Positive Behaviour Support in the UK and Australia: What Families and Carers Should Know

Imagine two young adults with intellectual disabilities living in supported accommodation—one in Manchester and the other in Melbourne. When an expected evening routine changes, each becomes distressed and throws objects across the kitchen.

In Manchester, professionals may describe this as “behaviour that challenges” and consult guidance from the National Institute for Health and Care Excellence. In Melbourne, it may be called a “behaviour of concern”, with specialist support delivered through Australia’s National Disability Insurance Scheme.

The language, regulation and documentation differ, but the central question should be the same: What is the person communicating, experiencing or trying to achieve through this behaviour?

Positive behaviour support, usually shortened to PBS, aims to answer that question while improving quality of life, protecting rights and reducing reliance on restrictive practices. It should not be used merely to make a person appear compliant or more socially conventional.

 Effective behaviour support is collaborative and should involve the person in decisions about their goals and daily life.

Quick Answer

The UK and Australia share the basic principles of positive behaviour support: understand why behaviour occurs, identify unmet needs, improve the environment, teach useful skills and involve the person and those who know them well.

The main difference is structural. The UK primarily guides practice through NICE recommendations, professional frameworks and separate national policies. Australia places specialist behaviour support within the regulated NDIS system, particularly when a plan contains a regulated restrictive practice.

In either country, a good plan should be person-centred, evidence-informed, medically aware, practical for everyday supporters and regularly reviewed against quality-of-life outcomes.

Key Takeaways

• Behaviour may communicate pain, fear, sensory overload, confusion, a need for predictability or difficulty expressing a request.

• A sudden change in behaviour should prompt consideration of physical and mental health causes—not only behavioural explanations.

• Functional assessment examines patterns before, during and after an event to develop a testable explanation of its purpose.

• Effective PBS changes environments and support practices as well as helping the person develop new skills.

• The UK relies mainly on clinical guidance and professional standards; Australia combines practice guidance with national NDIS regulation.

• Restrictive practices should never become routine merely because they are written into a plan.

• Staff training alone is insufficient without implementation support, monitoring,

  leadership and meaningful involvement from the person.

Table of Contents

1. What Does Positive Behaviour Support Mean?

2. Why Physical and Mental Health Must Be Considered First

3. How Does a Functional Behaviour Assessment Work?

4. How Australia Built Behaviour Support Into the NDIS

5. Positive Behaviour Support in the UK and Australia Compared

6. Consent, Human Rights and Restrictive Practices

7. What Does the Evidence Say—and What Criticism Matters?

8. Questions Families and Carers Should Ask

9. Frequently Asked Questions

What Does Positive Behaviour Support Mean?

Positive behaviour support is a multicomponent framework rather than one technique or a reward programme. It aims to understand behaviour within the person’s physical health, emotional wellbeing, communication, relationships, sensory environment, daily opportunities and wider support system.

The University of Warwick’s overview of positive behavioural support describes twelve connected components arranged under three areas:

• Rights and values: person-centred support, self-determination, partnership and elimination of aversive or abusive practices

• Theory and evidence: biopsychosocial understanding, behavioural learning principles and multidisciplinary knowledge

• Process and strategy: individualised assessment, evidence-informed decisions, personalised plans, implementation and evaluation

These elements work together. A plan is not genuinely person-centred merely because that phrase appears on its cover. The person’s preferences, communication, goals, culture, relationships and right to take reasonable risks must influence what happens in practice.

What Behaviour May Be Communicating

Throwing an object, refusing an activity, leaving a room or hitting may serve very different purposes for different people. Possible explanations include:

• Escaping pain, noise, demands or an overwhelming environment

• Seeking predictability, a familiar object, connection or sensory input

• Communicating “no”, “stop”, “help” or “I need a break”

• Responding to fear, trauma, grief or an unfamiliar supporter

• Trying to access an activity, person or item

• Coping with limited communication options

The same visible action can have different functions. This is why a generic behaviour-management script is rarely enough.

Why Physical and Mental Health Must Be Considered First

Behaviour is not a diagnosis. A new or escalating pattern may be associated with pain, illness, constipation, reflux, dental problems, infection, sleep disruption, seizures, medication effects, anxiety, depression or trauma.

NICE guidance on behaviour that challenges advises assessors to consider physical and mental health, medication, communication, sensory profile, recent life events, trauma, the care environment and changes to routine.

