the resource will be trialled with a range of patients in the hospice setting.

Our hope is that Talking Mats can be used by trained staff in a hospice setting to support people to express their views and help them plan for the end of life and that it will also be helpful for many other people to consider future options in their lives.

We will write an update once the new resource has been completed.