Understanding Behaviour in Supported Living: A Positive Behaviour Support Assessment Framework for Person-Centred Care

Behaviour is a form of communication, but in Supported Living services it can be easy for teams to focus on what behaviour looks like rather than understanding what it means. Effective Positive Behaviour Support (PBS) encourages staff to explore unmet needs, environmental influences, communication differences and quality-of-life factors before drawing conclusions about risk or behaviour. This approach sits at the heart of the Positive Behaviour Support Knowledge Hub and aligns closely with both PBS Principles & Values and Understanding Behaviour. Understanding why behaviour occurs enables providers to move beyond reactive responses and develop support approaches that improve wellbeing, reduce distress and promote independence.

In Supported Living, behaviour may be shaped by communication barriers, sensory overload, trauma history, physical health needs, environmental stressors, staffing inconsistency or lack of meaningful activity. PBS assessment helps teams move from assumption to understanding. It asks what the behaviour may be communicating, what function it serves and what changes are needed to improve quality of life.

The purpose of PBS assessment is not to label a person or predict every possible risk. It is to build a compassionate, evidence-informed understanding that supports better planning, safer practice and more consistent support.

The PBS Assessment Mindset

A PBS assessment begins with curiosity. Instead of asking, “How do we stop this behaviour?”, teams ask, “What is this person trying to communicate, and what needs are not currently being met?”

This mindset changes the entire support response. Behaviour is no longer viewed as a problem owned by the person. It is understood within the context of relationships, routines, environments, communication, health and support quality.

Strong PBS assessments explore:

• What happens before behaviour occurs
• What the behaviour looks like objectively
• What happens afterwards
• What the person may gain, avoid or communicate
• What environmental or sensory factors contribute
• How staff responses influence future patterns
• What proactive support could reduce distress

Moving Beyond Labels and Incidents

Traditional incident recording often focuses on what happened. PBS assessment goes further by exploring why it happened. Without this deeper understanding, services may repeatedly respond to incidents without addressing the underlying cause.

For example, a person who leaves a room during meals may be described as refusing to eat. A PBS assessment may reveal that the dining environment is too noisy, that the person needs more processing time, or that the mealtime routine has changed without warning.

Once the function is understood, support can become more effective and less restrictive.

Gathering Clear and Objective Data

Good PBS assessment depends on reliable information. Staff should collect data that is factual, respectful and useful. ABC recording is often helpful because it explores the antecedent, behaviour and consequence.

Useful data includes:

• Time of day
• Location
• Staff present
• Environmental conditions
• Communication used
• Demands or expectations placed on the person
• Sensory factors
• Health or pain indicators
• What happened afterwards

It is equally important to record successful moments. Understanding when the person is calm, engaged and confident can be just as valuable as analysing incidents.

Understanding Behaviour Function

PBS assessment often explores the function of behaviour. This means identifying what purpose the behaviour serves for the person.

Common functions include:

• Escape or avoidance: avoiding a demand, environment or situation that feels overwhelming
• Access: gaining access to an activity, object, person or preferred environment
• Connection: seeking interaction, reassurance or emotional support
• Sensory regulation: managing sensory overload, under-stimulation or internal discomfort
• Communication: expressing pain, fear, frustration, confusion or unmet need

Understanding function helps teams avoid superficial responses and develop more meaningful proactive strategies.

Communication as a Core Assessment Area

Communication should always be central to PBS assessment. Many behaviours of concern emerge when a person cannot express needs, understand expectations or process what is happening around them.

Assessment should explore:

• How the person communicates when calm
• How communication changes when distressed
• Whether staff use the person’s preferred communication methods
• Whether instructions are too complex or too fast
• Whether visual, symbolic or object-based communication is needed
• Whether Speech and Language Therapy input is required

When communication improves, distress often reduces because the person has more control and fewer misunderstandings occur.

Environmental Assessment

Supported Living environments can either reduce or increase distress. A PBS assessment should examine the physical, sensory and social environment.

Key questions include:

• Is the environment too noisy, bright or busy?
• Are routines predictable?
• Are expectations clear?
• Does the person have access to quiet spaces?
• Do staffing changes increase anxiety?
• Are household dynamics contributing to stress?
• Does the person have meaningful control over their home?

