Understanding Behaviour Around Waiting and Delays in PBS: Reducing Uncertainty Before Distress Builds

May 12, 2026

Positive Behaviour Support requires services to understand how waiting and delays affect behaviour, emotional safety and participation. The Positive Behaviour Support knowledge hub supports providers to connect behaviour, communication, proactive support, rights and reduction of restrictive practice.

In specialist services, understanding behaviour through PBS means asking how the person experiences time, uncertainty, queues, appointments, transport delays and waiting for preferred activities.

This reflects PBS principles and values, because support should make time and change understandable. Strong services do not interpret distress during waiting as impatience before understanding uncertainty, control and predictability.

Concept Explained Clearly

Waiting is not a neutral gap for everyone. It can involve uncertainty, sensory exposure, loss of control and difficulty understanding when something will happen. The person may not know whether the wait is short, long, cancelled or forgotten.

Behaviour linked to waiting may include pacing, repeated questions, shouting, leaving, checking doors, refusing to continue, grabbing items, distress in queues or becoming unsettled before appointments. In PBS, these behaviours should be understood as possible communication that the delay is unclear, stressful or too hard to tolerate without support.

Why It Matters in Real Services

Waiting happens across everyday support: transport, meals, medication, appointments, activities, staff changes, family calls and community access. If delays are poorly supported, behaviour may escalate before the planned activity even begins.

The practical consequence is reduced access. People may stop attending clinics, refuse transport, avoid shops or become distressed during community participation. Commissioners and CQC will expect providers to evidence that predictable barriers are planned for rather than repeatedly managed as incidents.

What Good Looks Like

Strong services demonstrate that waiting support is personalised. Staff know whether the person understands time through clocks, timers, visual sequences, objects, routines or repeated reassurance.

Good PBS practice makes waiting visible and purposeful. This may include countdowns, now-and-next boards, planned waiting activities, quieter spaces, accurate information, clear cancellation messages and recovery time after delays.

Operational Example 1: Transport Delay Before Day Service

Step 1 – Delay pattern identified: A person in supported living became distressed when transport arrived late for day service. They repeatedly checked the window, paced near the door and shouted when staff gave vague reassurance.

Step 2 – Meaning explored: The provider identified that the person understood the routine as “coat on means leaving now.” When transport was late, the person had no clear way to understand the delay.

Step 3 – Support approach: Staff changed the routine so the coat was put on only when transport was confirmed nearby. A visual waiting card showed “van not here yet” and “van coming.”

Step 4 – Day-to-day delivery detail: During delays, the person was offered a short familiar waiting activity away from the door. Staff used one consistent phrase rather than repeated explanations.

Step 5 – How effectiveness was evidenced: Door pacing reduced, shouting decreased and transport transitions became calmer. The provider evidenced that changing the waiting sequence reduced uncertainty.

Deepening the Understanding: Waiting Can Remove Control

Waiting may feel difficult because the person cannot influence what happens next. They may not know whether anyone is doing anything about the delay. Behaviour can become a way of seeking control, certainty or action.

Strong providers should be able to evidence how waiting is explained, how delays are managed and how staff avoid vague reassurance. “Soon” may not help if the person cannot understand what soon means.

The article on seeing behaviour as communication in PBS reinforces why pacing, repeated questioning or leaving during delays should be understood as meaningful communication about uncertainty and control.

Operational Example 2: Waiting Room Distress Before Health Appointments

Step 1 – Access barrier recognised: A person repeatedly became distressed in clinic waiting rooms and sometimes left before being seen. Health appointments were becoming harder to complete.

Step 2 – Environment and time reviewed: The provider identified that crowded seating, unpredictable waiting times and unclear appointment order increased distress. The person coped better when they knew what would happen next.

Step 3 – Support adjusted: Staff contacted the clinic in advance to request quieter waiting arrangements and clearer estimated timings where possible.

Step 4 – Practical delivery: The person waited outside or in a quieter area until close to appointment time. Staff used a simple appointment sequence: arrive, wait, see nurse, go home.

Step 5 – Outcome evidence: Appointment completion improved, leaving reduced and health access became more reliable. The provider evidenced that adapting waiting conditions protected both wellbeing and healthcare access.

Systems, Workforce and Consistency

Waiting support must be consistent across settings. If one staff member prepares the person for delay and another gives vague reassurance, distress may continue. Strong services include waiting guidance in PBS plans, community access plans, appointment planning and handovers.

Supervision should review whether staff recognise delay-related behaviour and whether they give information that the person can understand. Handovers should include what helped during waiting, not just whether the person became distressed.

Operational Example 3: Queueing in a Community Shop

Step 1 – Community pattern noticed: During shopping, a person became distressed at the checkout queue. They placed items down, moved away and sometimes refused to return.

Step 2 – Waiting demand analysed: Observation showed that the person chose items successfully but struggled when the queue stopped moving. The wait felt unpredictable and crowded.

Step 3 – Support response: The shopping plan changed to quieter times and smaller baskets. Staff introduced a queue card showing “stand here,” “pay,” and “finished.”

Step 4 – Delivery detail: Staff positioned the person at the end of the queue with space where possible and avoided unnecessary conversation. If the queue was too long, the person had a planned choice to wait, use self-checkout or return later.

Step 5 – Evidence reviewed: Checkout distress reduced, shopping trips were completed more often and the person retained community independence. The provider evidenced that structured waiting support improved access.

Governance and Evidence

Governance should show how waiting-related behaviour is identified, planned for and reviewed. Providers should be able to evidence PBS plan updates, appointment planning, transport records, community access reviews, incident analysis, staff briefings and outcome monitoring.

Strong governance connects behaviour to delay conditions. Records should show what the person was waiting for, how the wait was explained, what environmental pressures were present, what support was offered and whether outcomes improved. This creates a clear line of sight from behaviour to waiting difficulty, from waiting difficulty to support action, and from action to outcome.

Commissioner and CQC Expectations

Commissioners expect providers to maintain access to ordinary life, health appointments and community activity. They need assurance that predictable waiting barriers are understood and planned for.

CQC will expect care to be person-centred, responsive and accessible. Inspectors may review whether people are supported to access healthcare and community life, whether communication needs are met and whether repeated incidents lead to learning. Strong services demonstrate that waiting support is practical, personalised and evidence-led.

Common Pitfalls

Using vague reassurance such as “soon” without explaining what will happen.
Preparing the person too early and creating a longer waiting period.
Recording queue distress without reviewing crowding, timing and uncertainty.
Assuming waiting behaviour is impatience rather than loss of predictability.
Failing to plan waiting support before appointments or transport.
Measuring success only by incident reduction, not improved access.

Conclusion

Understanding behaviour around waiting and delays helps PBS teams recognise when distress is linked to uncertainty, time processing and reduced control. Behaviour may communicate that the person needs clearer information, shorter waits or a safer waiting environment.

Strong providers make waiting understandable, structured and purposeful. They evidence how better preparation, clearer communication and environmental planning improve access, reduce distress and protect quality of life.