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Registration Number: {{org_field_registration_no}}

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Positive Behaviour Support (PBS) Policy for Adults(LD/A)

1. Purpose

The purpose of this policy is to outline {{org_field_name}}’s approach to supporting adults who may display distressed behaviours, sometimes described as behaviour that challenges, using a Positive Behaviour Support (PBS) approach.

Our aims are to improve the person’s quality of life, wellbeing, dignity, autonomy and independence through proactive, person-centred support; understand behaviour as communication of unmet need; reduce the likelihood, frequency, severity and impact of distress through prevention and early intervention; reduce and, wherever possible, eliminate restrictive practices; and maintain the safety, dignity and rights of the person, their family or carers, staff and the public.

This policy supports compliance with the Fundamental Standards and other applicable legal duties in England.

{{org_field_name}}  is registered with the Care Quality Commission to carry out the regulated activity of {{org_field_regulated_activity}} for

 {{org_field_service_users_bands}} in their own homes.

2. Scope

This policy applies to all employees, volunteers, contractors and others working for or on behalf of {{org_field_name}} who provide domiciliary care or related community-based support to adults in their own homes or community settings.

It covers:

• preventative strategies for promoting positive behaviour;
• identifying, recording and responding to distressed behaviour;
• functional behaviour assessment and PBS planning;
• safe de-escalation techniques;
• crisis response procedures including withdrawal and emergency escalation;
• restrictive practices only where absolutely necessary and lawful;
• safeguarding and risk management;
• training, supervision and reflective practice; and
• monitoring, auditing and continuous improvement.

Domiciliary care considerations: in people’s homes we must work respectfully within the person’s environment, often alongside family members or others. We may have limited ability to change the environment, and staff may be lone working. Our PBS approach therefore includes robust dynamic risk assessment, clear escalation routes, and safe withdrawal processes.

3. Definitions

Positive Behaviour Support (PBS): An evidence-informed approach that aims to improve quality of life and reduce distressed behaviours by understanding the function of behaviour, making reasonable adjustments, teaching alternative skills, and using proactive strategies first.

Distressed behaviour / behaviour that challenges: Behaviour that signals distress or unmet need and may put the person or others at risk.

Functional Behaviour Assessment (FBA): A structured assessment that aims to understand why a behaviour occurs, including triggers, maintaining factors and consequences.

Proactive strategies: Planned supports that prevent distress and reduce triggers.

Reactive strategies: Steps used when early signs of distress appear or in a crisis; used as a last resort and alongside proactive strategies.

Restrictive practice / restrictive intervention: Any action that restricts a person’s liberty of movement or choice, including subtle restrictions and not only physical restraint.

Least restrictive option: The minimum level of restriction needed to achieve a legitimate safety aim, used for the shortest time.

4. Legal, Regulatory and Best Practice Framework

This policy reflects duties and expectations from:

• Health and Social Care Act 2008 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including Regulation 9 (person-centred care), Regulation 10 (dignity and respect), Regulation 11 (need for consent), Regulation 12 (safe care and treatment), Regulation 13 (safeguarding service users from abuse and improper treatment), Regulation 17 (good governance), Regulation 18 (staffing) and Regulation 20 (duty of candour).
• Mental Capacity Act 2005 and its Code of Practice, including the principles of presumption of capacity, support to make decisions, best interests and least restrictive practice.
• Care Act 2014 and Care and Support Statutory Guidance, including adult safeguarding duties, wellbeing, prevention and partnership working.
• Equality Act 2010 and Human Rights Act 1998.
• NICE guidance, including NG11 and NG93 where relevant.
• CQC guidance on Positive Behaviour Support and restraint policies, and wider government guidance on reducing restrictive interventions.

{{org_field_name}} will review this policy and practice whenever legislation, statutory guidance or CQC guidance changes.

5. Principles of Positive Behaviour Support (PBS)

{{org_field_name}} will ensure that PBS is delivered in line with these principles:

5.1 Dignity, respect and person-centred care

We treat every person as an individual, with strengths, preferences, history and identity.

We support choice and control, including the right to refuse non-essential support.

