Reactive Strategies in Positive Behaviour Support: Responding to Distress Without Escalation
Reactive strategies sit at the most ethically sensitive end of Positive Behaviour Support. They are used when distress has escalated despite preventative approaches, and decisions must be made quickly to reduce risk without causing harm. When poorly designed or inconsistently applied, reactive responses can escalate behaviour, embed restrictive practice and expose services to regulatory challenge. This article explores how reactive strategies and incident response should operate within the wider framework of PBS principles and values in UK regulated care.
The role of reactive strategies in PBS
Reactive strategies are not a failure of PBS. They acknowledge that behaviour occurs within complex systems and that even the strongest preventative plans cannot remove all risk. Their purpose is to:
- Reduce immediate risk to the person and others
- Prevent escalation and trauma
- Support recovery and re-engagement
- Protect dignity, rights and relationships
Crucially, reactive strategies should never stand alone. They must link directly to functional assessment, formulation and proactive planning.
Designing proportionate and lawful reactive responses
Well-designed reactive strategies are specific, graded and time-limited. They describe what staff do at different stages of escalation, not just at crisis point. This typically includes:
- Early indicators and low-level responses
- Mid-level escalation responses focused on de-escalation
- Last-resort measures to manage immediate risk
- Clear recovery and post-incident support actions
Language matters. Plans should avoid vague phrases such as “manage behaviour” or “maintain safety” and instead specify observable staff actions and decision points.
Operational example 1: Reducing escalation through clearer early-stage responses
Context: A supported living service experiences frequent escalation to physical intervention during evening routines. Incident reviews suggest staff often miss early distress signals.
Support approach: The reactive strategy is rewritten to clearly describe early indicators (pacing, withdrawal, repetitive questioning) and immediate staff actions (reduce verbal input, offer space, provide predictable choices).
Day-to-day delivery detail: Staff practise responding to early indicators during supervision, using real scenarios. The plan specifies who leads, who observes, and who manages the environment during escalation.
How effectiveness is evidenced: Incident data shows fewer escalations beyond early-stage responses, reduced use of physical intervention and improved staff confidence.
Reactive strategies and restrictive practice
Reactive strategies often intersect with restrictive practices, including physical intervention, PRN medication or environmental controls. Governance must ensure:
- Restrictions are clearly justified and last-resort
- Staff understand when and why they may be used
- Each use triggers review and learning
- Reduction plans are actively pursued
Reactive strategies should explicitly state what must happen before any restrictive practice is considered, and what happens immediately afterwards.
Operational example 2: Strengthening post-incident recovery
Context: Following incidents, individuals are left unsettled and staff focus mainly on reporting rather than recovery.
Support approach: Reactive strategies are expanded to include a recovery phase: quiet space, reassurance, preferred activity, hydration, and predictable reconnection.
Day-to-day delivery detail: Staff are assigned clear roles post-incident, ensuring one person supports emotional recovery while another manages documentation.
How effectiveness is evidenced: Post-incident distress reduces, repeated incidents within the same shift decrease, and individuals re-engage more quickly.
Operational example 3: Improving consistency across staff teams
Context: Agency and night staff respond differently to incidents, increasing risk and confusion.
Support approach: The reactive strategy is condensed into a one-page escalation flow that mirrors the full PBS plan.
Day-to-day delivery detail: The flow is used in handovers and displayed discreetly in staff areas. Agency induction includes a walk-through of reactive responses.
How effectiveness is evidenced: Incident narratives become more consistent and staff decision-making aligns with the plan.
Commissioner expectation: risk managed without defaulting to restriction
Commissioner expectation: Commissioners expect services to demonstrate that incidents are managed proportionately, with clear evidence that reactive strategies reduce escalation and support long-term reduction in restrictive practices.
Regulator expectation: lawful, least restrictive incident response
Regulator / Inspector expectation (CQC): Inspectors will test whether reactive strategies are understood by staff, consistently applied and aligned with least restrictive practice, safeguarding and human rights requirements.
Making reactive strategies part of learning, not just response
Reactive strategies are strongest when they feed learning back into preventative planning. Each incident should test the formulation, refine triggers and strengthen future responses. When this loop is active, incident response becomes a source of improvement rather than a sign of failure.