Environmental changes are often among the most effective proactive strategies because they reduce stress before it escalates.

Operational Example 1: Understanding Escape Behaviour

Context: A person regularly leaves the communal lounge when staff suggest group activities.

Assessment approach: Staff initially describe this as refusal. ABC recording shows the behaviour occurs most often when activities are introduced verbally without preparation.

Finding: The person appears overwhelmed by sudden social expectation and unclear choice.

Support response: Staff introduce visual activity options earlier in the day, offer a clear choice and allow the person to join for shorter periods.

Outcome: Participation increases and the person shows less anxiety around group activities.

Operational Example 2: Identifying Sensory Function

Context: An autistic adult becomes distressed during household cleaning routines.

Assessment approach: Staff record time, noise levels, proximity to vacuuming and the person’s physical responses.

Finding: Distress is strongly linked to unpredictable noise and vibration.

Support response: Cleaning routines are scheduled when the person is out or prepared in advance. Noise-reduction strategies are offered.

Outcome: Distress reduces significantly and the person feels more comfortable within the home.

Operational Example 3: Understanding Communication Breakdown

Context: A person becomes upset during personal care routines.

Assessment approach: Staff review communication, timing, sequencing and consent processes.

Finding: Staff were moving too quickly and not allowing enough processing time between each step.

Support response: The team introduces visual sequencing, clear pauses and repeated consent checks.

Outcome: Personal care becomes calmer, more predictable and more dignified.

Turning Assessment Into Proactive Support

The purpose of PBS assessment is action. Once teams understand patterns and function, they must translate learning into proactive strategies.

This may include:

• Adjusting routines around known stress points
• Reducing unnecessary demands
• Changing communication methods
• Introducing sensory regulation strategies
• Increasing predictability
• Improving staff consistency
• Building meaningful activity into daily life
• Reducing environmental triggers

Assessment should lead directly to changes in the PBS plan, risk assessment, staff guidance and daily recording expectations.

Involving Families and MDT Partners

Families, advocates and multidisciplinary professionals often hold valuable insight. Families may understand long-term patterns that are not visible in short-term records. Psychologists, occupational therapists, speech and language therapists and behaviour specialists can support formulation and strategy development.

Good PBS assessment draws on multiple perspectives while keeping the person at the centre.

Dynamic Review and Updating PBS Plans

PBS assessment is not a one-off exercise. Behaviour, health, routines, environments and relationships change over time. Plans must evolve as new information emerges.

Review should consider:

• Whether strategies are reducing distress
• Whether new triggers have appeared
• Whether staff are applying plans consistently
• Whether quality of life is improving
• Whether restrictive practice is reducing
• Whether the person’s goals have changed

Regular review ensures PBS remains current, responsive and meaningful.

Commissioner Expectations

Commissioners increasingly expect providers to demonstrate that PBS is evidence-informed, proactive and person-centred. They want to see assessment processes that identify need, reduce distress and support better outcomes.

Strong evidence may include:

• Functional assessment summaries
• Clear PBS plans linked to assessment findings
• Reduction in incidents or restrictive practice
• Staff training and competency evidence
• Family and professional involvement
• Quality-of-life outcome tracking

CQC Expectations

CQC will usually look for evidence that support is person-centred, safe, least restrictive and responsive to individual need. PBS assessment supports these expectations when it demonstrates that staff understand the person and adapt support accordingly.

Inspectors may ask whether staff know the person well, understand triggers, follow support plans and use proactive strategies before escalation occurs.

Common Weaknesses in PBS Assessment

• Focusing only on incidents, not patterns
• Using judgemental language
• Failing to explore communication needs
• Ignoring sensory or environmental factors
• Not involving families or professionals
• Creating plans that are not used in practice
• Failing to review plans when needs change

What Good Looks Like

Strong PBS assessment helps Supported Living teams understand the person behind the behaviour. It creates practical strategies that reduce distress, increase predictability and improve quality of life.

When staff understand behaviour as communication, they respond with curiosity rather than judgement. They adapt environments, improve communication and strengthen relationships. This is how PBS moves from theory into meaningful, everyday support.

Understanding behaviour is the heart of PBS. It ensures services respond to needs, not symptoms, and empowers people to live with confidence, dignity and greater control.

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