Talking Mats for Mental Capacity Act Assessments and Debriefing

1. everyone has a personal best Talking Mats for Mental Capacity Act Assessments and Debriefing

2. Aims • Introduce the services Cambian provide • Share the ideas developed to use Talking Mats to support Mental Capacity Act assessments. • Share the ideas around using Talking Mats to support debriefing people in our care.

3. Cambian Group • 25 Education facilities, ages 7-25+, both 38 and 52 week residential placements. • 22 Mental Health facilities, 1 age 12-18, 21 age 18+. • 21 Learning Disability services, day centres and residential, ages 16+. • 2 ABI and Neuropsychiatry facilities, age 18+. • 5 Hearing Impairment facilities, age 11+.

4. Cambian MDT • Psychiatry • Nursing • OT • SLT • Physiotherapy • Psychology (Clinical and Assistant • Holistic Therapy

5. Education Facilities • ASD schools, 38 and 52 week residential placements ages 7-25. • AS schools, 38 and 52 week residential placements, ages 7-25. • Residential satellites to both ASD and AS schools. • Registered care home status for 52 week placement schools, registered special schools status for 38 week only services.

6. Education MDT • 2 or 3 FT SLT • 2 or 3 FT OT • 2 or 3 Assistant Psychologists • 1 FT or PT Clinical Psychologists • 1 FT Nurse • 1 PT Psychiatrist • Variety of Holistic Therapists

7. The young people we support… • Mostly ASD and AS diagnosis. • Many co-morbid diagnoses: OCD, ODD, ADHD, Epilepsy, Hearing Impairment, Genetic Syndromes, Learning Disabilities, Sensory Processing Disorder, PDD-NOS, Dyspraxia, PDA, Mental Health difficulties, attachment disorder, Pica, ABI. • Importantly – significant communication disorders.

8. everyone has a personal best Talking Mats for Mental Capacity Act Assessments

9. Mental Capacity Act The five key principles are: • Every adult has the right to make own decisions and be assumed to have capacity unless it is proved otherwise. • Given all practicable help before anyone treats them as not being able to make their own decisions. • Just because a decision seems unwise, they should not be treated as lacking capacity to make that decision. • Decision made on behalf of a person who lacks capacity must be in their best interests. • This should be the least restrictive of their basic rights and freedoms.

10. SLT Role in MCA Assessments… • Blurred boundary within close working teams within a school. • Some schools the SLT take different roles. • How can we help young people to access appropriate support before anyone treats them as lacking capacity?

11. Two Stage Test of Capacity • Diagnostic Test – is there an impairment of, or disturbance in, the functioning of the person’s mind or brain? If so… • Functional test – is the impairment or disturbance sufficient that the person the lacks capacity to make that particular decision?

12. Talking Mat Approach • Used the Talking Mats approach • Resources developed to support individuals with range of diagnoses • Supports processing difficulties, memory, expression, understanding, organisation of thoughts and many more • Works by making the conversation visual and tangible • Used mixture of stimuli – we made our own.

13. General Approach – More able student… • Session 1: Categorising (e.g. animals vs. furniture, food vs. drink). • Session 2: Match actions to consequences (e.g. what you would happen if you didn’t look before crossing a road). Personal likes and dislikes

14. Session 2

15. General Approach • Session 3: multiple choice answers around specific question capacity is being assessed (e.g. Can X student contribute to the decision of a suitable post 19 provision?) Multiple choice questions around, what would happen if you played Playstation all day, spent all your money on sweets, what things do you need help with?

16. Evaluation • Allows expressing non-verbally. • Multiple-choice answers did have to be offered per question. • Establishes an ability to evaluate effectively. • Evaluates insight into own abilities and support that might be needed.

17. General Approach – Less Able Student • Session 1: does the student know the difference between symbols used for a visual scale. Do they know what the topic of the question being assessed is (e.g. Can they independently manage their finances?).

18. General Approach – Less Able Student

19. Final Points on Capacity • May not have capacity to make decision but may be able to have some input. • Allowing input can improve rapport with client. • Difficult to find suitable standardised resources. • Beneficial to have understanding of their communication style and ability beforehand. • MDT working is vital – something Cambian are very well placed to do.

20. everyone has a personal best Talking Mats for Debrief

21. Communication Disorders Young people with communication disorders Lots of frustration, anxiety and low self esteem. Resulting in challenging behaviours; aggression, violence, non-compliance, and withdrawal.

22. Social Problem Solving Skills • Students regularly have ‘social problems’ this could be down to tolerance of their environment, communication difficulties or sensory processing disorder, amongst other things! • So, how do we develop these skills in the young people we support?

23. Debrief Packs • Highlighted a need for a more structured way to debrief students following social problems. • Evidence to Ofsted we are supporting students to develop skills to manage their own behaviours. • How to meet the needs of all students in the education facility, while providing a more structured approach for staff?

24. Debrief Packs and Joint Working… • The answer, to work with OT and Psychology to develop a flexible but standardised approach to debriefing students using Talking Mats. • Format to organise thoughts, feelings and evaluate the situations our young people face. • Tiered system that each student can be allocated a tier depending on their receptive, expressive and cognitive skills.

25. Talking Mats Approach • Developed an appropriate visual scale (event, feeling, action, evaluation). • Provided packs depending upon the students communication abilities, some symbol/photograph based packs and some as seen to show ‘blank’ pictures that can be written on. • Staff training – discussed flexible use of the system under the same visual scale.

26. An example… Action Evaluation Event Feeling

27. Event • Appropriate to a students ability, e.g. symbols, blank spaces to write the event. • Planned in line with their sequencing ability e.g. one symbol ‘horse riding’ or several blanks to lay out the event.

28. In practice… Event – Student able to break down each part of the event

29. Feelings • Simple symbols to give a range of feelings e.g. happy, sad, angry, confused, excited. • Blank spaces for emotionally competent students to identify their own emotions.

30. In practice… Range of feelings can be expressed in relation to each stage of the event.

31. Action • Linking an action to the feeling, for example hitting staff, shouting, listening to staff. • Again blank spaces can be offered as well as symbols to support students who are able to identify what they did.

32. Evaluation • Was what the student did helpful or unhelpful? • Offers the opportunity for staff to make suggestions that they may do in future and what students could do.

33. Linking the skills to positive events…

34. Summary • Hopefully this has given you an idea of how Talking Mats can be used in principle with visual scales etc. to support practicable help for young adults going through Mental Capacity Assessments. • Hopefully I have shared some useful ideas in using Talking Mats to develop social problem solving skills.

35. Questions and Contact Ruth Spilman, Speech and Language Therapist, Purbeck View School. ruth.spilman@cambiangroup.com