This Positive Behaviour Support (PBS) Policy establishes the framework for understanding and supporting people whose behaviour may challenge within ‘s domiciliary care services. PBS is a person-centred, values-based approach that focuses on understanding the reasons behind behaviour, improving quality of life, and reducing the need for restrictive practices. This policy aligns with CQC’s Right Support, Right Care, Right Culture guidance, the PBS Competence Framework, and NICE guidelines (NG11, NG93, CG142).
1.2 Application
This policy applies to all employees, agency workers, contractors, and volunteers involved in providing care. It is particularly relevant to the support of autistic people, people with learning disabilities, people with dementia, and anyone who may display behaviour that challenges.
1.3 Policy Ownership and Review
This policy is owned by the Registered Manager () who has overall accountability for ensuring PBS is embedded in practice. The policy is reviewed annually or following significant incidents, changes in guidance, or CQC recommendations.
2. Legal and Regulatory Framework
Legislation/Regulation
Requirements
CQC Right Support, Right Care, Right Culture
Statutory guidance for services supporting autistic people and people with learning disabilities. Focuses on maximising choice, control, and independence.
PBS Competence Framework
UK framework developed with CQC setting out competencies for delivering effective PBS across three levels.
NICE Guideline NG11
Challenging behaviour and learning disabilities: prevention and interventions.
NICE Guideline NG93
Learning disabilities and behaviour that challenges: service design and delivery.
Mental Capacity Act 2005
Framework for decision-making for those lacking capacity. All behaviour support must follow MCA principles.
Human Rights Act 1998
Right to dignity, liberty, and freedom from degrading treatment.
CQC Regulation 9 (Person-Centred Care)
Care must be appropriate, meet needs, and reflect preferences.
CQC Regulation 13 (Safeguarding)
Protection from abuse and improper treatment including inappropriate restraint.
Restraint Reduction Network Standards
Training standards for restrictive practice. All training must be RRN certified.
3. PBS Principles and Values
Principle
Application
Person-Centred
The person is at the centre of all support. Their views, wishes, and communication needs shape the approach.
Understanding Function
All behaviour serves a purpose. Understanding why behaviour occurs is essential to developing effective support.
Quality of Life Focus
The primary goal is improving quality of life, not just reducing behaviour.
Rights-Based
Human rights are central. People have the right to dignity, choice, and freedom from degrading treatment.
Proactive Not Reactive
Focus is on preventing behaviour by addressing needs, not just responding to incidents.
Least Restrictive
Any intervention must be the least restrictive option. Restrictive practices are reduced wherever possible.
Capability Building
Support teaches new skills rather than just managing behaviour.
4. Definitions of Key Terms
Term
Definition
Positive Behaviour Support
Person-centred framework for understanding and supporting people who display behaviour that challenges. Focuses on quality of life and reducing restrictive practices.
Behaviour that Challenges
Behaviour of such intensity, frequency, or duration that physical safety is at risk, or behaviour likely to seriously limit access to community facilities.
Functional Assessment
Systematic process to understand the purpose behaviour serves for the person. Identifies triggers and communicative intent.
Behaviour Support Plan
Written document detailing proactive and reactive strategies based on functional assessment.
Primary Prevention
Strategies that address underlying needs and improve quality of life to prevent behaviour occurring.
Secondary Prevention
Early intervention when warning signs are observed to prevent escalation.
Reactive Strategies
Planned responses when behaviour occurs to keep everyone safe. Must be least restrictive.
Active Support
Evidence-based approach to enabling engagement in meaningful activity throughout the day.
Capable Environment
Environment providing the physical, social, and organisational conditions needed for high-quality PBS.
5. Policy Statement
5.1 Commitment
is committed to delivering high-quality Positive Behaviour Support that improves people’s lives and reduces the need for restrictive practices. We recognise that behaviour is communication and that understanding why behaviour occurs is essential to providing effective support.
5.2 Core Commitments
Understanding Behaviour: We seek to understand the function and meaning of behaviour, recognising it as communication of unmet needs.
Quality of Life: The primary outcome is improved quality of life, not just behaviour reduction.
Prevention Focus: We prioritise proactive, preventive strategies that address underlying needs.
Reducing Restrictive Practices: We actively work to minimise and eliminate restrictive practices.
Skilled Workforce: Staff are trained and competent in PBS, with access to specialist support.
Collaboration: Behaviour support is developed collaboratively with the person and their family.
6. Roles and Responsibilities
Role
Responsibilities
Registered Manager
Overall accountability for PBS. Ensure PBS is embedded in culture. Commission specialist input. Monitor quality of BSPs.
