Tag Archives: Talking Mats

Talking Mats and Trauma Work

thoughts_and_feelings

 

We are delighted to share this latest guest blog from Debbie Mole, Clinical Nurse Consultant in Mental Health and Intellectual Disability for DHM Mental Health Care in Melbourne, Australia.  This is a great example of the positive impact Talking Mats can have for people who have experienced trauma.

Throughout my 35 year career I have always had a big interest in finding ways to help clients express themselves. My passion is around trauma and working in creative ways to help bring some closure and recovery for the person.

This desire grew when I met a woman who had multiple disabilities. She was blind, deaf, and non-verbal. She was sensitive to touch and had very few ways to express herself. She needed to be admitted to hospital as she was unwell, we had no way to explain to her what was happening. At the time I was working in a new specialised mental health and disability team. This humbling experience of working with her pathed a way for me to find ways to help people communicate and understand.

Working in mental health I am acutely aware of risks and that so many people who struggle to verbalise thoughts, feelings, and past issues. I was always concerned that because a person could not verbalise their thoughts, feelings, and intentions that so much information and potential risks were being missed.

I heard about Talking Mats training in Australia and booked myself on the course. This inspired me and has helped me support clients to find a voice and solutions to issues.

My client was a 30-year man with Down Syndrome, he also has ASD and over the last five years had lost his ability to speak. When I met him, he had poor eye contact and appeared to be locked into his world. It was evident he was also suffering from psychosis as he was responding to auditory and possibly visual hallucinations. He could use some sign language to communicate. He had chronic OCD and anxiety and sleep was a major issue.

I did a Talking Mat exercise and checked his understanding of “like”, “don’t like” and “not sure”. I did a simple exercise to start using the images for his family and carers. There was no real form and the cards appeared to become a collection of images that did not hold any clues.

I decided to use to the personal care cards, this was very different. Showering, bathing, and going to the toilet were placed in the negative area. There was also a change of behaviour and some vocalisation of words that made no sense. Talking to his team and mother, there was a restive quality to his behaviour – he wanted to avoid this area.

I did further assessments and his mom believed that in the past when he was young, he may have experienced some bullying, she also feared that he had suffered some form of abuse. Through the assessment it also transpired that my client was one of five children, all had a significant mental health issue. I organised a specialist to see him and he was diagnosed with Schizophrenia. He was treated with antipsychotic medication.

As the psychosis was being treated his team became aware that my client was starting to talk, it was not clear, but the content had a theme. Tragically themes, names and places started to be spoken about. When he spoke about these events his OCD behaviours of arranging his items on the floor became more chaotic. He spoke of trauma from other boys that took place in bathrooms.

I worked with the client and introduced some basic trauma work, simply allowing him to say what he wanted to and then helping him to realise that he was safe and that was the past. His team did the same. We offered choice about showering, bathing and looked at ways it could be fun or a nice activity to follow. The idea was to change his thinking around baths and showers and for him to realise he was safe and free from threat. We used the talking mats to build upon the things he liked.

I repeated the Talking Mats exercises three, six, nine and twelve months after treatment.

After the psychosis was treated, we became aware that the client looked sad and flat. There was a loss of interest in social activities and there was a lot of talk about the past. We assessed that he was depressed and that it was possible that his recall about the past was becoming clearer. He was commenced on an antidepressant and monitored intensely. We also needed to address the sleep issues. His OCD had led to his bed to being covered in items. We later realised that this helped reduce his anxiety when he was heightened.

My client has regained some speech, I believe he was locked in a world of trauma and psychosis. Now he mentions the names of some of the people who have hurt him. His team reassure him that he is safe, that was the past, and he is ok. He seeks physical attention when he distressed, and he is acknowledged and reassured. We cannot offer typical trauma therapy to him, but just helping him unlock his thoughts, knowing that what was happened was wrong and being heard is healing.

I have since developed my own set of cards, based on the Mental State Examination. I use these to expand on issues and focus on problem areas. These cards talk about perceptual issues, thought problems, beliefs and risks, all areas that are typically private and too often unexplored. The cards have images on them, so clients who struggle to verbalise can use the same system as the talking mats.

Talking Mats allowed me and his team to see things from a different angle. There were many hypotheses used to gain an understanding of his behaviour. This led to effective treatment and partial recovery.

Picture 1 at the assessment stage, images of the clients family were made into an orderly collection with no clear indication of how he felt towards the images:

DM Pic 1

Picture 2 was also at assessment, showing a clear ability to like, not like and feel unsure about aspects of self care.