Medical causes can be missed when a person does not communicate pain conventionally. Supporters should record changes in eating, sleep, bowel habits, mobility, menstrual patterns, urination, facial expression and willingness to take part in familiar activities.

Expert Tip: If behaviour changes suddenly, ask “What has changed in this person’s body, environment, communication or relationships?” before assuming the person is choosing to be difficult.

Immediate medical attention may be necessary when behaviour occurs alongside a head injury, breathing difficulty, severe pain, loss of consciousness, suspected poisoning, a first seizure or another acute health concern.

How Does a Functional Behaviour Assessment

Work?

A functional behaviour assessment gathers information to develop and test an explanation of why behaviour occurs. It should involve the person as fully as possible and include family members, carers, clinicians, educators or support workers where appropriate and consented to.

Describe the Behaviour Clearly

Labels such as “aggressive”, “attention-seeking” or “non-compliant” are interpretations. A useful description states what can be observed—for example, “throws cups or utensils more than one metre” or “leaves the room within two minutes of a request”.

Identify What Happens Before and After

The assessment may examine where and when the event occurs, who is present, what was requested, whether the routine changed, signs of discomfort and how other people responded.

Develop and Test a Hypothesis

A hypothesis might propose that unexpected schedule changes create uncertainty and that throwing objects reliably delays the transition. This explanation should be tested against observations rather than treated as fact after one interview.

Build a Multicomponent Plan

A plan may increase predictability, offer visual information, provide meaningful choice, change the timing or difficulty of a task, teach a request for a break and explain how supporters should respond to early distress.

In Australia, a positive behaviour support plan may document the functional assessment, proactive strategies, skill development, implementation responsibilities and any safeguards governing restrictive practices.

Measure Quality of Life as Well as Incidents

Fewer incidents do not automatically mean life has improved. A person may appear quieter because activities, relationships or choices have been removed. Useful outcomes may also include better communication, increased participation, safer relationships, improved health, greater autonomy and fewer restrictions.

How Positive Behaviour Support Developed in the UK

The abuse exposed at Winterbourne View in 2011 intensified scrutiny of institutional care for people with learning disabilities and autistic people. The UK Government’s Winterbourne View review and response set out a programme intended to reduce inappropriate hospital placements and improve community-based support.

UK practice subsequently developed through clinical guidance, professional frameworks and policies that vary across England, Scotland, Wales and Northern Ireland.

NICE Guidance in England

NICE recommends a phased assessment that aims to understand why behaviour occurs. Its guidance says the person should remain central, families and carers should be involved, environmental and personal factors should be considered and assessment should remain flexible because triggers may change.

A written support plan should include proactive environmental changes, opportunities to develop alternative skills, early de-escalation approaches, risk management, implementation responsibilities, staff training and objective monitoring.

A Guidance-Led System

The UK does not have one national PBS regulator equivalent to the NDIS Commission. Professional roles, governance and qualification requirements depend on the service, employer, commissioning arrangement and practitioner’s regulated profession.

Families should therefore ask who completed the assessment, what qualifications and supervision they have, how medical issues were considered and who is accountable for reviewing the plan.

How Australia Built Behaviour Support Into the NDIS

Australia incorporates specialist behaviour support into the National Disability Insurance Scheme. The NDIS Restrictive Practices and Behaviour Support Rules 2018 provide the national regulatory framework, alongside state and territory authorisation requirements.

The NDIS Quality and Safeguards Commission explains that specialist behaviour support providers must be registered and must engage a practitioner whom the Commission considers suitable to conduct assessments and develop plans.

Plans Without Restrictive Practices

A participant can receive specialist behaviour support even when no restrictive practice is proposed. The plan should still reflect the person’s needs, strengthen quality of life and help supporters implement consistent, evidence-informed strategies.

Plans Containing Regulated Restrictive Practices

When a regulated restrictive practice is used, additional requirements apply. The practice must meet relevant authorisation rules, be used only as a last resort, represent the least restrictive response and be included within a plan that aims to reduce and eliminate its use.

NDIS guidance states that an interim plan must be developed within one month of the specialist provider being engaged and a comprehensive plan within six months when regulated restrictive practices are involved. Comprehensive plans containing such practices must be reviewed at least every twelve months, or sooner when circumstances change.

Practitioner Suitability Does Not Remove the Need to Ask Questions

Commission suitability is an important safeguard, but families should still ask about relevant qualifications, experience with the person’s disability and communication style, clinical supervision, cultural competence and approach to consent and restrictive-practice reduction.

