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Positive Behaviour Support and Managing Aggression Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} promotes a person-centred, positive approach to behaviour management while effectively preventing and managing aggression or challenging behaviour in a way that protects the dignity, rights, and safety of service users and staff. This policy aligns with the Positive Behaviour Support (PBS) framework, which emphasises understanding the causes of behaviour and using proactive strategies to reduce distress.

This policy ensures compliance with:

• The Regulation and Inspection of Social Care (Wales) Act 2016.
• The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 (as amended), including requirements on:
  • the use of control, restraint and restrictive practice (including recording within required timescales);
  • deprivation of liberty and the requirement for lawful authority;
  • notifications to Care Inspectorate Wales (CIW) of specified incidents and events.
• The Social Services and Well-being (Wales) Act 2014, including duties to promote well-being and to safeguard people at risk.
• The Mental Capacity Act 2005, the MCA Code of Practice and, where applicable, Deprivation of Liberty Safeguards (DoLS).
• The Human Rights Act 1998 (including the requirement that any restriction is lawful, necessary and proportionate).
• Social Care Wales Codes of Professional Practice and practice guidance on positive approaches and reducing restrictive practices.

2. Scope

This policy applies to:

• All employees, including care workers, managers, and administrative personnel.
• Service users who may exhibit challenging behaviour due to medical, cognitive, or emotional conditions.
• Family members, advocates, and external healthcare professionals involved in behaviour support planning.

It covers:

• Principles of Positive Behaviour Support (PBS).
• Identifying triggers and risk factors.
• Preventative strategies and de-escalation techniques.
• Safe intervention and incident management.
• Staff training and competency requirements.
• Incident reporting and learning from events.

3. Principles of Positive Behaviour Support (PBS)

Positive Behaviour Support (PBS) is a proactive, evidence-based approach that focuses on:

• Understanding the causes of challenging behaviour rather than just reacting to incidents.
• Promoting independence, choice, and engagement to improve quality of life.
• Using least restrictive interventions and avoiding punishment or unnecessary restraint.
• Ensuring that staff respond with empathy, patience, and professionalism.

3.1 Definitions (Control, restraint and restrictive practice)

For the purposes of this policy, control/restraint/restrictive practice includes any act or omission that restricts a person’s rights or freedom of movement, including (but not limited to):

• Physical restraint (using force or physical contact to restrict movement).
• Mechanical restraint (use of devices or equipment to restrict movement).
• Chemical restraint (use of medication primarily to control behaviour rather than to treat a diagnosed condition).
• Environmental restrictions (e.g., locking doors, restricting access to rooms/objects).

Any restrictive practice must be the least restrictive option, used for the shortest time, and only where it is necessary and proportionate to prevent harm.

4. Identifying Triggers and Risk Factors

Challenging behaviour often arises from unmet needs, frustration, or distress. Staff must recognise and document:

4.1 Common Triggers for Aggression or Challenging Behaviour

• Pain or medical conditions (e.g., dementia, anxiety disorders).
• Communication difficulties leading to frustration.
• Changes in routine or unfamiliar environments.
• Fear, anxiety, or past trauma.
• Side effects of medication or withdrawal symptoms.

4.2 Risk Assessment and Behaviour Support Plans

• A Positive Behaviour Support Plan (PBSP) must be developed for service users who require additional support.
• PBSPs should include:
  • Known triggers.
  • Preferred de-escalation strategies.
  • Alternative coping techniques.
  • Emergency response plan.
• Staff must review risk assessments regularly and update PBS plans when necessary.

5. Preventative Strategies and De-escalation Techniques

The best way to manage challenging behaviour is to prevent incidents from occurring.

5.1 Creating a Supportive Environment

• Maintain clear communication and provide visual aids if needed.
• Offer structured routines to reduce anxiety.
• Provide calm, quiet areas for individuals who need to de-stress.
• Allow service users to make choices about their care whenever possible.

5.2 Proactive Behaviour Management

• Engage service users in meaningful activities to prevent boredom.
• Encourage the use of relaxation techniques such as deep breathing.
• Use positive reinforcement to reward good behaviour.
• Adapt care plans based on the individual’s needs and preferences.

5.3 De-escalation Strategies During an Incident

If a service user becomes distressed, staff should:

1. Stay calm and use a non-threatening tone.
2. Respect personal space to avoid escalating aggression.
3. Acknowledge feelings and provide reassurance (e.g., “I understand this is frustrating for you.”).
4. Redirect attention to another activity or topic.
5. Encourage problem-solving by offering choices and solutions.

6. Safe Intervention and Incident Management

6.1 Use of control, restraint and restrictive practice

{{org_field_name}} adopts a positive and proactive approach to behaviour support so that restrictive practices are avoided wherever possible.

