Sylvia Cox

Improving service approaches and outcomes for people with complex needs through consultation and involvement

Services have not always catered well for people with complex needs. The term ‘complex needs’ is used here to signify people who have cognitive impairments and communication difficulties that present major challenges for getting ones views and preferences heard and understood, and/or who may not fit into traditional categories of service provision. Current developments in policy and practice, such as the single shared assessment process, emphasise inclusion through user involvement. There is a danger, however, that people with complex needs will be seen as too difficult to involve, and will therefore remain effectively excluded from the decision-making process and from the opportunity to influence service provision. This article explores the current situation in relation to ensuring genuine involvement for people with complex needs, highlights obstacles to progress and examples of good practice, and identifies future directions for research and practice.

The effectiveness of the Talking Mats framework in helping people with dementia to express their views on well-being

Deteriorating communication is one of the most distressing aspects of dementia and it becomes increasingly difficult to ensure that the person’s views are heard. This study involved 31 people at different stages of dementia who were each interviewed about their well-being using Talking Mats, a low-tech communication framework, and usual communication methods. The communication effectiveness of each method was compared. This study found that the Talking Mats framework was associated with better communication at all stages of dementia compared to usual communication methods. Better communication effectiveness was evident in the participants’ understanding, engagement, keeping on-track and ability to make their views understood. There was also less repetitive behaviour and less distractibility when using the Talking Mats framework. The findings suggest that the Talking Mats framework can play an important role in improving communication by providing an accessible, low cost tool which family and staff can use with people with dementia to help them express their views.

Service provision for people with dementia in rural Scotland: Difficulties and innovations

The provision of health and social care services to people with dementia and their carers living in remote and rural areas has been neglected globally. Meeting the needs of people with dementia poses many challenges for service providers. Such challenges may be compounded by the difficulties of providing and accessing services in rural areas.This article explores the views of Scottish service providers drawn from the voluntary, statutory and private sectors. Our findings highlight the difficulties relating to dementia and rurality faced by service providers in Scotland. We also consider innovative measures reported by service providers. Such measures indicate that not only can the distinct challenges of dementia service provision be overcome, but also challenges posed by providing services to people with dementia and their carers in rural and remote areas.These findings extend the literature on rural dementia service provision.The article concludes with a consideration of the practice and policy implications of providing dementia services in remote and rural Scotland.

Talking Mats: the effectiveness of a low technology communication framework to help people with dementia express their views

The aims of this project were to establish whether Talking Mats, a low tech communication framework, helps people with dementia to communicate and to examine how effective the Talking Mats framework is for people at different stages of dementia. Thirty‐one people at three stages of dementia were interviewed about their well‐being under three interview conditions ‐ an unstructured (ordinary) conversation, a structured conversation and using the Talking Mats framework.The results indicated that conversations using the Talking Mats framework improved communication for people at all stages of dementia but that not all people at late‐stage dementia could use the Talking Mats framework effectively.The researchers concluded that the Talking Mats framework may therefore play an important role in improving quality of care by providing a simple, low‐cost tool that family and staff can use to engage with people with dementia and help them express their views about a range of topics.

The use of Talking Mats to improve communication and quality of care for people with dementia

Enabling people with dementia to continue to communicate their views, needs and preferences as their condition progresses is essential for development of person-centred services and care facilities. This paper describes part of a 15-month research project funded by the Joseph Rowntree Foundation. It examined the effectiveness of Talking Mats, a low-technology communication tool, to help people with dementia express their opinions, in comparison with usual communication methods. The study involved 31 people at different stages of dementia who were interviewed about their well-being under three conditions: unstructured (ordinary) conversation, structured conversation and Talking Mats conversation. The study found that Talking Mats can improve the communication ability of many people at all stages of dementia in expressing their views about their well-being.