Many thanks to Edith Barrowcliffe from The Action Group for sharing her experiences of using Talking Mats to support counselling with adults who have cognitive or communication difficulties. Watch this space for Edith’s follow-up blog next week which will describe how she has continued to use Talking Mats during lockdown.  Please note that the image used in this blog is from a mock session and has been taken for publicity purposes only.

Eleven years ago, I began working at The Action Group with adults who have additional support needs and was struck by how many had mental health difficulties that they were getting little help with. Sadly, with services scarce enough for the “mainstream” population, I could see why.

The issue resurfaced for me in 2016 when I began training as a counsellor. I kept returning to whether talking therapy was possible with those who had difficulty communicating – or even thinking about – their feelings.

Then in 2019, I attended Talking Mats training. Immediately excited by the potential for emotional connection, I signed up for the advanced “Keeping Safe” training and approached The Action Group’s CEO with the beginnings of a plan.

I’m fortunate in working for an organisation willing to take new ideas and run with them. Within six months I was embarking on a pilot project, called HearMe, offering counselling to adults with cognitive or communication difficulties, with Talking Mats as a key method to help overcome those barriers. Within a fortnight of opening the service was full to its limited capacity and had a waiting list!

The work has been experimental, learning as I go and adapting to the particular needs of each client. To conduct initial assessments, I’ve assembled symbols based on “Thoughts and Feelings” from the “Keeping Safe” pack. We return to this to review progress. Most clients have used a top scale of “True”/ ”Not True” with statements “about me” for the assessment. We always begin with a practice mat based on more neutral material, allowing the client (Thinker) to learn what’s involved and me to gauge whether the mat is right for them. This is crucial – one client found a way to frame everything we placed on the mat positively even when they’d been able to tell me the opposite was true a moment before! In this case we simply used each symbol as a focus for exploration.

We’ve kept the number of questions relatively small, but the assessment can take two or three sessions to complete as clients often respond quite deeply to the symbols.

Some more verbally able clients move on to a more “freeform” style of counselling as we progress, relying less on the mat to open up. But even in these cases having symbols on hand can be helpful. One client brought up the topic of sex – then apologised and asked if it was OK to talk about it.

“It’s fine,” I was able to reassure her, producing the relevant symbol. “Look, we even have a picture for it”. She laughed and visibly relaxed, the card giving her tangible evidence that the topic was allowed.

It’s still early days, but from the feedback we’ve received so far, the project really seems to be helping people to open up, express feelings they’ve never given space to before, and explore ways they want to change their lives.  The power of simply being heard.

Edith Barrowcliffe, Hear Me, The Action Group

 With thanks to our funders and partners for making this work possible – Hospital Saturday Fund, The Action Group Board, Leith Benevolent Society, Port o’Leith Housing Association, and The Scottish Government.  And to the team at Talking Mats for their support and help!

Follow the link below to find out more about our Keeping Safe training (now available online) and resource:

https://www.talkingmats.com/keeping-safe-a-new-talking-mats-resource-available-to-purchase/

As a group of Allied Health Professionals (AHPs) working in a secure hospital we recently embarked on a mini project using Talking Mats to check in with our service users with learning disabilities during Covid-19. We collated the evidence from our respective professional bodies (Royal College of Occupational Therapy, Royal College of Speech and Language Therapy, Chartered Society of Physiotherapists and British Dietetic Association) in terms of changes that people might experience if they’d had Covid-19 and produced a talking mat around these.  

It quickly dawned on us that we might be on to something here, and that creating an opportunity to ‘check in’ more broadly with our service users would serve a useful purpose, so we added some additional categories around changes to routine, psychological wellbeing and feeling safe.  

This was my colleagues’ first experience of using talking mats, and their faces when I turned up clutching my 99p actual doormat were a picture! I introduced them to the theory behind the mat and its presentation and harped on about the benefits in terms of attention, comprehension, non-threatening interaction, initiation and structuring narrative; they nodded supportively.  

We set off across our learning disability wards in multi-disciplinary pairs and all but a few of the service users agreed to have a chat with us. My colleagues commented that they were pleasantly surprised by the engagement and the amount and novelty of the information gained; we  identified things that the service users hadn’t told anyone because they hadn’t been asked that question!  

