Priming and Preparation in PBS: Setting People Up for Success Before Support Begins

Strong Positive Behaviour Support practice recognises that uncertainty is a common driver of distress. When people do not know what is about to happen, who will be involved or what is expected, anxiety can increase quickly.

Within proactive preparation strategies, priming is used to reduce that uncertainty before behaviour escalates. It involves giving clear, accessible information about upcoming events in a way the person can understand.

When grounded in PBS principles and values, priming supports autonomy and dignity. It reflects understanding behaviour as communication, where distress may indicate confusion or lack of preparation rather than resistance.

Concept Explained Clearly

Priming is the process of preparing a person for what will happen next. This may include explaining an activity, showing visual information, practising a routine or describing who will be involved.

In PBS, priming is proactive because it happens before the situation. It gives the person time to process, ask questions or regulate before expectations are placed on them.

Preparation should be simple, consistent and matched to the person’s communication needs.

Why It Matters in Real Services

In many services, activities and routines change quickly. Staff may move from one task to another without giving the person time to understand or prepare.

This can lead to confusion, refusal or escalation. Behaviour may be interpreted as non-compliance when the person has not been given enough information to respond.

Inconsistent preparation across staff can also increase anxiety. One worker may prepare the person effectively, while another may not.

What Good Looks Like

Strong services demonstrate that preparation is part of everyday support. Staff provide clear, accessible information before transitions, activities and changes.

Good practice includes visual supports, simple explanations, rehearsal where appropriate and time for the person to process information.

Providers should be able to evidence how preparation reduces distress and improves engagement. This creates a clear line of sight from preparation to outcome.

Operational Example 1: Preparing for Personal Care

Context: A supported living service supported a person who became distressed when personal care started unexpectedly.

Step 1 – Identify the issue: Review showed that staff often began tasks without warning.

Step 2 – Introduce priming: Staff provided a short visual and verbal explanation before starting personal care.

Step 3 – Allow processing time: Workers paused after priming rather than moving immediately into the task.

Step 4 – Monitor response: Staff recorded distress levels, task completion and engagement.

Step 5 – Review outcome: The person showed reduced anxiety and improved cooperation during care routines.

Deepening Preparation: Matching Information to Need

Preparation should be tailored to the individual. Some people need visual information, while others respond better to verbal explanation or demonstration.

Strong services identify how the person processes information and adapt priming accordingly. Overloading with information can be as unhelpful as providing none.

This approach aligns with person-centred care delivery, where communication is adapted to the person’s needs.

Operational Example 2: Preparing for New Activities

Context: A day service found that a person became distressed when introduced to unfamiliar activities.

Step 1 – Identify the trigger: Distress occurred when activities were presented without explanation.

Step 2 – Develop preparation tools: Staff created simple activity stories and visual guides.

Step 3 – Use consistently: The person was shown the information before the activity began.

Step 4 – Record engagement: Participation levels and emotional responses were tracked.

Step 5 – Evaluate outcome: The person engaged more confidently with new activities.

Systems, Workforce and Consistency

Priming must be applied consistently across staff teams. If preparation is used on one shift but not another, the person may experience inconsistent support.

Providers should include preparation strategies in care plans, handovers and training. Staff should understand when and how to prepare the person for change.

Strong services demonstrate that priming is part of routine practice, not an optional extra.

Operational Example 3: Preparing for Changes in Staff

Context: A person in residential care became anxious when unfamiliar staff were present.

Step 1 – Identify the pattern: Distress increased when staff changes were not explained.

Step 2 – Introduce preparation: Staff showed a simple rota or introduced new staff in advance.

Step 3 – Support familiarity: New staff used consistent communication and followed known routines.

Step 4 – Monitor impact: Anxiety indicators and behaviour were recorded.

Step 5 – Confirm outcome: The person showed reduced anxiety when staff changes were prepared.

Governance and Evidence

Providers should be able to evidence how preparation is used and reviewed. Evidence may include behaviour data, participation records, staff observations and care documentation.

Good governance examines whether priming reduces distress and improves engagement.

This creates a clear line of sight from preparation to outcome.

Commissioner and CQC Expectations

Commissioners expect providers to demonstrate proactive support that improves predictability and reduces distress.

CQC will expect care to be responsive and person-centred. Inspectors may observe whether staff prepare individuals effectively for activities and changes.

Strong services demonstrate that preparation is embedded and consistent.

Common Pitfalls

• Starting tasks without preparation.
• Providing too much or too little information.
• Inconsistent use of priming across staff.
• Rushing from one activity to another.
• Ignoring individual communication needs.
• Failing to review effectiveness of preparation.
• Recording behaviour without analysing preparation.

Conclusion

Priming and preparation are essential proactive support strategies in PBS. They reduce uncertainty, support understanding and prevent avoidable distress.

Strong providers demonstrate that preparation is personalised, consistent and evidence-led. When this is achieved, people experience greater confidence, improved engagement and better outcomes.