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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Positive Behaviour Support and Managing Aggression Policy

1. Purpose

The purpose of this policy is to provide clear guidance on promoting positive behaviour and managing aggression within {{org_field_name}}’s Supported Living Service. It aims to ensure that service users receive care and support in a manner that promotes dignity, respect, safety, and person-centred care while safeguarding the rights of all individuals.

This policy is rooted in the principles of Positive Behaviour Support (PBS), which prioritises understanding the underlying causes of behaviour rather than reacting to incidents. Our approach ensures that interventions are evidence-based, proactive, and designed to enhance the quality of life for service users, while minimising the need for restrictive practices.

This policy is aligned with CQC Regulation 9 (Person-Centred Care)​, Regulation 10 (Dignity and Respect)​, and Regulation 13 (Safeguarding Service Users from Abuse and Improper Treatment)​. It reflects the requirements of the Health and Social Care Act 2008, the Care Act 2014​, and the Mental Capacity Act 2005.

2. Scope

This policy applies to all staff employed by {{org_field_name}}, including agency workers, contractors, and volunteers who interact with service users. It covers the promotion of positive behaviour, understanding the causes of challenging behaviour, the prevention and de-escalation of aggression, and the safe and ethical management of incidents when they arise.

It also applies to all service users who receive care and support within our service, ensuring that any interventions are tailored to their individual needs and preferences, as outlined in their care and support plans.

3. Our Approach to Positive Behaviour Support

Right support, right care, right culture and culture of care

• Commitment to capable environments, community inclusion, meaningful activity, avoiding institutional/controlling practice
• Leadership expectations and “everyone’s responsibility” for proactive support
• Link to governance (Reg 17) and workforce capability (Reg 18 Staffing)

3.1 Promoting Positive Behaviour

At {{org_field_name}}, we adopt a strengths-based, person-centred approach to promote positive behaviour. This involves understanding each individual’s needs, preferences, and communication styles to create supportive environments that reduce triggers for challenging behaviour.

We believe that all behaviour serves a purpose and is often a form of communication. Therefore, our approach focuses on identifying the root causes, whether they relate to unmet needs, environmental factors, or emotional distress. Staff are trained to use proactive strategies, such as clear communication, structured routines, and promoting choice and control, to create a positive and predictable environment.

3.2 Person-Centred Care Plans

Every service user has a detailed, person-centred care plan that includes a Positive Behaviour Support (PBS) plan. This plan is developed in collaboration with the individual, their family, and relevant professionals. It includes:

• A comprehensive behaviour assessment, identifying triggers and antecedents.
• Personalised strategies to promote positive behaviour and prevent incidents.
• De-escalation techniques that respect the individual’s dignity and preferences.
• Clear guidance on how staff should respond if behaviours escalate.

The care plan is regularly reviewed, ensuring it remains relevant and responsive to changing needs. Staff receive training in PBS to ensure they can implement strategies effectively and sensitively.

Review and update frequency: PBS plans will be reviewed at least every 3 months, and immediately after:

• any serious incident, injury, safeguarding concern, or use of restrictive intervention,
• a significant change in presentation/health/medication, or
• where monitoring indicates strategies are not effective.

Reviews will include the person (and their representative where appropriate), and will be recorded with clear actions, responsibilities, and timescales.

3.3 Proactive Prevention

Our service places strong emphasis on prevention. This includes ensuring that service users’ physical, emotional, and social needs are met, reducing the likelihood of challenging behaviour. Staff are trained to identify early warning signs and respond promptly to prevent escalation. This includes:

• Monitoring for signs of distress, discomfort, or anxiety.
• Providing meaningful activities and promoting social inclusion.
• Ensuring effective communication, including the use of visual aids or alternative communication methods when needed.
• Creating a calm, predictable environment with clear routines.

3.4 Functional Behaviour Assessment (FBA)

Where a person displays (or is at risk of) behaviours of distress, we will complete a functional behaviour assessment to understand the function/purpose of the behaviour and identify proactive supports that improve quality of life.