In talking to others we were asked why weren’t rolling this out in a partner secure hospital for people with mental health conditions? ‘no reason really, we just haven’t got there yet’ we answered. Then came the…. but we can just do it like a questionnaire with them. This question wasn’t, and in my experience isn’t ever ill meant. It comes from a place of naivety in relation to the presence of communication difficulties in people with mental health conditions and because of that, lack of exposure to different professional groups such as Speech and Language Therapy and the skills and approaches we have to offer. Skills in gaining and holding someone’s attention. Skills in decreasing pressure in communication situations. Skills in enabling time, space and ways in which people can initiate their thoughts.  

The Multi-Disciplinary Team (MDT) working around the project has enabled me to show others how talking mats can support their practice. It has enabled them to see how a very simple and non-threatening visual tool can open up conversations and lead to information that the service users hadn’t shared before, in a way that a face to face conversation doesn’t.  

Thanks to Jo Brackley, Clinical Lead, Speech and Language Therapy Secure Services at Cumbria, Northumberland Tyne and Wear NHS Foundation Trust for this inspiring blog – which demonstrates when we shift the way we listen and gather information from patients we get a different result and improve the quality of information and communication . If you or your team want to consider Talking Mats training then we can provide this for organisations . At the moment we can take a cohort through our online course together and then arrange a zoom call to discuss application to your work setting  – email info@talkingmats.com for more information.

Our first Talking Mats advanced online module has launched. We are pleased we had developed our online foundation training well before lockdown. There has been such great feedback from people who have completed our online foundation course and they have been asking for more. They like the bite size chunks, being able to pace their own learning and the reflective practice approach. Now we are adding to our online course with an advanced Talking Mats module focusing on Talking Mats use in safeguarding. This course is structured around the Talking Mats Keeping Safe resource and how to use it.

The Keeping Safe Talking Mats resource was developed to check in with people and find out how their lives are going. It uses a holistic framework to do this and the conversation it supports is structured around three topics: 1) well-being; 2) relationships; 3) thoughts and feelings. The resource was trialled and tested in projects involving over 700 practitioners. Originally, it was designed for people with learning disabilities but feedback has been that it has been helpful with a wide range of people including, those with stroke, head injury, dementia and mental health issues.

The advanced online module involves 2 to 3 hours of learning that you do at your own time and pace. It involves short talks, reading, videos and reflective practice activities. You will develop confidence in using the resource as well as an understanding of relevant issues, such as diagnostic overshadowing, developing the capacity of individuals to raise concerns, the impact of trauma. You will be encouraged to reflect on how you can apply the Talking Mats Keeping Safe resource to your own area of practice

To apply for the course, you must have completed your foundation Talking Mats training.  If you haven’t completed this training book now – there is still the reduced price training offer if you book your place before the end of August 2020. Access to this advanced course will begin on the first of every month and you will have the full month to complete it.

Book your place now. The cost is £85 for the course and the Keeping Safe resource and £35 if you already have your Keeping Safe resource and just want to do the training.

What do the young people I work with think and feel about returning to school after lockdown? I am a Speech and Language Therapist working within the Learning Centre at the Donaldsons Trust in Linlithgow. I work with young people with a variety of communication needs and although the Learning Centre was closed for a short period, we re-opened a few weeks ago to provide continuity for our young people who all have additional needs. Given the current situation, many changes having been put into place to ensure the safety of the staff and children in these unprecedented times. This has included children coming in part-time and on different days from some of their peers and a designated staff team for each group of children. For some children the changes have also meant that their parents now drop them to school rather than coming in a taxi and they have their temperatures taken on arrival. The children now see some staff wearing PPE and they are asked to socially distance from those in their class. They have all coped incredibly well, adapting and accepting these ‘new normals’. As a team we have tried hard to make the transition back into the Learning Centre as relaxed as possible as many of our young people find change difficult to manage.

Prior to lockdown I was almost finished my foundation Talking Mats course and was about to submit my video assessment. Lockdown meant that this did not go ahead as planned. On returning to work, I felt a Talking Mat would be a perfect way of exploring the children’s feelings and opinions about the changes that they have been faced with both at home and within the Learning Centre. I printed symbols which I felt were the most relevant for the current situation and this included symbols such as ‘socially distancing’, ‘having temperature taken’, ‘coming to school in the car with mum and dad’, ‘staff wearing masks’ and ‘friends coming on different days’ I  used the top scale of  ‘this is working  well ’ – ‘I’m ok with this’-  ‘this isn’t working well’. I completed the mat with one of our pupils as part of my video assessment, but the aim is to complete with all of the young people within the Learning Centre over the next few weeks.

