Positive Behaviour Support
What is Positive Behaviour Support?
Positive Behaviour Support (PBS) is a research-based approach to improving the quality of life for people with learning disabilities or autistic people, by increasing their skills.
The main focus of PBS is to reduce the frequency, intensity, and duration of the things someone does that are detrimental to their well-being. This is done by working out what the behaviour is in response to, known as a trigger, then reducing exposure. Also, crucially, PBS recognises and encourages the person’s strengths and increases their skills, which in turn has a positive impact on their quality of life.
Why is positive behaviour support used?
Positive Behaviour Support is recommended for best practice based on over 30 years of studies investigating human behaviour. It aligns with key legislation like the Human Rights Act 1998 (particularly Article-8and Article-14), and the Mental Health Code of Practice 2015.
Most importantly, PBS is kind, humane, and effective. Because it is focused on improving quality of life, Positive Behaviour Support can have a profound and lasting impact on people.
PBS is used across many professional settings, not just in social care. This is because it is person-centred, easy to implement, and values respect and dignity.
What is in a Positive Behaviour Support Plan?
A PBS plan identifies what skills the person supported needs to learn, and how those skills can be developed. It is a collaboration between the person it is for, the PBS practitioner, family members and other involved people, like social care professionals.
Typically, a Positive Behaviour Support plan includes:
- The person’s strengths
- Their likes and dislikes
- Common behaviours with personalised explanations
- Warning signs of behaviours of concern
- Proactive, active, reactive strategies to common behaviours and the first and last resorts
- Post-incident support for both the person and staff or family
Creating a Positive Behaviour Support Plan
Creating a PBS plan is a collaborative process that should always have the person supported at the heart. Family members will also contribute, along with other people in their support network, like teachers, social workers, and doctors, who make valuable contributions, too. This ensures that the plan is applied consistently in all the places that the person could be exposed to triggers.
- Identify the person’s strengths
- Evaluate the data
- Find out the function of the behaviour of concern
- Identify which skills will meet the person’s needs in a safer way
- Make a plan to teach those skills
- Evaluate progress regularly
- Review and revise as necessary
The Principles of Positive Behaviour Support
Consent and collaboration: the person is in control of how they are supported and involved in developing their PBS plan. Their plan will include the people who are important to their quality of life, like family, teachers and even people in the community, perhaps at a local shop or club.
Person-centred approach: Plans are tailored to the specific needs of the person, focusing on their strengths and coaching them in the skills they need to improve their quality of life.
Positive reinforcement: encouraging positive behaviour through praise, rewards, and engagement.
Proactive prevention: implementing proactive strategies to decrease exposure to triggers. An example of this is making sure the route taken for a walk is quiet if the person does not like dogs.
Assessment-based: studies in human behaviour have established the relationship between triggers (antecedents), behaviour and consequences. Positive Behaviour Support starts with a functional assessment to understand what triggers there are and continuously evaluates progress to ensure that strategies are effective.
Outcome-focused: understanding what a good life looks like for the person supported and equipping them with the skills to achieve it. Ensuring that the people in their support circle understand their needs and skills, so that the person has a consistent experience.
Understanding behaviour
Behaviour is a way of communicating a person's wishes and needs – every human being exhibits behaviour, and much of it is involuntary or instinctive. For example, we recognise someone drumming fingers as a sign of impatience, which may make us hurry up in response.
We also exhibit behaviour in response to environmental stimuli, like visiting a busy supermarket. It might overload your senses with noise, cause frustration because your movement is limited, and make it difficult to do your shopping. So, you could decide to come back later when it is quieter, wear noise-cancelling headphones, or even go to a different shop or order online to be delivered. These are strategies that help meet your needs.
Positive Behaviour Support is about developing skills so that people learn safe strategies to meet their needs in response to what is happening around them.
Functions of behaviour
The four functions of behaviour are:
Sensory: any behaviour that is stimulating by itself. For example, scratching an itch or fiddling with something. Everyone engages in sensory behaviours; they are not unique to autistic people.
Escape: a way to retreat from a situation or avoid an activity. For example, wearing headphones on public transport to avoid talking to people.
Attention: done to get a response from someone else, like shouting.
Tangible: to get an object or go to do an activity. For example, walking over to the car to go out.
All behaviours fit at least one of the categories and sometimes more than one. By understanding its function, support workers, friends, and family are better equipped to respond appropriately to the behaviour of a person with a learning disability.
How is behaviour assessed?
A Functional Behaviour Assessment is a process used to identify why behaviours happen; why someone behaves in a certain way and, in particular, what reliably predicts that behaviour occurring. These are called antecedents or triggers.
The assessment will look at how the person interacts with the different environments that are part of their life, like home, school or college, and their local neighbourhood. Understanding the functions of behaviours, in particular behaviours of concern, means the PBS practitioner can identify what strategies best meet the person’s needs in a safer way.
Understanding the Behaviour Escalation Cycle
A person is usually referred to a Positive Behaviour service because their behaviour is negatively impacting their quality of life and that of their family and others in their community. This is often due to the person exhibiting behaviours of concern. Those behaviours are the person’s learned or instinctive response to their triggers.
There are several models of escalation cycle, which all follow the same principles:
- Baseline: Calm behaviours.
