Positive behaviour support plan example: a worked PBS plan, section by section

A positive behaviour support plan is a written plan that explains why a person's behaviour happens, what that behaviour does for them, and how the people around them will change the environment, teach new skills, respond to early signs and keep everyone safe when things go wrong. It is built on a functional assessment and organised into primary, secondary and reactive strategies. The example in this guide is a full plan for one composite person, so you can see what each part looks like when it is written properly.

The short answer

PBS stands for positive behaviour support. It is a framework, not a technique, that starts from the idea that behaviour which challenges is a way of meeting a need, and that the right response is to understand the need and meet it differently rather than to suppress the behaviour. A PBS plan has four parts that matter most: a functional assessment that says what the behaviour achieves for the person; primary strategies that change the environment and teach skills so the behaviour is needed less; secondary strategies that respond to early signs before a crisis; and reactive strategies that keep people safe during an incident with the least restriction possible. Everything else, including PRN medication, post-incident support and the reduction plan for any restrictive practice, hangs off those four. The rest of this guide takes each part in turn and then sets out a complete worked example.

What is positive behaviour support and what does PBS mean in care?

Positive behaviour support grew out of applied behaviour analysis and the person-centred movement in the 1980s and 1990s, and it is now the approach expected by NICE guideline NG11 on challenging behaviour and learning disabilities and by CQC's guidance for learning disability and autism services. The PBS meaning in care is practical: understand the function of the behaviour, improve the person's quality of life so the behaviour is needed less, teach them better ways to get what they need, and respond to incidents in ways that are safe, proportionate and least restrictive.

Three things distinguish it from older approaches. It is values-led: the goal is a better life for the person, not compliance. It is evidence-led: decisions come from data, mainly ABC charts and frequency counts, not impressions. And it is proactive: most of the plan is about what happens when the person is calm, because that is when behaviour is prevented. A plan that is mostly about what to do during an incident is not a PBS plan; it is a crisis plan with a new name.

The positive behaviour support framework

The framework used across UK services, set out by the PBS Academy and BILD, describes PBS as having a values base, a theory and evidence base, and a process. The values are that the person's rights, dignity and quality of life come first, and that restrictive practices are reduced and never used as punishment. The theory is that behaviour is learned, serves a function, and is influenced by the environment. The process is assessment, plan, implementation, monitoring and review, with data at every stage.

The framework also sets out what a competent PBS practitioner does, and what a service that says it delivers PBS must have in place: staff trained in the approach, a functional assessment for every plan, data collection that is actually used, and leadership that models the values. A service can claim PBS and not deliver it, and inspectors have become good at telling the difference by asking staff what the function of a person's behaviour is. If they cannot answer, the plan is a document, not a practice.

At a glance: the parts of a PBS plan

Meet Tom: the person in the example

Tom is a composite. He is 29, autistic, with a moderate learning disability, and lives in a four-bed registered home. He uses some spoken words and a communication app on a tablet. He has been in the home two years, having moved from an assessment and treatment unit where he spent fourteen months. The behaviours that led to that admission were hitting his own head, hitting staff, and trying to leave the building. In the home those behaviours have reduced but not stopped, and the current plan is the third version.

Everything below is written as if it were Tom's plan. The names and details are invented; the structure and the level of detail are what I would sign off.

Step 1: describe the behaviour precisely

A PBS plan describes each behaviour in terms that two people watching would agree on. Not aggression, but: Tom hits out with an open hand toward the face of the nearest person, usually once, sometimes two or three times. Not self-injury, but: Tom hits the side of his head with the heel of his hand, repeatedly, hard enough to leave a red mark. Not absconding, but: Tom walks fast to the front door, pulls at the handle, and if it opens, walks toward the main road.

