Behaviours which challenge always happen for a reason and might be the only way a person can communicate - it can arise for different reasons which are personal to the individual.
People who display or are at risk of displaying behaviours which challenge might need care and support which involves both positive support, such as positive behavioural support, and some form of restrictive practice or intervention, such as physical restraint or use of devices, medication or seclusion.
Any restrictive intervention must be legally and ethically justified, be absolutely necessary to prevent serious harm and be the least restrictive option.
It’s important that adult social care workers, including managers, have the right skills and knowledge to support people who display or are at risk of displaying behaviours which challenge, and we have resources to help.
What is positive behaviour support (PBS)?
Before you get started, read these FAQs from the Challenging Behaviour Foundation to find out more about how PBS can help you deliver high quality support.
PBS is a person-centred approach to supporting people who display or at risk of displaying behaviours which challenge.
It involves understanding the reasons for the behaviour and considering the person as a whole - including their life history, physical health and emotional needs - to implement ways of supporting them. It focuses on creating physical and social environments that are supportive and capable of meeting people's needs, and teaching people new skills to replace the behaviours which challenge.
Watch this short video from the Challenging Behaviour Foundation about what is PBS.
The process of PBS
The UK PBS competency framework explains the things that you need to know and the things that you need to do when delivering best practice PBS for people with learning disabilities and/ or autistic people who display or at risk of displaying behaviours which challenge.
The PBS Academy has also developed Standards for Services which outlines the standards services should meet when delivering PBS.
One part of PBS is to understand why the behaviour happens, how it's been learned and how it's maintained - this is called a functional assessment.
Watch this video from the Challenging Behaviour Foundation about understanding behaviour and the importance of functional assessments.
When you've found the reason, you should produce a PBS plan that includes ways of intervening when people are at risk of displaying behaviour that challenges, and includes teaching new skills.
PBS plans should be co-produced and followed by everyone involved in supporting the person, including the person and their family.
Watch this video from the Challenging Behaviour Foundation about putting PBS into practice.
The Centre for the Advancement of PBS at BILD has also created an animation that gives an overview of PBS and how PBS approaches work in practice when supporting an individual.
PBS training for social care workers
A positive and proactive workforce guide will help adult social care commissioners and employers to make decisions when planning, purchasing or providing learning and development which will help your workforce to work in a positive and proactive way, and minimise the use of restrictive practices, when supporting people who display behaviours which challenge.
PBS training should reflect the PBS competency framework, which was developed by the PBS Academy in 2015.
They've also designed the Standards for Training for all those involved in the delivery, purchase or commissioning of PBS training.
Principles for arranging PBS training
Consider the following principles when arranging PBS training.
- Training should be based on the actual needs of the individual(s) being supported.
- Training should be consistent with your organisation's policies and procedures, and support by the culture and practices of your service.
- Training should be proportional to the behavioural support plan for each individual, with positive approaches taught before, and given significantly more time, than any restrictive practices.
- Learners should be assessed at the end of training, to ensure that they know how to put the skills and knowledge they've learnt into practice.
- People who need care and support, and their families, should be involved in planning their own support and in training.
Choosing a learning provider
Here are some questions to consider when choosing a learning provider to deliver PBS training.
- Can they evidence bespoke learning to meet the specific needs of the individual or service?
- What qualifications do the people delivering the learning have – has the person attended a university accredited course on PBS? Do they have teaching qualifications?
- Can they provide examples of services that have previously applied the learning?
- Does the proportion of the training content programme conform to the balance of proactive/reactive strategies in the individual’s support plan, and include any restrictive practices that are planned?
- Does the learning provider have a system of feedback or testimonials you can check?
- Does the learning contain an element of competence testing – for instance observations or role play testing as well as verbal competence and reflection?
- Does the learning provider have a system in place to feed back about learners who are unsafe in their practice?
- Can the learning provider describe the biomechanical issues of any techniques that are taught?
- Do you know how to conduct a behaviour audit in order to meet the needs of people who need care and support, and ensure staff have the appropriate knowledge and skills after the learning?
- Is the learning consistent with or integral to the process of functional analysis and formulation?
- Can the learning provider offer support to your organisation following the learning provision?
- Can they help with plans or suggestions about how training and learning should be monitored to make sure it is working in practice?
- Has the learning provider been accredited by undertaking a rigorous external process?
Peer review pilot to improve PBS training
In 2019/20 we're running a pilot project to develop and test a peer review process for PBS training.
This will involve a number of learning providers who peer review each other’s training, to give feedback and share ideas. We hope that this will be a successful model to improve the quality of PBS training across the sector.
