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.
Social workers are required to complete a detailed assessment of their client’s needs. It is recognised that it can be a challenge to ensure clients fully participate in the process if they have cognitive or communication difficulties. The City of Edinburgh Council were keen to explore if we could adapt their standardized assessment tool and make it into a Talking Mat framework. Several staff in the council are already skilled practitioners in Talking Mats so are familiar with the framework and use Talking Mats in their practice. They are enthusiastic about the benefits of using Talking Mats both in terms of how it increases participation of service users but also because in their view it makes interviews easier for staff to undertake.
Structuring Talking Mats assessment framework
In order to develop the bespoke Talking Mat we held a seminar to discuss the social work assessment tool and approach used. Six key staff attended the seminar, facilitated by two Talking Mats associates. The discussion at the seminar identified a structure that would enable us to construct a coherent visual conversation that would cover the issues required to complete the assessment, using mind mapping to support this process. It is also important to identify a top scale that matches the question you are asking and make sure the options you are including are neutral and not leading.
The structure that emerged from this discussion is a Talking Mat that enables people to explore their views on 3 topics
their health and well being
their community involvement
Trialling the Talking Mats framework
Talking Mats then took the mind maps and developed these into symbol sets that were piloted by social work staff. At the end of the pilot a review was held and changes made which included alterations to
the language used
the symbols used
the topic an option was included under
making it clearer to staff when options were more abstract and required further explanation and or personalisation
Nicki Ewing from Edinburgh City Council who leads on the project says ‘ I am very excited that staff have a tool that can make assessment more meaningful for service users to participate in and makes it easier for staff to get good quality information’.
We are thinking of holding a focus group for others that might be interested in using the framework for their practice if, you are interested please contact Lois via the firstname.lastname@example.org email – call your email ‘social work focus group’.
Thanks to an OT colleague for this powerful story of how Talking Mats helped a woman with Multiple Sclerosis with goal setting by getting to the root of the problems she was having.
I am an OT working in a community rehabilitation team in Scotland. I have been seeing a woman (who I will call Jill) with MS. Jill has been experiencing increasing problems associated with her MS and finding it difficult to cope. During my first visit, Jill found it difficult to tell me about the problems she had been experiencing, and almost impossible to consider how we could translate these problems into tangible goals that we could work on. She was closed to any suggestions I made about potential rehabilitation goals. In her mind, the problems she had were there to stay, nothing could be done about them and she would just have to struggle on. We didn’t seem to be getting anywhere just talking about it. Jill was getting a bit exasperated and I was finding it difficult to keep a structure to our conversation and steer it towards agreeing on a goal that we could work towards. I felt there was a real risk of her disengaging from the service because we could not agree on a way forward.
Then I decided to use Talking Mats to see if that would help. I knew that using Talking Mats could help people with cognitive problems as well as those with communication difficulties. I wondered if doing a general Talking Mat using the Health and Well-being TOPIC symbols would help me identify what Jill thought her main problem areas were. Then I planned to do a sub-mat to look at her priority areas in more detail. My aim was to try and identify one or two rehabilitation goals (reflecting Jill’s priorities) that we could work towards. I really felt that there was potential to make a positive impact on Jill’s quality of life if I could get her to engage and agree on a goal to work towards.
Using Talking Mats proved to be a great success. Jill very quickly got the concept of it. It seemed to be much easier for her to pick up a symbol card, consider it, and then place it on the Mat. Using the Mat appeared to reduce the ‘cognitive load’ of the conversation and gave her structure to work within which she found much easier. Jillwas able to identify what her main problem areas/ priorities were: – Mobility and Learning/ Thinking (see picture of her Mat above). Jill was pleased that she had got her message across and actually seemed to enjoy the process of using Talking Mats.
Now we have got a starting point. In my next session I’m hoping to complete sub-Mats with Jill in the Topics of Mobility and Learning/Thinking. This will allow us to explore these areas in more detail. UsingTalking Mats was a real breakthrough in Jill’s rehabilitation.
To read another blog about using Talking Mats with someone with Multiple Sclerosis click here
We are launching our fantastic eating and drinking resource to support shared decision making. This has been co-produced with the help of people with eating and drinking difficulties and a range of different professionals. The resource is designed to help people think about, discuss and make informed decisions about how to manage their eating and drinking more safely. People with eating and drinking difficulties should initially be assessed by a qualified Speech and Language Therapist and Dietitian who will recommend appropriate strategies to help them eat and drink safely. This resource is particularly useful in helping people understand the effect that their eating and drinking difficulties can have on their health. It also helps people talk about how they feel about recommended strategies.
When discussing eating and drinking, there are many issues to consider. We have provided symbols under three main topics to help present ideas in a structured way that reduces the likelihood that the person will be influenced.
Click on this image to see it more clearly.
Discussing these topics separately means that people can firstly consider how they feel about different meal times, where they eat and types of food and then think about the impact that their eating and drinking has on their health. It also allows people to have a conversation about some of the suggested strategies and how acceptable these are.
We have run seminars specifically on this new resource in London and Stirling