In this latest blog, our Director, Lois Cameron describes the initial stage of a Scottish Learning Disabilities Observatory project aimed at enabling involvement and engagement of people with learning disabilities in supporting people with learning disabilities to have a voice. A great example of co-production in action:

Background

The Scottish Learning Disabilities Observatory aims to generate evidence, build understanding and provide information on the causes of poor health and health inequalities experienced by people with learning disabilities in Scotland. However, they recognised that there was a need to develop their approach to involving people with learning disabilities. They considered whether a citizens’ jury for people with learning disabilities on health and health research would be a constructive way of engaging people with learning disabilities in supporting people with learning disabilities to have a voice. From the outset, they acknowledged that communication would be a key challenge and approached Talking Mats to work with them to put forward a bid to the Welcome Trust Public engagement fund. This bid was written, submitted and was successful.

To establish the project, our first task was to recruit a Public Engagement Lead to take the lead on project delivery. This raised the first hurdle, as since the Engagement Lead was not in post there was no citizen’s jury and therefore no pool of people with learning disabilities to approach to be involved in the interview panel. From the outset, involvement of people with learning disability was seen as central to the project. Talking Mats had recently completed a course working with people with learning disabilities from the National Involvement Network to become Talking Mats interviewers, so we approached one of the participants who had completed the course and asked if he would be willing to be on the interview panel. He was very happy to take part and contribute his skills and experience to the interview panel.

Planning the interview Talking Mat

We examined the job description and divided it into questions that were more factual and knowledge-based and those that we might describe as ‘softer’. However, calling them soft might be misleading as they were actually value based and we felt that the successful candidate’s proficiency and self-awareness in responding to these options would be central to the success of the project. After going through this sifting process we came up with 8 possible options for the interview talking mat. We met with our interviewer from the National Involvement Network and with him honed it down to six and choose the top scale: extremely confident, confident, not that confident. He also choose the symbols he wanted to use. Candidates would be asked to justify where they placed their options. A script was developed to support the interviewer e.g. ‘It would be good if when you placed the card down you gave us a reason why you placed it there. Examples from other work you have done would be helpful’ .   The full script can be found here – Interview Script

The six options were:

1. Making information accessible
2. Making sure everyone has a chance to speak
3. Helping the group understand research
4. Helping the group set its goals
5. Involving people with severe learning disabilities in the research agenda
6. Not taking power away from the group

The interview

In the interview, candidates were asked to give a short presentation, and then the member of the National Involvement Network carried out the Talking Mat. After this, there were some further panel questions and a chance for the candidate to ask questions.

The experience and outcomes

“I really liked being involved in making the mat. At the interview I knew what I had to do and I felt the other interviewers listened to me and my opinion.”

Other panel member’s perspective

“Having never used a Talking Mat in a recruitment interview before I was not sure how effective it would be as a recruitment tool. We wanted the process to be as inclusive as possible, where all interviewers had a clear and purposeful role. The Talking Mat worked really well, both as a way of gathering knowledge and information from the candidates, but also by providing an opportunity to observe the interactions between the candidate and the interviewer. I also think that the structured framework of the Talking Mat put the interviewer at ease and it was nice to observe that his confidence in using it in this context and, where necessary, in prompting and supporting the interviewee. All in all this was an effective way of conducting an inclusive interview process that signalled to our candidates that people with learning disabilities should be involved meaningfully in all stages of the process. It also meant that when we came to reviewing the candidates against the role criteria all members of the panel were able to contribute. I can’t wait to do more interviews like this!”

Candidate perspective:

“For me, an interview process is really about making sure that you and your potential new employer have compatible values. Therefore, it was a relief to have someone with learning disabilities on the interview panel who could help direct the questions. It was also clear that the interviewer knew how he fit into the interview process and was taking the lead on his section of the interview.

The Talking Mat itself was an interesting tool for the interview discussion because the top scale allowed me to look at where my skills and confidence were but also identify some potential challenges within the project. The interviewer also really kept me on my toes with some good follow up questions. In one in particular, he asked me what I would do if he was talking too much and dominating the conversation in the group. It was a challenging question and quite uncomfortable on the spot, but it forced me to be honest about my own values and say that actually, the right thing to do is to politely confront someone who is not letting others speak.

The benefit of a Talking Mat is that it has to be really clear and concrete to work, so I actually felt that I understood the demands of the role better than reading the much longer job description.”

Summary

The involvement of people with learning disabilities was possible from the start of the project because we were able to harness the skills and experience of a person from the National Involvement Network who was trained in Talking Mats. He had a clear independent role which was central to the interview process and improved the quality of the information gained by panel members . The Talking Mats design gave all panel members particular insight into those ‘soft skills’ that were felt to be crucial to the project and that might not have come through so clearly if just the traditional presentation and questions were used.

