What Is Positive Behaviour Support? A Guide for Managers

Positive behaviour support (PBS) is a person-centred way of understanding why someone's behaviour challenges, then changing the support and environment around them so their life gets better and the behaviour is needed less. It's used mainly with people with a learning disability and autistic people. It blends person-centred values with behavioural science, puts prevention first and treats restrictive practice as a last resort.

What positive behaviour support means

The PBS Academy describes PBS as "a multicomponent framework for developing an understanding of behaviour that challenges". It isn't one technique. It looks at the person's whole situation (health, history, communication, routine, surroundings) and builds support around what that tells you.

It's for children, young people and adults with a learning disability and autistic people who have, or are at risk of developing, behaviour that challenges, including those with mental health conditions. Health Education England's summary puts the aim as "to improve the quality of a person's life and that of the people around them". Fewer incidents should follow from a better life.

"Behaviour that challenges" describes behaviour, not the person. The Challenging Behaviour Foundation explains it as behaviour such as aggression, destruction or self-injury that puts the person or others at risk, or has a significant impact on their quality of life.

Why behaviour that challenges happens

Behaviour that challenges happens for a reason, and it may be the person's only way of telling you about an unmet need. Common reasons:

• Pain or illness. Earache, toothache or a bad night's sleep. Many people with a learning disability can't easily tell you they're in pain, so a sudden change in behaviour should prompt a health check first.
• Communication. If someone can't say "no", "I'm bored" or "that hurts", behaviour may become the way they say it.
• Getting or avoiding something. Behaviour can work: it gets a drink, attention or more control, or it ends a demand the person doesn't want.
• Sensory needs. Too much or too little stimulation. NICE lists heat, light, noise and smell as things to consider.
• The environment and the support. Restrictive settings, demands that don't fit the person, and changes in staff are all recognised risk factors.

The core elements of PBS

Functional assessment

PBS starts by finding out what the behaviour does for the person. NICE guideline NG11 describes a functional assessment as describing the behaviour clearly, identifying when it does and doesn't happen, and finding out what keeps it going. It uses direct observation, records of how often and how intensely it happens, and a baseline of the person's quality of life.

Proactive strategies

Proactive (or primary) strategies change things before behaviour is needed: adjusting the environment, structured and personalised daily activity, and teaching a new skill that does the same job as the behaviour, such as a way to communicate. Proactive work should make up the majority of any plan.

Early warning signs

Secondary strategies cover the moments when the person starts to become distressed. The plan describes what those signs look like for this person and what helps, such as space, relaxation or a change of activity.

Reactive strategies

Reactive strategies are for behaviour that can't be prevented, to keep everyone safe and calm things down. NICE says to use them only as a last resort, alongside proactive work, considering the least restrictive options first. They should be a small part of any plan.

Reducing restrictive practice

Restrictive interventions deliberately restrict a person's movement, liberty or freedom to act. NICE says any restrictive intervention must come with a programme to reduce its use. PBS cuts the need for restriction by tackling the reasons behind the behaviour.

What goes in a PBS plan

A PBS plan (often called a behaviour support plan) turns the assessment into practical instructions that everyone can follow the same way. Drawing on NICE NG11, a good plan includes:

• A clear description of the behaviours and the best current understanding of why they happen
• Proactive strategies, and the skills the person will be supported to learn
• Early warning signs and how to respond
• Reactive strategies and how risks will be managed
• How progress will be measured, the training staff need, and named people responsible for the plan

Who writes it: usually a practitioner with specialist PBS skills, working with the person, their family and the staff who know them best. Frontline staff then deliver the plan day to day and record what happens. A plan only works if the agency worker on a Sunday night knows it as well as the keyworker.

Reviewing it: a PBS plan is a live document. NICE recommends reviewing it fortnightly for the first two months and monthly after that, and sooner if behaviour or restrictive interventions increase or the person's quality of life drops.

The policy context

• NICE NG11 (2015, updated 2020): the main guideline on challenging behaviour and learning disabilities, covering assessment, behaviour support plans and restrictive interventions.
• Regulation 13 (England): care must not include acts intended to control or restrain a person that aren't necessary to prevent, or aren't a proportionate response to, a risk of harm. That includes physical, mechanical and chemical means, and it's why restraint belongs in your adult safeguarding training too.
• CQC's Right support, right care, right culture: statutory guidance on how CQC regulates services for autistic people and people with a learning disability. Providers must have regard to it. It expects support that maximises choice, control and independence, and person-centred care that promotes dignity, privacy and human rights.
• Positive and Proactive Care (England, 2014): anyone in adult health and social care at reasonable risk of restrictive interventions must have an individualised behaviour support plan, and restrictive interventions should only ever be a last resort.
• Elsewhere: for children's services, see Reducing the need for restraint and restrictive intervention (DHSC and DfE, 2019). Wales has the Welsh Government's Reducing Restrictive Practices Framework (2021). In Scotland and Northern Ireland, check what the Care Inspectorate and RQIA expect.

Planned restrictions must also be lawful and in the person's best interests. Where someone lacks capacity to make the decision, that's Mental Capacity Act territory (England and Wales).

What PBS isn't

• It isn't a behaviour-management technique. In Health Education England's words, "It is not simply about getting rid of problematic behaviour."
• It isn't physical intervention. A plan may include a planned restrictive intervention as a last resort, with a plan to reduce it, but restraint isn't PBS. The Restraint Reduction Network's Training Standards apply to training with a restrictive intervention component, and CQC has expected that training to be certified against them since April 2021.
• It isn't about punishment. PBS builds skills and better support rather than taking things away.
• It isn't just for specialists. A specialist may write the plan, but your team delivers it on every shift.

Training your team in PBS

Kasorb's positive behaviour support training gives care and support staff a practical grounding in PBS. The half-day session covers what behaviour that challenges is and why it happens, what PBS is, developing and reviewing PBS plans, applying PBS principles in practice, and action planning for next steps.

It runs on-site anywhere in the UK or live online, for up to 12 staff at one flat rate for the group. Learning is checked throughout with case studies and questions, and your trainer has used these skills for real. Certificates of completion are emailed the next day. It's awareness-level, non-physical training: no restraint or restrictive practice is taught, it isn't certified against the Restraint Reduction Network Training Standards, and it isn't a regulated qualification.

This guide summarises the law and guidance; it isn't legal advice.

FAQs

What is a PBS plan?

A PBS plan, or behaviour support plan, sets out why a person's behaviour happens and how everyone should support them. It covers proactive strategies, skills to teach, early warning signs, reactive strategies, risk management and who is responsible. It changes as the person's needs change.

How often should a PBS plan be reviewed?

NICE guideline NG11 recommends reviewing a behaviour support plan fortnightly for the first two months and monthly after that. Review it sooner if the behaviour increases, restrictive interventions are used more often, or the person's quality of life gets worse.

Is positive behaviour support the same as restraint training?

No. PBS is about understanding behaviour and changing support so it's needed less. Restraint is a restrictive intervention that should only ever be a last resort, and training that includes it falls under the Restraint Reduction Network Training Standards. PBS awareness training without physical skills is a different thing.

Is PBS training mandatory for care staff?

No law names PBS training specifically. In England, regulation 18 requires staff to have the training necessary for the duties they're employed to perform. If your team supports people whose behaviour challenges and follows PBS plans, you need to be able to show they've been trained to do that.