Pieces of the Puzzle is a conversation toolkit for national application in hospital wards which care for adults with learning disabilities who have either had a breakdown in care provision or have been sectioned under the Mental Health Act of 2003.

The toolkit is not just a set of conversation tools but a comprehensive strategy for an individual’s transition back to their community with their new care provider. It is designed to rebalance power dynamics and foster positive relationships. Prompting discussions that enable patient agency within their continuum of care makes the transition process more comfortable and reassuring for both the patients and the healthcare professionals.

The icebreaker, a crucial and impactful part of the toolkit, aims to help individuals recognise their efforts to progress during their hospital stay. It also plays a significant role in starting the relationship between the individual and their new care provisions on an equal footing. The questions give people the platform to introduce themselves informally, fostering a positive and comfortable environment.

The scenarios in the toolkit serve a specific purpose. They assist nursing staff in creating a bespoke graded planner. The exercise asks individuals to envisage realistic scenarios to understand their tolerance towards specific 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.

The consultation guide houses all of the tools, and most of the elements are printable, which makes replicating the toolkit easy for professionals. The guide contains information to help care providers and staff adapt the tools to make the activities accessible for the specific needs of the intended individual. The guide also includes information relating to the space in which the tools are used and the creation of a person-centred graded planner.

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