Improving communication, improving lives
Search Talking Mats

When people have been in hospital for a period of time, for whatever reason, consideration needs to be given to discharge planning. There are often concerns about what a person may manage to do independently when they get home, and this often has an impact on where people are discharged to and what type of support they might need.
The ‘looking after yourself’ symbol sets in the health and well-being resource provide a good starting point for exploring some of these issues. This set is made up of three topic sets:

  • Domestic life
  • Self-care
  • Work/education

I used these when I worked with a woman (Ruby) who had severe receptive and expressive aphasia. She had been discharged from hospital with a care package (carers came in three times a day to help her with personal care, meal time preparation and housework). Ruby had difficulty communicating through speech but was able to use Talking Mats effectively to express her views. I used the ‘domestic life’ symbols to find out how Ruby felt about managing the daily running of the household. Ruby was able to tell me that she felt she could now do more things around the house, such as hoovering and the laundry. She was ‘unsure’ about cooking and shopping, but indicated that these were areas that she wanted to work on.

Ruby dom life

Using Talking Mats, Ruby was able to tell me that she wanted to try to do more things for herself. We used photographs of the completed mats to discuss these issues in more detail with Ruby’s social worker and her husband. Initially, Ruby’s husband was hesitant about her doing more things around the house, but seeing the mat in front of him meant that he really listened to her views and felt happier about her taking risks and trying things for herself. As a result of our discussions, Ruby’s social worker reviewed her care package. She reduced the daily visits by carers and Ruby was given support from the rehabilitation team to help her work on preparing meals. Her husband arranged for a friend to take her to the supermarket once a week so that she felt more in control of the cooking. Use of Talking Mats meant that Ruby was really involved in setting her rehabilitation goals and ensured that her views were heard when her care package was reviewed.
The ‘looking after yourself’ symbols can be used to include people with communication difficulties in the decision making process. This is particularly important given the current legislative drive to promote self-directed support. Find out more about how to use Talking Mats by signing up for a training course at Talking Mats.

 

 

The Health and Well-being resource is based on the WHO International Classification of Functioning, Disability and Health (ICF) which is a framework which covers almost every aspect of daily life and can be applied over different cultures (WHO 2001).

ICF

Use of the WHO ICF helps professionals to think holistically about the people they are working with. We have produced four sets of symbols, based on WHO ICF, to help people express their views about different aspects of their lives. These cover 13 topics:

mindmap

You can use the symbols in different ways, depending on the cognitive abilities of the person you are working with. For example, if you are working with someone who can understand abstract concepts, you could start with the 13 main health and well-being symbols. Your top scale might be ‘managing’ and ‘not managing’. Here is an example of a mat completed by Duncan who had a stroke which affected his ability to communicate through speech:

Duncan mat 1

Using these symbols as a starting point, Duncan could tell us that his main concerns related to worries about his health, expressive communication and work. From here, we did ‘sub mats’ to help Duncan identify the specific areas he wanted to work on/explore.

Here is the mat Duncan completed in relation to his health:

duncan mat 2

Having done this mat with Duncan, it became clear that he was worried about various aspects of his health, particularly the risk of having another stroke. The wider team were able to give him and his wife information about stroke prevention. Other mats were also completed, exploring expressive communication, work and education and higher level communication (which is included in the ‘learning and thinking’ topic, and covers written communication as well as memory and concentration). Using the Health and Well-being symbols, we were able to work with Duncan to help him identify the main issues that he wanted to work on and then work towards more specific rehabilitation goals. Duncan had copies of all the mats he had completed and found it useful to refer to them over the months. This helped everybody stay on track in relation to his goals and he was also able to track his progress over time.

Have a look at our Health and Well-being resource on our website. It is available both as an original Talking Mat with a physical mat and symbol cards or as a  digital version  as part of The Talking Mats pro subscription

Has Talking Mats been used in court ?

This is a question that we have often been asked and up until now we have been until able to give examples. On a recent training in Belfast there were two registered intermediaries, their role is to assist vulnerable witnesses and defendants with communication difficulties in the criminal justice system. The registered intermediaries scheme was set up in England and Wales and more recently was established in Northern Ireland. On the course they talked about two cases where Talking Mats was used as part of the achieving best evidence (ABE) interviews.

1. The first case was the case of R versus James Michael Watts http://www.bailii.org/ew/cases/EWCA/Crim/2010/1824.html . Here the clinical forensic psychologist used them to support an individual with severe disabilities to express her view of what had happened.

2. The second case that was discussed was the work of a registered intermediary, Catherine ‘O’Neil where she used them with a young man called Tim  in his early twenties who had been severely stabbed and suffered a severe head injury which resulted in locked in syndrome. He had some very limited movement of his hand.  Initially, Catherine worked with him to establish a yes/ no and then went on to assess Tim’s ability to use Talking Mats.   The focus of the first Talking Mat was to find  out about his interests and to enable Catherine and Tim to engage and interact with each other.  Catherine said ‘he  seemed totally relieved to be able to communicate his narrative. This allowed us to get to know him and his likes, dislikes and interests. Tim had never been a great friend of the police and in the like/dislikes/ don’t know mat, I included many pictures including Basketball, which went slowly but immediately to YES; Snakes under No and Police he joked and eye pointed to the door.!’  Catherine went on to use Talking Mats and these were used jointly with the police in 5 ABE interviews. This did enable evidence to be gathered in terms of the assault weapon, people etc. Through the support of a skilled registered intermediary Talking Mats contributed to enabling the victim to have a voice at the trial where otherwise none would be had. In this case a conviction was made.