DM Pic 2

Picture 3 was during treatment for Psychosis and therapy – some changes were being noted with his self care and allowing his team to help him:

DM Pic 3

Picture 4 was towards the end of treatment and intensive therapy. Some aspects of bathing remained unsure, but his behaviour indicated that he was more comfortable with activities around bathing.

DM Pic 4

Picture 5 was a repeat of the family cards after treatment:

DM Pic 5

Picture 6 are the cards I have created based on the Mental State Examination – this was six months into therapy and medication. He expressed issues around his mood, thoughts and sleep – these needed more explaining. With the mood pictures, I offered my client different images for mood and he picked the ones that reflected what he was feeling. My mood collection has happy, angry, scared and sad in them as I tend to quote these 4 basic raw emotions daily in my work:

DM Pic 6

Picture 7 was at the end of treatment the same cards were used with a very different result. As for the previous mat, for the mood pictures, I offered my client different images for mood and he picked the ones that reflected what he was feeling:

DM Pic 7

 

Many thanks to Debbie Mole for sharing this powerful example.  If you would like to read more about Talking Mats use in Mental Health, take a look at top 8 blogs here:   https://www.talkingmats.com/top_8_mental_health/

If you are feeling inspired and have not yet accessed our Talking Mats Foundation Training Course, find out more here:  

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

Creating a Talking Mats Podiatry Resource Set to support Patient Involvement & Engagement

feet

Many thanks to Karen Mellon, NHS Fife Lead Podiatrist for Learning Disabilities and Care Homes, for this guest blog describing our exciting Fife Health Charity funded Talking Mats Consultancy project, aimed at supporting patients with a learning disability (LD), or dementia, to be more involved in decisions around their care. 

I was initially introduced to Talking Mats by my Learning Disability SLT colleagues who were using the resource to support patient engagement.  I could see the real benefits of how it could support our interactions with patients with a LD or dementia and empower people to be more involved with decisions around their care. Our SLT colleagues had undertaken the Talking Mats Train the Trainer program and were then able to train our podiatrists in using the resource. Having used the existing resources we found that we weren’t able to discuss/explore people’s views deeply enough, for example, when they developed a foot ulceration, or were at risk of ulceration.  This was the spark that ignited the idea to look at developing a specific podiatry resource to enable these conversations.   

The aim was to promote patient engagement in their care – both in preventative care and when specialised input is required. By creating the resource we aimed to explore what really mattered to the person and what for them were acceptable goals and outcomes. By developing a specific Talking Mats resource we were able to explore treatments options and impact of conditions and actively engage the person in expressing their views thus creating a person centred care plan. Evidence shows us when people are involved in decision making they are more satisfied with their care, which in turns improves their quality of life. 

Having consulted with Talking Mats we jointly created an initial resource which we piloted within NHS Fife over a 6 week period. People living within care homes and people with a learning disability were the target audience for the pilot. Using the resource, we were able to understand more about the impact that foot ulceration was having on patients, and patient’s views on treatment options.   

One example of this positive impact involves a 60 year old patient with learning disabilities and dementia. She lives independently with one hour support each day to assist with personal care. She has been known to podiatry for some time due to repeated ulceration. Specialist footwear has been supplied and regular input is in place to reduce the risk of re-occurrence, however at times the foot does break down.  

In May the patient experienced a break down on her foot. She is a very pleasant lady who always comes across as if nothing bothers her and everything is fine; she doesn’t like to “cause a fuss”. It was felt the use of a Talking Mat might give us greater insight into the impact the wound was having.  

Podiatry example mat

As a result of completing the Talking Mat we were able to discover the patient was in fact experiencing difficulties with the type of dressing and was experiencing pain. We were able to address this and change  the dressing type to an adhesive dressing, which took up less room in her shoeand started her on Paracetamol 4 times a day to address her pain. Follow up discussions reveal the patient was much more satisfied with the dressing, it was more comfortable and easier to keep dry when showering. She also reported to be experiencing much less pain.  

As a result of the mat, we were able to identify concerns she had, but didn’t want to share as she didn’t want to be a burden.  We were able to address this and create a plan which was acceptable to the patient and improved her wellbeing.   

I hope this resource will go on to benefit other professionals and carers working with people who may be impacted by their foot health. By using this resource, we can help our patients explore their views and wishes, therefore enabling co-production in care. The resource promotes preventative care as well as specialist intervention. Going forward there are many other areas of foot health that could potentially be explored in developing further resources – such as paediatrics, nail surgery, musculoskeletal. 

Following the feedback from the pilot, the Podiatry Talking Mat Resource set is now being finalised, and we are exploring the best ways to take this to wider Podiatry Services. Please get it touch with us at info@talkingmats.com  if you are interested.   