The FBA will be proportionate to risk and may include:

• ABC analysis (Antecedents–Behaviour–Consequences), identifying triggers, early warning signs, and maintaining factors.
• Review of communication needs, sensory profile, environmental factors, trauma history (where appropriate), physical health, medication effects, sleep, and pain.
• Discussion with the person (using accessible communication), family/advocates, and relevant professionals.
• Where required, involvement of a suitably skilled professional (e.g., PBS practitioner/psychology/behaviour specialist).

The outcome of the FBA is a clear hypothesis (what the behaviour is communicating/achieving) and a set of primary prevention strategies to reduce the likelihood of recurrence.

PBS plans must include: primary prevention, secondary/early intervention, reactive strategies (last resort), and post-incident learning

A statement that reactive/restrictive measures are not the plan—they are contingency only

4. Managing Aggression and Challenging Behaviour

4.1 De-escalation Techniques

When an individual displays aggressive behaviour, staff are trained to respond calmly, maintaining a non-threatening posture and using de-escalation techniques. These include:

• Speaking calmly and clearly, using non-confrontational language.
• Providing space and allowing the person time to calm down.
• Redirecting attention to positive activities or interests.
• Offering choices to give the individual a sense of control.

Our approach prioritises de-escalation to avoid the need for restrictive practices. Staff are trained to understand the importance of empathy and reassurance in calming situations.

4.2 Minimising the Use of Restrictive Practices

 Restrictive practices, such as physical restraint, are only ever used as a last resort when there is an immediate risk of harm to the individual or others. Any use of restrictive practices must be:

• Proportionate to the risk presented.
• The least restrictive option available.
• Used for the shortest time possible.
• In line with the individual’s PBS plan and agreed by all stakeholders.

Staff are trained in non-restrictive crisis intervention techniques, ensuring that any intervention upholds the dignity and rights of the individual. Any use of restrictive practices is documented, reported, and reviewed to identify learning opportunities and reduce future occurrences.

4.3 Post-Incident Support

 Following any incident of aggression, {{org_field_name}} ensures a thorough debriefing process for both the service user and staff involved. This includes:

• Checking the wellbeing of all individuals involved.
• Discussing what happened and identifying triggers.
• Reviewing the individual’s PBS plan and care plan to update strategies.
• Providing emotional support and reflective practice for staff.

Service users are supported to express their feelings and needs in a safe, supportive environment. This helps build trust and promotes resilience.

4.4 Restrictive Practices: Definitions, Authorisation, and Reduction

We define restrictive practice as any intervention, rule, or control that limits a person’s rights, choices, privacy, liberty, or freedom of movement. This includes (but is not limited to): physical restraint, mechanical restraint, chemical restraint (including PRN medication used to manage behaviour), environmental restrictions, covert medication, continuous supervision, restricted access to possessions/areas, and blanket rules that are not based on individual assessment and need.

Our commitment
We are committed to reducing and, wherever possible, eliminating restrictive practices through proactive Positive Behaviour Support (PBS), capable environments, meaningful activity, trauma-informed and person-centred approaches, communication support, reasonable adjustments, and addressing underlying health and wellbeing needs. Restrictive interventions are used only as a last resort to prevent foreseeable harm and are never used as a routine response to behaviour that challenges.

General rules

• Restrictive interventions are never used as punishment, for staff convenience, to enforce compliance, or because of staffing shortages.
• Any restriction must be lawful, necessary, proportionate, evidence-informed, least restrictive, and used for the shortest time possible, with a clear rationale.
• Blanket restrictions are not permitted. Any restriction must be individualised, documented, and based on assessment (including a human rights impact consideration).
• Restrictions must be incorporated into an individual plan (PBS plan/care plan/risk assessment), with clear guidance on who can authorise, when it can be used, how it will be monitored, and how it will be reduced.
• Any restriction must include a reduction plan (how we will step it down), and a review timetable to support restraint reduction and promote quality of life.
• We prioritise primary prevention (quality-of-life and environmental changes) and early intervention strategies. Reactive restrictive interventions are contingency measures only.