For each behaviour the plan records how often it has happened in the last three months, how intense it usually is on a simple scale, how long an episode lasts, and what harm has resulted. That is the baseline. Without it, nobody can say whether the plan is working. Tom's baseline: head-hitting eleven times in three months, mostly low intensity; hitting out four times, one bruise to a staff member; leaving the building twice, both times returned within ten minutes.

Step 2: functional assessment, what the behaviour does for Tom

The functional assessment is the heart of the plan and the part most often missing. It asks what the behaviour achieves, and there are broadly four answers: it gets something (attention, an object, an activity), it escapes something (a demand, a noise, a person), it produces a sensation, or it communicates pain or discomfort. Most behaviours serve more than one function in different situations.

Tom's assessment was done by the community learning disability team's behaviour specialist using interviews with staff and family, direct observation over three days, and analysis of six months of ABC charts. The findings: head-hitting happens most often when there is unexpected noise or when a planned activity is cancelled, and it stops when the noise stops or when he is taken to his room. Its function is escape from an aversive environment. Hitting out happens almost only when someone stands close in front of him while he is already distressed, and its function is also escape, from proximity. Leaving the building happens after a cancelled outing and its function is to get the thing he was promised. There is a secondary finding that head-hitting also increases when he is constipated, which is a discomfort function and points to a health need.

Step 3: setting events and triggers

Setting events are the background conditions that make the behaviour more likely: poor sleep, constipation, a change of staff, a visit that did not happen, a noisy morning. Triggers are the immediate events that set it off: the fire alarm test, being told the bus is cancelled, a new staff member standing too close. The plan lists both, because the response to a setting event is different from the response to a trigger.

For Tom, setting events are: less than six hours' sleep, no bowel movement for two days, an agency worker on shift, his mum's Sunday visit being cancelled. Triggers are: unexpected loud noise, a change to the visual timetable without warning, someone standing within arm's reach in front of him when he is showing early signs, being asked a direct question when he is agitated. Staff record the setting events every day on the daily log, so that the ABC charts can be read against them.

Step 4: primary strategies, changing the environment

Primary strategies are what happens when Tom is calm, and they are most of the plan. They aim to make the setting events and triggers less frequent and to make life good enough that the behaviour is not needed.

Tom's environment strategies: a visual timetable agreed with him each evening for the next day, and no changes without showing him the new picture and offering a choice of replacement. Notice of the fire alarm test the day before and on the morning, and the option to be in the garden when it happens. Ear defenders available in every room. Agency workers introduced by a familiar staff member and never left alone with him on their first shift. His mum's visits confirmed by phone on Saturday evening; if she cannot come, a video call is arranged and shown on the timetable. A bowel chart checked daily, with the PRN laxative protocol followed at two days. A sleep record, with a quiet-evening routine from nine.

None of this is about behaviour. All of it reduces behaviour, and the ABC data over the last year shows it: head-hitting has fallen from twenty-three episodes in the first three months of the plan to eleven in the last three.

Step 5: primary strategies, teaching new skills

The second half of primary is teaching Tom better ways to get what the behaviour gets. If head-hitting is escape from noise, teach a way to ask to leave. If leaving the building is getting the promised outing, teach a way to ask what will happen instead.

Tom's skills teaching: a too loud button on his communication app that any staff member responds to immediately by helping him leave the room, practised daily when he is calm, with the response guaranteed. A what next card he can hand to staff when he is unsure, which staff answer by pointing to the timetable. A three-step calming routine, headphones, garden, swing, taught with his keyworker on quiet afternoons so that it is familiar when he needs it. Each skill has a teaching plan, a record of practice sessions, and a note of how often he uses it independently. The too loud button was used unprompted nine times last month; that number is the evidence the skill is taking hold.

Step 6: secondary strategies, early signs and de-escalation

Secondary strategies respond to the first signs that Tom is becoming distressed, before any behaviour that could hurt anyone. The plan uses a traffic light. Green is calm. Amber is early signs. Red is the behaviour itself.

