What professionals can do

Several elements need to be in place for positive behaviour support (PBS) to be delivered appropriately and to be considered 'positive behaviour support'.

On this page, you will find information that you can start putting in place to help with behaviour which challenges. They are:

Capable environments

The following can help improve capable environments for individuals:

Relationships and positive social interactions

The support and care providers like the person and they are interacted with frequently in ways the person enjoys and understands.

Support for communication

The person is interacted with in ways they understand and others notice, interpret and respond to their communication.

Support for meaningful activity and skill development

Assistance is tailored to help the person participate in preferred activities, including recreational and social and they are supported to learn new skills and experiences. 

Consistent and predictable environments

Carers support the person consistently, so regardless of who is caring for the individual, the support experienced is similar. Carers use a range of communication and other approaches tailored to the individual, such as visual timetables and regular routines, to ensure that the person understands as much as possible about what is happening and about to happen.

Skilled, mindful staff and carers

Support or care providers understand the general causes of behaviours which challenge, such as a functional need, slow and fast triggers and reinforcing consequences, and the specific causes of the persons behaviour and do not take it personally. They reflect on, and adjust, their support to prevent and quickly identify circumstances that may provoke behavioural challenges. 

Effective organisational context

Support provided by carers is delivered and arranged within a broader understanding of behaviour which challenges that recognises (among other things) the need to ensure safety and quality of care for both individuals and carers.

Effective management and practice leadership

Staff are supported by leaders with practice skills and by managers who recognise that behaviours of concern are less likely when staff are well managed and supported. Care and support providers are aware of the impact of their own wellbeing on the individual's behaviours.

View the Medway Healthy workplace programme and employers guide.

Find out more about mental wellbeing.

Support to maintain health

Care and support providers are attentive to the person’s healthcare needs, identifying pain/discomfort and being aware of behavioural challenge is more likely to occur when a person is unwell or in pain.

Support to maintain relationship

Carers understand the importance of family, and the significance of relationships with others. Carers actively support all such relationships while being aware of the risks that sometimes arise in close or intimate relationships.

Suitable physical environment

The person’s environment meets their needs in respect of space, sensory preferences, noise, light, stimulation & support and care providers are aware that behaviours of concern are less likely when the environment is right.

Provision for choice

Carers ensure that the individual is involved as much as possible in deciding how to spend their time and the nature of the support they receive.

Independent functioning

Carers support the individual to learn new skills, to try new experiences and to take more responsibility for their own care, safety and occupation.

Martin Selligmans PERMA model

Think about how you can increase an individuals healthy sense of well being, fulfilment and life satisfaction through Martin Selligmans PERMA model:

  • Positive emotion - feeling good about something. Optimism and enjoyment through intellectual stimulation and creativity.
  • Engagement - when someone is fully immersed, engrossed or a sense of 'flow' or the feeling of time flying by.
  • Relationships - having meaningful relationships and connections. We have a natural desire to want to be connected and be part of a group.
  • Meaning - a sense of purpose having a reason for why you exist to drive fulfilment.
  • Accomplishment - when we achieve something we feel a sense of pride and want to continue to do more. A sense of accomplishment makes us feel good.

Active support

Active support is a way of providing help to people which focuses on making sure they are engaged and participating in all areas of life.

The four main parts of active support are:

  1. Every moment has potential: using the activities that need to be done, such as day to day choirs, and activities which are available to do (such as visiting friends, going for a swim or an educational course) to support people to be engaged throughout the day.
  2. Little and often: breaking activities and relationships down into a series of steps and identifying parts the person can do for themselves, parts which can be done with help and what needs to be done for them. This enables people to be involved in ways that work for them, perhaps in small parts or spread over time.
  3. Graded assistance: providing the right amount and type of support at the right time. Too much may mean the person is ‘over-supported’, hindering their independence. Too little and they will fail.
  4. Maximising choice and control: looking for opportunities around relationships and activities for the person to express their preferences, then listening to and acting upon this to enable the person as much control as possible.

Find out more about active support.

Understanding behaviour

Every behaviour happens for a reason.

Think about the function or the motivation

Is it for a form of social attention, to escape or avoid something, such as escaping a demand, a particular sensory stimulation or a person, or to get something tangible (a particular person or item) or to meet a sensory need?