To find out more about the work and projects supported by the Fife Health Charity follow their Social Media accounts at: 

 Facebook – @fifehealthcharity 

Twitter – @FifeHealth  

 

Sex and Relationships – Using Talking Mats to assess understanding of concepts and vocabulary that keep you safe (Part Two)

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Thanks to Kate Boot for the second part of her interesting blog describing her use of Talking Mats to assess and teach understanding of concepts and vocabulary related to Relationships and Sex Education, illustrating use of Talking Mats in a teaching context. Check out the first part of her blog here:  https://www.talkingmats.com/sex-and-relationships-part-one/

In the second part of this two-part blog series, I explore how using Talking Mats enables us to review the progress of linguistic and pragmatic understanding within the context of Relationships and Sex Education.  

Considering the speech and language therapist’s focus is on increasing a person’s linguistic and pragmatic understanding we also use talking mats to explore potential target vocabulary and concepts.  Drawing on the best evidence-based practice from the developmental literature (Steele and Mills, 2011; Justice et al, 2014; Lowe et al, 2018) we need to use a variety of methods to teach the underpinning vocabulary which wider RSE concepts relate to or hinge upon, e.g., safe, consent, power and control.   

Using Talking Mats enables me to assess what the student already knows or understands of the vocabulary, which in turn informs the ongoing therapy programme, e.g., the degree of prompting or support needed to learn new words and to apply them to situational contexts.  We repeat these activities throughout the academic year to evaluate how well the therapy programme is going and how the young adult’s understanding is developing.  

Thinking back to Young Adult B from the first part of this blog, from their initial assessment, it was evident that they did not understand the word ‘safe’, therefore applying the evidence base described above we spent one term working on developing their understanding using a variety of communication friendly strategies.  They even wrote two songs about the word ‘safe’ to the tune of Jingle Bells and Ariana Grande’s ‘Thank u, next’.  Towards the end of the term, we completed a talking mat activity to review their progress.  As I referred to in Part One it’s important to give control to the ‘thinker’, it is their mat.  

Moving forwards, we will continue to review their progress using Talking Mats, which combined with the data from other best evidence-based practice will be used to determine the increase in their word knowledge which in turn, should develop their self-awareness and improve their skills needed to make decisions about sexual relations.   

Kate Boot is Clinical Lead, Specialist Speech and Language Therapist and Sensory Integration Practitioner at Phoenix Learning and Care.   To share ideas or chat further about this work you can contact her via Twitter @SLTinSEND or LinkedIn www.linkedin.com/in/kate-boot-salt 

References 

Justice, L. M., Schmitt, M. B., Murphy, K. A., Pratt, A., & Biancone, T. (2014). The ‘robustness’ of vocabulary intervention in the public schools: targets and techniques employed in speech–language therapy. International Journal of Language & Communication Disorders, 49(3), 288-303. 

Lowe, H., Henry, L., Müller, L. M., & Joffe, V. L. (2018). Vocabulary intervention for adolescents with language disorder: a systematic review. International Journal of Language & Communication Disorders, 53(2), 199-217. 

Steele, S. C., & Mills, M. T. (2011). Vocabulary intervention for school-age children with language impairment: A review of evidence and good practice. Child Language Teaching and Therapy, 27(3), 354-370. 

 

Sex and Relationships – Using Talking Mats to assess understanding of concepts and vocabulary that keep you safe (Part One)

relationship

Thanks to Kate Boot for her interesting blog describing her use of Talking Mats to assess and teach understanding of concepts and vocabulary that keep you safe.  This is part one of a two-part blog, illustrating use of Talking Mats in a teaching context.  

For several of my students (young adults aged 16-25 with special educational needs and disabilities) the focus of our therapy work is Relationships and Sex Education.  They’ve worked with me through Mental Capacity Assessments, the result of which indicate that they require further education and support to build their capacity to make decisions in relation to sexual relations.  All of the young adults I work with have significant speech, language and communication needs.  As their Speech and Language Therapist it’s my duty to ensure that I work with them to enhance their understanding of the linguistic and pragmatic concepts which underpin their understanding of sex and relationships.  As the Department for Education state in their latest RSE statutory guidance ‘to embrace the challenges of creating a happy and successful adult life, pupils need knowledge that will enable them to make informed decisions about their wellbeing, health and relationships and to build their self-efficacy. 

According to case law (D Borough Council v AB [2011] EWHC 101) there are key factors an individual must understand to have capacity to sexual relations.  These are: 

  • The mechanics of the act;  
  • That there are health risks involved, particularly the acquisition of sexually transmitted and sexually transmissible infections; 
  • That sex between a man and a woman may result in the woman becoming pregnant. 