Tom's amber signs, in the order they usually appear: he stops using his app and goes quiet; he begins to hum; he rocks from foot to foot; he repeats a phrase, usually bus, bus, bus. At amber, staff do the following and nothing else. Reduce noise: turn off the television and radio, ask others to move to another room. One person only: the most familiar staff member stays, everyone else leaves the space. Step back: stay at least two metres away and to the side, never directly in front. Offer, do not ask: hold up the headphones and the garden picture, and wait. Do not ask questions, do not explain, do not touch. If he takes the headphones or moves toward the garden, go with him at a distance and stay quiet. Most amber episodes end here. The ABC data shows that when these steps were followed, eight out of ten amber episodes did not reach red.

Step 7: reactive strategies, keeping everyone safe

Reactive strategies are what staff do if the behaviour happens anyway. They are the shortest part of the plan and the part staff are most anxious about, so they must be simple and rehearsed.

Tom's red behaviours and responses. Head-hitting: move anything hard away from him, stay two metres back, say his name once calmly, hold up the headphones, wait. Do not attempt to hold his hands; the functional assessment showed this increases both intensity and duration. Hitting out: step back out of reach, turn side-on, do not speak, and if a second person is present they leave the room. Leaving the building: do not block the door or grab him; one staff member follows at a distance, calling the office so that a second person can go ahead to the road; the front door has a delayed release under his DoLS authorisation, which is a restriction recorded below. If he reaches the road, staff position themselves between him and traffic and wait for him to stop. He always has. Physical intervention is not part of Tom's plan, and staff are not trained to use it with him. If there is an immediate risk to life, staff call 999.

Step 8: PRN medication in the plan

Tom has lorazepam prescribed as required for severe distress. The PRN protocol is a separate document, and the PBS plan points to it and says where it sits: as the last reactive strategy, only at red, only after fifteen minutes of the amber and red strategies above, and only where he is at risk of hurting himself or others. It is never used at amber. It is never used because staff are short or tired. Every dose triggers an ABC chart, a report to the manager, and a review if there are three doses in a month.

The data on PRN use is part of the review. In the last year Tom has had lorazepam twice. Both doses were on days with two setting events present and both followed a cancelled outing. That tells the review that the primary strategy around cancellations needs strengthening, not that the medicine needs increasing. The PRN protocol guide covers how to write the protocol so the two documents agree.

Step 9: restrictive practice and the law

Every restriction on Tom is listed in the plan with its lawful basis, its justification, and the plan to reduce it. The Mental Capacity Act 2005 and Tom's DoLS authorisation are the legal framework; the Restraint Reduction Network standards and the CQC guidance on restrictive practice set the expectation that every restriction is recorded and reviewed.

Tom's restrictions: the delayed-release front door, authorised under DoLS, justified by the two incidents of reaching the road, with the reduction plan that it is reviewed at every DoLS renewal and that Tom is practising supported walks to the shop to build a route he can use safely. Two-to-one staffing on outings, justified by the same risk, with the reduction plan that it drops to one-to-one on routes he has completed calmly five times. Staff being in the room when he is at amber, which is not a restriction on him but is recorded as a form of observation. Nothing else. There are no locked internal doors, no seclusion, no physical intervention, and the plan says so explicitly so that no worker can believe otherwise.

Step 10: post-incident support and debrief

After any red episode, the plan says what happens for Tom and for staff. For Tom: space and quiet for as long as he wants it, then his keyworker or the most familiar person present checks in with the calm routine, and later the same day they look at the visual timetable together so he knows what is next. Nobody discusses the incident with him unless he raises it. He is checked for injury and it is recorded on a body map.

For staff: a short debrief with the senior on shift before the end of the shift, covering what happened, what was done, and how they are. Anyone hurt is checked and the injury recorded. The incident is reported through the incident system the same day. A longer reflective debrief happens at the next team meeting or supervision, and what is learned goes into the review. The plan is clear that debrief is not blame. A worker who followed the plan and was hit did nothing wrong. Recording the incident in the daily log with a body map the same day, rather than at the end of the week, is what makes the debrief accurate.