Consent, Mental Capacity Act, and best interests

• We will seek the person’s informed consent wherever they have capacity and ensure information is provided in an accessible way (including communication aids, interpreters, and reasonable adjustments).
• Where capacity is in doubt, we will carry out a Mental Capacity Act (MCA) 2005 capacity assessment. If the person lacks capacity, we will make a best interests decision, involving the person as far as possible and consulting family/advocates and relevant professionals as appropriate.
• Where restrictions may amount to a deprivation of liberty, we will obtain the appropriate legal authorisation. This means applying for a DoLS authorisation where applicable and ensuring our processes transition to the Liberty Protection Safeguards (LPS) when/if commenced, with staff training and documentation updated accordingly.
• We will ensure restrictive practice decisions are compatible with human rights principles (including dignity, autonomy, and least restrictive options) and are subject to robust oversight and review.

PRN medication (chemical restraint) and STOMP principles

• PRN medication for behaviour will only be used where it is clinically prescribed, clearly documented with indications, maximum doses, contraindications, side effects, and monitoring requirements, and incorporated into the PBS plan and medication plan.
• We apply STOMP principles: psychotropic/PRN medication is not used as a substitute for PBS and will never be used as a punitive measure or for staff convenience.
• Any PRN administration triggers review of potential underlying causes and contributory factors, including known triggers, physical health needs (for example pain, infection, constipation, sleep disturbance), mental wellbeing, sensory processing needs, communication needs, trauma history where known, and environmental or social contributors.
• All PRN use will be recorded, reviewed, and used to strengthen proactive and early-intervention strategies. We will support regular prescriber review (and pharmacy input where appropriate) to assess effectiveness and side effects and to agree reduction or discontinuation plans where safe and clinically appropriate.

Recording, monitoring, and review

• All restrictive interventions will be recorded immediately (what happened, antecedents/triggers, de-escalation attempted, rationale, type of restriction used, duration, who authorised, impact/outcome, injuries/medical attention, and any follow-up required).
• The Registered Manager (or delegated responsible person) will review all restrictive interventions within 24 hours (or the next working day) to ensure the intervention was necessary and proportionate, confirm that recording is complete, and ensure learning is captured.
• Where restrictive interventions are used, we will complete a post-incident review and update relevant plans (PBS plan/care plan/risk assessment) to prevent recurrence, reduce reliance on restriction, and improve quality of life.
• We will monitor patterns and trends (frequency, duration, triggers, settings, and outcomes) and use governance systems to drive restraint reduction and improvements to training, staffing, environment, and care planning.

Prohibited practices

• We do not use pain-inducing techniques, aversive interventions, or any form of degrading, humiliating, or discriminatory treatment.
• We do not use seclusion unless it is explicitly risk-assessed, legally justifiable, agreed within a formal individual plan, and subject to enhanced oversight and review (and in most supported living contexts, this would not be used).
• We do not use blanket rules or restrictions that are not supported by individual assessment, risk assessment, and an explicit reduction plan.

5. Safeguarding and Reporting

All incidents involving aggression or behaviour that challenges are treated as potential safeguarding concerns. Staff are required to report incidents promptly through our incident reporting system to ensure appropriate, timely action is taken. This includes:

• Conducting a risk assessment and updating care plans and PBS plans as required.
• Notifying family members, advocates and/or commissioners where appropriate and in line with the person’s communication needs, consent and best-interest decision-making (where applicable).
• Notifying external agencies where required, including notifying the Care Quality Commission (CQC) without delay when an incident meets the notification thresholds under Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (Notification of other incidents).

Safeguarding procedures are followed in line with Regulation 13, ensuring that people are protected from abuse, avoidable harm and improper treatment. Any concerns are investigated promptly, thoroughly and proportionately, with actions taken to reduce recurrence and improve outcomes.

Where an incident constitutes a notifiable safety incident, we will comply with Regulation 20 (Duty of Candour) by acting in an open and transparent way with the person affected and/or their representative. This includes providing a clear explanation of what is known at the time, offering an apology where appropriate, keeping a written record of all communications and actions taken, and providing written follow-up information and updates in line with our Duty of Candour procedure.

Where a person or their representative is dissatisfied with how a concern is handled, they will be supported to use our Complaints Policy and to access independent advocacy where appropriate. Staff are also reminded of their right and duty to raise concerns under our Whistleblowing Policy. Safeguarding decision-making, actions and outcomes are recorded, reviewed and used to improve practice, including learning from incidents, reviewing restrictive practices, and strengthening proactive PBS strategies.

