Understanding Behaviour as Communication in PBS: Listening Before Responding

Positive Behaviour Support starts from the belief that behaviour has meaning. The Positive Behaviour Support knowledge hub supports this approach by connecting behaviour, communication, proactive support, rights and reduction of restrictive practice.

For specialist providers, understanding behaviour in PBS services means treating distress, withdrawal, refusal, aggression or self-injury as information. The question is not simply what happened, but what the person may have been trying to communicate through the behaviour.

This reflects PBS values in everyday support, because communication must be respected even when it is difficult to interpret. Strong services do not wait for people to communicate in ways that suit staff. They adapt support so people have safer, clearer and more reliable ways to be heard.

Concept Explained Clearly

Understanding behaviour as communication means recognising that behaviour may express a need, feeling, preference, fear, pain, frustration or attempt to regain control. This does not mean every behaviour has one simple message. It means staff should approach behaviour with curiosity and evidence, rather than judgement.

A person may refuse support because they are anxious about who is providing it. They may shout because the environment is overwhelming. They may leave a room because they need space. They may damage property because no one has noticed earlier signs of distress. When communication systems are limited, inconsistent or ignored, behaviour can become the most reliable way to communicate.

Why It Matters in Real Services

When behaviour is not understood as communication, services often respond too late and too restrictively. Staff may focus on stopping the behaviour rather than listening to what it is saying. This can increase distress, damage relationships and leave the person dependent on escalation to have needs recognised.

There are also operational risks. If staff interpret communication as non-compliance, records become inaccurate, care plans become weak and support becomes inconsistent. Commissioners may question whether the provider can manage complexity proactively. CQC may look closely at whether staff understand people’s communication needs, whether plans are person-centred and whether restrictions are used only when necessary and proportionate.

What Good Looks Like

Strong services demonstrate that communication is embedded into daily support. Staff know how the person communicates comfort, discomfort, choice, refusal, pain, confusion and overload. They understand early signs and respond before behaviour escalates.

Good support also gives the person alternative ways to communicate. This may include visual choices, objects of reference, communication passports, pain indicators, sensory signals, consistent phrases, quiet spaces or planned ways to refuse. Providers should be able to evidence how communication understanding changes staff response and improves outcomes. This creates a clear line of sight from behaviour to communication need, then from communication need to practical support.

Operational Example 1: Refusal Communicating Lack of Control

Context: A person in supported living regularly refused evening meals and pushed plates away. Staff initially recorded this as refusal to eat, but the behaviour was most common when meals were chosen and served without discussion.

Support approach: The provider reviewed communication preferences, food choices and staff routines. The likely message was not “I do not want food,” but “I have not had enough control over what happens next.”

Day-to-day delivery detail: Staff introduced picture-based meal choices earlier in the day. The person chose where to sit, whether food was plated or served in bowls, and whether staff stayed nearby or stepped back. Staff used short, consistent language and avoided repeated prompts when the person turned away.

How effectiveness was evidenced: Meal refusals reduced, food intake improved and staff recorded fewer signs of distress at mealtimes. The provider could evidence that behaviour previously seen as refusal was communicating a need for choice, preparation and control.

Deepening the Understanding: Communication Happens Before Escalation

Many people communicate distress before behaviour becomes high risk. They may change facial expression, avoid eye contact, move away, repeat a phrase, become quieter, increase movement, refuse eye-level interaction or seek a familiar object. If staff miss these early signs, the person may need to escalate to be understood.

Strong PBS services teach staff to notice and respond to these earlier forms of communication. This requires observation, reflection and consistency. Staff should know what early signs mean for that person and what action is required. The response might be reducing language, offering a break, changing the environment, checking pain, slowing the routine or giving a clear choice.

The related guidance on seeing communication rather than challenge in PBS reinforces why services need to listen to behaviour before they decide how to respond.

Operational Example 2: Self-Injury Communicating Pain

Context: In a specialist residential service, a person began hitting the side of their face several times a week. Records described self-injurious behaviour, but there was no clear review of possible health-related communication.

