Understanding Behaviour Through Unmet Communication Needs in PBS: Making Support Easier to Understand

May 12, 2026

Positive Behaviour Support requires services to understand when behaviour is linked to unmet communication needs. 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 checking whether the person understood what was being asked, whether they had enough time to process, and whether they had a reliable way to say yes, no, stop, pain, wait or help.

This reflects PBS principles and values, because people should not have to use distress to be heard. Strong services adapt communication around the person rather than expecting the person to fit staff language.

Concept Explained Clearly

Unmet communication needs occur when information is too fast, too complex, too verbal, too abstract or not matched to the person’s communication style. This may happen during personal care, meals, medication, activities, appointments, transitions or emotional distress.

Behaviour may increase because the person does not understand what is happening, cannot express refusal, cannot ask for a break, or cannot communicate discomfort. This may look like refusal, shouting, leaving, repeated questioning, withdrawal, self-injury or aggression. PBS requires staff to ask what communication support was missing before deciding what the behaviour means.

Why It Matters in Real Services

When communication needs are missed, staff may interpret behaviour as non-compliance or risk. They may repeat the same instruction more loudly or more often, when the person actually needs fewer words, visual support, extra time or a different way to respond.

This creates avoidable escalation. It can also weaken governance because records describe behaviour without explaining whether communication was accessible. Commissioners and CQC will expect providers to evidence that staff understand communication needs and that behaviour support plans translate those needs into daily practice.

What Good Looks Like

Strong services demonstrate that communication is practical, consistent and individual. Staff know how the person understands information, how they make choices, how they refuse, how they show confusion and how they ask for help.

Good PBS practice uses accessible communication before distress builds. This may include objects of reference, photo prompts, visual schedules, short phrases, body maps, break cards, now-and-next boards or consistent staff wording. Providers should be able to evidence how communication changes reduce incidents and improve participation.

Operational Example 1: Medication Support and Confusing Instructions

Step 1 – What staff saw: A person in supported living pushed medication away and turned their head when staff approached. Records described refusal, but different staff used different explanations each morning.

Step 2 – What was analysed: The provider reviewed timing, wording, staff approach and the person’s processing needs. The person appeared confused when staff gave several verbal instructions together.

Step 3 – What changed: Staff introduced one consistent phrase, showed the medication cup visually, offered water first and waited before asking for a response.

Step 4 – How it worked in practice: If the person turned away, staff paused and returned at the agreed time rather than repeating instructions. The approach was added to the medication support plan.

Step 5 – What was evidenced: Medication refusals reduced, distress signs decreased and staff records showed more consistent communication. This created a clear line of sight from communication need to staff action and outcome.

Deepening the Understanding: Repetition Is Not Always Reassurance

Some staff repeat information because they want to reassure. For some people, repeated explanations increase anxiety because the wording changes each time or the person cannot process the volume of language. Strong PBS services make communication simpler, not louder or longer.

Providers should be able to evidence how communication needs are reviewed after incidents. This includes whether the person understood the request, whether refusal was available, whether staff waited long enough, and whether visual or non-verbal support would have helped.

The related article on seeing behaviour as communication in PBS reinforces why behaviour must be read as a possible message about what the support system has failed to make clear.

Operational Example 2: Activity Refusal in a Day Service

Step 1 – Practice concern: A person regularly left the activity room when staff asked them to choose between several options. Staff believed the person did not want to participate.

Step 2 – Communication review: The team found that staff were offering five or six verbal options at once. The person had no clear way to compare choices or ask for time.

Step 3 – Support redesign: Staff reduced the choice to two photo cards and offered the same choice routine each morning. The person could point, pick up a card or move towards the activity.

Step 4 – Risk reduction: If the person left the room, staff did not follow with more questions. They offered a quiet space and returned later with the same two visual options.

Step 5 – Outcome evidence: Participation increased, unplanned exits reduced and staff recorded clearer choice-making. The provider evidenced that accessible choice improved engagement without pressure.

Systems, Workforce and Consistency

Communication support only works when the whole team uses it. If one staff member uses visuals and another relies on rapid verbal prompts, the person experiences inconsistent support. Strong services include communication guidance in PBS plans, handovers, induction and supervision.

Managers should observe whether staff communicate as agreed. Supervision should review real incidents and ask whether staff used the right words, pace, tools and waiting time. Handovers should include what the person understood well that day and what caused confusion.

Operational Example 3: Health Appointment Breakdown

Step 1 – Access difficulty: A person became distressed during GP appointments, stood up repeatedly and tried to leave before the consultation finished.

Step 2 – Communication barrier: The provider reviewed appointment flow and found that unfamiliar professionals asked several questions quickly, while staff tried to answer over the person.

Step 3 – Support arrangement: A health communication sheet was prepared with preferred wording, pain indicators, processing time and the person’s way of saying stop.

Step 4 – Delivery detail: Staff briefed the GP before the appointment, used a visual appointment sequence and agreed a pause signal the person could use.

Step 5 – Evidence gathered: The person completed a longer appointment with fewer distress signs and used the pause signal once. The provider evidenced that communication planning improved healthcare access.

Governance and Evidence

Governance should show how communication needs are assessed, reviewed and acted on. Providers should be able to evidence communication profiles, PBS plan updates, incident reviews, staff briefings, supervision notes, health communication tools and outcome monitoring.

Strong governance connects behaviour to communication access. Records should show what the person may not have understood, what staff changed, and whether the person gained a safer way to communicate. This creates a clear line of sight from behaviour to communication need, from communication need to action, and from action to outcome.

Commissioner and CQC Expectations

Commissioners expect providers to understand communication needs because they affect safety, stability, choice and access to services. They need assurance that providers reduce escalation by improving understanding, not by relying on restriction.

CQC will expect staff to communicate effectively, support choice and respond to distress appropriately. Inspectors may review whether communication plans are current, whether staff use them and whether behaviour support reflects individual need. Strong services demonstrate that communication support is visible in daily delivery.

Common Pitfalls

Repeating verbal instructions when the person needs fewer words or visual support.
Recording refusal without checking whether the person understood the request.
Creating communication profiles that staff do not use in real routines.
Offering choices that are too many, too abstract or not meaningful.
Failing to give the person a reliable way to say stop or wait.
Not sharing communication guidance with health or community professionals.

Conclusion

Understanding behaviour through unmet communication needs helps PBS teams see distress as a possible sign that information, choice or expression has not been accessible enough. Strong services respond by changing communication, not blaming the person.

When communication support is clear and consistent, people are better able to understand, refuse, participate and recover. Providers can evidence how behaviour, communication, staff action and outcomes connect, giving commissioners and CQC confidence that PBS is practical, respectful and rights-based.