The outcome from the completed mat was very helpful .Using Talking Mats allowed me to gather information in a clear way that I would not have been able to do otherwise. The framework allowed for improved understanding of the questions presented as well as a clear and visual way to indicate responses. I feel that having the Talking Mat as a tool has been a wonderful resource to gather the opinions of the young people in order to make sure that we are minimising any anxieties that they may be feeling. We hugely value and respect the opinions of our young people and allowing them a means of sharing their opinions about what is happening around them, through the use of Talking Mats, has been invaluable.

Thanks to Kirsten Lamb for her helpful blog describing how she used Talking Mats to help the young people express their views about adjusting to the new normal . If you want to develop your Talking Mats skills like Kirsten then take advantage of the reduced training during lockdown.   Training Order Form – 30% Discount

Many thanks to our new Talking Mats Research Associate, Dr Jill Bradshaw (Tizard Centre, University of Kent), for this latest blog focusing on how Talking Mats can help people with communication difficulties to express themselves – to help work out the reasons for behaviour that challenges.

We know that around 10-15% of people with intellectual and developmental disabilities display behaviour that can be challenging.  This might include hitting out at other people or injuring themselves.  These behaviours can serve very important functions for the individual (e.g. to avoid something unpleasant or to get a need met).  When we try to help make things better, we often focus on improving communication, quality of life and health and wellbeing more broadly.

How do we work out why behaviours that are challenging occur?

We often spend time observing the person and talk to carers and staff who work with the person to gain information about what is working well and what might help.  This is part of a functional analysis.  Here, the aim is to identify the factors that have led to and are maintaining the behaviours displayed.   Traditionally, we have not really asked people directly what they think.  This is partly people who display behaviour that challenges almost always have complex communication challenges.

How can we better access views of children and adults and would Talking Mats be one way of gaining views?

Together with Nick Gore, we have been working on ways of using Talking Mats to enable children and adults to give their views.  We developed a series of mats focusing on:

• Likes and dislikes;
• Difficult behaviours;
• Things that help;
• Things that don’t help;
• General preventative variables.

What happened when we used the Talking Mats?

People were able to use these Talking Mats to tell us about what was important to and important for them.  Some information was similar to reports from carers and staff and some information was in addition.   For example:

• we gained information about preferred activities, such as riding bikes and preferred snacks. Doing things we like to do is important for all of us!;
• people gave us information about their difficult behaviours and where these took place;
• people were also able to give us at least some information about what made a bad day and what helped on a bad day. This information helped to inform support strategies.

You can read more about this work here: https://kar.kent.ac.uk/67033/1/PDF_Proof%20%283%29.pdf

Using Talking Mats certainly enabled some people to give their views.  It was particularly helpful as a way of talking about difficulties, where a focus on the mat rather than on direct questioning was useful.

As expected, more people were able to access the more concrete topics we discussed and the more abstract topics were more difficult.  We have also been working with the Challenging Behaviour Foundation to develop a range of methods (including Talking Mats) to help to gain the views of people with communication challenges.  You can read more about this work here:

https://www.challengingbehaviour.org.uk/learning-disability-assets/valuingtheviewsofchildrenwithalearningdisability.pdf

To view Jill’s presentation about this topic from our Talking Mats is 21 event last August, click here: TM and PBS final version for handout

If you are interested in Talking Mats and Research and have completed our Foundation Training Course, you can find out more about our new Talking Mats Research Network Group by emailing Jill at  J.Bradshaw@kent.ac.uk, and watch this space for a new blog all about the group – coming soon!

In the first of two blogs, we talk about how using Talking Mats Resources can help people have better conversations.

Talking Mats provides a visual framework to help people express their views and feelings, using a selection of communication symbols that cover a variety of topics.  Talking Mats resources are used by many professionals across a wide range of health, social care, residential, and education settings.  Most of our resources are available in both low-tech, and digital, formats.  In this first blog we focus on the resource bundles which are available to purchase with our Foundation Training course.

