P.I.E.C.E.S. Education Initiative

Outreach Education Services

The key function of Education Services is to take a leadership role in assisting regions to build capacity among healthcare workers who support individuals with altered behaviours in their own region. Currently Rosehaven Outreach Education provides educational opportunities for frontline caregivers through face-to-face workshops and telehealth sessions.

The ABCC model is utilized as the framework for managing altered behaviours and 20 related modules have been developed by the Rosehaven Education team. Over the last eight years there have been approximately 600 sessions with over 7000 health care workers participating. The learners represent frontline caregivers such as nursing, therapies, housekeeping, and dietary staff. While this service has been a valuable first step, it requires a stronger emphasis on specialized knowledge acquisition for the health professional and the strength of transfer coaching to support the transfer of knowledge to the workplace.

In recognition of the need for education for regulated health care professionals and the need for supporting transfer of knowledge, the Education team researched learning programs across Canada and other countries. The most comprehensive program was determined to be the P.I.E.C.E.S. program from Ontario.

What is P.I.E.C.E.S.?

P.I.E.C.E.S. is more than a train-the-trainer education program; P.I.E.C.E.S. is a performance improvement approach. The P.I.E.C.E.S. 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 care, services, and support to older adults with complex needs and associated behaviours.

P.I.E.C.E.S. 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. P.I.E.C.E.S. provides a framework for understanding why we behave the way we do and what resources we have to build on. “Putting the P.I.E.C.E.S. Together” represents Physical, Intellectual, Emotional, Capabilities, Environment, and Social components, which are the cornerstones of the philosophy.

What is the History of P.I.E.C.E.S ?

The P.I.E.C.E.S. Learning Initiative was developed in Ontario. Following an extensive consultative process in 1997, the Ministry of Health implemented a comprehensive 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. Work on this initiative dates back further 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. This education initiative continues to improve based on the evaluation results and current practices related to the complex cognitive/mental health issues of the elderly. Since the inception of the P.I.E.C.E.S. learning initiative, over 3000 regulated health professionals have been involved with the program in Ontario. Nova Scotia adopted P.I.E.C.E.S. and is currently rolling it out provincially. The Rosehaven Provincial Program in Alberta has also adopted this program and is in the initial steps of implementation. Other provinces are also reviewing the P.I.E.C.E.S. learning strategy and considering implementing the program.

Why was P.I.E.C.E.S. Education Developed?

Continuing care is becoming 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 challenging 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.

What are the Deliverables?

Advanced Knowledge and Skill

Staff will develop knowledge and skills through face-to-face interactive learning and Telehealth 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 P.I.E.C.E.S. program in collaboration with key stakeholders in Alberta.

Standardized Instruments

While a number of standardized assessment instruments are included in the P.I.E.C.E.S. program, the Rosehaven consultation team has supplemented this program with work completed by other healthcare professionals in Alberta. The Rosehaven Provincial Program has 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 P.I.E.C.E.S. consultation team will collaborate with the S.A.S.C. committee in this endeavor and continue to build upon this toolkit.

The P.I.E.C.E.S. decision-making templates are designed to help collect information and systematically think through issues. These tools are described below.

Decision-Making Templates

The ABCC Model/ 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.
P.I.E.C.E.S. 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.

Job Aids

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 (i.e., RISKS, SIG E CAPS, I Watch Death, the 7 A’s of Cognitive Losses in Dementia).

Timely Information P.I.E.C.E.S. Service (“TIPS”)

The P.I.E.C.E.S. TIPS service provides timely fax or e-mail advice on clinical and educational problems. A cadre of experts provides the practical TIPS responses and advice for thinking through complex problems. Responses are posted on the P.I.E.C.E.S. website.

Performance Improvement Approach

Support for a performance improvement approach is reinforced. P.I.E.C.E.S. training in and of itself is most likely “not the answer” to the complex challenges faced by organizations providing continuing care – it will need to be part of larger, long-term sustainable solutions which includes clear performance expectations, on-going support and feedback from senior management regarding the application of skills and knowledge, supporting policy and procedures, time to practice and evaluate practice changes, etc.

The Enabler Program

The Enabler Program provides leaders with a solid foundation in P.I.E.C.E.S. This highly interactive session provides practical ideas for transferring knowledge into day-to-day practices and sustaining learning in the longer-term. Research consistently demonstrates the critical role management plays in creating a flourishing learning environment in an organization.

Support Network

Research reflects that classroom learning translates into minimal practice improvements; therefore it is necessary to provide a network to foster support and coach transference of knowledge. The P.I.E.C.E.S program will facilitate an infrastructure of organizational support as demonstrated below.

In-house Psychogeriatric Resource Person(s) (PRP)
The goal is to have one to four professionals per continuing care organization (i.e., continuing care facility, home care office) across the province trained in P.I.E.C.E.S. within the next five years. These professionals may include registered nurses, licensed practical nurses, psychiatric nurses, occupational therapists, recreation therapists, physical therapists, social workers, etc. When the PRP returns to work after their training he/she will:

Assess how team members are currently managing the cognitive/mental health needs and associated behavioral issues of residents
Determine how those practices compare to what was learned through participation in the training program
Set realistic goals for improving day-to-day practices
Develop practical strategies for imparting new knowledge and skills learned through participation in the training program
Develop strategies to encourage integration of new practices on a day-to-day basis
Evaluate improvements over time.

Psychogeriatric Resource Consultant(s) (PRC)
Each participating region will identify individuals to take the P.I.E.C.E.S. PRC training. These individuals will have a recognized designation in a health care profession and have extensive clinical geriatric mental health experience. The P.I.E.C.E.S. training will provide an overview of the program and philosophy, clarify/align the role of a PRC together with existing job description(s), review the decision-making templates and standardized assessments, practice use of learning aides together with coaching strategies, and provide networking opportunities. It is acknowledged that individuals taking this training are already geriatric mental health experts and the focus of this training will be on “process” rather than “content”. The role of the PRC involves consultation, education, and program development.

Linkages with Stakeholders
A network of health care professionals who have a special interest in working with individuals with complex needs and associated behaviors will be developed across the province. This network will also include organizations such as the Alzheimer Society, Schizophrenia Society, Specialized Geriatric Services, Education Services and University faculty with research expertise. An inventory of existing programs and services will be developed in an effort to narrow the gaps and avoid duplications and inefficiencies in service delivery. This inventory will also determine what informal alliances and formal partnerships currently exist among these service providers.

P.I.E.C.E.S. Consultation Team
The consultation team will lead and coordinate the P.I.E.C.E.S. Network. On-going development, implementation and sustainability will be supported through dialogue and linkages with Key Stakeholders and Enablers. The team will be comprised of educators, multi-disciplinary clinicians, and content specialists.

Sustained Networking and Shared Learning

On-going dialogue and shared learning will be supported through telehealth sessions, the discussion forum, TIPS, individualized consultation and meetings as necessary.

Evaluation

The implementation of the P.I.E.C.E.S. learning program will be evaluated. Pre and post assessment will reflect the learners’ acquisition of knowledge. Factors will be identified that help and hinder implementation of this learning strategy and the application of knowledge to the workplace. The outcomes of collaboration, coordination across sectors, and development of healthcare networks will also be evaluated.

Link to the P.I.E.C.E.S. Canada Website

Link to Me and U-First! A FREE eight module e-learning program on dementia care, developed for front-line care providers