What is the positive behaviour support framework?

Positive Behaviour Support (PBS) is a comprehensive and powerful framework for supporting service users with learning disabilities or mental health needs who are at risk of exhibiting behaviours that challenge. This person-centred approach is vital in creating environments where service users have greater control and autonomy over their lives, and significantly reduces the occurrence of behaviours that challenge. PBS is an incredibly valuable framework for care providers. Not only does the framework offer a path to brilliant, person-centred care, it also enhances compliance with CQC standards, and creates a culture of respect and independence for service users.

At the core of PBS: Person-centred values and behavioural science

PBS integrates person-centred values with behavioural science, focusing on understanding and addressing the root causes of behaviours that challenge. Rather than attempting to "fix" behaviours, PBS aims to enhance the individual’s quality of life by:

1. Recognising behaviour as a form of communication
2. Identifying and addressing the environmental triggers and unmet needs behind challenging behaviours.
3. Empowering individuals to make choices and exert control over their surroundings.

Understanding and communicating through behaviour

In the context of learning disabilities, social constructs and communication can often be challenging. Behaviours that challenge are frequently misinterpreted due to these communication barriers. PBS emphasises that behaviour is a means of expressing needs and preferences, making it essential to decode the underlying messages. For instance, a person who hits at a light switch may be experiencing a sensory trigger around light levels being too high for their needs.

Enhancing quality of life through empowerment

Central to PBS is the belief that improving an individual's quality of life can significantly mitigate episodes of behaviours that challenge. By creating environments that are responsive to the individual's needs, PBS fosters a sense of control and autonomy. This might involve simple changes like adjusting lighting to reduce sensory overload or more complex interventions like installing smart home technology to enable easier interaction with the environment. Understanding a service user’s individual needs and triggers, and allowing them control of their environment is absolutely key to preventing behaviours that challenge.

The importance of functional assessments and personalised strategies

Functional assessments are a cornerstone of PBS, involving comprehensive evaluations that include input from the individual, their family, and a multidisciplinary team of professionals. This collaborative approach ensures a deep understanding of the person’s behaviour, sensory needs, and environmental triggers. For example, if someone is repeatedly hitting a light switch, the assessment might reveal a sensory issue, prompting adjustments like dimmer switches to alleviate discomfort.

To carry out an effective functional assessment, there are three key behaviour types that you must assess to be able to identify when a service user’s behaviour might be escalating:

1. Baseline behaviour

When they are at their baseline are they calm and docile or social and chatty? Understanding baseline behaviour is crucial to being able to recognise when a service user’s behaviour might be escalating. ‍‍

‍2. Escalating behaviour

When their behaviour is escalating, do they experience irritability? Or do they start talking negatively about themselves? Recognising and reacting to escalating behaviour is imperative to preventing crisis point.

‍3. Crisis point

If they were to reach crisis point, would they be a risk to themselves or others? Having a risk assessment in place for a service user’s crisis point is fundamental to mitigating harm to themselves or others.

Building trust and reducing trauma

For individuals with learning disabilities, building a relationship of trust is fundamental. Many have experienced multiple transitions through children's services, hospitals, and community placements, each potentially adding layers of trauma. By prioritising trust and understanding, PBS helps in creating a safe and supportive environment where individuals feel respected and valued.

The benefits for care providers: Delivering outstanding care

Implementing PBS not only benefits service users but also significantly enhances the capabilities and performance of care providers. By adopting PBS, care providers can:

1. Move from reactive to proactive care, focusing on prevention rather than crisis management.
2. Reduce the use of restrictive practices and over-medication, promoting a more humane and ethical approach to care.
3. Enhance compliance with CQC standards, demonstrating a commitment to person-centred care and continuous improvement.

Supporting care providers in a demanding environment

Care providers often work long hours under immense pressure, making it tempting to rely on reactive strategies. However, PBS offers a structured yet flexible framework that, when properly implemented, simplifies the process of delivering exceptional care. Training and support in PBS can help care providers understand the framework’s principles, enabling them to create environments where challenging behaviours are less likely to occur.

The impact of PBS on CQC compliance

Adopting the Positive Behaviour Support (PBS) framework aligns perfectly with the CQC's new single assessment framework, which emphasises person-centred care, safety, and effectiveness. The PBS framework supports learning disability providers in meeting these updated regulatory requirements in several key ways:

Safe - PBS reduces the need for physical and chemical restraints by focusing on preventative strategies and understanding the root causes of challenging behaviours.

Effective - PBS implements evidence-based practices that improve the quality of life and reduce challenging behaviours, ensuring care is tailored to each individual’s needs.

Caring - PBS ensures that care is respectful, dignified, and responsive, aligning with the CQC’s emphasis on person-centred care and involvement in decision-making.

Responsive - PBS tailors care to the unique needs of each individual, prioritising their preferences and choices, which is central to the new framework.

Well-Led - PBS promotes a culture of continuous improvement, learning, and innovation, helping providers stay ahead of CQC expectations and deliver outstanding care.

Fundamentally, Positive Behaviour Support is a transformative framework that places individuals at the heart of their care. This empowered approach allows them to have more control and autonomy in their environments, which has a powerful effect on reducing episodes of behaviours that challenge. Not only is this framework beneficial for the service user, it is extremely valuable for care providers. PBS is a pathway to delivering more effective, compassionate, and compliant care. By embracing PBS, care homes can create environments where challenging behaviours are better understood and mitigated, leading to improved outcomes for both service users and providers.