Functional Behavioural Formulation and Multi-Disciplinary Working in PBS
Functional behavioural formulation is most effective when it is shared, understood and owned across disciplines. In UK care services, PBS rarely sits in isolation; it intersects with health, safeguarding, commissioning and regulatory oversight. This article examines how functional assessment and formulation support effective multi-disciplinary working while remaining grounded in PBS principles and values.
The risk of siloed formulations
When behavioural formulations are developed in isolation—by a single professional or team—they often fail to translate into consistent practice. Staff may not understand the rationale, health professionals may not recognise their role, and governance leads may struggle to evidence impact.
Multi-disciplinary formulation ensures that:
- Behaviour is understood within health, psychological and social contexts
- Roles and responsibilities are explicit
- Risk decisions are shared and defensible
- Learning is embedded across the system
Operational example 1: Integrating health and PBS formulation
Context: A person supported in residential care displays increased self-injury and agitation. Behaviour support plans exist but show limited impact.
Support approach: Functional assessment is expanded to include input from nursing, GP and speech and language therapy. Pain, sleep and communication barriers are jointly reviewed.
Day-to-day delivery detail: Staff implement health-informed adjustments (hydration routines, pain indicators, communication aids). Behaviour support strategies are updated to reflect health triggers and reviewed jointly.
How effectiveness is evidenced: Incident frequency reduces alongside improved health indicators. Multi-disciplinary review notes link health interventions directly to behavioural outcomes.
Operational example 2: Aligning formulation with safeguarding processes
Context: A service experiences repeated safeguarding alerts linked to aggressive incidents.
Support approach: Functional assessment is reviewed through safeguarding and quality forums to ensure consistent understanding of triggers and responses.
Day-to-day delivery detail: Staff training focuses on early indicators and de-escalation. Safeguarding action plans explicitly reference behavioural hypotheses and agreed responses.
How effectiveness is evidenced: Safeguarding alerts decrease in frequency and severity. Audit trails show learning from incidents feeding back into formulation updates.
Operational example 3: Commissioning and provider collaboration
Context: A commissioner raises concerns about persistent high-risk behaviours and restrictive practices.
Support approach: The provider presents a functional assessment summary showing data trends, hypotheses and reduction plans.
Day-to-day delivery detail: Joint review meetings agree clear milestones, outcome measures and review dates. PBS plans are aligned with contract expectations and safeguarding frameworks.
How effectiveness is evidenced: Commissioners receive regular outcome updates showing reduced incidents and improved quality of life indicators.
Commissioner expectation: shared ownership and transparency
Commissioner expectation: Commissioners expect to see evidence that behavioural formulation is understood and implemented consistently across teams, not held by a single specialist.
Regulator expectation: coordinated, person-centred care
Regulator / Inspector expectation (CQC): Inspectors look for joined-up working where behavioural support aligns with health, safeguarding and governance processes, demonstrating safe, effective and responsive care.
Governance structures that support multi-disciplinary PBS
Strong governance includes regular multi-disciplinary reviews, shared documentation standards, and clear escalation routes when outcomes are not achieved. Functional assessment should be a standing agenda item in quality and safeguarding meetings.