Whole system PIEs

 Whole system PIEs (aka 'a PIE of pathways')

New thinking on early trauma suggest the importance of attachment, and of valuing continuity of support. This may sometimes mean tackling and transcending the barriers between specific services ( see: Gaps and Barriers); and this may need to challenge the ways that services have been provided, in the past.

The stress on relationships, central to any kind of working as a PIE, suggests that it is not simply the proponents of Housing First that question the constant 'staircase' (or 'pass-the-parcel') approach that has characterised much thinking on service provision in the past.

Likewise measures of success and 'value for money' that might be quite workable for simple interventions can ignore the real nature of work with the more marginalised and disengaged. Complex and entrenched needs require both longer timescales and subtler and more multi-dimensions outcomes.

But this is not to say that short term services themselves cannot be psychologically astute; on the contrary, short term and initial engagement services play a crucial role in initial engagement, paving the way for others to build on a constructive first encounter.

An Abacus for whole systems work?

For commissioners and other funders keen to see a 'whole systems' approach, and deeper system change, the PIE Abacus - still experimental -  may now offer a tool for obtaining that local overview of gaps and hindrances to be addressed.

Using the PIE Abacus, the views of services' staff can now also be complemented and strengthened with service user input in these local strengths and needs audit assessments.

This more systemic approach to assessment may help to operationalise the recommendations of the duo of papers published by Collaborate (with first Newcastle and now Northumberland universities), on commissioning for complexity.

The more systemic features of the PIE approach, and the Pizazz, aim at providing a mechanism, a tool for operationalising this new vision at system level.