Positive Behaviour Support in the UK and Australia Compared

Area	United Kingdom	Australia
Common terminology	Learning disability; behaviour that challenges	Intellectual disability; behaviour of concern
Primary structure	Clinical guidance, commissioning standards and professional frameworks	National NDIS regulation combined with state and territory requirements
Key national body	NICE provides guidance in England; arrangements vary across UK nations	NDIS Quality and Safeguards Commission
Practitioner status	Depends on profession, service and employer governance	NDIS behaviour support practitioners must be considered suitable by the Commission
Core assessment	Phased assessment and functional assessment for complex or persistent behaviour	Behaviour support assessment; comprehensive plans include functional behavioural assessment
Restrictive practices	Least restrictive approach, last resort, risk assessment and review	Specific national rules, reporting and relevant state or territory authorisation
Shared objective	Improve quality of life, understand unmet needs, build skills and reduce restriction

The systems should not be treated as interchangeable. A plan written for an NDIS participant must comply with Australian requirements, while a UK service must follow the law, safeguarding arrangements and clinical standards applicable where care is delivered.

Listening carefully and adapting communication can help supporters understand distress, preferences and unmet needs.

Consent, Human Rights and Restrictive Practices

PBS should begin with dignity, participation and self-determination—not merely incident reduction. The person should receive information in a form they understand and be supported to express preferences, objections and goals.

The UN Convention on the Rights of Persons with Disabilities reinforces rights relating to

liberty, safety, freedom from abuse, equal recognition and community inclusion.

What Counts as a Restrictive Practice?

Definitions depend on the jurisdiction, but restrictions may include physical, mechanical, environmental or chemical restraint and seclusion. Some apparently ordinary practices—such as locking food away, preventing access to an exit or using medication primarily to control behaviour—may require formal scrutiny.

Medication Should Not Replace Assessment

Medication may be appropriate for a diagnosed physical or mental health condition. It should not be used simply for staff convenience or as a substitute for investigating pain, communication, environmental stress and unmet need.

Least Restrictive Does Not Mean Risk-Free

Even a legally authorised restriction can affect dignity, trust, health and trauma. Any restriction requires clear justification, monitoring, review and an active strategy for reduction.

What Does the Evidence Say—and What Criticism Matters?

PBS is widely recommended, but the label alone does not guarantee good outcomes. Results depend heavily on assessment quality, leadership, implementation, staff competence, consistency and whether the person’s everyday life genuinely changes.

A 2018 cluster-randomised trial involving 23 English community intellectual-disability services found that manual-assisted staff training in PBS did not reduce challenging behaviour over twelve months compared with usual care. The finding does not show that every form of PBS is ineffective; it shows that staff training, as delivered in that study, was insufficient.

A systematic review of staff-training methods found that written description alone was not consistently effective. Implementation improved when training included combinations of feedback, modelling, role-play and other active components.

Neurodiversity-Affirming Criticism

Some autistic and neurodiversity-affirming advocates argue that behaviour programmes can prioritise conformity, obedience or outward appearance over autonomy. This concern is particularly important when harmless self-regulatory behaviour is targeted because it looks unusual.

A rights-based plan should not aim to remove safe stimming, preferred communication or disability-related differences merely to make someone appear neurotypical. Intervention needs a meaningful goal connected to safety, health, access, communication or the person’s own quality of life.

Myth Versus Fact

Myth: PBS is a reward chart for stopping unwanted behaviour.

Fact: Good PBS is a broad framework addressing health, communication, environment, skills, relationships and rights.

Myth: Every behaviour has one simple function.

Fact: Behaviour may serve several purposes, and its function can change across settings and over time.

Myth: Fewer incidents always mean the plan is working.

Fact: Incident reduction must be considered alongside choice, participation, wellbeing and restriction.

Myth: Registration or a written plan guarantees expertise.

Fact: Families should still examine experience, supervision, collaboration and implementation quality.

Questions Families and Carers Should Ask

Whether you live in Leeds, Glasgow, Melbourne or Brisbane, useful questions include:

• How will the person participate in the assessment and plan?

• How will you adapt communication to their needs?

• Which physical and mental health explanations have been considered?

• What direct observations and other evidence support your hypothesis?

• What will change in the environment, routine or support approach?

• Which communication, coping or daily-living skills will be taught?

