Positive Behaviour Support: Are We Missing the Point?
When a quality-of-life approach becomes behaviour management
Positive Behaviour Support (PBS) is not a plan for what adults should do when a child reaches crisis. It is not a list of consequences, a traffic-light system or a collection of strategies for stopping behaviour that adults find difficult. Nor should it be something that is only opened after an incident has occurred.
At its core, Positive Behaviour Support, commonly known as PBS, is about improving quality of life. It involves understanding the child within the full context of their life, including their relationships, communication, routines, environment, sensory needs, health, history, interests and opportunities to participate.
The reduction of behaviours of concern matters, particularly where there is a risk of harm. However, within genuine PBS, this should occur through creating a life in which the child feels safer, more understood, more involved and is supported by adults who are better able to meet their needs.
When the primary aim becomes controlling behaviour, PBS has lost its purpose.
How Does PBS Become Behaviour Management?
Most organisations using PBS would describe their approach as child-centred, proactive and strengths-based. The difficulty is that the practice recorded within plans does not always reflect these values.
A plan may contain detailed descriptions of aggression, damage, absconding or self-injury, yet provide very little information about what helps the child feel safe, what gives their day meaning or what they want for their future.
The escalation and crisis sections may be highly developed, while the parts intended to describe proactive support contain generic statements such as - offer choices, use distraction, maintain boundaries, give praise or encourage the child to engage.
These strategies may have a place, but they do not tell us enough about the individual child or what needs to change around them. When a plan contains six pages about crisis and two lines about everyday life, it tells us where the primary focus of attention is. This does not usually happen because staff do not care. Residential care teams are working with competing demands, high levels of risk, changing staff groups and children whose needs may be complex and difficult to understand. In these circumstances, immediate safety understandably takes priority.
The risk is that the service becomes organised around responding to crises rather than preventing the conditions that make crises more likely.
Reactive Support Has a Place, But It Should Not be Central to PBS Planning
Children need adults who can respond safely when they are overwhelmed. Clear guidance about early signs of distress, de-escalation, risk management and recovery is an essential part of a PBS plan. However, these are reactive and preventative safety strategies within PBS. They are not the whole approach. If staff only refer to the plan when behaviour begins to escalate, the plan has become a crisis-management document.
A genuinely proactive approach asks what is happening during the hours, days and weeks before the crisis and reduces the likelihood of distress before it occurs. It looks at the child’s experience of everyday life and considers:
Does the child understand what is expected of them?
Is their routine predictable without becoming overly rigid?
Do they have meaningful choices?
Are demands matched to their skills and current capacity?
Are communication differences being recognised?
Does the environment support their sensory and emotional regulation?
How do they experience belonging and connection?
Do they have access to activities, roles and relationships that matter to them?
Are they developing skills that increase their independence and control?
Do they have enough experiences of success?
These questions take us away from asking only, “How do we stop this behaviour?” and towards asking, “What would need to be different for this child?”
Looking at the Child’s Occupational Life
An occupational therapy approach brings attention to what the child does, wants to do and needs to do within everyday life. Occupation does not mean employment. For children and young people, it includes getting ready in the morning, attending education, eating, sleeping, caring for themselves, spending time with others, playing, creating, using technology, taking part in interests and contributing to home or community life. These everyday experiences shape health, development and identity.
When a child has experienced trauma, disrupted care or repeated exclusion, their occupational life may have been shaped by instability. They may have had limited opportunities to develop routines, explore interests, take manageable risks or experience themselves as capable.
A child can quickly become known through the things they have done during periods of distress. Their records may describe them as aggressive, absconding, refusing or high risk. Over time, this can become the dominant story told about them.
An occupational perspective asks different questions:
What does this child enjoy doing?
When do they feel competent?
What roles are important to them?
Where do they experience belonging?
What would they like to learn?
Who are they becoming?
These are not additional questions to place at the end of an assessment. They are central to understanding quality of life and developing meaningful support.
PBS Should Support Identity, Not Reinforce a Problematised Narrative
Occupational identity is the developing sense of who we are and who we might become, shaped through what we do, the roles we hold, where we belong and how other people respond to us. For a child living in residential care, identity may already have been influenced by trauma, separation, professional involvement and repeated descriptions of risk or concern.
PBS should help widen that identity.
A young person should not only be known as someone who becomes aggressive when demands are placed on them. They may also be a protective sibling, a talented artist, a loyal friend, a football supporter, a skilled gamer, an animal lover or someone who wants to become a mechanic.
These parts of the child’s identity should influence the support they receive.
Strengths should not be placed in a decorative box at the beginning of a plan and forgotten. They should be used actively to build relationships, create opportunities, develop skills and help the child experience success.