Step 11: data, ABC charts and frequency

The plan says what is recorded and how. An ABC chart for every red episode, and for any amber episode that lasted more than ten minutes or where the secondary strategies were not followed. The chart records the setting events that day, the antecedent in the minutes before, the behaviour in observable terms with intensity and duration, the consequence including what staff did and what happened next, and which strategies were used. Daily recording of the setting events on the daily log, whether or not anything happened. Monthly frequency counts per behaviour, plotted so that the trend is visible.

Data that is collected and not read is a waste of staff time and an insult to the person. The plan names who reads it: the keyworker weekly, the manager monthly, the behaviour specialist quarterly. The ABC chart guide explains how to record so the patterns actually show, and a system that holds ABC charts and the PBS plan together means the charts can be filtered by antecedent and by strategy without anyone retyping them. Kiwi holds both in the same record for that reason; any system that lets you filter charts by antecedent will do the job.

Step 12: review and the reduction plan

The plan is reviewed formally every three months with the behaviour specialist, and after any serious incident, any PRN dose, any change in medication or health, and any change in the home that affects Tom. The review reads the data first: frequency, intensity, duration, PRN use, restrictive practice use, skills use. It asks whether each strategy is being followed, using the ABC charts and the daily log to check. It asks whether the functional assessment still holds. It changes what is not working and records why.

The reduction plan is a specific part of the review. For each restriction, is the condition for reducing it met? For each reactive strategy, has it been needed, and could the primary strategies be strengthened so it is needed less? The direction of travel must be visible: fewer incidents, fewer restrictions, more skills, more life. When the numbers go the other way, the review says so honestly and asks why, rather than adjusting the plan to look better.

The worked example: Tom's plan in one place

The full plan reads as follows, with each part shortened here to the essentials.

About Tom

Tom is 29, autistic, loves buses, the swing in the garden, and his mum. He wants to go to the shop on his own. A good day is one where the plan does not change and he has been on a bus.

Behaviours

Head-hitting with the heel of his hand, eleven episodes in three months, mostly low intensity, under two minutes. Hitting out with an open hand, four episodes, one bruise. Leaving the building, two episodes, both returned within ten minutes.

Function

Head-hitting: escape from noise and from cancelled plans; also linked to constipation. Hitting out: escape from proximity when already distressed. Leaving: getting the promised outing.

Setting events and triggers

Setting: poor sleep, constipation, agency staff, mum's visit cancelled. Triggers: sudden noise, timetable change without warning, someone close in front, direct questions when agitated.

Primary strategies

Visual timetable agreed nightly, no unshown changes. Alarm test notice and garden option. Ear defenders everywhere. Agency staff introduced. Mum's visit confirmed Saturday. Bowel chart and laxative protocol. Sleep routine. Skills: too loud button, what next card, calming routine, all practised daily when calm.

Secondary strategies

Amber signs: quiet, humming, rocking, bus bus bus. Response: reduce noise, one person, step back and to the side, offer headphones and garden picture, no questions, no touch.

Reactive strategies

Head-hitting: clear hard objects, two metres back, name once, headphones, wait, no holding. Hitting out: step back, side-on, silence, second person leaves. Leaving: follow at distance, second person to the road, no blocking. No physical intervention. 999 if life at risk.

PRN

Lorazepam per protocol, red only, after fifteen minutes, risk of harm only. Two doses in the last year.

Restrictions

Delayed-release door under DoLS, reviewed at renewal, reduction via supported shop walks. Two-to-one on outings, reduced to one-to-one after five calm completions per route.

Post-incident, data, review

Quiet, check-in, timetable, body map. Staff debrief same shift. ABC every red. Setting events daily. Frequency monthly. Review quarterly and after any PRN or serious incident.

