Restrictive Practice Reduction Through Reviewing Communication Restrictions in PBS

May 17, 2026

Positive Behaviour Support requires providers to review restrictions that affect how people communicate, make choices and express distress. The Positive Behaviour Support hub for rights, behaviour and restrictive practice reduction supports services to connect safety with dignity, autonomy and proactive support.

In specialist services, restrictive practice review and reduction should include limited access to communication aids, rushed conversations, staff-controlled choices, ignored non-verbal cues, reduced advocacy access and routines where people are expected to comply before they are understood.

This reflects PBS principles around voice, dignity and person-led support, because communication is central to rights, safety and quality of life. Strong services review whether behaviour is being managed when communication support should be improved.

Concept Explained Clearly

Communication restrictions occur when a person cannot reliably use the methods they need to express preferences, refusals, pain, anxiety, confusion or choices. This may include unavailable communication boards, staff not waiting for responses, limited access to devices, poor use of symbols, lack of interpreters, or staff relying on verbal prompts when the person needs another format.

Some communication arrangements may need risk management. A device may require safeguarding support, an object of reference may need safe storage, or a person may need help using communication in public settings. PBS does not ignore those issues. It asks whether the restriction is proportionate and whether better support can increase access.

The key principle is simple: behaviour should not be treated as the main communication route if the service has failed to make communication accessible.

Why It Matters in Real Services

Communication restrictions can increase distress quickly. A person may repeat questions, refuse routines, leave activities, push items away, shout, withdraw or become physically distressed because staff are not understanding what they are trying to say.

Services may then respond by increasing prompts, limiting choices or redirecting behaviour. This can make the person feel unheard and increase reliance on distress-based communication. Commissioners and CQC will expect providers to evidence that communication needs are understood, supported and reviewed as part of restrictive practice reduction.

What Good Looks Like

Strong services make communication visible in daily practice. Plans explain how the person says yes, no, pain, stop, wait, help, finished, anxious, tired or overwhelmed. Staff know how long to wait, what tools to use and how to check understanding.

Providers should be able to evidence communication profiles, PBS plan updates, staff guidance, speech and language input where relevant, observation records and outcome evidence. This creates a clear line of sight from communication barrier to support action and from support action to reduced distress.

Operational Example 1: Restoring Access to a Communication Board

Step 1 – Context: A person’s communication board was kept on a shelf because staff worried it would be damaged during periods of distress.

Step 2 – Support approach: Review showed the person became distressed when they could not request breaks, preferred activities or “stop” before escalation.

Step 3 – Day-to-day delivery detail: Staff introduced a durable laminated board, placed copies in key rooms and practised using it during calm routines.

Step 4 – Restriction reduction: Communication access moved from staff-controlled availability to continuous access, with staff supporting early use instead of removing the tool.

Step 5 – How effectiveness was evidenced: The person requested breaks earlier, incidents during activities reduced and staff recorded fewer guessed interpretations. The provider evidenced that communication access reduced restrictive responses.

Deepening the Approach

Communication restriction review should examine whether staff are listening only to speech or whether they understand the person’s full communication system. Facial expression, movement, silence, object use, gesture, pacing and withdrawal may all carry meaning.

Strong teams use evidence to avoid assumptions. Using ABC data to understand behaviour within PBS can help identify whether incidents follow misunderstood requests, rushed responses, inaccessible choices, staff tone or lack of time to process information.

Operational Example 2: Reducing Repeated Verbal Prompts

Step 1 – Context: A person became distressed during morning routines when staff repeatedly asked verbal questions about washing, clothes and breakfast.

Step 2 – Support approach: Review found the person needed visual sequencing and extra processing time. Verbal questioning created pressure and confusion.

Step 3 – Day-to-day delivery detail: Staff introduced a morning visual strip, two-choice cards and a quiet pause after each choice was offered.

Step 4 – Restriction reduction: Repeated verbal prompting stopped and was replaced with accessible communication and paced support.

Step 5 – How effectiveness was evidenced: Morning distress reduced, choices became clearer and personal care routines were completed with fewer staff interventions. The provider evidenced that communication adjustment reduced restrictive prompting.

Systems, Workforce and Consistency

Communication support must be consistent across staff teams. If one staff member uses visual tools and another relies on fast verbal instruction, the person receives mixed messages and may lose trust.

Supervision should review whether staff use agreed communication methods, wait properly for responses and record what the person communicates. Handovers should include communication changes, successful strategies and any barriers observed. Strong services demonstrate that communication is a core PBS control, not an optional extra.

Operational Example 3: Supporting Refusal Communication During Health Appointments

Step 1 – Context: A person became distressed at health appointments and staff often interpreted this as refusal of the whole appointment.

Step 2 – Support approach: Review showed the person was trying to communicate “pause,” “too much noise” and “I need to know what happens next.”

Step 3 – Day-to-day delivery detail: Staff created appointment cards showing waiting, consultation, examination and finish. They also introduced a “pause” card and agreed breaks with the clinic.

Step 4 – Restriction reduction: Appointments were no longer cancelled after early distress. The person was supported to communicate specific needs and continue where possible.

Step 5 – How effectiveness was evidenced: Appointment completion improved, distress reduced and health professionals received clearer information about support needs. The provider evidenced that communication support reduced avoidance and restriction.

Governance and Evidence

Governance should show how communication restrictions are identified, reviewed and reduced. Providers should be able to evidence communication profiles, PBS plans, staff training, speech and language guidance where relevant, restriction register entries, incident analysis, supervision notes and feedback from the person or representative.

Strong governance creates a clear line of sight from behaviour to communication barrier, from communication barrier to support adjustment, and from support adjustment to outcome. Providers should be able to evidence that distress is not managed through control when communication access can be improved.

Commissioner and CQC Expectations

Commissioners expect providers to support communication, choice and participation. They need assurance that people are not restricted because staff have failed to understand how they express needs, preferences or distress.

CQC will expect care to be person-centred, responsive, safe and least restrictive. Inspectors may review whether communication needs are assessed, whether staff use agreed tools and whether people can express choices and concerns. Strong services demonstrate that communication support is embedded in PBS governance and daily practice.

Common Pitfalls

Keeping communication tools away to prevent damage.
Relying on verbal prompts when visual or object-based support is needed.
Not waiting long enough for the person to respond.
Misreading refusal, pain or anxiety as non-compliance.
Leaving communication barriers out of restrictive practice review.
Measuring success by task completion rather than understood communication.

Conclusion

Restrictive practice reduction through reviewing communication restrictions helps PBS services protect voice, dignity and safety. People need reliable ways to express what they want, what hurts, what worries them and what needs to change.

Strong providers evidence how communication barriers are identified, how staff practice changes and how distress reduces when people are better understood. This gives commissioners and CQC confidence that PBS is reducing restriction by strengthening the person’s voice in everyday support.