We envisage that the peer reviews will take place in Autumn 2019, and we'll publish the findings in early 2020. If you want to find out more about the pilot project, please email us.
PBS in practice – case studies
When it’s done properly, PBS can have a big impact on the quality of life of individuals who display behaviours which challenge. Here are three case studies.
- Eldertree Lodge supported J who has a mild intellectual disability and emotionally unstable personality disorder. They developed a positive behaviour support (PBS) plan and as a result, number of incidents of behaviour that challenges decreased and she’s more engaged in meaningful activities both in and out of the ward. Read her case study here.
- Rebecca has a rare genetic condition which presents as a severe learning disability, autism, an eating disorder and mild self-harm. When Rebecca moved into a shared residential home, the number of incidents of behaviours which challenge increased, so her support team introduced PBS to support her. Since then her wellbeing has improved and she is more active in her community. In this case study, her Mum explains how PBS has supported Rebecca and what her PBS plan includes.
- Michael has complex needs including autism, a learning disability and oppositional defiance disorder, and displays behaviour that challenges services. His supported living placement followed a PBS plan, which included an adult education programme focused on building his life skills, and his quality of life has improved. Read his case study here.
- Gloucestershire County Council has implemented a county-wide approach to PBS. They set up a ‘Challenging behaviour working group’ to develop a Challenging Behaviour Strategy which outlines their strategic approach to supporting individuals with learning disabilities and/or autistic people who display behaviours which challenge - PBS is strongly featured in the strategy. Read the case study here.
Funding to support PBS training in adult social care
The PBS and autism training fund in 2016-17 was used to explore the use of 'personal workforce budgets' to train and develop the workforce to better support people with learning disabilities and/ or autistic people, who display or at risk of displaying behaviours which challenge. It was funded by the ‘positive and safe programme’ to contribute to the aims of the Transforming Care programme.
A personal workforce budget is an amount of money allocated and spent specifically on developing the skills of the workforce that support an individual, including:
- developing ‘skills around the person’
- interagency/ multi agency work at a person centred level
- providing training in line with PBS competency framework or good autism practice
- contributing to the discharge (or avoided likely admission) of one or more persons.
Download the evaluation report.
Read these case studies to find out how organisations used the fund to improve outcomes for people with learning disabilities and/ or autistic people who display or are at risk of displaying behaviours which challenge.
- Read how The Lifeways Group used the fund to train staff who support Keith, who has a learning disability, complex autism and related anxiety. They worked with staff to develop a positive behaviour support plan, communication skills and ways they could encourage Keith to engage more. As a result, Keith now leads a more fulfilled life, with reduced levels of anxiety and his behaviour patterns have changed.
- Read how The Lifeways Group used the fund to train staff who support Jeremy, who has a severe learning disability, Downs Syndrome and Klinefelter syndrome. They used the fund to improve communication between Jeremy and staff, including developing a video of the Makaton signs that Jeremy uses. As a result, Jeremy accesses the community every day and the number of incidents of behaviour that challenges has decreased.
- Read how Wirral Evolutions used the fund to train staff how to better support autistic people who display or are at risk of displaying behaviour which challenges. They trained over 100 staff on courses ranging from an 'introduction to positive behavioural support, to 'coaches training'.
Restraint Reduction Network Training Standards
The Restraint Reduction Network (RRN) has been commissioned by the NHS to develop standards for the training for the prevention and use of restrictive interventions.
The standards focus on the fundamental principles that apply to all populations (people with mental health conditions, learning disabilities or dementia) and settings (across education health and social care), and provide a national benchmark for training in restrictive practices.
Training services can be certified as complying with the RRN Training Standards, through accreditation by UK Accreditation Service (UKAS). NHS commissioning requirements and CQC inspection frameworks will require UKAS accredited certification of training services from April 2020.
Skills for Care is keen to ensure that the standards are also adopted across local authority commissioned adult social care services. We’re therefore writing to:
- local authority commissioners to encourage them to include ‘UKAS accredited certification of training services to demonstrate they meet the RRN Training Standards’ in commissioning requirements
- service providers who commission training to strongly suggest that they ensure they commission training that complies with the standards.
The RRN Training Standards were published in April 2019 and are available, here, on the RRN website.
Download Skills for Care's full statement about the standards here.
For further information please contact RRN@bild.org.uk
Local networks and communities of practice
Local networks can help you share what’s worked well and learn from others, to improve best practice.
We've put together this list of networks and communities of practice.
They have different focuses including supporting autistic people, people with learning disabilities/intellectual disabilities, and/or the use of PBS – or a combination of the above. Each network is different so make sure you ask how they’re run and who can join.
If you want to join a local network, use this list to find their details and get in touch.
If you want us to add your details to the list, please email us.