Our thanks for this guest blog go to Meredith Smith, Paediatric Physiotherapist and Lecturer in Physiotherapy in the School of Allied Health Science and Practice at the University of Adelaide. In this blog, Meredith talks about the development of a Talking Mats resource to facilitate self-reporting in pain assessments for children and young people with cerebral palsy.
Our research team has been working on modifying pain assessment tools so they are more appropriate, relevant and accessible to children and young people with cerebral palsy (CP). People with CP have varying functional, communication and cognitive abilities, which makes existing assessment tools (often pen and paper questionnaires) difficult to use across the spectrum of ability. As a result, children and young people with CP often don’t have the opportunity to self-report how pain is impacting their function.
We are based in Australia and our team is made up of physiotherapists, an occupational therapist, a medical practitioner, researchers and people with lived experience of CP. One of the first things we did as part of this project was to ask people with lived experience of CP and clinicians what we could do to make two specific pain assessment tools more accessible and relevant to people with CP and different abilities. One of the clinicians (a speech pathologist), suggested we consider a Talking Mat alternative for each of the assessment tools. These two assessments focused on two concepts – 1) how pain interferes with function and 2) pain-related fear. We were keen to focus on these assessments as this would help us to not only open up a conversation about pain with children and young people with CP, but would also provide us with a way of identifying children who might benefit from particular pain interventions, and allow us to monitor the effectiveness of these interventions.
Prior to this suggestion I had heard of Talking Mats but never used it. Our research team underwent Talking Mats foundation training which was excellent, and we were all really impressed with the concept and its application in varying contexts. We had initially thought that we might need a Talking Mat to get feedback from children on the assessment tools, but we all agreed that converting the pain assessment itself into a Talking Mat would make the most sense for now.
Working with the Talking Mats team was a fantastic experience. We all really appreciated the expertise of the consultants in considering how we worded some of the assessment tool items. The symbols created were also excellent, and when we tested them with children and young people with CP they were simple and easy to understand.
Here is an example of a Talking Mat discussing pain interference with function. The lead in phrase is ‘how much does pain get in the way of……’. This Talking Mat was easily understood by most children with CP, even those with moderate cognitive impairment and complex communication needs.
The second Talking Mat looked at pain related fear, with the lead in phrase ‘pain makes me……’. This was a more challenging and abstract concept, but was much easier to explore using the mat than on a standard pen and paper questionnaire. The Talking Mat versions can be interpreted as a 5-point response scale (the three response options and then two in-between sections), allowing us to still total an overall score for the assessment.
The feedback from children, young people and their families has been very positive. Families of children with cognitive impairment or complex communication needs have shared with us that previously it was assumed that their child could not self-report pain, and often they were asked to proxy-report on their behalf. Parents have told us how difficult it is to proxy-report on personal concepts such as pain-related fear, and that they couldn’t possibly know for certain how pain was making their child feel.
We are in the process of continuing to test the Talking Mats resource and look forward to making the it more widely available in the future.
Keep an eye on our website for more information about the Pain Assessment Resource as this project progresses.
If you are interested in completing Talking Mats Foundation Training, you can find out more here.
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.
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.
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
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.
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 email@example.com.
Many thanks to Natalie Paris, CashBack 180 Project Lead for our latest guest blog. Natalie shares some powerful examples of how Talking Mats has helped her to open up conversations with the young people she works with:
I joined Y2K Mayfield and Easthouses Youth 2000 Project in February 2018 as a sessional worker looking to gain practical experience in youth work, I then became Part Time Young Women’s worker at Y2K, which gave me experience in working with vulnerable young women in Midlothian across an age range of 11 to 24, some with mild to moderate learning difficulties. When I first heard about the 180 project, I knew it was something I really wanted to be involved with, as I have always been interested in Criminology and Youth Offending.
In September 2018 I became the full-time 180 Project Lead, and have helped to shape and develop our CashBack 180 Project. CashBack 180 is a referral-based service, focusing on early support and prevention for young people involved in or at risk of becoming involved in offending, anti-social and risky behaviours.
We work with young people to make positive changes in order to work towards more positive futures. Young people accessing this service have the opportunity to take part in fun, participative and educational programmes of activities as well as 1:1 supports. The CashBack180 programme is delivered at Y2K, but we can also deliver programmes within High Schools.
CashBack 180 offers a menu of options and has adapted where necessary for our journey through the pandemic.
- 1:1 supports
- Groupwork programmes
- Community outreach support through detached youth work
Case Example 1:
A 12-year-old girl had been referred to me for violence, as she had attacked a girl in the playground, which was out of character for her. She was very uncomfortable in the 1 to 1 session, so I used a Talking Mat. This made the conversation flow more naturally.