We like to keep up to date about how Talking Mats is being used. You may well know of other cases where Talking Mats is being used to support people with communication disability to access justice. If so we would love to hear about them so please let us know.

The final part of my keynote talk at the AAC Conference in Helsinki last month focused on what we mean by communication effectiveness.
It is important to be able to determine the effectiveness / success of an interaction between two people, whether they are politicians, parent and child, husband and wife….. people using AAC systems or people using their own speech.
When I carried out a literature search of peer reviewed journals for my PhD in 2009 I could find no clear definition of communication effectiveness. Some people thought that effectiveness was synonymous with ‘word intelligibility’ or ‘correct syntax’. Others defined effectiveness in terms of the number of words produced on an AAC device. One publication even suggested that effectiveness was demonstrated by someone taking responsibility for charging their AAC device!
The main focus of all the papers I found, which mentioned communication effectiveness, was on needs and wants and only 3 papers cited social closeness as important (click here to read previous blog).
However, some publications did give useful pointers. Light (1988) emphasised that effective communication depends on 2 way interaction and that the partner is a major factor in the success or failure of communicative interactions. Lund (2006) described adequacy, relevance, promptness and communication sharing as key indicators. Ho et al (2005) highlighted satisfaction – partners’ feeling of how well they communicated during the conversation. Locke (1998) stressed that determining the success of any communication is a subjective undertaking as ‘Communication is not a mathematical formula of phonemes, morphemes and syntax, but rather includes casual conversation such as gossip’.

The Talking Mats team has tried to capture what we believe are the essential factors in determining communication effectiveness. We have produced a simple tool – the Effectiveness Framework of Functional Communication (EFFC) which can be used to chart key factors in an interaction on a 5 point scale and give an overall indication of whether the conversation is effective or not.

We have used the EFFC in several of our research projects and show participants how to use it during our training workshops. In Finland I tried it out with the audience of 200 AAC professionals using 3 video examples of different AAC conversations. The resulting scores were amazingly in agreement suggesting that this is a reliable tool.

For a free download please click here  EFFC 2014

We would welcome any comments or questions.

I undertook the ‘Talking Mats’ on-line course to acquire a new skill and a way to enhance my communication with people with dementia in practice. I have found the learning strategies used are varied and interactive – so there is not a sense of sameness, even though visually there is a consistent layout to the presentation of each module (this expedites navigation). This enhances engagement and my interest so that I am never reticent in logging on to complete the next module! In the beginning, I felt that I could move a lot quicker through the course if the modules were available once each part was completed, instead of having to wait for feedback on each assignment. However, nearing the end of the training course, the benefits of this approach are now clearer. Spaced learning and spaced practice allows for thinking time and internalisation of the module components. In this way, I have come to appreciate the part skills involved in the overall process and how they come together. I now find myself observing the skills involved and the reactions of all communicating as well as the surrounding environment, body language etc. I have also found myself looking back over the past module materials to ensure I am integrating as I go and to remind myself of the rationales for the actions that need to be taken, as well as ensuring that I am more and more familiar with the new terminology that I have been exposed too.

Little did I know when I signed up that the benefits of learning about and how to use ‘Talking Mats’ would stretch wider than what I initially anticipated or wanted! In completing the course, I am now much more aware of my communication practice in general, and the part-skills involved. I can also now see the wide applicability of ‘Talking Mats’ to different populations, age groups and conditions. Communication is everywhere but it needs to be efficient and effective – I am now more confident that my communication practice will improve as a result of this course. For me this is the best outcome possible.

Please click here to find out how to book on the next course 

When I went back to the Care Home where I was piloting our new Social Care symbols the staff told me this story about Ann (see previous blog). Apparently she usually is very quiet and never joins in with activities or with other residents. However when we used Talking Mats with the Activitiies symbols, she told me that she really likes singing and had started singing to me. Later that day, one of the care staff had suggested that she sing again and Ann started a song with him. Gradually other residents joined in and they had a lovely sing-song with Ann leading it!

On another day I used the Social Care symbols with Dorothy who tends to go off track and repeat stories over and over. She was quite sure about what she liked and didn’t like about the Care Home and using Talking Mats was a gentle and easy way to bring her back on topic.

I recently used the ‘Talking Mats Social Care’ pack in a Care Home with 3 residents, Ann, Barbara and Colin,  who all have dementia. Neither Ann nor Barbara were wearing their glasses but all three were able to see and recognise the symbols and use Talking Mats to express their views. All three conversations took place in the lounge where the TV was on, staff were moving around and and where other residents were chatting.

