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Catch up

When investigating peer interaction of adult AAC users in a residential setting, the research team needed a tool which would allow the users to express their views on the findings, which included residents ignoring each other and talking to staff rather than other residents. Boardmaker pictures with Velcro on the back placed on textured doormats allowed the users to build up and amend a picture of their own views and feelings. Talking Mats have now been used with a variety of people of all ages who need support in addressing complex issues.

Let your mats do the talking


Group B service development officer nurse dietitian occupational therapist occupational therapist social care worker day centre officer

Figure 1 - course participants by occupation


Group A nursery nurse occupational therapist teacher speech and language therapist social worker day centre officer advocacy worker

Therapy tools are only as successful as the practitioner who uses them so, when you have a good tool, you want to ensure people are making the most of its potential. Joan Murphy and Lois Cameron have developed a winning format for multidisciplinary training in the use of Talking Mats. Here, they tell us how.

Figure 2 - Evaluation Grid: feedback from course participants


What did you think about ....

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The background to the mats The number of people in the group The venue Course organisation The timing of the sessions The length between sessions Doing your own mat Creating your participants mat Course leaders presentation Handouts Videoing your participants mat Sharing your video with others

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7 1 6 6 4 5 3 3 1 1 5 4 2 3 3 1 3 2 1 1 3 1 2 1

Read this
if you offer training doubt the value of video want to enable people to express their views

eing able to communicate views and feelings is central to being able to access all forms of health and social care yet, so often, the professionals involved do not have the tools or resources to directly support and communicate with clients with communication impairment. Talking Mats (Murphy, 1998; Murphy, 2000; Cameron & Murphy, 2001) is a visual framework that uses picture symbols to help people with communication difficulties. It has potential for a wide range of people and is an approach that helps them to think about topics in a different way, while also providing them with a means of expressing their views more easily. Talking Mats as a tool is only as successful as the practitioner who uses it. A number of people in Forth Valley had expressed interest in learning more, so we sent a flier to them and developed multidisciplinary training courses, two of which are described here. Figure 1 illustrates the wide range of professionals who participated in these two courses. They worked with a range of clients, including children, young people, adults and the frail elderly, in a variety of settings. The difficulties their clients presented with included learning disability, stroke, degenerative neurological illness, challenging behaviour, head injury, mental illness, dementia and language disorder. As places were limited to seven people per course, it was emphasised that participants had to commit to both mornings and to be willing to undertake to video their use of Talking Mats. Thirteen of the fourteen who attended completed their Talking Mat and evaluation form. One participant had difficulties getting permission to interview a client using the video. The course was designed to ensure that the participants could apply the information learned directly to their workplace as, if new skills are to be transferred to the workplace, trainees must feel that the course is relevant to their job (Axtell et al, 1997). Each course involved two mornings with a months interval in between. Each participant was given a pack of materials which included: plan of each session action sheet

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SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2002

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issues to consider practicalities to consider templates of picture symbols what to do after session 1 video observation framework evaluation form. The first session provided background and a demonstration and video of the mats being used. Following this, the participants used the Talking Mats with each other and then worked in small groups to develop the materials needed to create a mat to use in their own work setting.

Successful use
We covered a number of issues which are central to the successful use of Talking Mats including consistency and complexity of language, the use of open questions, acquiescence, timing, access, areas to sub-mat, obtaining consent and reflecting on your own communication style. The participants were expected to video their use of the Talking Mats with a client between the two sessions.

They were all given the opportunity to meet with either of us individually between the sessions and some made use of this; for example, one wanted to discuss how to adapt the starter topic as her main topic was related to food. The second session provided the participants with the opportunity to use their videos and photographs of the completed mats as a focus for discussion, reflection and consideration of future implications. Some of the issues raised were mat preparation, obtaining permission, the training topic, clients reaction, participants reaction, language level and use, quality of information and outcomes. The final part was an open discussion of the participants views about the course. All made specific comments about how useful it had been, how much they had enjoyed it, and how they would use the Talking Mats in their own workplaces. Figure 2 shows the responses to the evaluation form but some of the answers were particularly helpful to us in planning future workshops. For example: The insistence that course participants do their

own mat in their own work environment provided them with a steep learning curve that they all found helpful. Many participants did not initially like the thought of using the video. Comments included: uncomfortable but vital; it was good once it was over; it is not something I particularly liked doing but it is a very valuable tool and I appreciated being able to view the other videos. Despite this expressed dislike, it was clear that the use of the video was a crucial part of the learning process. In response to the question, What aspect of the course was most useful? eleven of the thirteen cited making their own video and the group discussion that arose from watching them. The feedback on the amount of time available during the sessions varied between the two groups. One group felt that session 1 had been too rushed while the other commented that there was not enough time in session 2. One person commented, That doing the mats together was the most effective warm up exercise I had experienced, you really got to know the other course participants quickly. Course participants then told us how they used the Talking Mats with specific clients/ patients. This included to make choices It helped my client think about the possible options available - it opened her mind out; I used it with a child who tended to follow other childrens lead. You got to know what he was thinking and the mats helped him make his own decisions. keeping on topic It helped a young man with Asperger syndrome to stay in reality and stopped him going off at tangents. communication It took the pressure off verbal interaction through the focus on the mat. advocacy It increased equality between the two partners as its predominately a visual language system which makes the more verbal partner throw away the security and reliance on their verbal skills.

