Getting the foundations right: What are the key components of a successful PBS plan?
A successful Positive Behaviour Support (PBS) plan starts with strong foundations. If you get these components right, you'll set your team and the individuals in your care up for greater outcomes. With PBS, it's essential to ensure that everyone— from the individual receiving your care to your care team and wider stakeholders— is on board with what it takes to drive a successful PBS initiative.
In this chapter, we'll dive into the individual components of a PBS plan and how to get them right.
First, get the intentions right
Before creating a PBS plan for an individual in your care, it’s crucial to ensure you’re doing this with the right intentions. The intention of a PBS plan should be values-driven and centred around improving quality of life, inclusion, participation, and enablement.
The core purpose of a PBS plan is to enhance the individual's well-being. This means not just focusing on reducing distressed behaviours but promoting a holistic approach that fosters personal growth and happiness. Unfortunately, too often, PBS plans are created with the primary goal of reducing incidents or managing behaviour. While these are important outcomes, they shouldn't be the sole focus.
By building the PBS plan around a positive and motivational intention, you’re more likely to see success. When the priority focuses on improving someone's quality of life, community involvement, and personal growth, their distressed behaviours naturally decrease because they feel more supported, understood, and valued.
So, what are the core components of a successful PBS plan?
- Understanding
- Communication
- Engagement
- Incident management
- Recovery
- Consistency
Understanding: assess the individual’s needs
A great PBS plan starts and ends with the individual it seeks to benefit. They should be involved from the very beginning. An initial assessment is a crucial step in getting to know the individual, understanding their unique needs, preferences, and strengths, and determining the best way to communicate with them.
To tailor a PBS plan effectively, you need to deeply understand the individual. This involves identifying not just their struggles and difficulties but first and foremost, their strengths and potential. PBS is fundamentally a strength-based approach. Recognising and building on the individual’s strengths can provide powerful motivation and pathways for positive change.
Key areas to assess:
- Communication: Understanding how the individual communicates is key. This includes both their preferred communication methods and their ability to understand others. Some individuals may use verbal communication, while others may rely on non-verbal cues, assistive technologies, or alternative communication methods. The goal is to find the most effective way to engage and connect with them.
- Strengths and weaknesses: A comprehensive assessment should also identify the individual’s challenges and strengths. This includes recognising any triggers for distress or challenging behaviour and understanding the individual's capabilities, interests, and aspirations. By focusing on strengths, you can build a PBS plan that empowers the individual and promotes positive behaviours through encouragement and support.
- Goals: Working towards a goal can be a great motivation and provide a lot of fulfilment to an individual’s life. Using the SMART (Specific, Measurable, Actionable, Relevant, Time-bound) framework — which we explored in our last e-book Goal setting for service users) — work with the service user to understand any goals they would like to work toward and how they can support their PBS plan.
- Interests: Spending more time doing the things that interest us most is important for our wellbeing. It is important to understand what the individual’s interests are so you can work together to increase the frequency that they’re partaking in activities that they enjoy. The Subjective Quality of Life Tool is a great resource to use here. You can download it through the link below.
Communication: the cornerstone of effective support
Communication can make or break a PBS plan and so it’s critical to understand the individual’s communication preferences. It’s not just about talking to the individual but also about listening, observing, and responding to their needs in a way that they can understand and appreciate.
Why communication matters
Communication is the primary means through which we understand the needs, desires, and emotions of the individual in our care. Without effective communication, it’s nearly impossible to create a PBS plan that truly meets their needs.
Strategies for effective communication:
- Tailoring communication methods: Every individual has a preferred way of communicating. It might be through words, gestures, pictures, or technology. Understanding and respecting these preferences ensures that the individual feels heard and understood. In Chapter 2, we discuss some great tools that can be used here.
- Active listening: Active listening involves not just hearing the words spoken by the individual but also understanding the emotions and intentions behind those words. This requires patience, empathy, and attentiveness.
- Consistency in communication: Ensure that all team members are consistent in their communication with the individual. Mixed messages can create confusion and anxiety, leading to an increase in challenging behaviours.
A good and robust communication plan that is tailored to the individual's needs and preferences is critical to making a PBS plan a success.
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Engagement: encourage active participation in PBS
Engagement is about more than just keeping someone occupied. It’s about creating opportunities for the individual to be actively involved in their environment and daily life, fostering a sense of agency and self-worth.
Encouraging positive engagement
Engagement is a powerful tool in PBS. When individuals are meaningfully engaged, they are less likely to exhibit challenging behaviours. Engagement can take many forms, from participating in household chores to being involved in community activities or pursuing hobbies and interests.
