Understanding Behaviour During Transition Periods in PBS Services

Transitions can significantly affect behaviour, particularly for people who rely on predictability, trusted relationships and structured routines. The Positive Behaviour Support knowledge hub explores how proactive support, communication and rights-based practice reduce distress during periods of change.

Within specialist services, understanding behaviour through PBS approaches means recognising that transitions are not single events. They are ongoing experiences involving uncertainty, sensory change, emotional adjustment and altered expectations.

Strong providers applying PBS principles and values understand that distress during transitions is often predictable rather than unexpected. Behaviour may increase because the person is attempting to regain stability, communicate anxiety or manage loss of control.

Concept Explained Clearly

Transitions happen across all services. They may include moving home, changing schools or placements, staffing changes, hospital discharge, changes in transport, altered routines or movement between activities during the day.

For some people, even small transitions create uncertainty. A routine changing unexpectedly, a preferred worker being absent or an unfamiliar environment may affect emotional regulation. Behaviour may communicate anxiety, overload, confusion or attempts to maintain predictability.

PBS focuses on understanding what the transition means for the person rather than viewing behaviour as resistance.

Why It Matters in Real Services

Transitions are high-risk periods within health and social care services. If planning is weak, people may experience heightened distress, increased incidents, sleep disruption, refusal behaviours or reduced engagement.

Providers sometimes focus only on the practical movement itself while overlooking the emotional and sensory impact. Staff may assume the transition is complete once the move occurs, even though adjustment may continue for weeks or months.

Where services fail to understand transition-related behaviour, restrictive responses can increase unnecessarily. Staff may attempt to gain compliance quickly instead of slowing the process and reducing uncertainty.

What Good Looks Like

Strong services plan transitions gradually wherever possible. They identify predictable stress points, maintain familiar routines and communicate clearly using accessible methods.

Good PBS practice includes relationship continuity, visual preparation, environmental planning and flexible pacing. Teams understand what the person may find difficult and agree consistent support approaches before the transition begins.

Strong services demonstrate that transitions are monitored proactively rather than waiting for incidents to escalate.

Operational Example 1: Transition to Supported Living

Step 1 – Early planning: A young adult preparing to move from residential college into supported living began showing increased withdrawal and refusal during discussions about the move.

Step 2 – Behaviour interpreted: The provider identified that behaviour increased most when unfamiliar staff discussed future routines. The issue was uncertainty and fear of losing predictability rather than refusal of independence itself.

Step 3 – Support approach: The service created a gradual transition schedule involving repeated short visits, photo-based visual planning and introductions to consistent staff members over several weeks.

Step 4 – Day-to-day delivery: Staff maintained key routines from the college placement, including meal timing, preferred evening activities and communication structures. Familiar objects were transferred into the new flat before the move date.

Step 5 – Evidence of effectiveness: Distress reduced during visits, engagement increased and the move completed without restrictive interventions. Providers should be able to evidence how transition pacing reduced anxiety and improved adjustment.

Deepening the Understanding: Transitions Often Involve Loss

Transitions are not only logistical events. They may involve changes to relationships, routines, environments, sensory experiences or perceived safety. Some people may not communicate this verbally, but behaviour can reflect grief, uncertainty or fear.

Understanding behaviour during transitions requires services to examine what the person may feel they are losing. Staff consistency, preferred routines, familiar sounds, trusted environments and predictable expectations may all contribute to emotional regulation.

The article on seeing behaviour as communication within PBS practice reinforces why behavioural changes during transitions should be interpreted as meaningful communication rather than non-compliance.

Operational Example 2: Hospital Discharge Anxiety

Step 1 – Transition concern identified: Following discharge planning from an assessment and treatment setting, a person became increasingly distressed during discussions about returning home.

Step 2 – Risk review completed: Staff identified that previous failed placements had created anxiety about future instability. Behaviour increased most during conversations involving uncertainty about staffing and routines.

Step 3 – Support response: The provider introduced structured transition meetings with clear visual schedules, photographs of the home environment and confirmed staffing arrangements shared in advance.

Step 4 – Practical delivery: The same transition lead attended every meeting. Home staff visited regularly before discharge and followed consistent communication approaches already familiar to the person.

Step 5 – Outcomes evidenced: Self-injury reduced during the discharge period, the person engaged with home visits and transition meetings became calmer. This created a clear line of sight between predictable planning and reduced distress.

Systems, Workforce and Consistency

Transitions require coordinated workforce planning. Strong services ensure all staff understand the transition strategy, emotional risks, communication needs and agreed responses.

Supervision should explore how staff behaviour affects regulation during periods of uncertainty. Teams need guidance on pacing, reassurance, escalation prevention and maintaining consistency when routines are disrupted.

Good handovers are particularly important during transitions. Staff should record what increased distress, what reduced anxiety and which approaches supported engagement.

Operational Example 3: Change in Daily Transport Routine

Step 1 – Emerging behavioural pattern: A person attending a day opportunity service began refusing transport after their regular driver retired unexpectedly.

Step 2 – Behaviour explored: Incident reviews showed distress started before leaving the house rather than during travel itself. The change in familiar routine appeared to reduce emotional safety.

Step 3 – Support approach introduced: The provider arranged gradual introductions to the new driver and adjusted travel timing temporarily to reduce morning pressure.

Step 4 – Day-to-day support: Staff used visual countdowns, consistent greeting routines and a familiar support worker during the first weeks of transition.

Step 5 – Effectiveness evidenced: Refusal incidents reduced steadily, transport tolerance improved and attendance stabilised. The provider evidenced how predictable transition support improved behavioural outcomes.

Governance and Evidence

Governance systems should demonstrate how transitions are planned, monitored and reviewed. Providers should be able to evidence transition risk assessments, communication planning, workforce briefings, behavioural trend analysis and post-transition reviews.

Strong governance connects behavioural information to operational learning. Records should show what changed, how the person responded, which proactive adjustments were made and whether distress reduced over time.

This creates a clear line of sight between transition planning, staff practice and measurable outcomes.

Commissioner and CQC Expectations

Commissioners expect providers to manage transitions safely and sustainably. They look for evidence that services can maintain stability during periods of change without relying on restrictive responses.

CQC will expect providers to understand emotional wellbeing, continuity of care and person-centred planning. Inspectors may review whether transitions are proactive, whether behavioural risks are understood and whether people are supported to feel safe throughout the process.

Strong services demonstrate that transitions are governed carefully rather than managed reactively.

Common Pitfalls

• Focusing only on logistical planning while ignoring emotional adjustment.
• Changing too many routines simultaneously.
• Introducing unfamiliar staff without preparation.
• Assuming behaviour means the transition should stop immediately.
• Rushing transitions to meet organisational timelines.
• Failing to review behavioural patterns after the move or change occurs.

Conclusion

Understanding behaviour during transitions helps providers recognise how uncertainty, change and loss of predictability can affect regulation and wellbeing. Behaviour during these periods often communicates anxiety, confusion or attempts to regain control.

Strong PBS services reduce distress through preparation, pacing, relationship continuity and workforce consistency. They evidence how proactive transition planning improves outcomes, reduces incidents and supports safer, more stable adjustment for the people they support.