This blog summarises a project we have completed providing Talking Mats training for families living with dementia. A key aspect of the work done by Talking Mats is to find ways to improve communication for families living with long term conditions. In particular dementia is a long term condition where deterioration in communication will eventually affect everyone. This makes it increasingly difficult to ensure that the person with dementia continues to be involved in decisions about their life.
We have completed a project funded by Health and Social Care ALLIANCE Scotland. Training in the use of Talking Mats was given to families living with dementia and staff who worked with these families. The Alliance Family Training final report highlights how this training helped people with dementia to communicate their views and be more involved in making decisions about their lives.

Families identified issues relating to self-management that they had not previously been aware of and new insights emerged as the following comments illustrate.(click on box to enlarge)

For some family members an important outcome was that Talking Mats helped them see that their spouse was satisfied with many aspects of his/her life. They found this very reassuring as many assumed that the person with dementia was frustrated and discontented.

The following is an example of how using Talking Mats helped with self-management.

When using Talking Mats on the topic of Where you live, G explained that he found it difficult to find his way to the toilet in the night. As a result his wife bought special senior night lights to help him which solved their problem. As a result, night times improved for both of them.

For further examples and information read the full report here Alliance Family Training final report  and for further information about Talking Mats Family training please contact info@talkingmats.com

Thanks to Agnes Turnpenny for her  guest blog on her research on  views of people moving form institutional care in Hungary.

There are approximately 15 thousand adults and children with learning disabilities living in large institutions in Hungary. The average size of these facilities is over 100 places, and living conditions as well as the quality of care are often very poor. The Hungarian Government adopted a strategy in 2010 to close and replace these institutions with smaller scale housing in the community. Between 2012 and 2016 six institutions closed and more than 600 people moved to new accommodation. The Mental Health Initiative of the Open Society Institute and the Hungarian Civil Liberties Union commissioned a study to analyse the experiences of the deinstitutionalisation process and as part of this research we carried out some interviews to explore the views of people moving out of the institutions.

The participants – five men and four women – came from one institution in the North East of Hungary, they all had mild learning disability and some had additional mental health issues. Originally the study intended to explore the experience of moving out but due to delays in the project this was not possible. Instead, we decided to examine the expectations of moving from an institution to a smaller home that allows more independence and personalised support. Although only one of the participants had communication difficulties – thus conventional interview methods could have been utilised – I decided to use Talking Mats in order to help participants to contrast their current situation with expectations about the future.

I selected the ‘Where you live’ topic from the Social Care package with some additional images from the ‘Leisure and Environment’ and ‘Relationship’ topics. (The English labels were covered over with a Hungarian translation as most of the participants could read). The question I asked was “How do you feel about these aspects in the institution?” and “What do you think they will be like in the new home?”. (I forgot to take a mat with us, therefore we had to lay out cards on the table.)

It emerged – unsurprisingly – from the interviews that most participants anticipated the improvement of their living conditions from the move, especially better facilities (mainly bathroom and kitchen). Some also expected other positive changes, particularly less conflict with other residents, less noise and better safety –commenting on the prevalence of theft in the institution. There were also many uncertainties; people said they were unsure about how they would get on with their new housemates, how the new support arrangements with staff would work, whether the neighbours will be welcoming etc. The photos illustrate some these issues.

Overall, Talking Mats proved to be a very useful tool in interviewing participants, who really engaged with the method. The images and the completed mats encouraged further comments and explanations on issues that participants considered important with minimum prompting. The drawings were easily recognised and appropriate in the Hungarian context without any adaptations other than the labels. Finally, I felt that the use of Talking Mats in this particular situation helped to overcome some of the power imbalance between the researcher and the participants by giving them more control when handing over the images.

We are really grateful to Agnes Turnpenny from The Tizard Centre University of Kent for sharing her experience . We really value our European work and European connections.

Thanks to Laura Holmes for telling us more about the innovative work in Stockport.

