In 2003, The Rosehaven Provincial Program's Outreach Education team recognized the need to develop a program of education for regulated health care professionals, as well as a system that supports the sharing of knowledge across the province. After researching all possibilities, the team found the most comprehensive system to be the PIECES program from Ontario.
PIECES is an acronym that conveys the individuality and importance of the various factors in the well-being, self-determination, and quality of life of older adults. PIECES provides a framework for understanding why we behave the way we do and what resources we have to build on. “Putting the PIECES Together” represents Physical, Intellectual, Emotional, Capabilities, Environment, and Social components, which are the cornerstones of the philosophy.
The program provides a framework for understanding why we behave the way we do and what resources we have to build on.
PIECES is more than a train-the-trainer education program; it is a performance improvement approach. The PIECES learning strategy helps continuing care facilities, community agencies, home care, and acute care to improve performance by providing:
- A common set of values
- A common language for communicating across the system
- A common yet comprehensive approach for thinking through problems to enhance the capacity of those providing services to individuals with complex needs with associated behaviours.
Work on this initiative dates back to 1993, when the Ontario Ministry of Health and providers of long term, chronic care, and mental health services began working together to establish a coordinated strategy to address the requirements of older people with mental health needs.
Following an extensive consultative process in 1997, the Ministry of Health implemented a provincial training strategy to enhance the ability of long-term care facility staff to meet the care requirements of individuals with complex physical and cognitive/mental health needs with associated behavioural issues.
Since the beginning of the PIECES initiative, over 3000 regulated health professionals have been involved with the program in Ontario.
PIECES has been adopted in Nova Scotia, Manitoba and the Yukon. Other provinces are also reviewing the learning strategy and considering implementing the program.
- Continuing care has become increasingly complex, requiring education strategies to meet the needs for new knowledge and skills to provide care in an environment of fiscal restraint.
- Increasingly complex care requirements (including the responsive behaviours associated with dementia and other mental health problems) place considerable stress on family members, caregivers, and staff.
- Effective use of resources at a local, regional, and provincial level requires increased support across the continuum of care. This can only be accomplished and sustained through the development and strengthening of linkages.
Staff will develop knowledge and skills through face-to-face interactive learning and Webinar sessions. These sessions will be case-based and topic specific. Learning through dialogue is the approach utilized in these sessions. Dialogue allows the learner to discover (learn) insights perhaps not attainable individually and facilitates inquiring, hearing, and understanding multiple perspectives.
A Common Language
The adoption of standardized assessment scales and decision-making templates will be facilitated and supported through the PIECES program in collaboration with key stakeholders in Alberta.
While a number of standardized assessment instruments are included in the PIECES program, the Rosehaven consultation team supplemented this program with work completed by other healthcare professionals in Alberta. The Rosehaven Provincial Program developed a number of tools to facilitate a holistic assessment of the individual with complex needs and associated behaviours. The Inter-sectoral and multi-disciplinary Standardized Assessment Scales Committee (S.A.S.C.) was formed as an initiative of the Edmonton Seniors Mental Health Planning and Coordinating Committee. This committee identified brief, practical scales and evaluated the clinical usefulness of the scales in practice. They then printed the scales in a standardized format with guidelines for administration and scoring. The S.A.S.C. committee has provided some training on these tools and continues to collaborate with clinicians across the province. The Rosehaven PIECES consultation team collaborates with the S.A.S.C. committee in this endeavor and continues to build upon this toolkit.
The PIECES decision-making templates are designed to help collect information and systematically think through issues. These tools are described below.
- Three-Question Template : Provides a common, yet comprehensive, approach for thinking through problems and understanding the meaning behind behaviours.
- The Psychotropic Template : Consists of a three-question framework for selection and monitoring the use, risk, and benefits of psychotropics.
- PIECES Urgent Application: Provides an excellent structure to help focus assessments and care planning in situations where there may be some urgency required in decision making.
- An innovative yet practical “job aid” (referred to as the U-First Wheel) will be provided to serve as a tool to promote on-the-job dialogue and shared problem solving.
- Three laminates are provided as a quick reference for on-the-job assessment, monitoring, and care strategies. Learning is further enhanced through the use of acronyms (e.g., RISKS, SIG E CAPS, I Watch Death, the 7 A’s of Cognitive Losses in Dementia).