Restrictive Practice Reduction Through Better Communication Support in PBS

May 12, 2026

Positive Behaviour Support requires providers to reduce restrictive practice by improving communication, not simply increasing control. The Positive Behaviour Support knowledge hub supports services to connect behaviour, proactive support, rights and restrictive practice reduction.

In specialist services, restrictive practice reduction and review should examine whether restrictions are being used because the person cannot easily understand information, express refusal, ask for help, request a break or signal distress early.

This reflects PBS principles and values, because people should not lose freedom because communication systems are weak. Strong providers show how better communication reduces risk, increases choice and makes restrictive practice less necessary.

Concept Explained Clearly

Communication support in PBS means giving the person reliable ways to understand what is happening and express what they need. This may include visuals, objects of reference, now-and-next boards, communication passports, pain charts, break cards, choice tools, consistent phrases or assistive technology.

Restrictions may develop when communication breaks down. Staff may lock access, increase supervision, remove items or control routines because they cannot predict distress early enough. In PBS, the reduction question is whether better communication would allow the person to stay safer with more freedom.

Why It Matters in Real Services

Without clear communication, ordinary situations can become restrictive. A person may be unable to ask when food is available, why transport is late, whether a visit is cancelled or how to leave a busy room. Behaviour then becomes the communication route.

If the service responds only with restriction, the underlying communication need remains. Commissioners and CQC will expect providers to evidence that communication needs are assessed, supported and reflected in restriction reduction planning.

What Good Looks Like

Strong services demonstrate that communication support is practical and used consistently. Staff know what the person understands, how they express discomfort, how choices should be offered and how early distress signs should be acted on.

Good PBS practice links communication tools directly to reduction plans. Providers should be able to evidence that when communication improves, restrictions reduce, independence increases and distress decreases.

Operational Example 1: Reducing Staff-Controlled Food Access

Step 1 – Context: A person’s snack access was controlled by staff because they became distressed when preferred food was unavailable and tried to access cupboards repeatedly.

Step 2 – Support approach: Review showed the person did not understand when snacks were available or how to ask for alternatives when something had run out.

Step 3 – Day-to-day delivery detail: Staff introduced a snack choice board, a “finished” symbol for unavailable items and two agreed replacement options.

Step 4 – Reduction action: The person regained planned access to their own snack box, while staff used the communication board before usual distress times.

Step 5 – How effectiveness was evidenced: Cupboard attempts reduced, distress decreased and the person began using the symbols to request alternatives. The provider evidenced that communication support reduced the need for staff-controlled access.

Deepening the Understanding: Restriction Can Hide Communication Failure

When staff control access, routines or movement, behaviour may reduce temporarily because opportunity is removed. That does not mean the person understands more or feels safer. It may simply mean their communication need has been bypassed.

Strong PBS review asks what the person was trying to communicate before restriction was introduced. The article on using ABC data in Positive Behaviour Support explains how teams can analyse what happened before, during and after behaviour so communication needs are not missed.

Operational Example 2: Reducing Close Supervision During Activities

Step 1 – Context: A person was closely supervised during group activities because they sometimes left suddenly and pushed past others near the door.

Step 2 – Support approach: Review identified that the person had no reliable way to request a break before becoming overwhelmed.

Step 3 – Day-to-day delivery detail: The provider introduced a break card, a clear exit route and a short recovery routine in a nearby quiet space.

Step 4 – Reduction action: Staff moved from close physical positioning to planned observation, responding when the person used the break card.

Step 5 – How effectiveness was evidenced: Pushing past others reduced, activity participation increased and the person used the break card independently. The provider evidenced that communication reduced the need for close supervision.

Systems, Workforce and Consistency

Communication-led reduction only works when the whole team uses the same methods. If one worker uses visuals and another relies on verbal instruction, the person may still experience confusion and distress.

Strong services include communication guidance in PBS plans, handovers, supervision and training. Staff should practise using tools during calm periods, not introduce them only during escalation.

Operational Example 3: Reducing Restricted Community Access After Cancellations

Step 1 – Context: A person’s community access was reduced after repeated distress when planned outings changed at short notice.

Step 2 – Support approach: Review showed that the person understood the original plan but had no accessible way to understand cancellation, delay or replacement activity.

Step 3 – Day-to-day delivery detail: Staff introduced a change card, a visual choice between two alternative activities and a consistent phrase to explain cancellations.

Step 4 – Reduction action: Community access resumed with planned change-support tools rather than avoiding outings where change might happen.

Step 5 – Evidence reviewed: Distress during cancellations reduced, outings increased and the person accepted alternative plans more often. The provider evidenced that communication support protected access while reducing restrictive avoidance.

Governance and Evidence

Governance should show how communication needs are considered within every restrictive practice review. Providers should be able to evidence communication profiles, PBS plan updates, restriction register notes, incident analysis, staff competency checks, speech and language input where relevant and outcome monitoring.

Strong governance creates a clear line of sight from communication barrier to behaviour, from behaviour to restriction, from restriction to communication support, and from communication support to reduction outcome. Evidence should show that communication tools are used in real practice, not only listed in documents.

Commissioner and CQC Expectations

Commissioners expect providers to reduce restrictive practice through skilled support, including accessible communication. They need assurance that people are not being restricted because the service has not adapted information, choices or expression routes.

CQC will expect care to be person-centred, responsive and least restrictive. Inspectors may review whether people’s communication needs are understood, whether staff use agreed tools and whether restrictions reduce as communication improves. Strong services demonstrate that communication support is central to rights-based PBS.

Common Pitfalls

Using restriction when the person needs clearer information.
Relying on verbal explanations that the person cannot process under stress.
Introducing communication tools only during crisis.
Listing communication aids in plans without checking staff use.
Removing access instead of supporting requests, refusal or breaks.
Failing to link communication improvement to restriction reduction.

Conclusion

Restrictive practice reduction through better communication support helps PBS services reduce control by improving understanding, expression and early help-seeking. Behaviour often escalates when the person has no reliable way to communicate need.

Strong providers evidence how communication support reduces distress, restores access and improves autonomy. This gives commissioners and CQC confidence that restrictive practice is being reduced through practical, person-centred PBS rather than maintained through control.