Understanding Behaviour Through Communication Breakdowns in PBS: Supporting People Before Frustration Escalates

Positive Behaviour Support requires services to understand how communication breakdowns affect behaviour, confidence and emotional safety. 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 whether the person had a clear, reliable and respected way to communicate before distress appeared. Behaviour may increase when staff miss signs, use the wrong communication method, rush responses or fail to check meaning.

This reflects PBS principles and values, because communication should be supported with dignity, patience and respect. Strong services do not expect behaviour to reduce unless the person has a better way to be understood.

Concept Explained Clearly

A communication breakdown happens when the person’s message is not understood, not acted on, or not supported in the right format. This may involve speech, gesture, objects, signing, pictures, technology, body language, facial expression, movement, behaviour or changes in presentation.

Behaviour linked to communication breakdown may include shouting, grabbing, pushing items away, repeated questions, withdrawal, refusal, self-injury, aggression or leaving the situation. In PBS, these behaviours should be understood by asking what the person may have been trying to say and why the support system did not hear it early enough.

Why It Matters in Real Services

When communication breakdowns are missed, staff may respond to behaviour instead of the message behind it. They may correct, redirect or increase supervision without improving the person’s ability to express pain, preference, refusal, confusion, fear or choice.

This creates practical and ethical risks. People may lose control over routines, become distressed during care, miss health needs or be labelled as challenging when they are not being understood. Commissioners and CQC will expect providers to evidence that communication needs are assessed, supported and reviewed in daily practice.

What Good Looks Like

Strong services demonstrate that communication support is personalised and used consistently. Staff know how the person says yes, no, wait, stop, pain, help, finished, more, different, worried or tired. Plans describe preferred methods and what staff must do when meaning is unclear.

Good PBS practice gives behaviour less work to do. Staff slow down, use accessible formats, check understanding, respond to early signs and record what the person communicated. Providers should be able to evidence how improved communication reduces distress and improves choice, safety and participation.

Operational Example 1: Grabbing Items During Meal Choices

Step 1 – What staff saw: A person in supported living grabbed food items from the kitchen counter when staff discussed meal options. Staff first recorded this as impulsive behaviour and risk around food access.

Step 2 – Communication need explored: The provider reviewed the interaction and found that staff were offering meal choices verbally while items were visible but not clearly available. The person was trying to communicate preference through action.

Step 3 – Support approach: Staff introduced a two-choice visual meal board using photographs of available meals. The person could point, touch or move the card to a “chosen” space.

Step 4 – Day-to-day delivery detail: Food items were kept out of reach until the choice process was clear. Staff used the same phrase each time and waited before repeating the question.

Step 5 – How effectiveness was evidenced: Grabbing reduced, meal choices became clearer and records showed increased successful communication. The provider evidenced that behaviour reduced when the person had a reliable way to express preference.

Deepening the Understanding: Behaviour Often Appears After Earlier Messages Are Missed

Communication breakdown is rarely only about the final incident. The person may have shown earlier signs through facial expression, movement, silence, hesitation, repeated gestures or changes in tone. If staff miss these messages, behaviour may become louder because quieter communication has not worked.

Strong PBS services review the communication sequence, not just the outcome. They ask what the person tried first, how staff responded, and what communication route would have reduced pressure earlier.

The related article on seeing behaviour as communication in PBS reinforces why behaviour should be treated as meaningful information, especially when other communication methods have failed.

Operational Example 2: Refusal During Pain Communication

Step 1 – Concern identified: In a residential service, a person refused evening support and pushed staff away. The behaviour increased over several nights, but there was no clear verbal explanation.

Step 2 – Health communication checked: Staff reviewed the person’s communication profile and realised pain signs were poorly recorded. The person often used posture changes and hand placement rather than words.

Step 3 – Support adjusted: A pain communication tool was introduced, including body maps, yes/no cards and observation prompts for staff to record facial expression, movement and guarding.

Step 4 – Escalation route: The manager used the recorded evidence to seek clinical advice. Staff reduced non-essential demands while monitoring pain indicators and comfort.

Step 5 – Outcome evidence: A health concern was identified and treated. Evening refusals reduced, and the provider evidenced that behaviour had communicated discomfort before it was recognised clinically.

Systems, Workforce and Consistency

Communication support must be consistent across the workforce. If one staff member uses the person’s communication tools and another relies only on speech, the person may experience support as unreliable. Strong services include communication guidance in PBS plans, care plans, handovers, induction and supervision.

Managers should observe communication during ordinary routines, not only incidents. Supervision should explore whether staff wait long enough, use the right tools, recognise refusal and record what the person communicated rather than only what behaviour occurred.

Operational Example 3: Leaving Activity When Staff Misread “Finished”

Step 1 – Pattern noticed: A person at a day opportunity repeatedly left craft activities suddenly and knocked materials onto the floor when staff encouraged them to continue.

Step 2 – Meaning reviewed: Observation showed that the person had a subtle “finished” signal: placing both hands flat on the table and looking away. Staff often missed this and continued prompting.

Step 3 – Support response: Staff added the finished signal to the communication profile and introduced a clear finished card the person could use during activities.

Step 4 – Practice changed: When the person used the signal or card, staff acknowledged it immediately and offered either a break or a new activity. They stopped persuading the person to continue after the signal.

Step 5 – Evidence reviewed: Leaving incidents reduced, materials were no longer knocked to the floor and the person used the finished card more often. The provider evidenced that respecting communication prevented escalation.

Governance and Evidence

Governance should show how communication breakdowns are identified, reviewed and addressed. Providers should be able to evidence communication profiles, PBS plan updates, incident analysis, staff observations, supervision records, health escalation where relevant and outcome monitoring.

Strong governance connects behaviour to communication quality. Records should show what the person may have been communicating, what staff understood, what tools were used, what changed and whether outcomes improved. This creates a clear line of sight from behaviour to communication breakdown, from breakdown to support action, and from support action to outcome.

Commissioner and CQC Expectations

Commissioners expect providers to understand communication because it affects safety, choice, health access and placement stability. They need assurance that behaviour support is not replacing communication support, but strengthening it.

CQC will expect care to be person-centred, responsive and accessible. Inspectors may review whether staff understand communication needs, whether people can express choices and concerns, whether plans are followed and whether incidents lead to learning. Strong services demonstrate that communication is actively supported, observed and evidenced.

Common Pitfalls

• Recording behaviour without asking what the person was trying to communicate.
• Relying on speech when the person uses gestures, objects, visuals or behaviour.
• Missing subtle refusal, pain, finished or help signals.
• Using communication tools inconsistently across shifts.
• Repeating questions instead of changing the communication format.
• Failing to update communication profiles after new patterns are identified.

Conclusion

Understanding behaviour through communication breakdowns helps PBS teams recognise when distress is linked to not being understood. Behaviour may communicate preference, refusal, pain, confusion, fear, boredom or the need for help.

Strong providers make communication accessible, consistent and respected. They evidence how improved communication reduces escalation, protects rights and improves daily outcomes. This gives commissioners and CQC confidence that PBS is practical, person-centred and grounded in how each person communicates.