Social worker and academic Melanie Pocock examines a study of the effectiveness of a recently developed technique designed to help dementia sufferers and people with disabilities communicate their views and needs
KEY WORDS: Dementia decision making
AUTHORS: Joan Murphy, Tracey M Oliver, Sylvia Cox.
Title: Talking Mats help involve people with dementia and their carers in decision making.
PUBLISHED: Online by the Joseph Rowntree Foundation (April 2010) : .
Aim: To explore whether Talking Mats can enable people with dementia and their family carers to feel more involved when making decisions about their daily lives.
Methodology: The study, from April 2008 to June 2009, involved 18 couples. It set out to establish whether they felt more involved in decisions when discussions were made using the Talking Mat or their normal mode of communication (a verbal discussion). After each discussion, the couple were asked to complete a short questionnaire to establish how involved they had felt. Alongside the questionnaires, discussions were also recorded and later analysed by researchers, with photographs taken of each completed Talking Mat.
Conclusion: The research underscores the importance of supporting people with dementia to meaningfully participate in discussions around their daily care. Talking Mats are shown to be a highly efficient and successful way of doing this.
Government guidelines (National Institute for Health and Clinical Excellence and the Social Care Institute of Excellence, 2006; National Dementia Strategy, 2009) have emphasised the importance of ensuring people with dementia and their carers have their voices heard when discussing care needs.
This timely Joseph Rowntree Foundation study builds on evidence taken from initial research by Murphy et al (2007) examining the effectiveness of Talking Mats as a communication tool for care home residents with early to moderate stage dementia. In this study, the authors move from the care setting and into the community to explore whether Talking Mats are an effective tool in enabling people with dementia and their family carers to feel more involved in discussions regarding their care.
As a background to the report, this study reviews recent government policy and guidance on dementia. The authors provide a useful table examining the relevance of the Talking Mats framework to these documents. This helps to give the reader context and make them aware of how the framework can support them in meeting the guidelines and targets set within these documents. This helps to strengthen the credentials of the Talking Mat framework as not only a tool to aid successful communication, but also to support the agency to meet objectives set through guidelines and reports.
From analysing the taped interviews and questionnaires of the 18 participants, the authors note the positive effect the Talking Mats framework can have both on people with dementia and their carers. Most notably the results showed that Talking Mats not only significantly improved the effectiveness of communication for people with dementia when compared with having a normal verbal conversation, but that by using a Talking Mat it also enabled that person to feel more involved within the discussion.
The authors also found that Talking Mats can assist in the negotiation of daily decision making for people with dementia. Evidence showed that using a Talking Mat assisted the person with dementia to clarify and express their thoughts, enabling a decision to be reached with family carers. Furthermore, as the Mat can be photographed, these decisions could be recorded to inform later involvement with social workers and other professionals.
Although the evidence showed that both carers and the people with dementia felt more involved in discussions, the authors were surprised to find that carers actually reported a higher feeling of involvement than the person with dementia. Carers not only reported feeling “listened to” by the person with dementia, but also felt that their relative could “see” their point of view.
The outcome of this research should unquestionably contribute to the evidence-based practice of social workers and other professionals. This is particularly so when creating an environment where a person with dementia meaningfully participates and is involved with decisions regarding their care, can be a difficult outcome to achieve. However, it is something that all practitioners must take seriously and try to accomplish.
Talking Mats appear to offer a simple and effective person-centred solution where an individual can be significantly involved in the decisions that are made about their care. However, practitioners should be fully trained to ensure questions are not phrased in such a way that biases the person with dementia’s response.
Furthermore, although the authors give a valid reason behind their small sample size, the number of couples interviewed is still small and one could debate whether the study is truly representative. Furthermore, all participants could speak and understand English. This further raises concerns around the effectiveness of Talking Mats for service users where English is not their first language. It would therefore be useful to know how successful this communication tool would be on a wider sample size, and whether the same overall positive results would be found.
On the whole, this is a useful piece of research that will hopefully engage practitioners into the debate on how best to involve people with dementia and their family carers, when decisions are being made around their care needs. The findings of this research further corroborate with the evidence from Murphy et al’s research in 2007. This can only serve to strengthen the argument around the effectiveness of Talking Mats for this service user group.
What is a Talking Mat?
A low technology communication framework that helps people who have communication difficulties to make their views known.
It is a system of picture symbols, placed on a textured mat to allow people to communicate their views within a topic by placing the relevant image below a visual scale.
The Talking Mat framework was developed by the University of Stirling.
● Meaningful service user involvement is key when designing services and ascertaining need. The use of effective non-verbal communication systems may help support service users to acknowledge their care needs, particularly if they have been fully involved in the assessment process.
● Using a communication system such as Talking Mats can help to build and improve relationships between practitioners and service users/carers, particularly if all parties feel their views have been listened to and acknowledged.
● Practitioners need to be committed and open to finding creative and innovative solutions to enable service users with dementia and their carers to engage fully with the service and to ensure that their voices are heard.
For directors of adult and mental health services
● Focus on fostering creative and innovative services that will actively listen to service users and encourage meaningful involvement through the adoption of appropriate communication frameworks.
● Adequate resources are needed to enable social workers to train and develop skills, so that they are able to use these communication frameworks to best effect.
● DH (2009) Living Well with Dementia: A National Dementia Strategy: Implementation Plan. Department of Health.
● Murphy J, Gray, L and Cox, S (2007) Communication and Dementia: Talking Mats – Helping People with Dementia to Express their Views. York Publishing Services.
● National Institute for Health and Clinical Excellence and Social Care Institute for Excellence (2006) Dementia: Supporting People with Dementia and their Carers in Health and Social Care, NICE