Positive behaviour support

Also called PBS, Positive behavioural support, Functional assessment, Behaviour support plan

PBS starts from the fact that behaviour is communication, and treats giving the person a better way to say it as the first intervention, not the last.

What it is

Positive behaviour support is a framework for understanding behaviour that others find challenging, working out what it does for the person, and changing the environment and the person's skills so the behaviour is no longer needed. It grew out of applied behaviour analysis and the person-centred movement, and in the UK it is the approach national policy expects services for people with a learning disability or autism to use instead of restraint and medication. BILD and the PBS Academy publish the UK competence framework.

Its central claim is that behaviour has a function: it gets something, avoids something, or communicates something, and often all three. A person who hits out when a carer starts washing them is saying something. PBS asks what.

Who it can help

People with a learning disability, autistic people, people with dementia and people with brain injury whose behaviour puts them or others at risk or is leading to restrictive practice: restraint, seclusion, sedation, exclusion, a move to a hospital. Also the staff and families around them, because PBS is done with the whole team.

It is not a punishment system and it is not compliance training. PBS done as "reward the good, ignore the bad" without a functional assessment is not PBS. And it is not a reason to delay AAC: if the assessment finds the behaviour communicates, the communication system is the intervention, and it starts now.

How it works

A functional assessment gathers what happens before the behaviour, what the behaviour is, and what happens after, across enough situations to see the pattern, and reaches a hypothesis about function. Then a behaviour support plan sets out primary prevention (changing the environment, the routine, the demands, the sensory load, so the trigger is rarer), skill teaching (a better way to get the same result, which for communication means functional communication training: teaching a sign, a symbol, a device message that works faster than the behaviour), and reactive strategies (what to do safely when it happens anyway).

The plan is reviewed with data, the person's own view is sought in their mode, and the aim is a better life, measured in things like more choice, more activity and less restriction, not just fewer incidents.

Getting started

If a person you support has a behaviour that worries you, keep a simple record for two weeks: time, what was happening just before, what they did, what happened next. The pattern often appears on its own. Then ask what the person was trying to say and whether they had any other way to say it.

Give them that way this week, without waiting for the plan. If hitting out means "stop", teach a stop card or a stop button on the device and honour it every single time it is used, even when it is inconvenient. If throwing means "I want a break", give a break card and grant breaks. The Talk board's needs and feelings sets carry stop, break, help, hurt and don't want, and they speak aloud, which gives a person a signal that carries across the room as reliably as a shout. Ask the service for a PBS-trained practitioner and for the plan to name the communication method.

Where to get help

BILD publishes the UK PBS competence framework and trains staff and families. Mencap and the National Autistic Society explain PBS to families and challenge its misuse. Ambitious about Autism works on it in schools. NICE guidance on challenging behaviour and learning disabilities sets the clinical expectation. See also behaviour as communication and meltdowns and shutdowns.