Promoting agency: Hotel Model vs Active Model of care
One of the critical aspects of engagement is giving the individual a sense of control over their own life. This means moving away from a "hotel model" of care, where everything is done for the individual, to a more active model where the individual is actively involved in decisions and activities.
Active support involves:
- Reflecting on what's important: Considering what the individual values and what they need to live the life they want.
- Providing graduated levels of help: Offering assistance that ranges from simple verbal reminders to physical guidance, depending on the individual's needs.
- Using positive interactions: Providing supportive interactions that use positive reinforcement to encourage participation in activities.
Creating a capable environment
A capable environment is one where the individual feels safe, supported, and able to participate. This environment should be predictable and structured, with clear routines and expectations that reduce anxiety and promote confidence. It’s important that this is client-led, and that they are empowered to set the pace, routines, and anything else that impacts their environment.
Management of incidents: proactive and reactive strategies
While the primary focus of a PBS plan is to create a positive, supportive environment that prevents incidents, it’s also important to acknowledge that incidents can happen and to have strategies in place to manage them effectively.
Proactive strategies
Proactive strategies are essential in preventing incidents before they arise, and an effective PBS plan should dedicate around 80% of its focus to these strategies. Since every individual is unique, proactive strategies must be highly personalised, tailored to each person's specific needs and strengths. These strategies should include motivational tools, such as encouraging participation in activities that the individual finds fulfilling, addressing their environmental and communication needs, and creating clear plans to help them achieve their personal goals. It's crucial to remember that PBS is a strength-based framework, so the emphasis should always be on leveraging and building the individual's strengths and fostering their sense of agency over their environment.
Reactive strategies and the traffic light system
Reactive strategies come into play when an incident does occur. The goal is to manage the situation in a way that minimises harm and reduces the likelihood of recurrence. This might involve using de-escalation techniques, providing space for the individual to calm down, or removing triggers from the environment.
At Log my Care, we use a traffic light system in our PBS plans feature. Using a traffic light system, you can split your reactive strategies into “amber” and “red”. Amber can be used for softer touch actions like removing throwable actions from the environment. Red can be used for when things are escalating into ‘crisis’ territory.
Minimising restrictions
Restriction, whether medical, mechanical, or physical, should always be a last resort, and should only be used when the safety of the individual or of others is at risk. Instead, the care team might step back and allow the individual some space after ensuring all hazards have been removed from the environment, or use calm, reassuring communication to help de-escalate the situation. These communication strategies should be clearly outlined in the individual’s support plan.
Recovery: rebuilding trust and emotional safety
After an incident, it’s essential to focus on recovery. Recovery is about more than just returning to baseline; it’s about repairing any damage to relationships and ensuring that the individual feels safe, supported, and understood.
Addressing stigma and guilt
Incidents can sometimes leave individuals feeling ashamed or guilty. It’s important to address these feelings directly, offering reassurance and understanding. The focus should be on moving forward positively, rather than dwelling on what went wrong.
Repairing relationships
After an incident, the relationship between the individual and their caregivers can be strained. Engaging in enjoyable activities together, having open and honest conversations, and showing consistent support can help rebuild trust.
Emphasising emotional safety
Emotional safety is a critical component of recovery. The individual needs to feel that they are in an environment where they are respected, valued, and safe from judgement or harm. This means creating a supportive atmosphere where the individual can express their feelings and work through their emotions in a healthy way.
Consistency: the key to a stable environment
Consistency is the glue that holds a PBS plan together. It ensures that the individual knows what to expect, which can significantly reduce anxiety and challenging behaviours.
Consistent approaches across the team
All care team members must be on the same page when implementing the PBS plan. This means regular communication, shared understanding of the individual’s needs and preferences, and a unified approach to care.
Predictability and structure
A predictable environment is a safe environment. Individuals thrive when they know what to expect, which is why routines and clear boundaries are so important. This predictability doesn’t mean rigidity, but rather a structured approach that allows for flexibility when needed. This could look like having a timetable of activities available for the day but still allow the individual choice as to whether to participate in them.
Creating a capable environment
A capable environment is one that consistently supports the individual’s needs, promotes their strengths, and helps them navigate challenges. It’s an environment where the individual feels empowered, understood, and capable of achieving their goals.
A successful PBS plan is built on strong foundations, where the focus is on enhancing the individual’s quality of life, understanding and addressing their unique needs, and fostering a supportive and consistent environment. By getting these components right, you’re not just managing behaviour; you’re empowering individuals to live fulfilling, meaningful lives. This holistic approach, grounded in respect, empathy, and positive intentions, is what truly makes a PBS plan successful.
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