Control, restraint or restrictive practice must only be used where:

• there is an immediate risk of harm to the person or others;
• all reasonable de-escalation and least restrictive options have been attempted (unless unsafe to do so);
• the response is necessary, proportionate and for the shortest time possible; and
• the approach takes account of the person’s needs, communication, trauma history, and capacity/consent.

Control/restraint must not be used as punishment, to enforce compliance, for staff convenience, or to compensate for lack of staffing.

Only staff who are trained and assessed as competent in the specific method used may apply any form of control/restraint, and staff must work within the individual’s risk assessment and Positive Behaviour Support Plan (PBSP).

6.2 Managing Aggressive Incidents

If a situation escalates to physical aggression, staff should:

1. Call for assistance immediately.
2. Ensure their own safety and the safety of others.
3. Follow training guidance on safe interventions.
4. Use verbal communication to de-escalate whenever possible.
5. Seek medical attention if required after an incident.

6.3 Mental Capacity, consent and deprivation of liberty

Where restrictions are proposed (for example, continuous supervision, restricted access/egress, or repeated restraint), staff must consider whether the person has capacity to consent to the arrangements.

If the person lacks capacity, any acts of care and support must be in their best interests and there must be lawful authority in place where required.

Staff must escalate to the Registered Manager where restrictions may amount to a deprivation of liberty so that the appropriate legal route can be followed (e.g., DoLS where applicable, or other lawful authority as advised/required).

Capacity assessments, best-interest decisions and any authorisation/decision-making steps must be recorded within the person’s care records and reflected in the PBSP and risk assessment.

7. Incident Reporting and Learning from Events

All incidents of challenging behaviour or aggression must be documented and reviewed.

7.1 Reporting and Documentation

• Complete an Incident Report Form within 24 hours.

Where any form of control, restraint or restrictive practice is used, a specific record of the intervention must be completed within 24 hours, in addition to the incident report. The record must include: the reason for use, alternatives attempted, duration, type of restriction used, any injury/pain/distress observed, medical follow-up (if required), and post-incident debrief/learning actions.

• Record:
  • Date, time, and location.
  • Triggering events and staff response.
  • Techniques used to de-escalate the situation.
  • Any injuries or damage sustained.
  • Service user’s emotional state after the incident.

7.2 Reviewing Incidents for Improvement

• The Registered Manager and PBS Lead will review all incidents to:
  • Identify trends and triggers.
  • Adjust behaviour support plans accordingly.
  • Implement further staff training if required.
• Lessons learned will be shared with the team to improve future responses.

7.3 Notifications to CIW and other agencies (Regulation 60 / Schedule 3)

The Registered Manager (or delegated senior) will ensure that CIW is notified without delay (usually within 24 hours) of events/incidents that meet the Regulation 60 / Schedule 3 notification requirements. This includes (but is not limited to):

• any abuse or allegation of abuse involving the provider/staff;
• serious accident or injury to an individual (as defined in the statutory guidance);
• any incident reported to the police;
• any event that prevents, or could prevent, the service from being provided safely.

Notifications will be submitted using CIW Online in the form and manner required by CIW, and the notification reference/confirmation will be retained on file.

Where applicable, the service will also make timely referrals/notifications to the relevant local authority safeguarding team, commissioning authority/health board, and/or the police, in line with safeguarding procedures and the individual’s risk.

8. Staff Training and Competency Requirements

All employees must complete PBS training as part of induction and refresh this at intervals appropriate to their role and the risks of the service. Training and competency must include:

• Positive and proactive approaches and reducing restrictive practices;
• De-escalation and conflict management;
• Breakaway/personal safety techniques (where required by risk);
• Mental Capacity Act 2005, best-interest decision-making and (where relevant) DoLS, refreshed in line with changes to legislation/guidance; and
• Incident reporting, record keeping, safeguarding and CIW notification requirements.

No staff member may use any method of control/restraint unless trained and assessed as competent in that specific method. Competence will be monitored through supervision, observation and post-incident review.

9. Monitoring and Compliance

• The Registered Manager ensures compliance with this policy.
• Quarterly audits assess the effectiveness of PBS strategies and staff training. Audit and governance arrangements will include specific monitoring of:
  • frequency and type of restrictive practices;
  • themes/triggers and whether PBSPs are effective;
  • timeliness/quality of restraint records and incident records;
  • learning actions, staff support and training needs.

Findings and actions will be reported through the provider’s governance processes and reflected within the service’s quality-of-care review.

• Feedback from service users, families, and staff is used to improve practices.
• CIW inspections will evaluate the management of challenging behaviour.

10. Related Policies

This policy should be read in conjunction with:

• Safeguarding Adults from Abuse and Improper Treatment Policy (DCW13).
• Health and Safety at Work Policy (DCW16).
• Whistleblowing (Speaking Up) Policy (DCW29).
• Risk Management and Assessment Policy (DCW18).

11. Policy Review

This policy will be reviewed annually or sooner if required by legislative changes, CIW regulations, or operational needs.

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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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