If you are thinking about a Talking Mats project for your own organisation/service you can find more information here:  https://www.talkingmats.com/projects/

Rachel Woolcomb, our Talking Mats OT Associate, tells us about the recent Royal College of Occupational Therapists’ Report and considers the ways Talking Mats can support:

The Royal College of Occupational Therapists have recently published a new report. “Making personalised care a reality: The role of occupational therapy.”

As the OT Associate for Talking Mats, I took the opportunity to review the document and consider how Talking Mats can help OT’s in fulfilling the recommendations made.

The report recognises that people living with long-term conditions bring different and equally important, knowledge and expertise to the decision –making process.

It challenges OT’s to ensure that they really listen to, and hear the views of the people they work with.

A Talking Mat can help facilitate this. It helps people to understand what is being discussed, to reflect and organise their thoughts, to say what matters most to them and record their views. It helps OT’s to really listen, to learn new information, to involve the person in their own planning and support decision making.

Read more about how Talking Mats can help OT’s to make personalised care a reality in the TMOT Resource 1:  TM Personalised Care – Copy.

The RCOT report is available here: https://www.rcot.co.uk/news/delivering-personalised-care-frontline

Rachel would love to hear from you if you have any examples of how Talking Mats have helped you to provide personalised care, or if you want to know more about OT and Talking Mats. Her email is: Rachel@talkingmats.com.

If you are feeling inspired and would like to find out about accessing Talking Mats Foundation Training, take a look at our upcoming courses across the UK, as well as online and organisational training options: https://www.talkingmats.com/training/

Many thanks to Mary Walsh, Health Service Executive (HSE) Senior SLT at St Mary’s Hospital, Dublin for this fantastic blog post about their project involving use of Talking Mats to support people with Dementia to participate in decision making related to their needs:

In September 2016 Aideen Lawlor (SLT Manager) and I (Senior SLT) won the Dementia Elevator award with a project entitled “Empowering Persons with Dementia to become more Active Participants in Decision Making Related to Their Present and Future Needs.” with Talking Mats being an integral part of this project. In November 2017, the prize money was used to fund my training to become an accredited Talking Mats trainer so that I could then train others in TM Foundation Course on a prioritised basis.

This project is now complete with 6 speech and language therapists (SLTs) from a variety of settings working with persons with dementia all trained in using Talking Mats. As part of their training, The SLTs used TM with patients/ residents with particular reference to the Assisted Decision Making (Capacity) Act 2015. TMs were also used to help the clinicians to get to know their patients, in care planning, in improving increased opportunities for interaction and in improving choices and decision making. In effect, we were checking it out!

All the SLTs found that when TM principles are followed, that it helped to empower people with dementia to make decisions about their care. Some of the reported findings:

• That the pictures help maintain attention and aid comprehension.
• That it facilitated strengths rather than a deficit model.
• That photographed completed TM provided a pictorial record for meetings – very positive.
• That it provided a significant catalyst for change in some instances.
• That it helped people with dementia and responsive behaviour get needs met
• That video recording sessions with consent greatly enhances reflective practice and may be helpful in key decision making

The next phase is to expand the number of SLTs who can provide training in Talking Mats across the Republic of Ireland. Funding from the national SLT professional body training grant scheme has been sought for these 6 SLTs to become trainers for Talking Mats. This will result in cascading training on a priority basis, increase evidence base/ knowledge re using TM and embedding TM in variety of clinical settings with SLTs leading this practice.

Mary Walsh,

Senior speech and language therapist,

St. Mary’s Hospital,

Phoenix Park, Dublin 20,

Ireland

mary.walsh6@hse.ie

Aideen Lawlor

Speech and Language Therapy Manager

aideen.lawlor@hse.ie

If you are feeling inspired and are interested in accessing Talking Mats training, we offer Foundation Training courses throughout the UK and Ireland as well as online – take a look here for more details:

www.talkingmats.com/training

Once you have accessed Foundation Training you can apply for our Accredited Trainers course to enable you to deliver Talking Mats training to others in your area.

Thanks so much to all the practitioners who have sent us guest blogs about using Talking Mat in a Criminal Justice setting. Here are our top 5 – in no particular order!

