Positive behaviour support

Domain II · Behavioural & cognitive · Horner · 1990

What it is

Positive behaviour support (PBS) is not a single therapy. It is a values-led, multicomponent framework for understanding why a person's behaviour challenges (typically a person with learning or intellectual disability or autism, but also any child or adult in a school), and for building a…

Format

• Tier 3 (intensive; individual). Everything in Tiers 1 and 2, plus a multidisciplinary team, comprehensive function-based assessment (FBA), an individual plan covering prevention, teaching, reinforcement, controlled reduction of the natural rewards for problem behaviour and safety, and wraparound…
• Version followed: for individual (tertiary) support, the UK consensus definition of Gore et al. (2013) together with NICE NG11 (2015) and the Willis and LaVigna multielement model for plan structure and reactive strategies; for schools, the OSEP Center on PBIS Implementation Blueprint Part 1…

Who practises it, and how they are trained or regulated

• Phase 3: Plan development. Goal: a written, multicomponent behaviour support plan, devised with stakeholders and internally consistent with the assessment: operational definitions; proactive strategies (quality of life, removing triggers, functionally equivalent alternatives, coping skills); early calming strategies; a smaller set of reactive strategies; named responsibilities, training needs and data to be…
• Format and dose: no fixed session count. Work happens through home, residential, day-service or classroom visits, observation periods, team meetings and carer coaching; a typical complex case involves several weeks of assessment followed by months of supported implementation. Where parent training is used for children under 12, NICE describes manualised groups of 10-15 parents, about 8-12 sessions of 90 minutes.
• Tier 2 (targeted; small groups). Everything in Tier 1, plus an intervention team with a coordinator and behavioural expertise, formal screening, more instruction in self-regulation and social skills, more adult supervision, more reinforcement, more antecedent changes such as precorrection, more precision in not rewarding problem behaviour, and academic support. CICO is the most widely used Tier 2 intervention.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Shift to problem solving once arousal drops.
• Blame. Working when debriefs produce plan changes.
• Overly wordy problem solving with people at high arousal.
• Families too stretched to attend; offer individual sessions.
• Unpractised techniques rarely work in crisis; teach first (C4).

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.