PBS Lead/Coordinator
Lead PBS practice. Coordinate functional assessments. Develop and review BSPs. Provide coaching to staff.
Care Coordinators
Ensure BSPs are in care plans. Monitor implementation. Support staff. Identify when specialist input needed.
Monitor for safeguarding concerns related to behaviour support. Review restrictive practice use.
7. Procedures
7.1 Assessment and Functional Analysis
Understanding behaviour begins with comprehensive assessment including life history, preferences, communication, health, and relationships. Functional assessment identifies triggers, maintaining factors, and what function behaviour serves. For complex presentations, specialist functional assessment is commissioned.
7.2 Behaviour Support Planning
Behaviour Support Plans include: who the person is and what matters to them, analysis of what behaviour means, primary prevention strategies, secondary prevention strategies, reactive strategies (least restrictive), and skill teaching. BSPs are written accessibly and reviewed regularly.
7.3 Primary Prevention
Primary prevention includes creating capable environments, ensuring good health, providing meaningful activity (Active Support), supporting communication, building relationships, providing predictability, addressing sensory needs, and ensuring choice and control.
7.4 Secondary Prevention and De-escalation
When warning signs appear, staff use agreed strategies including changing demands, offering preferred activities, calming approaches personalised to the individual, providing space and time, and validating feelings. De-escalation is always attempted before reactive strategies.
7.5 Reactive Strategies
Reactive strategies are used only when necessary, must be least restrictive, proportionate, for minimum time, documented in BSP, and reviewed after every use. Restrictive practices require authorisation and are subject to the Restrictive Practices Policy.
7.6 Review and Evaluation
BSPs are reviewed quarterly minimum or following incidents. Reviews consider behaviour reduction, quality of life improvement, restrictive practice reduction, and adjustments needed. The person and family are involved in reviews.
8. Training and Development
Training is provided at three levels aligned with the PBS Competence Framework. All staff receive foundation PBS training. Staff in specialist roles receive enhanced training in functional assessment and BSP development. Physical intervention training is RRN-certified and minimised to those who need it.
9. Monitoring and Review
PBS quality is monitored through BSP audits using the Behaviour Support Plan Content Appraisal Tool (BSP-CAT), observation of practice, incident analysis, quality of life monitoring, and feedback from people supported. The CQC Quality of Life Framework informs evaluation. This policy is reviewed annually.
10. Reporting Concerns
Anyone with concerns about PBS practice must report to the Registered Manager or Safeguarding Lead. The whistleblowing procedure is available for serious concerns. All concerns are investigated and used to improve practice.
11. Related Policies
This policy should be read with: Restrictive Practices and Restraint Reduction Policy, Safeguarding Adults Policy, Mental Capacity and Best Interests Policy, Person-Centred Care Policy, and Incident Reporting Policy.
Document Control
Policy Title
Positive Behaviour Support Policy
Version
2.0
Policy Owner
Registered Manager
Appendix A: Behaviour Support Plan Summary
BEHAVIOUR SUPPORT PLAN SUMMARY
SECTION 1: ABOUT ME
Name:
Date of Birth:
Plan Date:
Review Date:
What’s important to me / What I like:
How I communicate:
SECTION 2: UNDERSTANDING MY BEHAVIOUR
Description of behaviour:
What this behaviour means / Function:
Triggers:
Early warning signs:
SECTION 3: PRIMARY PREVENTION
Environmental strategies:
Activity and engagement strategies:
Communication strategies:
SECTION 4: SECONDARY PREVENTION (De-escalation)
De-escalation strategies that work for me:
SECTION 5: REACTIVE STRATEGIES
How to keep everyone safe (least restrictive):
What NOT to do:
After the incident – how to support me:
SECTION 6: SIGN-OFF
Developed by:
Person’s involvement:
Family involvement:
Manager approval:
Date:
Appendix B: PBS Quality Audit Checklist
PBS QUALITY AUDIT CHECKLIST
Service User:
Auditor:
Date:
BSP QUALITY CRITERIA
Criteria
Yes
No
N/A
BSP is in place and current
BSP is based on functional assessment
Primary prevention strategies detailed
De-escalation strategies included
Reactive strategies are least restrictive
BSP developed with person/family
Staff can describe key strategies
Evidence of behaviour reduction
Evidence of quality of life improvement
OVERALL ASSESSMENT
Rating: ☐ Good ☐ Requires Improvement ☐ Inadequate