1. Supporting Families in the Criminal Justice System: Sally Kedge, Speech and Language Therapist from Trouble Talking New Zealand shares two powerful case examples of using Talking Mats with children and families caught up in the criminal justice system. https://www.talkingmats.com/support-for-prisoners-families-experience-from-new-zealand/

2. Communication Needs within Youth Justice – Part 1: On 17^th April 2017, we organised a seminar to look at underlying issues and share good practice when addressing the communication needs of people in youth justice. We had representatives from: the Scottish government, the NHS; Third sector organisations working in youth justice, the police, social workers, professional bodies, universities and social work – from as far afield as New Zealand. The emphasis from the start was that understanding communication is key to improving service delivery. https://www.talkingmats.com/communication-needs-in-youth-justice/

3. Communication Needs within Youth Justice – Part 2: The afternoon session of our seminar on 17.04.17 continued the underlying theme that communication support needs are often hidden and many looked after children have support needs that remain unidentified. The outcome of the day was the establishment of a collaborative network. https://www.talkingmats.com/youth-justice-and-communication-needs-2/

4. Setting up a SLT Service in Prison: This inspiring blog by Jacqui Learoyd explores her role in setting up a speech and language therapy ( SLT )  service in a prison and her use of Talking Mats in that setting https://www.talkingmats.com/setting-up-an-slt-service-in-prison/

5. Has Talking Mats been used in Court? Two registered intermediaries talk about a couple of cases where Talking Mats was used as part of the achieving best evidence (ABE) interviews. https://www.talkingmats.com/talking-mats-used-court/

If you have been inspired and are not yet trained, come along to one of our Foundation training courses – for details see https://www.talkingmats.com/training/foundation-training/

We also offer online training if you are unable to access the training locations – for details see https://www.talkingmats.com/training/online-training/

  Improving communication with board games

Thanks to Karen MacKay from Focus Games for this new guest blog.

 Playing board games can deliver more benefits than just having fun with friends and family. In the workplace they help people to learn, collaborate and communicate, while they are having fun:

1. Breaking the ice

Ever attended an event or meeting where you didn’t know anyone? A board game helps everyone to become involved, talking and interacting, with each other – who doesn’t feel more comfortable, relaxed and happy to chat after playing a game together?

2. Learning through play

We learn through play when we are children, and it works just as well for adults too. Educational board games are a great way to learn from others, share experiences, ideas and gather new knowledge from the game itself. Plus you’ll be having fun – what’s not to love?

3. Developing social skills

Playing board games helps children learn to share, take turns, be a gracious loser and, for shyer children, to come out of their shell more. As adults, we continue to refine our social skills through games. They promote collaboration, communication, and teamwork, useful skills for us all!

 If you like the idea of improving your communication skills using a board game, The Communication Game is your ideal tool. Effective communication allows everyone the opportunity to express themselves clearly. In health and social care, effective communication is vital to ensure individuals receive safe and appropriate care.

For many people who have communication support needs, accessing health and social care and other public services is a challenge. We partnered with Talking Mats who worked with us and a group of people with communication support needs to develop and test The Communication Game. Initial development was funded by NHS Education For Scotland, and The Communication Game was born as an engaging way to help us all to reflect and develop our own and our teams communication, and thus improve the quality and safety of services.

The Communication Game is designed to help anyone working in health and social care to improve how they communicate, particularly with people who have communication support needs. Playing the game will help you think about the barriers to effective communication; and things you can do to ensure you communicate well with others. It is being used by many groups across the country including allied health professionals, nurses, charities, voluntary and community groups, nursing/care home staff and students studying nursing, speech and language therapy, social care and more.

The Communication Game uses questions to help build knowledge, scenarios to help you see the issues people face when communicating, and activities to help you practise different ways of communicating. It is a 1-hour training session for up to 10 people that you can use over, and over again with different groups.

The game is available from Focus Games and you can learn more and order at www.communicationgame.co.uk

Our next train the trainer course is in 2 weeks and we’re  looking forward to welcoming people from a range of professions and a range of places-  New Zealand, Japan, England and Fife!

Becoming a trainer for Talking Mats means the staff member can offer Foundation training within their organisation or partnership.  This ensures that the standard of the communication and thinking tool is maintained and sustainability of its use is supported.  It is  a positive investment  for organisations in person -centred practise.

The trainers are provided with resources for delivering the Foundation course and their licence is renewed annually .

Comments from people who attend include:

Practical approach to training made it easy to try out and learn from ‘doing’

A wonderful inspiring course- really looking forward to continuing to work as part of the TM team

Really enjoyed the training.  Learnt a lot not just about my use of TM but also just about myself as a presenter and communication

If you’ve attended a Foundation course and would like to become a trainer, our next course is in June. You can find out more details on our webiste or on this link  20180621 Accredited Training flier Jun 2018

This new resource has been developed by Strathcarron Hospice and Talking Mats to help people with advanced illness or long term conditions to think ahead and plan for the future.