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Figure 3 - Potential uses of mats identified


Profession occupational therapists The mats potential for their workplace could use it to look at patient involvement in goal setting and measurement of achievement could help you prioritise and review goals that are truly patient centred outcome measures could use to look at pain and pain relief could use for initial interviews.

nurse dietitian advocacy worker speech and language therapist secondary teacher nursery worker day centre officers social worker

useful for those who can communicate verbally and for those who cannot. useful to explore issues re-compliance with dietary advice and motivation for change. I think it has the potential to help both myself and advocates get to know people who have significant communication challenge. very useful with my dysphasic patients concrete, visual, not reliant on the verbal. the mats have an empowering value could also use them to plan group activities together. it will enable all children to participate in planning for themselves. the possibilities of use are endless will help service users make decisions. I can use it in working with young people with learning disability and / or communication difficulties and with young children key tool for future needs assessment also for children going into foster care. will use to evaluate a day services project. will benefit new residents so we can learn about them, their abilities to explain feelings as things change for them.

service development officer social care worker

language input It makes you think about the level of the language you need and the type of language you use. consultation The mats supported educations policy of consultation with pupils. confirmation It confirms what the client is thinking. The range of applications for the Talking Mats described by the participants was wide, as shown in figure 3 which links specific quotes from the different professions attending the course with their views about the potential uses.

References

Joan Murphy and Lois Cameron are both Speech and Language Therapists with Forth Valley Primary Care Trust and also work as research speech and language therapists at the AAC Research Unit, Psychology Department, University of Stirling, Stirling FK9 4LA.

Resources
Boardmaker software is available from Don Johnson Special Needs Ltd, 18 Clarendon Court, Calver Road, Winwick Quay, Warrington WA2 8QO, tel. 01925 241642.

Time for reflection


We were successful in training a multidisciplinary and diverse group of staff to use Talking Mats. Key to this was the focus on the development of a practical tool that was useful in the participants own workplace and which gave time for reflection and development of course members own communication skills. The participants were ultimately able to use Talking Mats successfully for a variety of clients in different settings. This course provided a clear a structure which built confidence and enabled the participants to develop skills in the use of Talking Mats. We have altered the format in response to the feedback so that, to help us achieve more in the time available, we no longer spend part of the training session producing the symbols. We are now providing more flexible formats depending on the needs of each training group, tailoring training to specific as well as multidisciplinary groups and running full day training courses for people further afield. For further information about Talking Mats and our work at the AAC Research Unit, see our web site: www.aacscotland.com.

Axtell, C.M., Maitlis, S. and Yearta, S.K., (1997) Predicting immediate and long term transfer of training. Personnel Review 26 (3), 201-213. Cameron, L. & Murphy, J. (2001) Views of young adults at the time of transition. Communication Matters Journal 15 (1), 31-32. Murphy, J. (2000) Enabling people with aphasia to discuss quality of life. British Journal of Therapy and Rehabilitation 7 (11). Murphy, J. (1998) Talking Mats: Speech and language research in practice. Speech and Language Therapy in Practice, Autumn, 11-14.

Reflections on training
Do I ensure what I offer is relevant to the participants jobs? Do I use warm-up activities that also showcase what I am advocating? Do I allow opportunities for participants to reflect and consult me at a later date?

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Win a Talking Mats and Learning Disability package!


From the authors of Let your mats do the talking comes a new video and book package on the use of Talking Mats, specifically designed for those working with people with a learning disability. The normal retail price is 50, but Speech & Language Therapy in Practice has TWO copies to give away FREE to lucky readers, courtesy of Joan Murphy and Lois Cameron. For people with a learning disability choices can often be limited, and it can be difficult to ensure their voice is heard. This is particularly true for those with a learning disability who also have communication impairment. This new resource incorporates the thoughts, ideas and discussions which have evolved from both authors clinical and research experiences since Joan Murphy developed the original Talking Mats training package. The video demonstrates Talking Mats being used by three different people and the accompanying book provides clear guidelines for using Talking Mats plus sections on implications and uses with examples from real life. To enter simply send your name and address marked Speech & Language Therapy in Practice - Talking Mats and Learning Disability offer to AAC Research Unit, Department of Psychology, University of Stirling, Stirling, FK9 4LA. The closing date for receipt of entries is 25th April and winners, drawn randomly, will be notified by 30th April. Talking Mats and Learning Disability is available for purchase from the above address, or contact joan.murphy@stir.ac.uk. (See also www.aacscotland.com.)

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