6. Staff Training and Support

To implement this policy effectively, all staff receive comprehensive training in Positive Behaviour Support, de-escalation techniques, and safeguarding. Training is delivered during induction and refreshed regularly to ensure competence. Staff are also trained in understanding the Mental Capacity Act 2005 and the importance of consent when implementing behaviour management strategies.

If any restrictive intervention techniques are trained, they must be delivered/quality assured to RRN Training Standards

Competency assessment, refresher frequency, scenario-based learning, post-incident reflective practice requirements

Supervision and reflective practice sessions are provided to support staff in managing challenging situations and promoting continuous improvement.

7. Promoting Dignity and Human Rights

Throughout our approach to positive behaviour support and managing aggression, {{org_field_name}} upholds the principles of dignity, respect, and human rights. Our practices are underpinned by the Equality Act 2010 and CQC Regulation 10​, ensuring that all individuals are treated fairly and without discrimination.

We adopt a least restrictive, rights-based approach, ensuring that interventions are proportionate and respectful. Where restrictive practices are considered, the decision-making process is transparent, documented, and regularly reviewed.

7.1 Equality, Inclusion, and Reasonable Adjustments

We provide PBS in a way that is inclusive and accessible. This includes:

• adapting communication (easy read, visual supports, social stories, objects of reference, Makaton/BSL support where appropriate),
• respecting cultural, religious, and linguistic needs, including dietary, gender preferences, personal space, and family involvement,
• making reasonable adjustments for disabled people, including sensory environments, routines, and accessible information.

Before introducing any new restriction or service-wide rule that could affect people differently, we will complete an Equality Impact Assessment (EIA) to identify and mitigate any disproportionate impact on autistic people, people with learning disabilities, or people with protected characteristics.

8. Monitoring and Continuous Improvement

{{org_field_name}} is committed to continuous improvement in promoting positive behaviour and reducing incidents of aggression. We achieve this through:

• Regular audits of incident reports to identify trends and areas for improvement.
• Feedback from service users, families, and staff.
• Collaborative working with external professionals, including PBS practitioners and safeguarding teams.
• Ongoing staff training and reflective practice.

Lessons learned from incidents are shared across the organisation, ensuring that practice evolves in line with best evidence and CQC expectations.

8.1 Monitoring and Evaluation (Data and Outcomes)
We use monitoring to ensure PBS support is evidence-based and continuously improving. We will collect and review:

• frequency, duration and intensity of behaviours of distress,
• antecedents/triggers and outcomes using ABC charts where appropriate,
• de-escalation strategies used and their effectiveness,
• any restrictive interventions used (type, duration, rationale), and
• quality-of-life indicators meaningful to the person (e.g., engagement, relationships, choice, participation, sleep, wellbeing).

Data will be reviewed in supervision, team meetings, and care plan reviews to identify patterns and update proactive strategies. Findings will inform learning, training needs, and governance audits.

9. Related Policies

This policy should be read in conjunction with the following policies:

• Safeguarding Adults from Abuse and Improper Treatment Policy (SL13)​
• Person-Centred Care Policy (SL07)​
• Dignity and Respect Policy (SL08)​
• Mental Capacity and Deprivation of Liberty Safeguards Policy (SL39)​
• Risk Management and Assessment Policy (SL18)​
• Staff Supervision, Training, and Development Policy (SL27)​

9.1 Related Regulations and Best Practice
This policy supports compliance with:

Regulation 9 (Person-centred care), Regulation 10 (Dignity and respect), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment), Regulation 17 (Good governance), Regulation 18 (Staffing), and Regulation 13 (Safeguarding from abuse and improper treatment).
It also reflects the Mental Capacity Act 2005 and NICE guideline NG11 (Challenging behaviour and learning disabilities: prevention and interventions).

10. Policy Review

This policy will be reviewed annually or sooner if there are changes in legislation, CQC requirements, or operational needs. Feedback from staff, service users, and stakeholders will inform future revisions to ensure the policy remains effective and reflective of best practice.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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