It consists of a booklet and 3 topic symbol sets: Affairs; Care/treatment; Personal values

It can be used to help people have conversations about:
• the extent to which their personal affairs are sorted;
• what they would or would not consider about future treatments and care;
• what is going well/not going well in relation to their personal values

It is widely recognised that having discussions about end of life issues can enable people to remain in control for longer and help them to identify the care and support they need and want as they approach death. In spite of this, in Scotland:

• 74% of people have not discussed what their wishes would be if they did not have long to live
• 79% of people don’t have any written plans for their end of life care, financial wishes or funeral plans
• Only 35% of people have written a Will

It can sometimes be difficult for people to start conversations about planning for end of life and people this is exacerbated if people have specific difficulties communicating their thoughts and feelings because of symptoms, fatigue and emotional factors. Before initiating this type of conversation it can be helpful to check the extent of a person’s understanding of their illness and whether or not they want to talk about the future.

The importance of having conversations and making plans for end of life has been highlighted as being relevant for people in the early stages of life limiting illness as well as for those nearing the end of life. There is evidence that people who have Advance or Anticipatory Care Plans in place are more likely to receive the care that they want and treatment can be less invasive. ACP is a process rather than a one-off conversation. It is acknowledged that ACP discussions should take place in appropriate settings with sufficient time to enable to people to consider and weigh up different options. ACP should also be developed in line with peoples’ personal values and goals (Sinuff Tasnim, et al.(2015) “Improving end-of-life communication and decision making: the development of a conceptual framework and quality indicators.” Journal of pain and symptom management 49.6 2015): 1070-1080).

Perhaps we should think about planning ahead whether or not we have advanced illness or long term conditions??

Training

To get the most out of the resource we run half day advanced training courses which will include the Thinking Ahead Resource. This course will be relevant to you if you:

•  have attended a Talking Mats foundation training and are experienced in using Talking Mats with adults
• want to extend your use of Talking Mats and consider its role and application to advance care planning
• want to discuss sensitive topics around end of life care

Please contact us at 01786 479511 if you are interested in future dates.

Do you want to introduce Talking Mats to people with a communication disability and autism, but know they will need support to learn it?

We are holding a 2 hour seminar on the 1st of February in Stirling to share ways of supporting people with autism to learn to use Talking Mats and express their thoughts.Twilight ASD Seminar

Do you want to help people think about the future and what they might want to have in place at end of life?  Talking Mats and Strathcarron Hospice have developed a powerful new resource to support these sensitive conversations and an advanced course is being held in Stirling on the 21^st February   and in London 27^th of March http://www.talkingmats.com/training/specialist-seminars/

These opportunities are only open to people who have attended Foundation training

Do you need training to use Talking Mats ?

Talking Mats is an effective but deceptively simple tool so a question we are often asked is do you need training to use it.  Communication and supporting people with communication difficulties is a complex process and Talking Mats is based on a number of research projects which examined who could use Talking Mats, and how best to use it in different situations. It is therefore important that the integrity of the Talking Mats model is maintained and that Talking Mats training teaches the principles developed from our evidence base.
All our trainers are registered with Talking Mats and provide high quality training based on robust research findings. Only trainers accredited by Talking Mats are eligible to train others.

Some of these principles include:

• Understanding who can and who cannot benefit from using Talking Mats
• Asking open questions
• Handing over control
• Pacing
• Maintaining neutrality
• Interpreting additional information including both non-verbal and verbal information
• Matching the top scale to the question or view being explored
• Presenting the options in an order that maximises the individuals ability to respond by using our model which focuses on concrete to abstract symbols
• Monitoring language complexity and topic sensitivity

All our training courses include hands-on practice and video examples as well as reflection on all these aspects of using Talking Mats

The techniques used in Talking Mats accord with best practice guidance in semi –structured interview techniques including:

• being clear in what you want to find out and using open questions
• enabling elaboration in whatever form is appropriate
• planning in advance but in a context that is flexible and can respond to the dynamics of the conversation
• being cognisant of the influence of the environment
• taking time to establish engagement and rapport
• being non-judgemental
• supportive of periods of silence
• ensuring there is a summary at the end so that both parties agree on what was said .

