These behaviours may:

• challenge us because we may not understand what the person is trying to communicate
• cause harm to themselves, others, or their environment
• limit a person’s independence and overall quality of life.

Positive Behaviour Support (PDF) is a framework used to support people with challenging behaviours. It focuses on understanding the reasons behind behaviours and helping individuals develop alternative ways to communicate their needs.

PBS has been adopted and adapted across all four nations of the UK and is recognised as a best-practice approach in supporting people with learning disabilities.

Core principles of PBS

At the heart of PBS is a person-centred approach. Key principles include:

• improving independence and quality of life
• understanding what is important to the person
• avoiding aversive interventions or punishment-based strategies
• supporting the development of meaningful skills.

Some behaviours have clear meanings, while others require detailed analysis. This is where an FBA comes in.

FBA (PDF) is a structured process carried out by a trained health professional to identify the purpose or "function" of a behaviour. It helps determine what the person is trying to communicate or achieve through their actions.

Once the function of the behaviour is understood, a PBS plan can be developed collaboratively with the person and their support network. The plan aims to:

• build new skills
• reduce the need for challenging behaviours
• avoid triggers or situations that may lead to distress.

Multi-elemental interventions

PBS plans are multi-elemental, meaning they take a holistic view of the person’s life. This includes:

• environmental adjustments
• skill-building activities
• communication support
• emotional and behavioural strategies.

These interventions are tailored to the individual and designed to promote long-term wellbeing and independence.

The House

The image below uses a house shape to explain two different ways of looking at behaviour. The roof of the house shows a typical positive behaviour support approach. This is usually split into three levels:

• Proactive strategies: What you do every day when things are going well.
• Active strategies: What you do when there are early warning signs.
• Reactive strategies: How you respond during an incident.

This approach focuses only on the behaviour or concern. A key criticism is that it can overlook why the behaviour is happening and instead focus on stopping it, rather than meeting the person’s underlying needs.

The tall section on top (the ‘chimney’), labelled post-incident support, highlights the importance of helping the person recover after an incident. This includes repairing relationships and making sure care remains supportive and therapeutic.

The main body of the house (the rooms) represents a different approach. This focuses on understanding the function of behaviour and teaching alternative skills. It is based on the ABC model:

• Antecedent: What happens before the behaviour.
• Behaviour: What the person does.
• Consequence: What they gain or avoid.

Instead of only using ABC to analyse behaviours we want to stop, this approach uses it to build new skills that meet the same need. Each ‘room’ shows how this works in practice:

• Ecological strategies: Changing the environment or routine to reduce triggers.
• Positive programming: Teaching new skills or behaviours.
• Focused strategies: Reinforcing and rewarding the new behaviours so they are more likely to happen again.

The foundation of the house, labelled ‘function’, shows that understanding the purpose of behaviour is essential. The model suggests that effective support should focus not just on responding to behaviour, but on understanding and meeting the person’s needs.

Further information

Positive Behaviour Support (PBS)

UK-wide

• PBS Academy UK. About Positive Behaviour Support.
• NHS England. PBS Competence Framework (PDF).

England

• Positive Behaviour Support. Oxford Handbook of Learning and Intellectual Disability Nursing.
• Challenging Behaviour Foundation. Positive behaviour support.
• Health Education England. The key messages about Positive Behaviour Support (PDF).
• Royal College of General Practitioners: Health Checks Toolkit.
• Skills for Health. Supporting autistic people and/or people with a learning disability.

Guidance and policy

• NICE (2015). Challenging behaviour and learning disabilities.
• NICE (2018). Learning disabilities and behaviour that challenges: service design and delivery.

General health

• NHS Gloucestershire Health and Care NHS Foundation Trust. The A to Z of health issues (PDF).
• NHS Learning Disability and Autism. Improving health.

Scotland

• Scottish Commission for People with Learning Disabilities (SCLD). Positive Behaviour Support (PBS).
• Mental Welfare Commission for Scotland.

Health checks

• Down’s Syndrome Scotland. Annual health checks.
• NHS Education for Scotland . Once for Scotland. Learning disabilities.

Observatory and assembly

• Scottish Learning Disabilities Observatory.
• The Scottish Parliament.

Gender-based violence

• Public Health Scotland. Gender-based violence and learning disability.

Restraint reduction

• SCLD. Restraint Reduction Scotland. 

Mental health and autism

• Mental Welfare Commission for Scotland. Good practice guides.
• National Autism Implementation Team (NAIT).

Fetal Alcohol Spectrum Disorder (FASD)

• FASD Hub Scotland.

Screening

• NHS Lothian. Health screening.
• NHS Inform Scotland. Screening in Scotland.

Wales

Positive Behaviour Support (PBS)

• Public Health Wales. Supporting healthy behaviours.

Education and Frameworks

• Welsh Government. Learning Disability Educational Framework for Health Care staff in Wales (PDF).

Northern Ireland

General resources

• Health and Social Care, Northern Ireland