We use respectful language and never label a person as difficult or aggressive. We describe what happened and what it means for support planning.

5.2 Behaviour is communication

We assume distressed behaviour is often an expression of unmet need, such as pain, anxiety, sensory overload, fear, misunderstanding, trauma triggers, boredom, loneliness, frustration or communication barriers.

We look for what the person is telling us and adjust care accordingly.

5.3 Proactive and preventative first

We focus on prevention: predictable routines, meaningful activities, communication support, environmental adjustment and teaching alternative skills.

We do not use threats, punishment, humiliation, deliberate ignoring of distress, or power struggles.

We use reactive strategies only when needed and alongside proactive planning.

5.4 Least restrictive, lawful and time-limited

We avoid restrictive practices wherever possible and actively work to reduce them.

If a restrictive intervention is ever used, it must be lawful, proportionate, the least restrictive option, and for the shortest possible time.

5.5 Partnership and involvement

We work in partnership with the person and, where appropriate and consented, their family members, carers and professionals.

We share information in accessible formats and in a way the person can understand.

6. Roles and Responsibilities

6.1 All staff

Staff must:

• follow the person’s PBS plan and risk assessment;
• complete dynamic risk assessment at each visit;
• use proactive strategies first and record what works;
• report and record incidents promptly and accurately;
• seek support and guidance early before risk escalates; and
• participate in supervision and reflective practice.

6.2 Registered Manager / Responsible Person

The Responsible Person for this policy is:
{{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

They must ensure:

• PBS systems, training and supervision are in place and effective;
• incidents are reviewed, trends analysed and learning implemented;
• restrictive practices are monitored and reduced;
• safeguarding and statutory notifications are made when required;
• quality assurance audits are completed and actions tracked; and
• any safeguarding concerns, CQC notifications and duty of candour obligations arising from PBS-related incidents are considered and actioned without delay.

6.3 Coordinators / Seniors / On-call

They must:

• support staff decision-making during escalation;
• ensure debriefs occur after incidents; and
• support review and update of PBS plans and risk assessments.

7. Assessment and Planning (Functional Behaviour Assessment and PBS Plans)

7.1 When an FBA/PBS review is required

An FBA and PBS plan, or review of an existing plan, must be completed when:

• the person is new to the service or starting a new package of care;
• there are repeated episodes of distressed behaviour or increasing frequency or severity;
• there is a significant incident such as injury, police involvement or safeguarding concern;
• there is a significant change such as health deterioration, medication change, bereavement, environmental change, or change in routine or care team;
• staff report uncertainty about triggers or the function of behaviour; or
• a restrictive intervention occurs or is being considered.

7.2 The assessment process (domiciliary care)

PBS assessment must remain person-centred and proportionate to the risk and impact.

Step 1: Initial information gathering

• Review referral information, care history and known triggers.
• Confirm communication needs and preferences, including sensory needs.
• Identify any equality needs such as language, culture, religion and disability adjustments.

Step 2: Health and wellbeing checks

Because behaviour may be linked to physical health, we consider:

• pain, infection, constipation, hunger or thirst, fatigue and sleep difficulties;
• medication side effects and interactions where information is available;
• sensory overload or sensory-seeking patterns; and
• mental health factors and trauma triggers.

For adults, staff must also consider whether there are concerns about decision-making capacity, consent, fluctuating capacity, executive functioning, or whether a best interests decision may be required.

Step 3: Functional Behaviour Assessment (FBA)

We use structured methods such as:

• direct observation where possible;
• ABC recording (Antecedent–Behaviour–Consequence);
• frequency, intensity and duration tracking;
• review of times, locations and patterns; and
• interviews or discussions with the person, family or carers and professionals.

Step 4: Functional hypothesis

We develop a shared understanding of the likely function or functions of behaviour.

Step 5: Written PBS Plan

We develop a written PBS plan based on function and proactive strategies that improve quality of life.

7.3 Minimum content for an Individual PBS Plan

Each PBS plan must include, as a minimum:

About the person

• preferred name, routines, important relationships, strengths and interests;
• communication profile; and
• triggers and early warning signs.