Support approach: The provider introduced pain monitoring, reviewed dental and ear health, and spoke with family about previous signs of discomfort. A dental issue was identified, and the PBS plan was updated to include health-related early warning signs.

Day-to-day delivery detail: Staff recorded facial touching, changes in eating, sleep disruption and tolerance of noise. They offered pain communication cards and used a simple body map. Staff escalated concerns to health professionals when early indicators appeared, rather than waiting for self-injury.

How effectiveness was evidenced: Incidents reduced after treatment and improved health monitoring. Records showed earlier staff action when pain indicators appeared. The provider evidenced that self-injury had been communicating physical discomfort, and that daily health observation reduced escalation.

Systems, Workforce and Consistency

Communication understanding must be shared across the workforce. A communication passport is only useful if staff read it, use it and update it. Strong services include communication needs in induction, handover, supervision and PBS review meetings.

Managers should check whether staff understand the person’s communication in practice. This includes how the person says no, how they show pain, how they request space, how they indicate preference and how they signal overload. Consistency matters because people should not have to relearn how to be understood every time staff change.

Operational Example 3: Leaving the Room Communicating Overload

Context: A person attending a day opportunity repeatedly left structured sessions and walked outside. Staff initially recorded this as disengagement and risk-taking because the person sometimes moved towards the car park.

Support approach: The provider reviewed the timing, noise level, activity demands and staff response. The behaviour appeared to communicate overload and a need for escape. The team focused on creating a safer communication route before the person needed to leave abruptly.

Day-to-day delivery detail: The person was given a break card, a planned quiet space and a visible session timetable. Staff agreed that using the break card would be responded to immediately without challenge. The car park route was made less likely by positioning the quiet space closer and ensuring staff did not block exits.

How effectiveness was evidenced: Unplanned exits reduced, use of the break card increased and the person completed more sessions in shorter, supported blocks. The provider could evidence that behaviour had communicated overload and that providing a safer communication method improved both engagement and safety.

Governance and Evidence

Governance should show how communication understanding is developed and reviewed. Providers should be able to evidence communication assessments, behaviour records, health observations, PBS plan updates, staff briefings, supervision notes and outcome tracking.

Data should be combined with qualitative evidence. Incident reduction is useful, but so is evidence that the person has more choice, clearer ways to refuse, earlier pain recognition, better participation and fewer restrictive responses. This creates a clear line of sight from communication need to staff action and from staff action to improved quality of life.

Commissioner and CQC Expectations

Commissioners expect providers to understand behaviour as communication because it shows that support is proactive, skilled and person-centred. They need assurance that the provider can identify unmet need, adapt support and evidence outcomes rather than repeatedly escalating risk.

CQC will expect staff to understand people’s communication needs and provide care that is safe, responsive and respectful. Inspectors may review whether communication plans are current, whether staff understand refusal and distress, whether health needs are recognised, and whether restrictions are avoided where better communication support would reduce risk. Strong services demonstrate that communication understanding shapes everyday delivery.

Common Pitfalls

• Recording behaviour without asking what the person may be communicating.
• Treating refusal as non-compliance rather than a possible communication of fear, pain or lack of control.
• Missing early signs and only responding once behaviour has escalated.
• Creating communication passports that staff do not use in daily practice.
• Failing to review pain, sensory overload or emotional distress as communication factors.
• Using restrictive responses when a clearer communication route could reduce risk.

Conclusion

Understanding behaviour as communication is central to effective PBS. It changes how staff listen, record, respond and review support. Instead of seeing behaviour as disruption, strong providers see it as information about what the person needs and what the service must adapt.

When communication is understood properly, people are less dependent on distress to be heard. Staff respond earlier and with more confidence. Governance becomes stronger because the provider can evidence the link between behaviour, communication, support and outcome. This is where PBS becomes practical, respectful and genuinely person-centred.