Our resources are available to buy through our website (https://www.talkingmats.com/shop/) however we do strongly recommend completion of one of our Foundation courses (https://www.talkingmats.com/training/foundation-training/) to get the most benefit from Talking Mats – and to use it to its full potential.  If you add a Health and Wellbeing, Consulting Children & Young People, or Social Care resource pack bundle to your training you only end up paying £65 for the training day itself which is a great deal!

Resource Bundles available to purchase with Training

Health and Wellbeing Bundle:

These packs are based on the ‘activities and participation’ domains from the WHO ICF framework and includes 9 topics which are relevant to people, regardless of their health, disability or where they live around the world. We have translated these into more ‘user-friendly’ language and have generated symbols to represent each topic.

In addition to the 9 topics from the Activity and Participation domains, we have also included Environment and Health, which are important topics within the ICF framework and in people’s lives.

Consulting Children and Young People Bundle:

These packs are based on ‘Getting It Right For Every Child’ (GIRFEC), a Scottish framework for everyone to use when working with children and young people. There are three broad topics which are relevant to any child or young person’s life. This resource can also be used with SEND reforms in England.  There are different packs for each developmental stage: Early years (ages 3 to 7); Primary (ages 7 to 12) and secondary (age 13 upwards).

Best Value Bundle: This option includes the Health and Wellbeing and Consulting Children and Young People bundles above, as well as our Social Care resource packs, providing a complete set of resources to support communication on a comprehensive range of topics for children and adults.

If you’d like to book a place on one of our Foundation Courses and would like to know more about our bundle options, get in touch with us at info@talkingmats.com

Find out more about our Foundation Training course here: https://www.talkingmats.com/training/foundation-training/

Many thanks to Claire Wiseman & Ann Lafferty from The Advocacy Project (Scotland) for this guest blog, including a great example of how Talking Mats helped a young woman with learning  disabilities and psychosis share her views about being in hospital, receiving medical treatment and her preferences in respect of future post discharge welfare decisions:

For some time, The Advocacy Project have been thinking about how we could use the Talking Mats Framework to support people going through legislative processes such as the Mental Health (Care and Treatment) (Scotland) Act 2000, Adults with Incapacity (Scotland) Act 2000 and the Adult Support and Protection (Scotland) Act 2007.

Recently the Mental Welfare Commission published a best practice guidance on Supported Decision Making – https://www.mwcscot.org.uk/good-practice/guidance-advice, which we referred to as part of our presentation for the recent Talking Mats is 21 celebrations (click here to see the presentation Talking Mats and Supported Decision Making PP 2 (1)). The feedback from this session was that ‘yes’ there is a need for symbols to support legislation. As accredited trainers, we’ve also been asked when we’re delivering training to lawyers, Mental Health Officers, Social Workers, support workers and other advocacy organisations if there are specific symbols related to Supported Decision Making, particularly with regard to legislative issues.

Here is one of the Supported Decision Making and Talking Mats examples shared in our presentation:

One of our staff supported a young woman with a learning disability who was thought to be experiencing a psychotic episode. She had been detained in an in-patient learning disability unit under the Mental Health (Care and Treatment) (Scotland) Act 2003 on a Short Term Detention Certificate. The clinical team then made an application for a Compulsory Treatment Order, which was granted. Later, when discharge planning was in progress, an application for Welfare Guardianship was made under the Adults with Incapacity (Scotland) Act 2000.

Although the young woman was able to communicate verbally, the effects of the psychosis combined with her learning disability meant that her conversation was discursive and she was very easily distracted. Using a combination of Talking Mats and our additional symbols over a number of sessions, the advocacy worker managed to ascertain her views about being in hospital, receiving medical treatment and her preferences in respect of future post discharge welfare decisions.

The Talking Mats reports were submitted as evidence at two mental health tribunal hearings and the Welfare Guardianship hearing at the sheriff court. We received positive feedback from the Curator Ad Litem, Mental Health Officer and Sherriff regarding the reports as they had never had Talking Mats reports submitted before during these proceedings.

The use of Talking Mats had been instrumental in supporting the young woman to put forward her views and ensuring an outcome she was happy with.

