PBS-Led Support for Behaviours That Challenge
PBS-Led Support for Behaviours That Challenge
Behaviours that challenge, also referred to as behaviours of concern, are behaviours that are of an intensity, frequency or duration that threaten the quality of life or physical safety of the individual or others, and that are likely to lead to responses that limit or deny the person’s rights and opportunities (Emerson, 1995, as referenced in NICE guideline NG11).
The term ‘behaviours that challenge’ is preferred in current clinical and policy guidance because it reflects the fact that the challenge lies in the environment and support system, not with the person. These behaviours are most often a form of communication, a signal that something in the person’s life is not working for them.
Home Not Hospital provides PBS-led support for people with learning disabilities and/or autism who display behaviours that challenge and require a specialist, structured approach to live safely at home or in supported living.
The evidence base: NICE NG11 and Building the Right Support
NICE guideline NG11, challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges (2015), provides the clinical framework for this area of practice. It recommends Positive Behaviour Support as the primary evidence-based approach and sets out clear requirements for assessment, planning, delivery and review.
Building the Right Support (NHS England, 2015) and the subsequent National Development Team for Inclusion (NDTi) guidance reinforce that people with learning disabilities and/or autism who display behaviours that challenge should be supported in community settings with appropriate PBS-informed support, and that hospital admission should not be a default response.
The Restraint Reduction Network (RRN) Training Standards (2019) and the Mental Health Units (Use of Force) Act 2018 set clear expectations around the reduction and oversight of restrictive interventions. All restrictive practices used within our services are recorded, reported, reviewed and subject to active reduction plans.
What Positive Behaviour Support means in practice
PBS is not a single technique or intervention. It is a framework for understanding behaviour, designing proactive support, and improving quality of life. A PBS-led approach involves a thorough functional behavioural assessment (FBA) to identify the antecedents, the function of the behaviour, and the environmental or contextual factors maintaining it.
From that assessment, a structured behaviour support plan is developed, which typically includes:
- Primary prevention strategies — changes to the environment, routine and interaction that reduce the likelihood of distress occurring
- Secondary strategies — early recognition of warning signs and proactive responses that prevent escalation
- Reactive strategies — agreed responses when behaviour escalates, with a clear focus on keeping everyone safe with the minimum use of restriction
- Post-incident support — ensuring the person’s wellbeing is prioritised following a distressing episode
PBS support plans are implemented by a trained and consistently supervised team, reviewed regularly, and updated in response to changes in need and outcome data.
Functional behavioural assessment
Understanding the function of a behaviour is central to an effective PBS response. Behaviours that challenge typically serve one or more functions: access to preferred items, activities or people; escape or avoidance of demands, discomfort or people; sensory stimulation; or communication of an unmet need.
Without understanding function, interventions risk being ineffective or counterproductive. A functional assessment draws on direct observation, interview with the person and those who know them well, review of incident data, and analysis of antecedent-behaviour-consequence (ABC) patterns. Where appropriate, this assessment is led or guided by a suitably qualified practitioner, such as a Board-Certified Behaviour Analyst (BCBA) or a registered psychologist with competence in PBS.
Reducing restrictive practice
NICE NG11 is explicit: the use of restrictive interventions should be minimised and, where used, should be subject to clear authorisation, recording, review and reduction planning. Physical intervention should be used only as a last resort, not as a routine management strategy, and should be reviewed as part of a wider PBS plan.
Restrictive practice includes not only physical intervention but also chemical, mechanical, and environmental restraints, as well as practices that limit choice and freedom without lawful authority. As part of our PBS-led approach, we work with commissioners and clinical teams to identify and reduce all forms of restriction in line with current guidance.
Who PBS-led support is for
PBS-led support is most often appropriate for people with learning disabilities and/or autism who display behaviours that challenge. It may also be relevant for people with acquired brain injuries or other neurodevelopmental conditions that affect behaviour, communication and regulation.
Support is not one-size-fits-all. Some individuals need an intensive stabilising package quickly, particularly when there is a risk of placement breakdown or admission. Others need longer-term work focused on skill development, independence, and improved quality of life.
Supporting families and the wider network
Behaviours that challenge affect the whole support network. Families and carers may be exhausted, fearful, and uncertain about how to respond. Inconsistency across the network is one of the most common reasons PBS plans do not achieve their full potential.
We work with families, carers and other professionals to ensure a shared understanding of the behaviour support plan, agreed responses to early warning signs, and clear communication during incidents. Where appropriate, this includes training family members to ensure approaches are consistent across all settings.
How we build a PBS-led support package
We begin with a thorough assessment of the person, their environment, and the behaviours of concern. We gather information on routines, communication needs, sensory factors, health issues, and support history. We then develop a structured, evidence-based behaviour support plan and ensure the team is properly trained and supervised to implement it consistently.
Outcomes are agreed at the outset, including reductions in the frequency and severity of incidents, in restrictive practice, and in quality-of-life indicators. Progress is reviewed regularly in partnership with the person, their family, and the commissioning authority.
Speak to us about PBS-led support
If you are looking for PBS-led support as a commissioner, a professional, or a family member, we can talk through the situation and advise on what a safe, structured support package could look like. If there is concern about escalating incidents, placement breakdown, or risk of admission, it is worth speaking early. Contact Home Not Hospital, and we will come back to you as soon as possible.
FAQs about PBS led support for behaviours of concern
Both terms are used in the literature, but ‘behaviours that challenge’ is increasingly preferred in current guidance because it reflects the fact that the challenge lies in the system, environment, and support response rather than being an inherent characteristic of the person. NICE guideline NG11 uses ‘challenging behaviour’ in its title, but the principles are the same.
PBS was developed and has its strongest evidence base in relation to people with learning disabilities and/or autism. It may also be applied in other neurodevelopmental contexts. For autistic people without a learning disability, autism-specific frameworks such as SPELL and low arousal approaches form the primary evidence base, though PBS principles can complement these where behaviours that challenge are present.
We work with practitioners who have relevant competencies in behaviour analysis and PBS, including Board-Certified Behaviour Analysts (BCBAs), registered psychologists with PBS expertise, and senior practitioners trained through accredited PBS programmes. The level of specialist input is matched to the complexity of need.
Restrictive interventions are documented and reviewed as part of every PBS plan. We set clear reduction targets, analyse the circumstances in which restrictions are used, and develop primary prevention strategies to reduce the triggers. Progress is measured against incident and restriction data, which are reviewed at regular intervals.
Yes. PBS is designed to be effective even where a person has very limited verbal communication or capacity to engage in formal planning. Information is gathered through observation, from people who know the person well, and through systematic analysis of patterns. The focus remains on improving the quality of life and reducing distress.
Expert Care, Delivered
Home Not Hospital stands as a beacon of dedicated, comprehensive care in the community.
We deliver tailored support that can range from intensive complex care through to helping individuals build independence and improve quality of life, ensuring health and wellbeing are supported with expertise, compassion, and a commitment to care that feels like home, not hospital.
With a focus on personalised support and respect for each individual’s unique journey, Home Not Hospital sets a high standard for home-based care excellence.