Quality of life outcomes

• what a good day looks like for the person; and
• goals meaningful to them.

Proactive strategies (primary prevention)

Examples tailored to the person may include:

• predictable routines and visual schedules;
• clear choice-making opportunities;
• sensory adjustments;
• adapting task demands and pace;
• meaningful activities aligned with interests;
• communication aids; and
• reasonable adjustments for disability needs.

Early intervention strategies (secondary prevention)

• what staff do at the earliest signs of distress.

Reactive strategies (crisis plan)

Reactive strategies must:

• be clearly described, specific, and only used as last resort;
• prioritise de-escalation and safety; and
• include safe withdrawal guidance and emergency escalation points.

Risk management and safety

• known risks and controls including lone working controls;
• safe exit routes;
• when to contact on-call or manager;
• when to contact emergency services; and
• capacity and consent considerations relevant to the support being provided, including any best interests decisions and the legal basis for any agreed restrictions.

Post-incident support

• steps to help the person recover;
• steps to repair relationships and reduce future risk; and
• staff debrief and supervision requirements.

Restrictive practices (if applicable)

• any agreed restrictions must be clearly documented, lawful, time-limited and reviewed;
• what alternatives must be tried first; and
• how reduction will be achieved.

7.4 Review Frequency for Individual Positive Behaviour Support Plans

Individual Positive Behaviour Support (PBS) plans must be reviewed frequently to ensure that interventions remain appropriate, effective, person-centred and focused on improving quality of life.

As part of the organisation’s internal quality assurance arrangements, and taking account of NICE guideline NG11 and the individual’s assessed needs, Positive Behaviour Support plans will be reviewed at the following minimum frequencies:

• At least fortnightly during the first two months following the introduction of a new behaviour support plan.

• At least monthly thereafter while the plan remains active, with review frequency increased where individual risks or circumstances require.
• Promptly following any significant incident, use of restrictive intervention, deterioration in quality of life, increase in distressed behaviour or significant change in the person’s health, environment or support arrangements.

Each review must consider the person’s views and communication needs, progress towards agreed quality-of-life outcomes, the effectiveness of proactive strategies, recorded behavioural information, any restrictive interventions and opportunities to reduce restrictions.

The review must identify actions, responsible individuals, timescales and any additional specialist input required.

The Registered Manager must ensure that reviews are documented and that updated plans are communicated to all relevant staff.

8. Staff Training, Competence, Supervision and Reflective Practice

8.1 Mandatory PBS training

All staff who support people where distressed behaviour may occur must complete PBS training that includes:

• understanding behaviour as communication and unmet need;
• autism and learning disability awareness relevant to PBS;
• trauma-informed approaches and avoiding re-traumatisation;
• functional assessment basics;
• proactive strategies;
• de-escalation skills and conflict reduction;
• legal and ethical frameworks including consent, capacity and least restrictive option;
• recognising and reporting safeguarding concerns; and
• restrictive practice awareness and reduction expectations.

8.2 Domiciliary-specific competence

Before lone working in higher-risk packages, staff must be assessed as competent in:

• dynamic risk assessment in the home;
• personal safety and safe withdrawal;
• working appropriately with family members or others present; and
• professional boundaries and de-escalation in private settings.

Assessment and Verification of Staff Competence in Positive Behaviour Support

Before independently supporting a person with an identified PBS plan, staff must demonstrate that they understand the person’s communication needs, known triggers, proactive support strategies, early signs of distress, reactive procedures and escalation arrangements.

The Registered Manager or an appropriately trained and competent delegated assessor must assess staff competence through a combination of:

• Verification of completed training.
• Discussion and questioning to assess knowledge and understanding.
• Review of the individual’s PBS plan and risk assessment.
• Direct observation of practice, where appropriate and safe.
• Scenario-based assessment of responses to distress and emergencies.
• Review of the accuracy and quality of staff records.

Competency assessments must be documented, dated and signed by the assessor and staff member.

Staff who have not demonstrated competence must receive further training, supervision and reassessment before undertaking relevant duties independently.

