Restrictive Practice Reduction Through Reviewing Staff Responses to Change in PBS

May 17, 2026

Positive Behaviour Support requires providers to review how change is introduced, explained and supported. The Positive Behaviour Support hub for rights, behaviour and restrictive practice reduction supports services to connect predictability, dignity and proactive support.

In specialist services, restrictive practice review and reduction should include changes to staff, routines, rooms, transport, activities, mealtimes, appointments and community plans that may increase distress if introduced too quickly.

This reflects PBS principles around communication, choice and person-led support, because change should be supported in ways that reduce uncertainty rather than increase staff control.

Concept Explained Clearly

Change-related restrictive practice occurs when staff respond to distress caused by change by increasing prompts, limiting choice, blocking alternatives, cancelling opportunities or applying closer supervision. The original issue may be uncertainty, but the response can become restrictive if staff focus only on moving the person through the change.

Change may include a new staff member, altered routine, delayed transport, different room layout, cancelled visit, unfamiliar activity, new medication process or unexpected appointment. Some change is unavoidable. PBS does not remove change from life. It helps services introduce change with preparation, communication and proportionate support.

The aim is to help the person understand what is changing, what stays the same, what choices remain and how support will be adjusted.

Why It Matters in Real Services

Change often sits behind incidents that appear to be refusal, aggression, withdrawal or non-compliance. A person may not be refusing the activity itself. They may be reacting to the speed, uncertainty or lack of control around the change.

If staff do not recognise this, they may repeat instructions, remove options or escalate support too quickly. Commissioners and CQC will expect providers to evidence that change-related distress is understood, planned for and reviewed as part of restrictive practice reduction.

What Good Looks Like

Strong services identify which types of change are difficult and which supports help. Plans explain preferred preparation times, visual supports, transition objects, familiar staff roles, reassurance scripts and safe fallback options.

Providers should be able to evidence PBS plans, transition plans, communication tools, incident reviews, staff guidance, supervision records and outcome data. This creates a clear line of sight from change to support action, and from support action to reduced restriction.

Operational Example 1: Supporting a Change of Key Worker

Step 1 – Context: A person became distressed when their regular key worker moved to another service. Staff initially responded by avoiding discussion and redirecting the person whenever they asked about the change.

Step 2 – Support approach: Review showed the person needed clear, repeated information and a planned introduction to the new key worker rather than avoidance.

Step 3 – Day-to-day delivery detail: Staff created a transition story, arranged short joint sessions, used a photo board and agreed a consistent phrase for answering questions.

Step 4 – Restriction reduction: Staff stopped redirecting questions and supported the person to process the change openly with predictable reassurance.

Step 5 – How effectiveness was evidenced: Repeated distress reduced, the person began approaching the new key worker and incidents linked to staff change decreased. The provider evidenced that planned communication reduced restrictive redirection.

Deepening the Approach

Change review should examine timing, communication, emotional meaning and staff behaviour. A change may look small to staff but significant to the person if it affects trust, routine or predictability.

Strong teams use evidence to understand the pattern. Using ABC data to understand behaviour within PBS can help identify whether distress follows sudden announcements, staff substitutions, cancelled plans, altered environments or unclear explanations.

Operational Example 2: Managing a Cancelled Family Visit

Step 1 – Context: A person became distressed when a family visit was cancelled, and staff usually removed the calendar because repeated checking increased.

Step 2 – Support approach: Review showed the calendar was not the problem. The person needed help understanding cancellation and reassurance about the next contact.

Step 3 – Day-to-day delivery detail: Staff introduced a cancellation card, a replacement phone call, a calming activity chosen by the person and a visible rescheduled date.

Step 4 – Restriction reduction: Staff stopped removing the calendar and instead used it to make the change understandable.

Step 5 – How effectiveness was evidenced: Calendar checking reduced, distress settled faster and the person used the new date for reassurance. The provider evidenced that accessible information was less restrictive than removing reminders.

Systems, Workforce and Consistency

Supporting change requires team consistency. If one staff member explains change clearly and another avoids it, the person may become more uncertain and ask more often.

Supervision should review whether staff give enough preparation, use agreed communication tools and avoid rushing transitions. Handovers should record what changed, how the person responded, what reassurance was used and whether further support is needed. Strong services demonstrate that change management is part of PBS delivery, not an informal judgement made shift by shift.

Operational Example 3: Preparing for a Room Layout Change

Step 1 – Context: A person became distressed when furniture was moved in a shared lounge for maintenance work. Staff responded by asking them to stay out of the room until it was finished.

Step 2 – Support approach: Review found that exclusion from the room increased anxiety because the person could not see what had changed.

Step 3 – Day-to-day delivery detail: Staff used before-and-after photos, showed the person the planned layout, offered a short supervised look and kept one preferred chair in a familiar position.

Step 4 – Restriction reduction: Staff stopped excluding the person from the space and supported planned involvement in the change.

Step 5 – How effectiveness was evidenced: The person entered the lounge calmly, used the preferred chair and did not require redirection. The provider evidenced that involvement reduced restriction and improved tolerance of change.

Governance and Evidence

Governance should show how change-related distress is identified, reviewed and reduced. Providers should be able to evidence PBS plans, transition records, communication resources, incident trend analysis, supervision notes, debriefs and feedback from the person or representatives.

Strong governance creates a clear line of sight from change to behaviour, from behaviour to staff response, and from learning to better preparation. Providers should be able to evidence that restrictions are not introduced simply because change was poorly planned.

Commissioner and CQC Expectations

Commissioners expect providers to manage change safely while maintaining ordinary life, relationships and opportunity. They need assurance that staff can support transitions without over-reliance on avoidance, cancellation or control.

CQC will expect care to be responsive, person-centred, safe and least restrictive. Inspectors may review whether people are prepared for change, whether communication needs are met and whether restrictions following change are reviewed. Strong services demonstrate that change is managed through PBS planning and evidence, not reactive control.

Common Pitfalls

Avoiding discussion of change because staff worry it will cause distress.
Introducing changes suddenly without preparation or visual support.
Removing reminders instead of making change understandable.
Using increased prompting when the person needs time to process.
Failing to review incidents linked to cancellations or staff changes.
Measuring success by getting through the change rather than reducing distress.

Conclusion

Restrictive practice reduction through reviewing staff responses to change helps PBS services protect predictability, trust and autonomy. Change should be explained, paced and supported, not pushed through with increased control.

Strong providers evidence how changes are planned, how staff communicate them and how people experience less distress over time. This gives commissioners and CQC confidence that PBS is reducing restriction through thoughtful, practical and person-centred support.