Rolling out Positive Behaviour Support (PBS) shouldn't begin with writing individual plans. First, senior leaders need to establish what they want PBS to change and create the conditions for teams to put it into practice.
Without that groundwork, PBS implementation can become an exercise in new templates, written plans and staff training, and day-to-day support ends up changing very little.
A positive behaviour support framework puts individual planning within a wider organisational approach, covering leadership, workforce skills, practice support and how progress will be monitored. Current CAPBS guidance takes this whole-organisation approach, embedding PBS across everyday support, practice leadership and organisational culture.
Senior leaders make many of the decisions that determine whether PBS can be delivered properly. They decide whether staff have time for training and supervision, whether specialist expertise is available, how services collect and review information and who is responsible when implementation stalls.
To secure buy-in, connect PBS to the existing organisational priorities senior leaders are responsible for. That may be reducing restrictive practices, improving outcomes or having more consistent support between services. Be clear about what implementation will require from the organisation, including staff time, training and access to specialist expertise.
Bring together evidence from different parts of the service rather than looking at incidents in isolation. Complaints, safeguarding concerns, use of restrictive practices and feedback from people receiving support may reveal problems that incident numbers don't show. Look across services too. If one team is seeing fewer incidents or helping someone achieve better outcomes, understanding what they are doing differently can help identify where practice needs to change elsewhere.
Once leaders have agreed the case for change, their support needs to show up in practical decisions. Someone needs clear responsibility for implementation, and teams need enough time and expertise to carry out assessments, develop plans and review practice properly. Any gaps in PBS competence or specialist support are better identified here than halfway through rollout.
Senior managers also need to decide what they want visibility of once implementation begins. The useful information will depend on the organisation's aims, but it needs to show whether practice is changing and expose services or teams that need more support.
For more on using evidence, oversight and improvement activity to strengthen practice, watch our RI-to-Outstanding webinar.
Once the organisational groundwork is in place, implementation moves to the individual. The following process takes a plan from assessment through to day-to-day use and review.
Build the baseline around the person's life now. Bring together what is already known about their health, communication, history, interests and current support, then look at behaviours of concern in context. Existing care records and direct observation can sit alongside functional assessment and tools such as ABC charts.
The person should be involved in ways that work for them. Family members, carers and professionals who know them well may also hold useful information, particularly about changes over time or differences between settings.
As we covered in our guide to designing PBS plans, assessment tools help teams build and test an understanding of behaviour. The baseline should also capture what the person wants to change in their life. Progress might be taking part in an activity they've been avoiding, communicating choices more independently or needing less support with an everyday task.
If the only baseline recorded is the number of incidents that occurred last month, you'll know if that number changes. You won't know whether the person's life has improved.
Use the assessment to agree goals that matter to the person and work out what needs to change in their everyday support. That might involve adapting how staff communicate, changing something in the environment or helping the person develop a skill that gives them more independence.
Staff also need to know what to do if the person becomes distressed and proactive strategies haven't worked. Reactive guidance should focus on de-escalation and safety. Where there is a known risk of serious harm, make the escalation route clear and make sure it fits the person's wider risk or crisis plan. Any restrictive intervention must be justified and proportionate, using the least restrictive option for the shortest necessary time.
Before signing the plan off, test it against an ordinary shift. If it asks staff to offer a particular communication tool, is it available and do they know how to use it? If a proactive strategy relies on access to a quieter environment, can that realistically be provided?
Problems found during the testing phase are easier and safer to solve than problems that arise during an incident.
Our Positive Behaviour Support plan template provides a structure for recording the person's needs, goals and proactive and reactive support strategies.
Give staff the plan before they are expected to use it and allow them time to work through the parts that affect their role.
Make the changeover clear too. If the new plan replaces existing guidance, staff need to know when it takes effect and where the current version lives. Check that outdated instructions haven't been left in handover notes, printed care records or other places staff routinely look for information.
Think about staff who aren't present for the initial rollout as well. New starters, agency workers and colleagues returning from leave need to get up to speed with the current plan. Otherwise, old approaches can creep back in even when the core team understands what has changed.
Focus the rollout on what staff will actually do differently. Work through the strategies that affect everyday support and spend more time on anything staff will need to recognise or act on under pressure.
Explain the reasoning behind the strategies. A direction such as offering a quieter space is far more useful when the team knows what signs suggest the person is becoming overwhelmed, which spaces they prefer and how they communicate whether they want to move.
Decide from the outset how staff will feed back what happens in practice. Useful observations need to reach the people reviewing the plan rather than sitting unnoticed in daily records.
If your team identifies that a strategy can't be delivered safely in practice, find out why.
Our guide to getting the environment and team right for PBS looks more closely at staff preparation, reflective practice and maintaining consistency across shifts and settings.
Look at what's changed for the person since the plan was introduced, using the outcomes you agreed with them as well as incident and behavioural data.
Changes in participation, progress towards personal goals and the use of restrictive interventions may all be relevant. The person's own experience matters too, with staff observations and appropriate family input helping to explain what sits behind the data.
Then look separately at how the plan has been delivered. Poor outcomes don't automatically show that the strategy was wrong. First establish whether it was actually used as intended. Staff may have applied it inconsistently or discovered that an instruction which looked workable during planning was difficult to use on shift. If the strategy was used consistently and still didn't help, revisit the plan itself.
Your findings should determine what changes next. Sometimes the plan needs adjusting, or the problem may sit with training, staffing or how information is being shared.
Keep the person involved as the plan changes. Their circumstances, preferences and goals will change over time, and the plan needs to follow them.
Six months in, you should be able to see whether PBS has made it beyond the rollout phase. There isn't a formal six-month benchmark, but it's a useful point to look at what has actually changed.
Individual plans are one place to start. They should reflect what you know about the person now, not simply the information gathered when implementation began. Look for evidence that the person has remained involved and that strategies have changed where experience shows they need to.
The paperwork will only tell you so much. Look at what happens on shift. Staff should be able to explain why they use particular approaches with someone. What they notice on shift should find its way back into plan reviews, and new or temporary staff should be able to get up to speed without relying on whoever happens to know the person best being on duty.
Senior leaders should also have enough oversight to spot where PBS is getting stuck. If the same implementation problem keeps appearing, somebody needs to own it and follow it through rather than letting it disappear into another individual care-plan review.
If PBS still relies on one enthusiastic manager or specialist reminding everyone else what needs to happen, it hasn't been embedded yet.