Ann, whose mat is at the top of this blog, used the ‘Activities’ set and very quickly understood what to do although at times she needed to be reminded what the top scale meant. She said she was a very happy person and didn’t think I would find anything that she didn’t like but as we went through the symbols she became more thoughtful and said that she did not like DIY, exercise or knitting and sewing. She used the mid-point to indicate the things she used to enjoy but does not do now. She was delighted when she saw how positive her overall mat was.

Barbara
Barbara used the ‘You’ set to tell me how she felt about herself. Although she could have placed the symbols, she preferred to sit back, tell me what she thought and let me place them for her. She felt fairly positive about most things although she was aware that her eyesight and her memory were not as good as they used to be. She also joked that she never had enough money.

Colin
Colin has dementia and is also profoundly deaf. He has only recently moved into the care home so we used the ‘Where you live’ set of symbols. Colin said several times that he didn’t think there was any point in having a conversation as he can’t hear. However after writing down the reason for doing it, he gradually realised that he could use the symbols to understand what I was asking and then express himself. He said he was generally happy with the Care Home although he missed his garden and found it hard to make friends now as he cannot hear what the other residents are saying. He also felt there are not enough activities that he can take part in. He mentioned that he has a pet dog but doesn’t know what has happened to it since he moved. One of the staff said he would try to find out. He seemed satisfied with the final mat and staff felt it would be useful to use Talking Mats more with him to reduce his isolation.

The following are thoughts from Jenni, a Psychologist who attended the Talking Mats Accredited training course.

‘Meeting with five colleagues from Sweden, England and various parts of Scotland for the accredited Talking Mats Training this month has been a fascinating experience. I have been accustomed to using Talking Mats with children and young people over the past seven years, and have seen the value of the approach in helping young people give their views for a meeting – particularly if they have communication difficulties and would struggle either through lack of confidence or skill to speak out when others are present.
However, we were not just a group who work with children and young people. Most came from health settings and examples were drawn from elderly patients, some with dementia, others with autism. As we shared our videos and told our stories it was obvious to me how relevant Talking Mats can be in those settings too. Some of the stories shook me. One person told how she was deep in conversation with a lady over her Talking Mat when the tea lady burst in, poured a cup of tea for the resident, asked if she was having a good time playing at puzzles, then left before any answer could be given. Time and again we found ourselves asking what is it about our institutions that puts routines above real communication and above proper respect for an individual.

In preparing a video to bring to the training I undertook a Talking Mat with my father, who is almost 90. It was a new kind of conversation for us both, but we were surprised – the structure allowed us to talk about what was going well and what needed a bit of an adjustment in domestic life and we both learned from the conversation. I think we will do it again!

Indeed, at one stage in the training we were asked to dream big and look at how we might want to take use of Talking Mats into new areas. I identified some good friends – one 91, one 101 and one 104 – where conversation can become rather one-sided. I am interested in the power of Talking Mats to help create a genuine dialogue when these friends are reminiscing, in other words, to help me to be not just a listener but to enter the dialogue. Having a record of the conversation will help us take the discussion further when we return to it.

As ever, the time spent with Talking Mats colleagues was refreshing, stimulating and I can’t wait to go home and try out some new ideas!’

Jenni Barr, Educational Psychologist

Anthony capture

Thank you Joan and Sally for the fantastic hospitality and inspiring 2 day accredited  train the trainer course at Stirling university.

I cant wait to carry out our first session with all of the fabulous advice and support materials you have given us. Talking mats can reopen doors to communication that others may fear were closed for ever.

I was so lucky to meet a group of lovely people on the course, who also share the same enthusiasm for using Talking Mats. It is absolutely fantastic to be part of something that is world wide and getting bigger, long may you reign and long live Talking Mats.

Anthony Howe, Assessor/Tutor/Internal verifier
Training and Development Team, Adult Social Care
Tyne and Wear

 

During the final stages of developing Digital Talking Mats, we invited some people with aphasia and their partners to come and try it out for us. I spent some time talking to Matthew, who has severe global aphasia and dyspraxia. Matthew loves having a chat, but relaxed conversation can be a challenge because Matthew finds it difficult to generate language and sometimes his yes/no responses get mixed up. I used the ‘activities’ topic with Matthew to have a chat about the things he likes (and doesn’t like) doing. Matthew found the Digital Talking Mats easy to use and quickly gave me his views about activities. Using the i-pad made the conversation feel very natural, and Matthew was able to convey his sense of humour – when I asked him about Church; Matthew started to sing the Funeral March! We had quite a laugh about this, and it turned out that at the moment, Matthew really only goes to Church when there is a funeral. Matthew was also able to tell me about things that he finds difficult since his stroke, such as reading and doing DIY. During our conversation, I was struck by how equal the conversation felt. Matthew was able to express his views without feeling pressurised to think of words. I was able to ask Matthew open questions without worrying that I might not understand his responses. Using Talking Mats on the i-pad was easy and relaxed. I could imagine using it with Matthew to have a chat over coffee or at the pub. Perhaps we should think of some conversational symbol sets?

To see Matthew using the app, click here 

Awards
talking-mats-awards
talking-mats-awards2
talking-mats-awards3png