Writing a PBS plan: the procedure

1. Get the person's story first: who they are, what they enjoy, what a good life looks like, from them and the people who know them.
2. Describe each behaviour in observable terms and establish the baseline frequency, intensity and duration from at least three months of records.
3. Commission or carry out a functional assessment using interviews, observation and ABC data, and write down the function of each behaviour.
4. List the setting events and the triggers, separately.
5. Write the primary strategies: what changes in the environment and routine, and what skills will be taught, with a teaching plan for each.
6. Write the secondary strategies as a traffic light, with the person's own early signs and a short list of things to do and not do.
7. Write the reactive strategies for each behaviour, least restrictive first, and say explicitly what is not used.
8. Reference the PRN protocol and state where it sits.
9. List every restriction with its lawful basis, justification and reduction plan.
10. Write the post-incident section for the person and for staff.
11. Say what data is recorded, by whom, and who reads it when.
12. Set the review schedule, train every member of staff on the plan including bank and agency, and put a one-page summary where staff will see it.

A plan built this way usually runs to eight or ten pages. That is fine, as long as the one-page summary exists and the amber and red responses fit on it. Staff carry the summary; the manager and the specialist hold the full plan. If you want to see how the two sit together in a single record, with the audit trail behind them, that is worth asking any supplier to show you.

PBS plan checklist

• The plan opens with the person and what a good life means to them.
• Every behaviour is described so two observers would agree.
• There is a functional assessment and it names the function of each behaviour.
• Setting events and triggers are listed separately.
• Primary strategies are the largest section and include skills teaching with a practice record.
• Secondary strategies use the person's own early signs and say what not to do.
• Reactive strategies are least restrictive first and say what is not used.
• The PRN protocol is referenced and sits at red only.
• Every restriction has a lawful basis and a reduction plan.
• Post-incident support for the person and staff is written down.
• Data collection is specified and someone is named to read it.
• The review schedule is set and the last review changed something.
• Every member of staff has been trained on this plan and the record shows it.

Who writes the plan and who trains the staff

The functional assessment should be done by someone trained to do it: a behaviour specialist from the community learning disability team, a PBS practitioner employed by the provider, or a suitably qualified psychologist. The plan itself is written with the home, because the home has to deliver it, and with the person and their family. The registered manager owns it, and the plan sits inside the person's wider person-centred care plan rather than in a separate folder.

Training is not a one-off. Every worker who supports Tom is trained on his plan specifically, not just on PBS in general, before they work with him alone. The training includes the amber and red responses rehearsed, not just read. Refresher training follows every review. Agency and bank staff are included, and where they cannot be trained in time, they do not work with Tom alone. The training record shows who has been trained on which version of the plan, and the inspector will ask.

Common mistakes

• No functional assessment. The plan describes the behaviour and the response but never says why the behaviour happens.
• Reactive strategies first. The plan is mostly about what to do during an incident, and the primary section is two lines.
• Vague behaviour descriptions. Aggression, self-harm, absconding. Nobody can count them, so nobody knows if the plan works.
• PRN at amber. Medication is given at the first sign because the protocol and the plan do not agree.
• Restrictions not written down. The locked door and the two-to-one staffing exist in practice but not in the plan, so nobody reviews them.
• Data collected and never read. A drawer full of ABC charts and a review that says no change.
• Plan in the office. The agency worker on Saturday has never seen it and stands in front of Tom asking questions.
• Blame in the debrief. Staff stop reporting incidents because reporting feels like being told off.

What good looks like on inspection day

The inspector asks about Tom. The manager shows the plan and the inspector reads the functional assessment. They ask a support worker what Tom's behaviour is for, and the worker says he is trying to get away from noise or from people standing too close, and that when the plan is cancelled he is trying to get what he was promised. They ask what the worker does at amber and the worker lists it: noise down, one person, step back, offer the headphones, no questions. They ask what is never done and the worker says holding him and blocking the door.