As part of an ongoing project, we at NHS Stockport Children’s Speech and Language Therapy Service are introducing the Talking Mats approach to support the children we work with to contribute to their own EHC Planning, enabling them to make their voices heard.
For example, I have used the ‘Consulting Children and Young People – My Body and Skills’ (Primary) digital resource  to help identify and plan target areas for an 6 year old child with a diagnosis of Autism. I selected a top scale of ‘happy/unsure/not happy’ and chose a variety of options symbols from the resource. The child (R) was then able to drag and drop each option symbol to the area she felt it belonged in, producing the following talking mat:

Whilst completing the mat the child volunteered further information about particular options – in general I find I get to know the children I work with much quicker using this approach!
Once complete, we agreed that we would sub-mat the option ‘talking’ (which had been placed under ‘unsure’) and explore that option as a topic in our next therapy session.
I then thought about all the possible options I wanted to explore in this submat, and created symbols using Boardmaker. I was able to add these symbols as options for the digital mat by taking photos using my Ipad and selecting them from my camera roll.
R completed the submat as follows:

The mat enabled R to pinpoint the areas of talking she feels unsure about – i.e. ‘talking in front of my class/ in a large group’; ‘making choices’; ‘taking turns to talk’. I was then able to include this information in my review report, attaching the pictures of the mats as evidence of consultation. My review report included details of specific targets and recommendations to support R to work on the areas she had identified, which are designed to be incorporated into her EHC Plan.

We know from our own network that many practitioners are looking for training and tools to help implement the SEND reforms. Talking Mats are running a free seminar in Stockport to let practitioners see how Talking Mats can be used. The morning session is FULL  but we have added an afternoon session. Book your place now as it is first come first served and places are filling up fast.  Free Stockport afternoon seminar

Talking Mats considers both health and social aspects when it is used to include people in their care planning.  Lots of interesting comments are made by course participants on the forum in our online training course.  Annemarie, who works as an agency carer visiting clients in their own homes posted her thoughts about the social model of disability

 Remembering the person behind the condition

In my experience, society is fixated on the medical model, the ‘what’s wrong’ approach. Whilst the medical model is clearly a valuable and required tool, it often leads to labels that individuals are then lumbered with, such as, ‘she has dementia’, ‘she is visually impaired’, ‘he’s deaf’ or has a ‘leaning disability’. Taking this approach overlooks the person behind the ‘condition’ and so can restrict inclusion.  One example could be an individual with dementia being unable to make everyday choices about seemingly mundane issues such as what to wear that day. Using a medical model, a carer may be aware of the clients difficulties and make choices for them, whereas using the social model approach enables the carer to see beyond the condition and fully include the client, allowing them to be part of the decision making process for themselves. A second example could be a person with a communication disorder such as Asperger’s Syndrome. Access to work could be severely restricted using a medical model as the pragmatic manifestation of this condition may well exclude a person from seeking certain types of employment. Promoting the use of a social model would ensure work colleagues understood the possible limitations of the condition and ensure adequate support networks were in place. The social model attempts to embrace a person’s difference and raises awareness within society of individual needs that will facilitate inclusion into all aspects of life.

The WHO ICF -World Health Organisation International Classification Framework of Functioning, Disability and Health (2001, 2007b) aims to merge the medical and social model, encouraging professionals to think not only of the persons health condition and resulting impairment, but the impact this has on the persons participation and activities.  It captures the full complexity of people’s lives, including environmental and social factors and can be applied over different cultures

The Talking Mats Health and Well- being resource is based on the WHO ICF and supports a person to reflect and express their view on various aspects of their lives.  Using the Health and Well being  resource supports workers to remember the person behind the condition.

Thanks to Laura Holmes for telling us about the innovative work in Stockport.

The new SEND reforms in England, as described in the SEND Code of Practice: 0-25 years (2014), have highlighted the need for health, education and social care professionals to involve children and young people in decision-making processes, in particular, during the assessment, production and review of Education, Health and Care (EHC) Plans.