What Are the Goals?
One of the clearest signs that PBS has moved away from its purpose is when every goal or outcome concerns the reduction of behaviour.
Targeted intervention outcomes such as “reduce incidents of aggression” or “decrease episodes of absconding” may be necessary for adults to monitor safety. However, they are not the child’s own goals, and they do not reflect their true wishes, aspirations or choices.
Meaningful PBS goals might include:
Developing a morning routine that enables the child to reach education
Learning to recognise and communicate early signs of overwhelm
Choosing, shopping for and preparing a preferred meal
Building a trusting relationship with a consistent adult
Returning to a valued hobby or taking up a new community activity
Developing confidence when travelling locally
Increasing involvement in decisions about daily routines
Finding ways to maintain important family, cultural or community connections
Learning practical skills that support growing independence
Behavioural information remains useful, but it should sit alongside measures of participation, wellbeing, choice, relationships, skills and progress towards what matters to the child.
Collaboration Is More Than Asking Questions
PBS cannot be person-centred if the person is absent from the process.
Children should be supported to contribute in ways that work for them. This does not always mean sitting at a table, answering direct questions or completing a worksheet. Some children communicate more openly while walking, drawing, baking, listening to music, travelling in the car or taking part in a shared activity. Others show their preferences through patterns of participation, avoidance, body language and the relationships in which they appear most comfortable.
Good collaboration may include:
Conversations at the child’s pace
Visual or creative methods
Activity-based work
Observation of everyday routines
Information gathered through trusted relationships
Feedback from family members and other important people
Trying different approaches and noticing the child’s response
Plans should clearly distinguish between the child’s own words and adult interpretation. Where direct involvement is not currently possible, this should not be treated as permission to stop trying. The question is not simply whether the child attended a planning meeting. It is whether their experience, preferences and priorities shaped the plan.
Language Shapes How We See the Child
The language used in PBS plans influences how adults understand and respond to the child. Words such as manipulative, attention-seeking, non-compliant, controlling or refusing can present the behaviour as a personal flaw. They may also close down curiosity before the child’s needs have been properly explored and understood.
More reflective language might ask whether the child is:
Seeking connection or reassurance
Trying to regain predictability or control
Communicating that a demand feels unsafe or unmanageable
Avoiding a situation associated with distress
Responding to pain, fatigue or sensory overload
Protecting themselves using strategies that have previously worked
Lacking an accessible way to communicate what they need
These are not softer labels or automatic explanations. They are questions that require assessment. Strengths-based language does not minimise risk or avoid accountability. It describes concerns clearly while maintaining the child’s dignity and recognising that behaviour occurs within a context.
A Plan Is Not Evidence That PBS Is Happening
A well-written document does not, by itself, demonstrate good PBS.
Implementation depends on what happens around the child each day. Staff need time to understand the plan, opportunities to practise new approaches and supervision that helps them reflect when strategies are not working.
Managers and clinical leads need to examine whether:
Staff understand the purpose behind each strategy
Approaches are realistic within the home’s routines and resources
The child experiences consistency across different adults
Proactive strategies are used during calm periods
Environmental adaptations have actually been made
Agreed opportunities and activities are available
The child’s views continue to be sought
Outcomes are reviewed beyond incident numbers
Restrictive or reactive responses remain necessary and proportionate
PBS is a whole-system responsibility. It cannot be left to one manager, one keyworker or the person who wrote the plan.
Training matters, but training alone is not implementation. Services also need leadership, reflective supervision, coaching, review and a culture in which staff can acknowledge when an approach is not working.
Returning to the Purpose
Positive Behaviour Support asks services to do more than respond differently to behaviour. It asks them to think holistically about the child.
It requires us to look beyond incidents or problems and consider the child’s full experience of everyday life. It asks whether their environment supports safety, whether their relationships support trust and whether their routines provide opportunities for choice, contribution and growth. The central question should not be “How can we manage behaviour?” It should be:
“How can we understand this child and work together to create the conditions in which they can feel safe, take part and move towards a life that matters to them?”
That is the real work of Positive Behaviour Support.
References
Gore, N.J., McGill, P., Toogood, S., Allen, D., Hughes, J.C., Baker, P., Hastings, R.P., Noone, S.J. and Denne, L.D. (2013) ‘Definition and scope for positive behavioural support’, International Journal of Positive Behavioural Support, 3(2), pp. 14–23.
National Institute for Health and Care Excellence (2015) Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges. NG11. London: NICE.
Perez, M., Carlson, G., Ziviani, J. and Cuskelly, M. (2012) ‘Contribution of occupational therapists in positive behaviour support’, Australian Occupational Therapy Journal, 59(6), pp. 428–436.
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