Going forward, Talking Mats and The Advocacy Project will be exploring the possibility of a symbols set for Supported Decision Making and legislation. We are currently looking at funding possibilities.

A fantastic example of the power of Talking Mats – if you have any Talking Mats stories you would like to share, please get in touch!  Just send me an email at  laura@talkingmats.com

Many thanks to Paddy Carstairs, Development Worker (NIN) at ARC Scotland, for this guest blog describing the recent Talking Mats ‘Charter for Involvement’ project.

The National Involvement Network (NIN) is a large group of people who get support from different organisations across Scotland. Members meet to share ideas and experiences of being involved in things that affect their lives. In 2015 NIN published the Charter for Involvement. The Charter explains in their own words how people want to be more involved in:

• the support they receive
• the organisations that support them
• the wider community

Organisations are invited to sign up to the Charter. This means making a commitment to put the Charter into practice. At time of writing 81 organisations, including 7 H&SCPs have done so.

NIN members wanted to make sure that more people could engage with the Charter. In particular it wanted to help people express their views on living independently and taking part in their communities.

In partnership with Talking Mats and ARC Scotland eight NIN members trained in how to use a Talking Mat. They then created and designed a Talking Mat for the Charter for Involvement, using images that featured in the Charter. The theme was “Taking Part” and came in two stages, firstly using concrete images and then more abstract ones. A film was made to record the experience of NIN members developing and trying out the new tool.

With the help of the organisations that support them, NIN members piloted the new Charter Talking Mat and conducted 60 interviews with supported people. This helped everyone learn about what worked well and not so well, and changes were able to be made.

Just as importantly, it showed that people who get support were able to use a Talking Mat to help other supported people make changes and improve the support they receive. NIN members found that when thinkers gave a card the thumbs down, as listeners they were able to support people to seek changes to their support that they wanted, or pass on information that would help improve their lives. Some thinkers said they felt more comfortable doing the Talking Mat with another person who gets support.

These experiences have been recorded in a film called Talking Mats Stories. In it NIN members describe the impact the Charter Talking Mat has had, the changes that were made possible to enable people do things they wanted, and the confidence and satisfaction they drew from being able to help other supported people.

Talking Mats Stories can be viewed at https://www.youtube.com/watch?v=1aer7v4fyFU&t=3s

Or by visiting the NIN page on the ARC Scotland website – https://arcscotland.org.uk/involvement/national-involvement-network/

Talking Mats Stories was produced by Media Education

Organisations that supported NIN members to produce the Charter Talking Mats were: the Action Group, Hansel, Turning Point Scotland, Cornerstone, Streets Ahead Borders, the Redwoods Caring Foundation and Hillcrest Futures (formerly Gowrie Care)

Paddy Carstairs

Development Worker (NIN)

ARC Scotland

If you are interested in finding out about Talking Mats Projects check out this link  – https://www.talkingmats.com/projects/

And do get in touch if you’d like to discuss any potential projects – we would love to hear from you!

Many thanks to Susan Gowland, SLT at NHS Fife Forensic Learning Disability Service, for this guest blog summarising the fantastic presentation she delivered at our TM is 21 event in August 2019.

As a speech and language therapist within NHS Fife’s forensic learning disability service, I work across two low secure wards. In my presentation for the “Talking Mats is 21 event”  I talked about the way in which Talking Mats is used within these wards and the positive impact this has had for staff and patients.

Regular Check In: “it’s the same questions, but it’s easier to talk with the pictures”

Some of the people I work with use Talking Mats as a regular check in tool. Conversations are often based around the Wellbeing, Relationships and Thoughts and Feelings cards of the Keeping Safe resource, with personalised adaptations agreed with the thinker. Some people who find it difficult to express how they are feeling and irritations can either build up to a serious incident or the person can get weighted down by unexpressed needs and concerns. For these people a regular check in can address the small things before they become big things. This can help the thinker feel listened and responded to, build experiences of communicating effectively, as well as trust and therapeutic relationships, all of which are assets which will support the person to move on.