I used the Relationships topic, with the top scale ‘going well/okay/not going well’. This helped me get more information. I found out that most of the issues she was having were around peer relationships. For example, friends saying things that weren’t true, and not being believed by others in her friendship group. This allowed me to plan a session around what is healthy and unhealthy in friendships.
Case Example 2:
I was working with a 14-year-old care experienced boy, who had been referred to me for Anti-social behaviour, and because he was easily led. Once I got to know this boy a little better, I realised that he did not have much support within his family, apart from his older brother who he lives with now. I realised he was someone who had just learned to cope himself, and probably didn’t have many people to turn to when worried about things. I thought coping would be a good topic for a Talking Mat, as he always said things were fine, but I didn’t feel it was the full truth. I used the top scale ‘going well/okay/not going well’. This gave us the opportunity to discuss healthy and unhealthy coping mechanisms that he had and what he could do instead.
Case Example 3:
I was working with a 12-year-old care experienced boy, who had been referred to me due to his inappropriate sexualised language and reference to sexual experience. He has been out Mainstream school for 1 year, so had missed P7 sex education. I decided to start working on friendships and relationships over the first couple of weeks with him, to get an understanding of what he knew was acceptable in relationships. I used the Relationships Topic with the top scale ‘Going well/Okay/Not going well’. The Talking Mat helped me keep his attention for a little longer than usual, as he is a very chaotic young person and often gets up and walks about, or jumps on tables and pretends to be sleeping. It also showed me that he felt quite happy but was missing his friends from where he used to live. We are now looking at ways to address this.
Follow this link to Find out more about this project:
If you are feeling inspired and would like to know how you can access Talking Mats training, find out more here: https://www.talkingmats.com/training/
We are looking forward to our second Talking Mats Twitter chat on Thursday 10/12/20 7.30 – 8.30pm.
Join us to discuss and celebrate our new report ‘Can Scotland Be Brave’, which has a specific focus on children and young people’s participation. Find out more about the report here https://www.talkingmats.com/new-report-to-launch-10th-dec/
The report will be launched by the Scottish Government on the same day, to coincide with Human Rights Day 2020.
Here are the questions we will be asking:
Grab a cuppa – or better still, a mulled wine and mince pie! – and join us to share experiences and ideas.
Remember to use the hashtag #TimeToTalkTM on all your posts!
Many thanks to Peter Just, Head of External Affairs, RCSLT and Padraigin O’Flynn, External Affairs Assistant, RCSLT for this blog describing the newly launched UK-wide RCSLT Survey, which includes free Talking Mats resources to support those with communication difficulties to have their voices heard.
Like many of you, the Royal College of Speech and Language Therapists (RCSLT) has been worried about the impact of COVID-19 on people with communication and swallowing needs. Based on what we’ve heard from our members, service user organisations and service users themselves we’ve been very concerned about how the UK-wide lockdown (March-June 2020) affected people’s access to the speech and language therapy they and their families and carers need.
To help us understand the issue better and to inform our response, we’ve just launched a UK-wide survey. Following consultation with service user organisations, the three key questions we’re asking are:
- How did lockdown affect your speech and language therapy?
- What impact did this have on you?
- What are your thoughts about the future?
From the start, we were clear: we wanted the survey to be as accessible as possible to as many people as possible, no matter how they communicate and no matter what their communication preference is. Over the past couple of months, we’ve worked with members to produce the survey in a range of accessible formats.
We’re particularly delighted that one of those formats is Talking Mats – and we’re very grateful to Lois and Laura for all their advice and support . As you will know better than anyone, the mats will enable people to give us their views and tell us how they’ve felt and are feeling. We are delighted the mats will provide people with the means to self-advocate – this will add a richness to the survey findings that they might otherwise lack.
We’ll be working with service user organisations to promote the survey to their networks. But we’d also really like your help too. Please share the survey and encourage as many people as possible to fill it out. The more voices we hear, the more stories we collect and the more responses we receive, the greater the impact of the survey findings will be.
Those findings, which we hope to publish early in the New Year, will be used to influence Governments, Parliaments and Assemblies across the United Kingdom. The case that will be making to ministers, officials and parliamentarians – that people must have access to the speech and language therapy they need – will be all the stronger for it being based on service users’ lived experiences. The very powerful testimony that the mats will provide will strengthen that case even further.
The survey is open until 5pm on Friday, 8th January 2021 and you can find more information about it here:
We hope you find the mats useful and if you had any queries or wanted any more information, please let us know. We look forward to working with you to help make a difference to the lives of people with communication and swallowing needs.
