Positive Behaviour Support (PBS) is the recommended intervention for people with autism and learning disabilities who may display behaviours that challenge. Emerson and Einfield (2011) describe behaviours that challenge as those that fall outside of social norms, but also when they occur to such an extent, be it in frequency, duration, or intensity that they have social consequences such as harm to self or others. 

PBS is a non-linear, multi-element approach which holds the person we support and their family at the centre. PBS Plans share a common goal of quality-of-life improvement and address issues that go beyond challenging behaviour, such as skill development of general skills that will enhance the ability to take part in activities throughout the day. By achieving a better quality of life, those behaviours that challenge naturally decrease. 

PBS and Behaviours That Challenge

Behaviour that challenges is maintained because of the way it is responded to, the behaviour of others. These behaviours occur for a reason because they are often the most effective way of getting needs met. How behaviours are responded to is often embedded within a wider social context.

Clinicians supporting those who display behaviours that challenge need to have an understanding of why these behaviours occur. To find out why these behaviours are present, PBS Practitioners must, with the help of those who support clients, their families, and the person themselves, conduct Functional Behavioural Assessments (FBAs) to find the function of the behaviour – why are they engaging in these behaviours?

Once these have been completed, this knowledge can be used to create supportive environments that reduce the likelihood of behaviours that challenge and to also address the behaviour when it does occur, using best practice based on evidence. This knowledge needs to exist within organisations and across services, as well as be embedded in policy and practice.

PBS Behaviour Model Stages

There are three stages to PBS: Proactive, Active and Reactive. The main section of a PBS plan is the Proactive, which makes up 70% of a PBS Plan. These strategies are implemented daily and help keep the person we support at their baseline: calm and ready.

These can be things such as ensuring the environment is able to meet need, minimising triggers that lead to behaviours that challenge, or teaching skills to increase independence and coping strategies. These strategies can sometimes be difficult to implement, particularly if the person we support is already heightened or environmental factors which are out of our control.

Active strategies make up 20% of a PBS Plan. This section ensures we have the tools to support people when they start to become heightened. The emphasis here is on calming, redirection, distraction, and problem-solving to avoid the need for physical restrictions.

There are three elements to active strategies:

• Recognising early warning signs – these are different for each individual
• Active listening – closely monitoring the mood of the person we support
• Taking action – early intervention by removing triggers, distracting, and giving space.

Reactive strategies make up 10% of a PBS Plan. These are to be used as a last resort and must only be used when all other strategies have not worked when dealing with an isolated incident. These reactive strategies are specific to an individual and must be agreed upon between the multi-disciplinary team.

Implementing PBS Practice

There is a great need for the implementation of Positive Behaviour Support within the lives of those with autism, learning disabilities and mental health needs in order to create an environment in which the people we support can flourish. That being said: the goal of implementing PBS practice at the forefront of our support can only be realised when all that are involved play their part in the procurement and delivery of services and share an understanding of the PBS approach and its core values and goals.