everyone has a personal best
Talking Mats for Mental
Capacity Act Assessments
and Debriefing
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.
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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+.
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Cambian MDT
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Psychiatry
Nursing
OT
SLT
Physiotherapy
Psychology (Clinical and Assistant
Holistic Therapy
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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.
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Education MDT
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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
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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.
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everyone has a personal best
Talking Mats for
Mental Capacity Act
Assessments
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 9
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?
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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?
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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.
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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
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Session 2
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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?
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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.
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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?).
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General Approach – Less Able
Student
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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.
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everyone has a personal best
Talking Mats for
Debrief
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.
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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?
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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?
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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.
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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.
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An example…
Action
Evaluation
Event
Feeling
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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.
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In practice…
Event – Student
able to break
down each part of
the event
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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.
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In practice…
Range of feelings can
be expressed in relation
to each stage of the
event.
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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.
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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.
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Linking the skills to positive
events…
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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.
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Questions and Contact
Ruth Spilman, Speech and Language
Therapist, Purbeck View School.
ruth.spilman@cambiangroup.com
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