Peter Just, Head of External Affairs, RCSLT
Padraigin O’Flynn External Affairs Assistant, RCSLT
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:
Many thanks to Professor Anna Dunér, Dr Angela Bångsbo and Associate Professor Tina Olsson for this guest blog describing their research project where Talking Mats will be used to enable service users living with dementia to be involved in decisions about their home care services. The project is based on a collaboration between Department of Social Work at the University of Gothenburg, Borås University College and the municipality of Borås, aiming to develop and evaluate the use of Talking Mats.
Associate Prof. Tina Olsson
In Sweden, as in many other developed countries, ideas of consumer choice and personalisation of services have been implemented in social care with the intention of achieving better choice and control as well as increased quality of the services provided for the individual. However, persons living with dementia are at risk of being excluded from the opportunities provided to other groups of service users. Thus, it is important to develop both needs-assessment procedures, and improve the performance of home care services, to enable older people living with dementia continuous choice and control in their everyday living.
We hope that Talking Mats will improve the communication between service users, care managers and staff in eldercare and lead to increased influence of service users over the decisions and planning of their home care services.
During 2020 we have funding for a planning study where we can develop and test the Talking Mats decision aid, identify, translate and test outcome measurements, and refine and test the procedures for a comparative intervention project. In 2021 we hope to attain funding for a three year study.
We have already received valuable advice and information about Talking Mats research from Dr Joan Murphy and hope to keep in contact with her and the Talking Mats team throughout our project.
If you are interested in Talking Mats Research, check out our recent blog with details of how you can get involved with our Virtual Network:
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:
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 firstname.lastname@example.org
Find out more about our Foundation Training course here: https://www.talkingmats.com/training/foundation-training/
Many thanks to Charlotte Phillips and Laura Douglas, SLTs at Blossom House School, New Malden, for this latest guest blog which looks at how Talking Mats are used for therapy goal setting within the context of a specialist school for children with SLCN. Further information can be found on their RCSLT Poster Presentation (September 2019) here – AAC Poster RCSLT Conference September 2019
Goal setting can be a labyrinth to navigate! Do these goals reflect the pupil’s own views? Is there a discrepancy between staff and pupil ideas for goals? Are these goals motivating? Are the goals functional? Are pupils avoiding goals they would like to achieve for fear of failure? Add to this the language rich dialogue required in order to establish goals and similar to a maze you may encounter dead ends, twists, turns and a feeling of entrapment. How can we ensure we do not assume needs and that the goal setting process is collaborative and person-centered? Enter Talking Mats; a tool which enables you to make sense of the maze, like the lookout tower in the middle it allows you to have a clear view of how everything fits together. You’ll now find the goal of exiting is far easier!
How can Talking Mats help?
At Blossom House the Talking Mats framework is utilised at the beginning of therapy to support pupils with DLD and specific learning difficulties to identify areas of their strengths and needs and develop personally meaningful goals that are associated to these areas. Some of the pupils are competent verbal communicators within a social context but due to the emotive subjects they may be exploring they may not be able to access these skills within therapy. Talking Mats are also used to baseline students’ self-awareness alongside prompting pupil voice. Talking Mats are tangible and have low linguistic demands which allows students with kinaesthetic and/or visual learning style preferences, and communication needs to engage in these discussions.
Case Study This Talking Mat (using Widgit Symbols as options) was created with a student at the start of therapy whilst the therapist was building a therapeutic relationship. It helped a student who was reticent to share with a new adult to have a full conversation about things that he was happy with and those that were not happy. The mat options were chosen to include a) communication strengths and needs, b) school subjects and c) some areas the SLT knew were areas of strength. The function of this mat was threefold: to baseline the confidence the student felt about certain areas (with the aim to increase this over therapy), to assess his self-awareness of his strengths and needs and finally to act as a tool to help prioritise targets for therapy and develop relevant goals. The student’s self-awareness was accurate as he was able to rate known areas of strength e.g. singing, dancing and drama, as ‘happy’, whilst known areas of difficulty e.g. spelling were accurately labelled as ‘not happy’. Some of the areas of need that the student rated matched the SLT’s referral information as priorities for therapy from his teacher (starred) therefore these were used to go on to create joint goals with the student.
The school would now like to embed Talking Mats as a whole school approach. The first step will be Talking Mats forming a core part of School council meetings to ensure that every pupil has a voice. There will be consultation with SLTs around integrating Talking Mats into the Annual review pupil voice protocol and into therapy outcome measures. This will be facilitated through the use of the digital talking mats package which allows for staff to create mats with pupils on the move, with minimal resources. These can then be emailed to staff and pupils which makes this information practical for staff to use within the context of their extremely busy school day. The use of technology to facilitate self-advocacy is an interesting field which needs further investigation.
If you are feeling inspired and would like to access Talking Mats training to enable you to introduce a similar approach in your school take a look here –
To find out more about our resources, including our Digital Talking Mats app, check out this link here –