Consider triggers and antecedents

These are the things that happen before the behaviour. A slow trigger is something building in the background that makes the behaviour more likely to happen. And a fast trigger is the thing that sets something off instantly.

Consider the behaviour itself and what happens afterwards

This does not necessarily mean 'how is the behaviour punished?'. But what is happening directly afterwards that may be reinforcing or promoting that behaviour, such as the individual is given an item or sent to away? This reinforcing does not have to happen every time for the individual to continue with that behaviour. However, if the thing they want to happens some of the time (or all of the time) they are more likely to continue engaging in the behaviour. 

Total communication

Create a system of communication that works for the individual. You can do this by:

  • using any means to communicate with or allow the individual to communicate 
  • developing a best-fit system of communication to allow the individual to communicate, utilising strengths and skills 
  • ensuring the individual has some means of communication 
  • assisting and facilitating, providing supports and opportunities so that the individual can be involved. 

Examples of communications include:

  • non-verbal - such as eye pointing, breathing patterns and body movements
  • language-based communication - such as speech, braille, British sign language and hand over hand sign
  • symbol systems - such as picture exchange communication system (PECS), pictures and photographs.

Positive risk taking

Focus on what the individual can do rather than what they can't do. Are the risks of the activity greater than the risks of inactivity or loss of skills/independence? Consider these risks and benefits alongside the individuals needs and preferences.

Think about what could go wrong and plan for what to do if it does so that everyone involved has confidence the risk is worth taking. This involves using a carefully thought-out strategy for managing a specific situation or set of circumstances. This can enable positive benefits by enabling individuals to take part in something that may be taken for granted by someone else. 

Supporting someone to take risks can help them to gain self-confidence and take responsibility for their life and choices. 

A person-centred approach to risk assessment provides the individual with the tools to become informed and understand the potential consequences of their decisions, how to minimise risks and then decide based on what is important to them and what is needed to keep them safe. Support an individual to recognise potential risk in different areas of their life and to balance choices with their own and others’ health, safety and wellbeing

Bates and Silberman (2007) suggest seven criteria that person centred risk management should follow:

  • Involvement of service users and relatives in risk assessment - all key individuals in that persons life, including themselves to father information and discuss the element of risk and possible solutions to mitigate the risk
  • Positive and informed risk taking - creative solutions, utilising the persons strengths
  • Proportionality - consider the consequences of not taking the risks and what that would mean to the person
  • Contextualising behaviour - look at the history of the individual and how they have previously responded to consider the best way to support them
  • Defensible decision-making - ensure explicit and justifiable rationale for the risk management decisions. Gain evidence of the discussions, decisions made and references to legislation, for example the Human Rights Act
  • A learning culture - evaluates what is working and what is not and continuingly developing the risk assessment
  • Tolerable risks - taken to improve a person’s quality of life, happiness or self-esteem, whilst making them as safe as possible.

Trauma informed

An organisational transformation model that improves awareness of trauma and its impacts, supports services to consider and put in place appropriate support, and prevents re-traumatising those accessing or working in services

Adverse Childhood Experiences (ACE): refers to some of the most intensive and frequently occurring sources of stress that children may suffer early in life. Such experiences include:

  • multiple types of abuse
  • neglect
  • violence between parents or care-givers
  • other kinds of serious household dysfunction such as alcohol and substance abuse
  • peer, community and collective violence.

Exposure to multiple ACE is associated with health harming behaviours and physical and mental health conditions in adulthood.

Community presence

  • Enabling individuals to be part of the community, such as using active support
  • Identify and create opportunities for social inclusion
  • Develop strategies for developing, nurturing and maintaining relationships.

More information and additional support

For more information around positive behaviour support and understanding behaviour which challenges look at our free e-learning page.

To hear more about PBS, other positive strategies and to help improve the support that individuals with learning disability, autism or complex needs receive, join the Positive Behaviour Support Community of Practice.

Positive Behaviour Support Community of Practice is a supportive community who share and learn from others with experience around learning disability and autism either through working with, supporting and caring for, or any other experience. 

If you're unable to attend or you missed a session, you can watch the recorded videos on the Community of Practice page. Videos are also applicable to children without additional needs.

You may also be interested in: