Understanding Behaviour Through Waiting and Delays in PBS: Reducing Uncertainty Before Distress Builds

Positive Behaviour Support requires services to understand how waiting and delays affect behaviour. 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 looking at what happens when people are asked to wait for meals, medication, transport, staff attention, activities, appointments or information. Behaviour may increase when waiting feels uncertain, unexplained or outside the person’s control.

This reflects PBS principles and values, because support should make ordinary service delays understandable and manageable. Strong services do not blame people for struggling with waiting; they design support around how waiting is experienced.

Concept Explained Clearly

Waiting is not just empty time. For some people, waiting can create anxiety, sensory discomfort, frustration, repeated checking, fear of being forgotten or difficulty understanding when something will happen. A delay that seems minor to staff may feel significant to the person if they rely on predictability.

Behaviour linked to waiting may include repeated questions, pacing, shouting, leaving the area, interrupting staff, refusing later support or becoming distressed when plans resume. In PBS, these behaviours are understood as possible communication about uncertainty, control, emotional regulation or lack of accessible information.

Why It Matters in Real Services

When waiting is misunderstood, staff may respond with vague reassurance such as “soon” or “in a minute.” For some people, this increases uncertainty because the phrase has no clear meaning. Staff may also become frustrated by repeated questions, which can lead to sharper tone, rushed explanations or avoidable escalation.

Delays happen in real services. Transport runs late, medication rounds take time, staff are supporting emergencies, meals are delayed and appointments overrun. Commissioners and CQC will expect providers to show that predictable risks are managed through planning, communication and responsive support.

What Good Looks Like

Strong services demonstrate that waiting is supported proactively. Staff know what types of waiting are hardest for the person, what information helps, what language to avoid, what calming activity is useful and how to preserve control during delay.

Good PBS practice makes waiting visible and bounded. This may include timers, visual schedules, now-and-next boards, agreed phrases, meaningful interim activity, planned updates and clear alternatives. Providers should be able to evidence how better waiting support reduces escalation and improves access to daily routines.

Operational Example 1: Waiting for Transport

Step 1 – Service issue identified: A person attending a day opportunity became distressed when transport was late. They paced near the window, repeatedly asked when the vehicle would arrive and sometimes refused to go once it came.

Step 2 – Behaviour meaning explored: The provider reviewed transport records and staff notes. The distress was linked to uncertainty and loss of control, not reluctance to attend the day opportunity.

Step 3 – Support response agreed: Staff introduced a visual transport board with “waiting,” “vehicle arrived” and “alternative plan” options. They used one clear update phrase and avoided repeatedly saying “soon.”

Step 4 – Day-to-day delivery detail: If transport was more than ten minutes late, staff offered a preferred waiting activity and contacted transport for a real update. The person was shown the update visually rather than given several verbal explanations.

Step 5 – Evidence and outcome: Refusals after late arrival reduced, pacing became less intense and attendance improved. The provider evidenced that clearer waiting support protected access and reduced distress.

Deepening the Understanding: Waiting Can Remove Control

Waiting often becomes difficult because the person cannot influence what happens next. They may not know how long the delay will last, whether the plan has changed, who is responsible or what they are allowed to do while waiting. This can make behaviour more likely, especially where communication, anxiety or trauma are factors.

Strong PBS services do not promise certainty where it does not exist. They provide honest, accessible information and useful choices. The aim is not to eliminate every delay. The aim is to make waiting safer, clearer and less dependent on repeated reassurance.

The related guidance on seeing behaviour as communication in PBS reinforces why repeated questioning, pacing or refusal after delays should be understood as information about support needs.

Operational Example 2: Waiting for Staff Attention During Busy Periods

Step 1 – Presenting risk: In a residential service, a person shouted across the lounge and followed staff when they were supporting other residents. Incidents were most frequent during medication rounds and meal preparation.

Step 2 – Pattern reviewed: The team identified that the person found unplanned staff unavailability difficult. They did not know when staff would return or how to request support without escalation.

Step 3 – Practical support introduced: Staff created a visible check-in system. Before busy periods, a named staff member explained what was happening, when they would return and what the person could do while waiting.

Step 4 – Consistency secured: The check-in time was kept realistic. Staff avoided saying they would return immediately if they could not. A brief midpoint check was added during longer busy periods.

Step 5 – Outcome evidenced: Shouting reduced, staff-following incidents became less frequent and the person used the waiting activity more often. Records showed that planned attention reduced crisis-driven attention seeking.

Systems, Workforce and Consistency

Waiting support must be consistent across the team. If staff use different phrases, offer unrealistic times or fail to return when promised, trust can reduce quickly. Strong services include waiting guidance in PBS plans, handovers, activity planning and supervision.

Managers should review predictable waiting points in the service. These may include medication, meals, transport, staff handovers, appointments and activity changes. Supervision should explore how staff manage repeated questions, whether they become frustrated, and whether their responses increase or reduce uncertainty.

Operational Example 3: Delays in Health Appointments

Step 1 – Situation clarified: A person supported to attend hospital appointments often became distressed in waiting rooms. They walked towards exits, refused to return and sometimes missed appointments after long delays.

Step 2 – Environmental and timing risks mapped: The provider reviewed noise, seating, waiting length, unclear appointment times and staff explanations. The person could manage short waits but not open-ended delays in busy spaces.

Step 3 – Support plan developed: Staff contacted clinics in advance to request quieter waiting options and realistic timing updates. The person used a visual waiting sequence and had a planned break option outside the waiting room.

Step 4 – Multi-agency delivery: Health staff were given a short communication summary. The support worker checked delay length at reception and updated the person using agreed visual information.

Step 5 – Evidence reviewed: Appointment completion improved, unplanned exits reduced and the person tolerated short delays more successfully. The provider evidenced that waiting support improved healthcare access and reduced avoidable distress.

Governance and Evidence

Governance should show how waiting and delays are understood, planned for and reviewed. Providers should be able to evidence incident analysis, waiting plans, PBS updates, handover guidance, staff supervision, appointment planning and outcome monitoring.

Strong governance reviews whether predictable delays are being managed well. Records should show what delay occurred, how it was communicated, what support was offered and what outcome followed. This creates a clear line of sight from behaviour to waiting-related uncertainty, from uncertainty to support action, and from support action to outcome.

Commissioner and CQC Expectations

Commissioners expect providers to manage ordinary service delays because they affect stability, access and quality of life. They need assurance that providers can support waiting without repeated crisis or unnecessary restriction.

CQC will expect care to be person-centred, responsive and well led. Inspectors may review whether staff understand communication needs, whether plans reflect known triggers, whether people are supported to access healthcare and activities, and whether leaders learn from repeated incidents. Strong services demonstrate that waiting support is practical and evidence-led.

Common Pitfalls

• Using vague phrases such as “soon” when the person needs clearer information.
• Promising a return time that staff cannot realistically keep.
• Recording repeated questions without analysing uncertainty or control.
• Ignoring predictable waiting points such as transport, medication and appointments.
• Providing waiting tools that staff do not use consistently.
• Assuming refusal after a delay means the person no longer wants the activity.

Conclusion

Understanding behaviour through waiting and delays helps PBS teams see how uncertainty, time and control affect distress. Behaviour may show that the person needs clearer information, realistic updates, meaningful interim activity or a safer way to ask what is happening.

Strong providers do not remove all waiting from life. They make waiting more understandable and better supported. This improves access to activities, healthcare and routines while giving commissioners and CQC clear evidence that PBS is practical, responsive and person-centred.