The inspector looks at the data. Frequency has fallen over a year and the graph is in the review notes. Two PRN doses, each with an ABC chart, each followed by a review that changed the plan around cancellations. The delayed-release door is on the DoLS authorisation and the reduction plan shows Tom has completed three supported shop walks. The training record shows every worker, including two agency staff, trained on version three of the plan. The last quarterly review is dated, has the behaviour specialist's name on it, and changed two things.

That is inspection-ready evidence for PBS: a plan that explains, staff who understand, data that is read, restrictions that are reducing, and a person whose life is visibly better than it was.

Final conclusion

A positive behaviour support plan is not a list of what to do when someone kicks off. It is an explanation of why the behaviour happens, a plan to make it unnecessary, a set of early responses that stop it escalating, and a safe, least restrictive response for when it happens anyway, all held together by data and reviewed against it. Get the functional assessment done properly, make primary strategies the biggest section, write the amber and red responses so a new worker could follow them, put PRN and restrictions in their proper place, and read the ABC charts every week. That is what turns PBS from a phrase in a policy into a better life for the person.

Frequently asked

What is a positive behaviour support plan?

A PBS plan is a written plan, built on a functional assessment, that explains why a person's behaviour happens and what it achieves for them, and sets out primary strategies to make the behaviour unnecessary, secondary strategies to respond to early signs, and reactive strategies to keep everyone safe with the least restriction. It also covers PRN medication, restrictive practice, post-incident support and how the plan is reviewed against data.

What does PBS mean in care?

PBS stands for positive behaviour support. In care it means understanding behaviour that challenges as a way of meeting a need, improving the person's quality of life so the behaviour is needed less, teaching better ways to meet the need, and responding to incidents proportionately and with the least restriction. It is the approach expected by NICE NG11 and by CQC for learning disability and autism services.

What is a functional assessment in PBS?

It is the process of working out what a behaviour achieves for the person: getting something, escaping something, producing a sensation, or communicating discomfort. It uses interviews, direct observation and ABC chart data, and is usually done by a trained behaviour specialist. Without it, a plan is guessing at the response.

What is the difference between primary, secondary and reactive strategies?

Primary strategies happen when the person is calm and change the environment, routines and skills so the behaviour is needed less; they should be the largest part of the plan. Secondary strategies respond to early signs to prevent escalation. Reactive strategies are what staff do during an incident to keep everyone safe, least restrictive first.

Where does PRN medication fit in a PBS plan?

As the last reactive strategy, referenced from a separate PRN protocol, used only at the crisis stage after the non-drug strategies have been tried for a stated time, and only where there is a risk of harm. It is never used at early signs. Every dose triggers an ABC chart and a report, and rising use triggers a review of the primary strategies, not an increase in the medicine.

Who should write a positive behaviour support plan?

The functional assessment should be done by someone trained to do it, such as a behaviour specialist from the community learning disability team or a PBS practitioner. The plan is written with the home, the person and their family, because the home has to deliver it, and the registered manager owns it. Every member of staff is then trained on that specific plan.

How often should a PBS plan be reviewed?

Formally at least every three months with the behaviour specialist, and after any serious incident, any PRN dose, any change in medication or health, and any change in the home that affects the person. The review reads the data first, checks whether each strategy is actually being followed, and records what changed and why.

Sources

• NICE guideline NG11 Challenging behaviour and learning disabilities: prevention and interventions
• BILD and the PBS Academy: Positive behavioural support competence framework
• CQC: Right support, right care, right culture guidance for providers supporting autistic people and people with a learning disability
• Restraint Reduction Network training standards
• GOV.UK: Mental Capacity Act 2005 Code of Practice, including Deprivation of Liberty Safeguards
• Department of Health and Social Care: Positive and proactive care, reducing the need for restrictive interventions
• Skills for Care: positive behaviour support resources for adult social care