• How will supporters be trained and observed implementing the plan?

• How will quality of life, autonomy and participation be measured?

• Which restrictive practices are present, and what is the reduction strategy?

• When will the plan be reviewed, and who is accountable?

Families and paid carers also need sustainable support. Our guide to preventing caregiver burnout explains why rest, boundaries and practical help form part of safe long-term care.

Supporters navigating complex services may also find the guide to community mental health teams useful. For wider emotional-health education, visit the Mental Wellbeing Hub.

Frequently Asked Questions

Is Positive Behaviour Support a Form of Therapy?

PBS is better understood as a framework for assessment and support than as one therapy. It may incorporate behavioural, communication, medical, psychological, occupational and environmental strategies.

Does PBS Mean Ignoring Dangerous Behaviour?

No. Immediate safety may require a proportionate response. Good practice combines risk management with proactive work intended to prevent recurrence and reduce future restriction.

Who Can Write a Behaviour Support Plan in the UK?

There is no single UK-wide PBS practitioner register equivalent to the Australian NDIS system. Responsibility depends on the setting, local commissioning arrangements, professional role and complexity of need. Ask about qualifications, competence, supervision and accountability.

Who Can Develop an NDIS Behaviour Support Plan?

A specialist behaviour support provider must engage an NDIS behaviour support practitioner whom the NDIS Commission considers suitable. Requirements are stricter where a plan contains regulated restrictive practices.

What Is the Difference Between Behaviour That Challenges and Behaviour of Concern?

The phrases are used more commonly in the UK and Australia respectively. Both attempt to avoid defining the person as the problem, although any label can become stigmatising if it replaces an individual description and understanding.

Can Pain Cause Behaviour of Concern?

Yes. Pain, illness, constipation, dental problems, sleep loss and medication effects may alter behaviour, particularly when someone has difficulty describing symptoms. Sudden or unexplained changes warrant health assessment.

Should Harmless Stimming Be Stopped?

Not simply because it appears unusual. Self-stimulatory behaviour may help a person regulate, communicate or cope. Any intervention requires a clear, person-centred reason connected to the individual’s wellbeing or safety.

Final Thoughts

The strongest versions of PBS in the UK and Australia share more than they differ. Both seek to replace blame with understanding, improve the environment, strengthen communication and create a life in which distress is less necessary.

Australia provides a more explicit national regulatory structure through the NDIS. The UK relies more heavily on clinical guidance, workforce competence and service governance. Neither structure can guarantee humane, effective support without careful assessment and implementation.

The central test is not whether a document is called a positive behaviour support plan. It is whether the person is healthier, safer, better understood, more involved in decisions and able to participate more fully in a life they value.

This article provides general educational information and does not replace individual

medical, psychological, safeguarding or legal advice. Requirements differ by jurisdiction and can change. Seek qualified professional guidance for individual behaviour support, health concerns or restrictive-practice questions. If anyone is in immediate danger, contact the appropriate emergency service.

References

Clinical and Research References

1. National Institute for Health and Care Excellence. Challenging behaviour and learning disabilities: prevention and interventions. NICE Guideline NG11.

2. Hassiotis A, Poppe M, Strydom A, et al. Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial. British Journal of Psychiatry. 2018;212(3):161–168. doi:10.1192/bjp.2017.34.

3. MacDonald A, et al. A systematic review of training methods to increase staff knowledge and implementation of positive behaviour support. 2021.

4. University of Warwick, Centre for Educational Development, Appraisal and Research. Positive Behavioural Support across the lifespan.

5. Gore NJ, McGill P, Toogood S, et al. Definition and scope for positive behavioural support. International Journal of Positive Behavioural Support.

UK Policy and Guidance

1. Department of Health and Social Care. Winterbourne View Hospital: Department of Health review and response.

2. National Institute for Health and Care Excellence. Behaviour support plan and functional assessment recommendations.

Australian Regulation and Guidance

1. Australian Government Federal Register of Legislation. National Disability Insurance

2. Scheme (Restrictive Practices and Behaviour Support) Rules 2018.

3. NDIS Quality and Safeguards Commission. Rules for specialist behaviour support providers and NDIS behaviour support practitioners.

4. NDIS Quality and Safeguards Commission. Applying to become an NDIS behaviour support practitioner.

5. Australian Government Federal Register of Legislation. NDIS Practice Standards quality indicators: behaviour support.