So whilst Talking Mats may seem simple, it is not simplistic. The listener is creating a space that enables the thinker to think and express themselves. Training gives the listener time to reflect on the components of an effective Talking Mats conversation and identify which ones they are already skilled in and which ones they need to develop further. There are no short cuts to reflective practice training and we know Talking Mats foundation training has impact. Time and time again people who thought they knew about Talking Mats reflect and say things like ‘I got so much more from this training than I expected’ or ‘ I now see I  can use Talking Mats for so many different conversations not just ’ I like’ , ‘I don’t like’ ‘or ‘I have been using Talking Mats but now feel much more confident to use it and to make my own submats’

This is why we put so much emphasis on training.  We have developed our successful “Train the trainer” scheme to ensure that quality is maintained and reflective practice maintained.  If Talking Mats is passed by word of mouth then key aspects of the framework are missed and/or misinterpreted which in turn lessens its effectiveness and impact.

People who come on training are often excited, want to tell colleagues and share it with others. Demonstration and sharing is fine, but it is important to be aware of the difference between sharing and training.

Sharing can often be appropriate especially when there is a team of people supporting the person or  parents are keen to see how it works. You can show someone how to use a Talking Mat about a specific conversation. We call this a ‘demonstrating model’. It is helpful to give the listener the words to say to go with it. That way you are enabling other colleagues or family members to have an effective but specific conversation only.

If they then want to use it for other conversations we would strongly recommend they go on to attend the training. Attending a foundation course will enable them:

• to get more out of the technique
• to understand more about their own communication
• to become creative in their use of Talking Mats whilst still adhering to the research principles
• to be able to create their own mats or explore a topic in more depth using submats

So do you need training to use Talking Mats ? The answer is a resounding  yes . Training supports you to be an effective Talking Mats listener and get the most out of this versatile communication framework. So if you have not attended a course check out our course opportunities.

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

Thanks to the Action Group  in Edinburgh for their great blog about their co-trainer Lynnette Linton .

In 2016, a number of people with learning disabilities attended a Talking Mats training  designed to build their communication skills and confidence so they could  use  to interview others about their community participation, in regard to Charter for Involvement goals. One of those trained was Lynnette Linton, the National Involvement Network Chairperson, and a Service User of The Action Group in Edinburgh.

Lynnette interviewed several fellow service users using Talking Mats, and was supporting in the role of ‘Listener’ by Liz Taylor, an Action Group Training Officer, who as a consequence of this work requested to become an Accredited TM Trainer. The Charter highlights that support organisations should involve Service Users in training their staff, so it then seemed natural for Liz and Lynnette to deliver TM training to Action Group staff together, with Lynnette in the role of volunteer co-trainer.

Lynnette has since been a core part of training over 50 employees (including those at Senior levels) in Foundation Talking Mats training with the Keeping Safe add-on. Liz says, it helps that Lynnette is “naturally gifted at speaking to people, and ably demonstrates the significance of TM as a means of having your say on the service you wish to receive”.

Lynnette and Liz do a demonstration Mat together, and then when trainees are doing their own Mat or showing their videos, Lynnette points out where they are applying the key TM principles (Lynnette enjoys issuing certificates to those who successfully complete the course). She also shares anonymised stories from her experience of interviewing ‘Thinkers’, which help get across what Action Group Users “want to change and improve about their service”.

Liz says, “Our first experience of demonstrating a Mat together didn’t quite go to plan, as Lynnette became unexpectedly upset when discussing her views of a football team, when she was reminded of a close friend who had died who had been a fan”. As difficult as this was for both Lynnette and Liz at the time, it was a powerful example of how TM helps us express emotions we may not even have been ourselves aware are ‘under the surface’, and sparked real interest in TM as a communicative tool.

The Action Group started gathering feedback specifically for Lynnette in her role as co-trainer, as part of the training evaluation and trainees have said that “she is exceptionally welcoming and puts everyone at ease; her passion for the topic is very evident, and it is very beneficial to hear real life examples, and how TM helps in her own life”. This includes how Lynnette benefits from the Keeping Safe pack, as a means of raising more ‘difficult’ issues.

Lynnette says, “As a service user, I also now see myself as an important, valued co-trainer. [Training] is something I see myself doing more of in the future. My confidence has shot right up. It makes me feel proud, and my parents get to hear about it at my Review”.

Staff also see the real importance of acting on the actions from each person’s Mat. Lynnette acknowledges that co-delivering has sometimes “been difficult, because I know some of the people we’re training. But I’ve been able to speak up about what I want from my support, my environment.”  Recently she trained her own Service Development Manager and Team Manager, and although she felt it was harder to be honest, she had a captive audience, and her Managers then followed through on actions from her demonstration mats:  “It’s made a difference to me, after doing a Mat with my DM about my home. I put ‘safety’ in the ‘Thumbs Down’, because I get frightened, and now I’ve got a security chain and a peephole on the door”. 

“I never thought I would be training the staff.  Now we’re booked up!”

Click for  information  about the Accredited training and or the Keeping Safe resource mentioned in the blog