Self Reporting: “It helps me understand how I’m feeling about things”

For some people, the check in can have a specific focus. In a hospital based forensic service, unexpected and unrecognised changes in mental health can lead to serious incidents. To address this we have used Talking Mats to talk about mental health. SLT have worked with individuals, psychiatry & nursing to identify personal symptoms of mental health changes. These symptoms become options in the Talking Mat & can be used to support person to self report at the times their mental health changes. Being able to do this enables people to discuss the support they need & reduce the risk of out of the blue incidents. The Talking Mat itself can be a support. As one thinker said, “Talking Mats relaxes you, it calms you down”.

 As and when required:

The regular use of Talking Mats on the ward has led to other patients asking for Talking Mats sessions. As a licensed trainer I offer training to all professionals within our multi-disciplinary team and there is often at least one Talking Mats trained nurse on shift. This means ad hoc requests can be facilitated and some thinkers have started using Talking Mats in weekly meetings; as a tool to talk through emotional events and as a way of exploring the mixed emotions around discharge. In the words of one of the charge nurses:

“Talking Mats has enabled me to communicate with people in a way that is meaningful. To support someone to express and understand their thoughts and feelings regarding both joyous and distressing events is a privilege. The format may be simple, but the outcome is often comprehensive and insightful.”

 (Picture drawn by Fiona Glanville, staff nurse, NHS Fife)

If you would like to find out more about accessing Talking Mats training, check out this link:

https://www.talkingmats.com/training/

 If you are interested in our Keeping Safe resource mentioned here (available to those who have accessed our Foundation Training / Online Training Course) please see these links for more details:

https://www.talkingmats.com/keeping-safe-a-new-talking-mats-resource-available-to-purchase/ 

 https://www.talkingmats.com/product/keeping-safe/

Many thanks to Marit Boot, founder of the charity What? Why? Children in Hospital for this guest blog sharing information about the fantastic family-friendly videos they make to help children understand hospital procedures.

As a mum, I know the worry when your child is ill and needs tests in hospital. It’s the not knowing what is wrong, understanding all the different tests and how to explain them to your child. That’s why I founded the What? Why? Children in Hospital charity to make family-friendly videos about hospital. So when we make a new video explaining a procedure in an easy to understand way, it’s the reaction from parents that makes it worthwhile. The relief, that they now have an idea of what will happen and that they can share the video with their child, it makes their preparation much easier. I want to share with you the story of one of the mums in our latest video. Louise talked to us about Rocco’s gastrostomy feeding tube operation.

“We didn’t have anything like the videos WWCIH make when Rocco first had the gastrostomy surgery. Being a parent in that position is daunting. You want to do what’s right for your child but there’s so much to take in. It isn’t always easy to remember what you’re told in the doctor’s office. So when we had the opportunity to help other worried parents and children by making this video, we jumped at it.”

Thousands of children go through a gastrostomy procedure in Scotland every year. It’s a major procedure and can be a complex idea to communicate to children and anxious parents. In the videos, medical specialists talk through how a gastrostomy feeding tube works, how the procedure is done and how parents should look after the feeding tube at home.

 The videos are absolutely fantastic! With 32 doctors, nurses and specialists helping to deal with my son’s complex needs, it can be overwhelming to take in information they give to us. These videos are amazing for parents to find out information when they’re ready to absorb it. Even if that’s when you finally get to sit down at 2am.Gastrostomy is major surgery and we had to weigh the risks against the benefits for Rocco’s life. There was so much to take in, about the operation, the aftercare. At one point the doctor used a teddy to show how the tube worked – it was useful but didn’t give the full picture. The videos What? Why? have made cover what you need to know in a calm, thoughtful way. They will be a huge help to worried parents and will help them explain to their child what will happen and why. They should make as many videos as possible!”

 We have 55 videos on our YouTube channel about tests such as MRI, CT, ECG, ultrasounds, allergy tests, breathing tests and sleep studies and we are always making new ones. They’re made in partnership with children’s hospitals in Scotland and are suitable for school-aged children, children with learning difficulties and autism as well as parents and carers from all cultural backgrounds and literacy levels. The videos have already been viewed by 2.8 million families across the world.

If you know a parent or carer who’s worried about their child going to hospital send them to our YouTube page (WWCIH charity), Facebook page (@wwcih) or our website: www.wwcih.org.uk

And if there’s a procedure you think we should look at next, get in touch! We’re here to help children and parents just like you!

info@wwcih.org.uk

Marit Boot, Founder What? Why? Children in Hospital, July 2019