Introduction
Pieces of the Puzzle is a conversation toolkit for national application in hospital wards which care for individuals with learning disabilities who have either had a breakdown in care provision or have been sectioned under the Mental Health Act of 2003.
These conversation tools are to be used throughout an individual’s transition back to their community with their new care provider. The activities aim to rebalance power and build a positive relationship to make the transition process more comfortable. Both activities are targeted at different stages of a person’s journey, they complement and enhance the current system by prompting discussions which enable patient agency within their continuum of care.
The icebreaker aims to aid individuals in recognising their efforts to progress during their time in the hospital and to think more positively and confidently about the journey ahead. The activity also intends to start the relationship between the individual and their new care provisions on an equal footing as the questions give people the platform to introduce themselves informally.
The scenarios assist nursing staff in creating a bespoke graded planner. The exercise asks individuals to envisage realistic scenarios to understand their tolerance towards certain objectives that must be achieved before their departure. The prompts go in chronological order and get increasingly more challenging. The exercise aims to ensure safety and comfort as they move towards a time that can feel unsettling and disruptive.
Before carrying out the following activities, it is important to meet with the nursing staff, who know the transitioning individual best, to adapt the activity to the person’s specific needs. Some questions to ask before conducting are:
1. Is this style of questioning appropriate for them?
i.e. Open-ended questions, closedended questions, one-word answer questions or yes/no answer questions.
2. What method of communication works best for them?
i.e. written, verbal, visual or Makaton.
3. Is the individual comfortable with answering questions that cover different tenses?
i.e. past, present, future.
4. How can I keep them comfortable and engaged with the activity?
i.e. more interactive and more accessible.
Consultation
Traffic Light Controller
The traffic light controller allows individuals to control the activity. Transferring ownership of the activity over to the individual gives them a safe way of ending the activity without resulting in challenging behaviour. Through the
symbolism of red, amber and green, this tool helps a person with limited communication skills to communicate how tolerant of the activity they are as they can stop, pause or continue with the activities.
Stop Pause Go
Walkthrough Cards
Activity
“Today we are going to be doing an ACTIVITY”
Puzzle You
“This activity involves a PUZZLE to complete”
“I want to learn more about YOU”
Some individuals find it valuable to break down the activity into simple language and visual aids to understand better what the following activity entails. Therefore, the toolkit supplies ‘walkthrough cards’ which can be implemented at the
beginning of the icebreaker and scenario activity if they are deemed useful for the individual’s specific needs.
Activity in Relation to Space
When conducting the following activities, make sure the environment is welcoming and comforting. To understand if the intended space is appropriate for participation, analyse the sensory elements such as the
lighting/natural light, the surrounding noise pollution and its privacy.
Icebreaker
The icebreaker activity should start* during the first meeting with the person who is transitioning. It is formatted as a jigsaw puzzle, with each piece having a discussion prompt on the back. After the
question is read out, the individual can be given the jigsaw piece to start to complete the puzzle. The playful nature of this activity should allow both participants to open up and learn more about each other.
*If the person who is participating appears to feel uncomfortable, it is important to stop the activity. The task can be attempted during your next session.
Scenario Board Game
The scenarios prompt participants to discuss and find solutions to possible future scenarios. There are 12 spaces on the game board; however, the toolkit comes equipped with 36. Before conducting this activity, care providers and nursing staff should consult on which 12 are
the most appropriate for the intended individual. The scenario prompts are placed around the board, going in an incrementally challenging order in a clockwise direction. There are 4 categories of scenarios to choose from:
Building Familiarity
The scenarios which fall under this category take place before reintegration. Therefore, it is recommended to have between 3-6 places devoted to these prompts.
Applying Learnt Skills
These scenarios prompt the participants to discuss and apply the skills which have been learnt during their time on the ward to scenarios for when they are about to leave until they settle into their new home.
Stepping Out of the Comfort Zone
These scenarios envisage the time once they have settled into their new environment. However, these scenarios might not apply to all, therefore it is recommended that 0-3 spaces be reserved for this category.
Dealing with Challenges
The prompts for this category are more extreme. Therefore, these are optional and if used, only 1 place is recommended.
Creating a Person-centred Graded Planner
The discussions to come from the scenarios’ activity can be useful for building a graded planner for the individual. Some of the scenarios from the Building Familiarity category are based on real exercises for helping people transition out of the hospital. Therefore, the discussion
of hypothetically conducting these exercises allows individuals to safely input their feelings and opinions on these activities before potentially doing them which helps care providers and nursing staff design a more person-centred planner.
If you require inspiration for adapting the tools or wish to input your expertise, scan the QR code to check out the public bank of questions and scenarios!
IOnline Data Bank