This was added to recently in A Local Authority v JB [2020] EWCA Civ 735 where Lord Justice Baker included the fact that the other person must have the capacity to consent to the sexual activity and must in fact consent before and throughout the sexual activity. 

My talking mat activities give me an opportunity to assess student’s self-awareness, an important consideration for mental capacity work when the law expects a person to be able to use knowledge and weigh it up to make a decision. Without the Talking mats structure, the responses are often ‘I don’t know’ or I’m offered a learned response, e.g., ‘to keep safe’.   

The case study examples below demonstrate poor self-awareness, because when combined with further assessment to explore their understanding of key vocabulary and concepts it is evident that the young adults do not understand many of the terms used within these different sexual and social situations. 

When working with talking mats it’s important to remember that you’re giving control to the ‘thinker’, it is their mat and therefore where or how they place visuals is their choice and part of the trust building exercise between the ‘thinker’ and ‘listener’.  

Young Adult A  

They expressed through their talking mat that they know how to keep themselves safe in various social and sexual situations, however upon further assessment, including follow on mats they did not understand many words and concepts used within this contexte.g., ‘hook-up’, ‘one night stand’, ‘morning after pill’ and were unable to offer examples of sexually transmitted diseases when offered visual choices on their mat.   

Young Adult  

This young adult expressed that they understood how to keep themselves safe from sexually transmitted diseases and to manage their own and others privacy, however, upon further assessment it became clear that they did not understand the word ‘safe’.  Understanding this concept is necessary for us to manage the majority of sexual and social interactions. Therefore, this talking mat helped to pave the way for our ongoing therapy work with the young adult.  

Young Adult C 

Kate Boot Blog 1 picture

This talking mat facilitated a conversation with the young adult who explained how they sometimes find it difficult to keep themselves and others safe, specifically when they are struggling to manage their mental health.  It acted as a starting point, allowed us to explore skills necessary to manage executive functions, e.g. planning, controlling our impulses and sequencing events.  Again, it enabled us to consider what we would add into the therapy programme and how we would work with other key people involved in the young adult’s life to keep them and others safe. 

Kate Boot is Clinical Lead, Specialist Speech and Language Therapist and Sensory Integration Practitioner at Phoenix Learning and Care.   To share ideas or chat further about this work you can contact her via Twitter @SLTinSEND or LinkedIn www.linkedin.com/in/kate-boot-salt  

References 

Department for Education (2020) Relationships Education, Relationships and Sex Education (RSE) and Health Education [pg 8] 

 

Talking Mats Digital App Subscriptions

New DTM 2

What they are called, what they cost and what you get. 

The re-developed Digital Talking Mats is nearly ready to launch with its new look and new functions.  How you can buy it is new too so the team here thought we should put the new price structure down in black and white.  The blogs we normally publish are interesting and thought provoking.  I can tell you now, it is quite tricky to make a list of prices interesting or thought provoking, but I think you will be pleasantly surprised with the flexibility and creativity offered.  

There are a lot of words used in these descriptions and because we use them every day we are used to them and know what they mean but sometimes we have to just stop and remember that’s not the case for everyone.  So here is our Talking Mats Glossary to help. 

Glossary: 

DTM – Digital Talking Mats.  Also referred to as the digital ResourceDigital App or digital V2 

Foundation Level training – our training course that can be complete online or face to face (Covid 19 restrictions permitting) 

Resource – a collection of symbol sets that has been created to look at a particular areaeg Health and Well Being. 

Resource library – all the symbols you have access to on the DTM depending on your subscription level, including on any photos you may upload. 

Symbol set – a collection of around 15 symbols looking at a particular topic. 

Top scale - symbols that show what a person thinks with a positive point, a mid-point and a negative point. 

 We are switching to a ‘subscription’ model.  This means you choose the level you want, and then how often you pay for it – monthly or yearly. For individuals whave 3 levels that provide increased flexibility and choice.  Organisations can buy subscriptions for groups of staff at our most flexible level. 

Individual Subscriptions:

DTM Starter Level

DTM Enhanced Level

DTM Complete

Organisation Subscriptions:

The subscription model for Organisations that want to buy several digital resources can be either a Yearly charge or a 3 yearly charge. 

DTM Organisational

To offer more control over your Organisation’s subscription each Organisation will be able to appoint someone to oversee the account who will be able to switch user emails as staff change.  

Current Users:

Finally, for anyone who currently has a digital logon for our V1 app we will ensure the following: 

DTM Existing

We always recommend people access our Foundation Training course to ensure effective use of our resources.  Our training is currently available online – find out more  here: https://www.talkingmats.com/training/online-training/ 

So that’s it, the new Digital Talking Mats, What it’s called, what it costs and what you get. As always, we can be contacted on info@talkingmats.com if you have further questions.