PIECES

PIECES is a holistic, relationship focused approach that utilizes collaborative engagement, shared assessments and supportive care for older persons living at risk or with complex health conditions that include but are not limited to:

Neurocognitive disorders (Including but not limited to dementia)

  • Mental health and substance use disorders
  • Neurological conditions
  • Physical health issues

Using the PIECES approach and Job aides help to engage all members in an evidence informed team approach with collaborative assessment and shared care, building on the individuals’ strengths, promoting health and preventing unnecessary disability. Always consider the persons: Physical, Intellectual, and Emotional Health, strategies to support their Capabilities, their social and physical Environment and Social self (life story, cultural, spiritual, sexuality, gender identity).

Remember, all behaviors have meaning. The PIECES approach provides a framework that is practical and versatile and will help enable early detection, health promotion and disability prevention through:

  • Common language for communicating with the Person, Care Partner and Care Team.
  • A Common set of values modeled through the Core Competencies.
  • A collaborative, evidence-based approach for finding strategies to support the individual.

PIECES Foundational Principles


History

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.


Development

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.


Deliverables

Advanced Knowledge and Skill

Staff will develop knowledge and skills through face-to-face interactive learning or virtual delivery. The sessions are 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.

Common language

The integration of the PIECES framework and Core Competencies will allow collaboration with the Person, Care Partners, Care team and with other key stakeholders in Alberta.

Standardized Instruments

In the PIECES learning and development program commonly used best practice tools are identified, PIECES recognizes that there will be organizational, regional and national variation in utilization of best practice assessment tools. PIECES encourages team conversation to reach consensus on the best choice of tools within the context of collaboratively working through the 3-Q template.  These assessment tools should support the evidence-based approach to care planning and augment information gathered using a person centered holistic and relationship approach to Team collaboration.

Included in the resource guide are some examples of the best practice assessment/ screening tools commonly used in the support of the person living with complexity. These include:

  • BSO-DOS- Behavioral Supports Ontario-Dementia Observation System
  • CMAI- Cohen Mansfield Agitation Inventory
  • CAM- Confusion Assessment Method
  • MoCa Test- Montreal Cognitive Assessment
  • Clock Drawing Test
  • MMSE- Mini Mental State Examination

Job Aids

  1. PIECES 3 Question Template : Provides a common, yet comprehensive, approach for thinking through problems and understanding the meaning behind behaviours.
  2. PIECES Team Mobilization : Acting on the information/evidence gathered from the 3-Question template requires incorporating the investigations, interactions and Interventions into the persons care plan, mobilized into action then maintained, monitored and modified as needed.
  3. The Psychotropic Template: Consists of a three-question framework Detect-Select-Effect in choosing the appropriate pharmacological intervention.

Assessment Tools

Resources

Personalized Workshops

Please see our page on available workshops.