Competence must be reassessed where incidents, observations, supervision, complaints or changes in the person’s needs indicate that additional support is required.

The Registered Manager must maintain an up-to-date training and competency record and ensure that staff are only allocated responsibilities appropriate to their demonstrated competence.

8.3 Supervision and reflective practice

To ensure consistency and learning:

• staff receive scheduled supervision, minimum every 8 weeks, more frequently for new staff or high-risk packages;
• reflective practice sessions follow incidents and complex situations; and
• staff are supported to recognise and manage their own stress.

PBS-Focused Staff Supervision

Supervision for staff supporting autistic people and people with a learning disability must include a structured review of their application of Positive Behaviour Support.

The supervisor must discuss:

• The person’s current wellbeing, communication needs and quality-of-life outcomes.
• Whether staff are implementing proactive strategies consistently.
• Any episodes of distress, their possible causes and the effectiveness of staff responses.
• Any restrictive interventions, including whether less restrictive alternatives were considered.
• Staff understanding of consent, capacity, safeguarding and reporting responsibilities.
• The staff member’s confidence, emotional wellbeing, training needs and competence.
• Feedback from the person receiving support and, where appropriate, their family, advocate or relevant professionals.

The supervisor must record the discussion, any identified concerns, agreed actions, responsible persons and completion dates.

Where unsafe or inappropriate practice is identified, the Registered Manager must take immediate proportionate action, which may include closer supervision, additional training, reassessment of competence or temporary restriction of relevant duties.

Supervision records must be reviewed by management to identify recurring themes and opportunities to improve the quality and safety of support.

8.4 Post-incident debrief

After any significant incident, we complete:

• an immediate hot debrief; and
• a planned cold debrief within 72 hours.

9. Identifying and Responding to Distressed Behaviour

9.1 Early recognition

Staff must recognise early indicators specific to the person and documented in the PBS plan.

9.2 Proactive responses

Staff must:

• reduce demands and pace;
• validate feelings and offer choices;
• increase predictability;
• use known sensory or regulation supports; and
• redirect to preferred topics or activities.

9.3 Safe de-escalation techniques

Staff may use:

• calm, non-threatening body language and voice;
• active listening and empathy;
• reducing stimulation where possible;
• offering space and time without punishment; and
• ensuring staff safety, including keeping exit access and not cornering the person.

9.4 Crisis response in domiciliary care

If risk escalates to imminent harm:

• prioritise safety, create distance and remove staff from danger;
• contact on-call or manager for guidance;
• call 999 if there is immediate danger to the person or others; and
• record the actions taken and outcomes.

Staff must not remain in an unsafe situation in a person’s home.

10. Restrictive Practices

10.1 Our position

{{org_field_name}} is committed to:

• preventing the need for restrictive practices through PBS and early intervention;
• reducing restrictive practices through continuous review, staff training and incident learning; and
• never using restriction as punishment, intimidation, convenience or routine.

10.2 What counts as restrictive practice

Restrictive practice includes, but is not limited to:

• physical restraint or holding;
• blocking a person’s movement;
• locking doors or restricting access to rooms or the community;
• removing items to control behaviour unless essential for immediate safety;
• constant observation that significantly restricts privacy or choice;
• time out used in a way that isolates or controls; and
• PRN medication used primarily to control behaviour rather than treat a health need.

10.3 When restrictive intervention may be used

Restrictive intervention may only be considered when:

• there is an imminent and serious risk of harm to the person or others;
• all reasonable de-escalation and proactive strategies have been attempted unless not possible due to immediacy;
• the intervention is lawful, proportionate, least restrictive and time-limited; and
• it aligns with the person’s PBS plan and risk assessment, or it is an unavoidable emergency response.

10.4 Consent, capacity and best interests

If the adult has capacity for the relevant decision, {{org_field_name}} will seek and record consent for planned strategies and will respect refusal where safe and lawful to do so.

If the adult lacks capacity in relation to the relevant decision, any decision must be made in accordance with the Mental Capacity Act 2005, in the person’s best interests, and using the least restrictive option.