In NHS Stockport Speech and Language Therapy Special Needs Service, we have recognised this need and are in the process of introducing the Talking Mats approach to enable the children we work with to share their views and opinions – i.e. to hear the ‘Voice of the Child’. We also obtain the views of parents/carers and school staff through use of questionnaires. These views and opinions are then incorporated into a child’s Individual Therapy Plan and consequently their EHC Plan.
Children with Speech, Language and Communication Needs (SLCN) can often struggle to express their views and opinions. We have found that Talking Mats is a highly effective way of gaining the views of the children and young people we work with, whether they are verbal or non-verbal. Talking Mats enables them to become involved in their own therapy planning and interventions, which in turn feeds into the EHCP process.
In addition, the Talking Mats approach links well with the use of Therapy Outcome Measures (TOMS), particularly in relation to the evaluation of the general activity, participation and well-being of a child/young person. TOMS is the outcome measurement tool recommended by the Royal College of Speech and Language Therapists (RCSLT).
In my next blog, I will provide an example of how Talking Mats has helped the children we work with to participate in the EHC plan process.

We know from our own network that many practitioners are looking for training and tools to help implement the SEND reforms. Talking Mats are running a free seminar in Stockport to let practitioners see how Talking Mats can be used. Book your place now as it is first come first served. Free seminar Stockport

Engaging with people who have difficulty communicating can take time and may result in misunderstandings which can cost a lot in terms of time and cost and emotion for all involved. Research and anecdotal evidence have both shown that using Talking Mats is efficient and cost effective in that staff or carers can get better quantity and quality of communication with the people they work in a shorter time with than with usual methods of communication. The average time for someone trained in Talking Mats to have a Talking Mats conversation is 15 minutes, although some people may choose to talk for longer.

In addition, staff often rely on relatives to gather information about a person’s needs and preferences. The process of gathering that information can be protracted owing to availability of family members and, because it is second-hand, is liable to misinterpretations. This in turn can lead to frustrations which can damage relationships, result in poor care and cost time.

At a practical level, the feedback from staff has been that the wipe clean, ready-made Talking Mats symbol sets give immediate access to a practical communication tool. Staff compared this favourably with the time taken to source images on-line, print them out, cut them up and develop them to a standard that is infection control compliant.

The Talking Mats team have invested their time and skills over several years to develop topics which are based on sound research. For example the Health and Well-being Resources is based on the World Health Organisation ICF, the Children and People’s Resource is based both on WHO-ICFCY and GIRFEC. The Eating and Drinking Resource has been co-produced with people with eating and drinking difficulties and a range of different professionals. The Talking Mats symbols have been carefully designed to represent both concrete and abstract topics

In addition sending staff on a Talking Mats training course results in a work force which is effectively trained in communicating with a wide range of people as well as having a bespoke communication tool. Using Talking Mats is efficient for organisations both in terms of time and costs.

We are delighted to have received funding from Life Changes Trust to work with Patient Opinion to help improve the access to their website by developing a Talking Mats to enable people to tell their stories.

Like Talking Mats, Patient Opinion is a Social Enterprise and has an excellent independent website https://www.patientopinion.org.uk/  that enables people to share their experiences of UK health services, good or bad. They then pass the stories to the right people so that they can learn from them.

The project we are working on is focusing on people with dementia but in the long run we hope that lots of people will benefit.  It will bring our two innovative technologies together marrying the expertise of the Patient Opinion website with that of the Digital Talking Mats.

Our aim is that people affected by dementia can use their own voice to share their experiences and make real differences to relationships, services and culture, just as many others are already doing across health and care. We also hope that this work will empower others with communication or cognitive difficulties to share their experiences and be heard in an open and transparent way.

This ground breaking work is being funded and supported by Life Changes Trust, People Affected by Dementia programme. The Big Lottery funded programme is committed to working with people living with dementia and those who care for them, investing resources so that individuals are more able to face the challenges before them, and can exercise more choice and control in their own lives.

We expect the project to take 18 months to complete and have already run focus groups with people with dementia, family members and expert practitioners to plan the new symbols. We are now working with the technical experts to create the website interface which we will then pilot with people with dementia.

Watch this space for more updates…..