- Trigger phase: The person is exposed to antecedents that cause a move away from calm behaviour.
- Agitation: Observable behaviours of discomfort increase.
- Acceleration: Behaviours escalate significantly, potentially including aggression, threats, or self-harm.
- Peak: The behaviour reaches its most intense level, often involving extreme distress or physical aggression.
- De-escalation: The behaviour gradually subsides.
- Recovery: The person returns to a calmer state.
Careful observation of the person by their practitioner means that strategies can be implemented in response to behaviours, depending on where they are in the cycle of escalation. The aim is to move into the de-escalation and recovery phases as soon as possible.
Stages of Positive Behaviour Support
PBS strategies are tailored to each person’s needs and applied depending on where they are in the behaviour escalation cycle.
Proactive: These are the strategies that keep the person in positive behaviours, the ones that meet their needs in the safest way. The PBS Practitioner collaborates with the person supported in a proactive way to address potential triggers before they arise. For example, the practitioner uses a now and next board to inform the person of what will be happening.
Active: Active strategies are used during a behaviour, to redirect or de-escalate it. This could be as simple as offering the person choices or implementing calming techniques.
Reactive: Reactive strategies are implemented when a person has escalated to peak behaviour or crisis. They support the person to de-escalate safely as soon as possible.
Movement through the behaviour escalation cycle is normal for everyone. It’s important for families to understand that reaching crisis isn’t a failure; while Positive Behaviour Support is very successful, it is not a linear process, and people will have better days and worse days.
The principle of Positive Behaviour Support is that it primarily works in the positive, using proactive strategies. This means the function of the behaviour of concern is not needed but, if it does occur, the plan includes effective strategies to de-escalate safely. Strategies are created bespoke to the person’s needs.
By understanding the behaviour escalation cycle, the practitioner can improve the person’s skills, and therefore their quality of life, which means that behaviours of concern are naturally reduced.
De-escalation following crisis
If a person reaches a peak in the escalation cycle, when reactive strategies are used, the PBS practitioner will move back to active strategies as the person starts to de-escalate. At this point, the person remains very susceptible to triggers, so it is important to monitor them and work with them using active strategies to support them in returning to baseline. Some people also experience post-incident depression before being at baseline.
Baseline is important, as it is the only state where someone can learn – something that again is true for all people. This is why early stages of behaviour support focuses on things like environmental changes that reduce or eliminate exposure to triggers, so the person is at baseline and receptive to learning new skills.
Baseline is important, as it is the only state where someone can learn – something that is true for all people.
What are behaviours of concern?
Behaviours of concern are any behaviours that have the potential to be detrimental to the safety and well-being of the person exhibiting the behaviour, or of those around them.
When talking about PBS, the term behaviours of concern is often used. What this really means is behaviours that are unsafe or unsettling for the person or, very often, that are unsafe or unsettling for others. It’s important to remember that someone exhibiting behaviours of concern is not giving someone else a hard time – they are having a hard time. They have learned that the behaviours bring them relief from a trigger.
Behaviours of concern can have a huge impact on quality of life, both of the person exhibiting the behaviour, and people around them. In the worst cases, it can put the person at risk of admission to residential care. Positive Behaviour Support aims to reduce the frequency, intensity and duration of behaviours of concern, and give the person new skills to respond to their environment in a way that is safer for them.
By ensuring they and their support network (like family, school and health teams) have the right skills to improve their quality of life, behaviours of concern naturally reduce.
What are the triggers for behaviours of concern?
There are many different triggers for behaviour of concern, and some are unique to a person. Triggers are not always the same, even for the same or similar behaviour.
Common triggers for behaviour of concern include:
- Feeling unsafe or scared
- Pain or feeling unwell
- Sensory overload or overstimulation
- Being misunderstood or ignored
- Having to wait too long or being rushed
- Something bringing up a bad memory
What is “challenging behaviour”?
Challenging behaviour is another name for behaviours of concern. We don’t use this term anymore because it is not a person-centred approach and instead reflects the experience of external people. It also suggests that there is an element of defiance about the behaviour and that it is in the person's control.
An empathetic approach like Positive Behaviour Support recognises that the behaviours are often a learned response to specific stimuli, and therefore a safer alternative response can be learned to improve quality of life.
What training is there for Positive Behaviour Support?
Being a Positive Behaviour Support practitioner is an interesting and rewarding career that offers good opportunities for progression. At entry level, you do not usually need a qualification or experience, and many organisations fund recognised qualifications for staff.
Qualifications start at BTEC Level 4, which can be done at some universities or distance learning with BILD. You can then go on to complete a Level 5 in Positive Behaviour Support.
There are several options for postgraduate level qualification. Northumbria University offers Level 6 and 7 in Positive Behaviour Support, courses which also cover leadership. The Tizard Centre at University of Kent, offers a Masters in Positive Behaviour Support, as does Galway University.
PBS can be studied on campus or distance learning at many universities. Several others offer a Masters in Applied Behaviour Analysis which is more data-driven and data-focused than PBS.
Once someone has achieved their Masters, they can go on to do supervised competencies and become UK Behaviour Analyst certified. The UKSBA is the regulatory body for the profession.
People who are appointed at practitioner level are normally required to study the BTEC Level 4 as a minimum, and many employers fund that study.