Any restraint must meet the legal test under section 6 of the Mental Capacity Act 2005. Any arrangement in the community that may amount to a deprivation of liberty must be escalated promptly for legal review and authorisation through the appropriate legal route.

Any planned restrictive measure must be clearly documented, justified, time-limited, reviewed regularly, and accompanied by a reduction plan.

10.5 Domiciliary care boundaries

In a person’s home, staff must not:

• use force to make a person accept care;
• lock a person in a room or prevent them leaving unless there is lawful authority and a clear, proportionate plan; or
• remove phones, money, food, drink or medication as a behaviour consequence.

11. Safeguarding and Risk Management

11.1 Safeguarding

Distressed behaviour can increase an adult’s vulnerability to abuse, neglect, coercion, exploitation or self-neglect. Any concern that an adult has been harmed, improperly treated, unlawfully restrained, over-restricted, neglected or placed at avoidable risk must be treated as a safeguarding concern and escalated immediately in line with the organisation’s adult safeguarding procedures.

11.2 Risk management

Risk management includes:

• initial and ongoing risk assessments for the home environment, lone working and community access;
• dynamic risk assessment at every visit;
• clear escalation routes; and
• safe withdrawal procedures where risk becomes unacceptable.

12. Equality, Inclusion and Equality Impact Assessments

12.1 Cultural and linguistic needs

We will:

• identify preferred language and communication needs at assessment;
• use interpreters or translation when needed;
• respect cultural and religious practices; and
• adapt PBS approaches so they are culturally respectful and meaningful.

12.2 Disabled people’s needs

We will:

• provide information in accessible formats;
• use communication aids and communication passports;
• adapt routines and tasks to reduce distress and maximise independence; and
• ensure staff understand sensory profiles and adjustments.

12.3 Equality Impact Assessments

We complete and record an Equality Impact Assessment when:

• introducing a new PBS approach that could restrict choice or liberty;
• restrictions are proposed or have occurred; or
• incident data suggests a particular group may be disproportionately impacted.

13. Monitoring, Data Collection, Evaluation and Quality Assurance

13.1 What we record

For each incident, staff must record:

• date, time, location and who was present;
• what happened;
• triggers or antecedents;
• early warning signs noticed;
• strategies used;
• whether emergency services or police were contacted;
• outcomes;
• any restrictive intervention including type, reason and duration;
• immediate actions taken to support the person afterwards; and
• recommended plan changes.

13.2 How we analyse and learn

Management will:

• review incidents promptly;
• conduct root cause analysis for repeated patterns;
• update PBS plans and risk assessments;
• identify training needs and deliver targeted coaching; and
• share learning through team meetings, supervision and bulletins.

13.3 Audits and governance cadence

• Monthly incident trend review.
• Quarterly restrictive practice review.
• Quarterly PBS plan quality audit.
• Annual policy review or sooner if guidance changes.

The governance process must also review whether incidents trigger safeguarding referrals, duty of candour obligations, CQC notifications, training needs, or review of the person’s ongoing suitability for the package of care.

14. Working with Families, Carers and Professionals

We will:

• involve the person and, where appropriate, family or carers in planning and intervention, sharing information in accessible formats;
• seek specialist input when needed; and
• coordinate information sharing appropriately and lawfully, ensuring the person’s privacy and consent are respected.

15. Documentation and Record Keeping

PBS-related records must include:

• PBS plan;
• risk assessments;
• incident forms and follow-up actions;
• evidence of review meetings and plan updates;
• training and competence records; and
• supervision and reflective practice notes where appropriate.

Records must be stored securely and shared only on a need-to-know basis.

16. Links to Other Policies

This policy must be read alongside:

• safeguarding policy and procedures;
• complaints policy;
• consent and mental capacity policy and procedures;
• risk assessment and lone working policy;
• incident reporting policy;
• equality, diversity and human rights policy;
• restrictive practice or restraint policy, if separate; and
• medication policy, including PRN guidance where applicable.

17. Monitoring and Review

This policy will be reviewed annually or sooner if legislation, best practice or CQC guidance changes.

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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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