Talking Mats was used as part of a Speech and Language therapy assessment  for a boy with a stammer (dysfluent speech).  He was very aware of his stammering and would change what he was going to say or avoid some situations because he anticipated that he would stammer. He had low self-esteem about his speech and felt that whenever anyone laughed in his class, it was to do with his stammer.

Talking Mats was used to gather information about which situations and  people made speaking easier, and any situations and particular people which caused more of a challenge.  The activity provided much more information than originally anticipated.

A starter mat was used  to show how a Talking Mat worked, using pictures of food. He engaged well with this, and understood the process quickly.  We then moved onto discussing his speech – we wrote names of people in his life and situations which involved speaking onto pieces of paper,  and he placed these on the mat where he felt appropriate.  We started with people and situations which appeared more positive, then gradually moved onto those it was anticipated would be more challenging.

His insight into his speech and what helped him or made speaking more difficult was impressive. We were able to use this information to compile a list of “Do’s and Don’t’s” for people he came into regular contact with. He agreed that this information could be shared with school to give them strategies to support him there.

The most powerful part of the Mat was him being able to say that he did not feel happy about talking with his big brother sometimes, because he could make fun of his speech, and this made him feel really upset. This was a powerful revelation for his Mum who had sat in on the session, as she had not realised he felt this way.    After the session, the family  had a chat around the table at tea-time about how his therapy session had gone that day – with Mum’s support he was able to say to his brother about how his teasing had made him feel. His older brother had thought it was all a bit of fun and hadn’t realised the impact it was having. They agreed the older brother wouldn’t tease him anymore.

When he came back for his next session, he commented on being much happier about his talking at home, and felt the activity had been really helpful. His Mum was very positive about it too, and proud of how he had managed to speak up for himself and be able to say how other people could help him with his talking.

Our thanks  to Kirsten Taylor, Speech and Language therapist for sharing this powerful story

We have an additional 2 new Talking Mats training venues – one in Liverpool on 21st April and the other in Dublin on 18th May.

Both courses combines hands on experience of Talking Mats with role-play, discussion and reflection of the use of both the original and digital version of the tool in a variety of real-life situations.

Here are a comments from people who have attended our training courses recently.

I thoroughly enjoyed the training. Found the mix of DVDs to see how it is done and the practical tasks to be well balanced.

Fantastic presenters – interesting and enjoyable training which I can take forward to enhance my practice in promoting effective communication and respecting service users wishes.

We know that to get the most benefit from Talking Mats it is best to combine our resources with a training course. The most cost effective way to undertake your training is to buy the training and a resource together. This way you can put your training into practice straight away and use Talking Mats to its full potential.

Combining with a resource means the training will cost you only £65.00! It’s a fantastic deal. To take advantage of this – click on your desired location below and select either the digital or original resource most suited to your client group to accompany your training.

Liverpool on 21st April

Dublin on 18th May

We are delighted to introduce Laura Holmes our first Regional Talking Mats Associate. She is joining the Talking Mats team and will be working in the North West of England. I will let Laura introduce herself:-

” Hi, I am a Speech and Language Therapist working in Stockport, Cheshire. I am delighted to be joining Talking Mats as the first Regional Associate, covering the North West of England. I work 1 day a week, term-time only for Talking Mats, as well as 3 days a week for the NHS. I am excited about developing awareness, understanding and use of Talking Mats across the area, within the context of the SEND reforms in particular, over the next few months. I feel Talking Mats is a very effective way of truly capturing the voices of the children and young people I work with. The Talking Mats approach also links well with the use of Therapy Outcome Measures, which I am currently trialling with my caseload.  I am looking forward to sharing my knowledge and experiences to facilitate wider use of this versatile approach across the North West region.”

It is great to have Laura working with us to build on some of the excellent work being done already in the North West. Two examples of best practice are in Wigan where Talking Mats are used to increase child participation and more recently in Salford. Children’s services in Salford NHS foundation trust are committed to seeking the views of children and young people about how they feel about their health appointments. They have finished piloting their own Talking Mats set and the revised set has just been sent to the printers – it looks great.

We are running a training course in Liverpool on the 21st April and we would love to meet more of you from the North West.