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

May 12, 2026

Positive Behaviour Support requires services to understand how waiting affects behaviour, communication and emotional regulation. 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 what waiting feels like for the person. Delays, queues, late transport, staff handovers, appointment times, meal preparation and activity start times can all create uncertainty before behaviour appears.

This reflects PBS principles and values, because support should make time, choices and next steps understandable. Strong services do not treat distress during waiting as impatience without checking whether the person has enough clarity and support.

Concept Explained Clearly

Waiting can be difficult because it combines uncertainty, lack of control and delayed access to something meaningful. A person may understand what is happening but not how long it will take, what they can do while waiting, or whether the plan will still happen.

Behaviour linked to waiting may include repeated questioning, pacing, calling out, leaving, grabbing items, shouting, refusal, withdrawal, self-injury or aggression. In PBS, these behaviours should be understood by asking whether waiting was explained, supported and made manageable.

Why It Matters in Real Services

When waiting is poorly supported, staff may respond to the visible behaviour rather than the uncertainty underneath it. They may say “wait a minute” repeatedly, offer vague reassurance or become frustrated when the person asks the same question again.

This can increase distress and reduce access. People may struggle with appointments, community activities, transport, meals or staff availability because waiting has not been planned. Commissioners and CQC will expect providers to evidence proactive communication, reasonable adjustment and person-centred support around predictable delays.

What Good Looks Like

Strong services demonstrate that waiting is built into PBS planning. Staff know how the person understands time, what helps them wait, what makes waiting harder, and what early signs show that uncertainty is building.

Good PBS practice makes waiting visible and purposeful. Staff use timers, visual countdowns, now-and-next boards, clear alternatives, realistic updates and calming routines. Providers should be able to evidence how supported waiting reduces escalation and improves access to ordinary routines.

Operational Example 1: Waiting for Transport

Step 1 – What triggered concern: A person in supported living became distressed when transport arrived late for a weekly community activity. They paced near the window, asked repeated questions and shouted when staff said the minibus was delayed.

Step 2 – What staff analysed: The provider reviewed the routine and found that staff used vague phrases such as “soon” and “not long,” which did not help the person understand the delay.

Step 3 – Support approach: Staff introduced a transport waiting plan with a visual countdown, a backup activity and a clear explanation of what would happen if transport was more than fifteen minutes late.

Step 4 – Day-to-day delivery detail: Staff checked transport before the person got ready where possible, gave factual updates, and offered the agreed waiting activity before pacing escalated.

Step 5 – How effectiveness was evidenced: Distress during delays reduced, the person waited more calmly and fewer activities were cancelled because of escalation. The provider evidenced that clearer waiting support protected community access.

Deepening the Understanding: “Soon” Is Not Always Accessible

Words such as “soon,” “later” and “in a bit” may be too vague for some people. They may create more anxiety because the person cannot predict what will happen. Strong PBS services use communication that makes time understandable in the person’s preferred format.

Waiting also needs purpose. A person may manage a delay better when they know what they can do while waiting and what will happen next. This is not distraction as a quick fix. It is structured support that reduces uncertainty and protects control.

The related article on seeing behaviour as communication in PBS reinforces why distress during waiting should be understood as communication about uncertainty, control and support needs.

Operational Example 2: Waiting in a Clinic

Step 1 – Access issue: A person receiving outreach support often left clinic waiting rooms before appointments. Staff recorded refusal to attend health reviews, but the person usually arrived calmly.

Step 2 – Waiting demand explored: The provider identified that distress built during long waits with no clear update. The person struggled with noise, other people and not knowing when they would be called.

Step 3 – Practical adjustment: Staff contacted the clinic in advance to request realistic waiting information and permission to wait outside or in a quieter area if delays occurred.

Step 4 – Support delivery: The person used a simple appointment sequence and an agreed break signal. Staff checked reception for updates rather than offering repeated reassurance without facts.

Step 5 – Outcome evidence: Appointment completion improved, leaving reduced and recovery after appointments was quicker. The provider evidenced that supported waiting improved healthcare access.

Systems, Workforce and Consistency

Waiting support must be consistent across staff. If one staff member gives accurate information and another uses vague reassurance, the person may lose confidence in the plan. Strong services include waiting guidance in PBS plans, appointment plans, transport routines, handovers and supervision.

Managers should review recurring waiting points in the service. These may include meal preparation, medication rounds, staff handover, personal care, transport, appointments and activity transitions. Supervision should explore whether staff understand how the person experiences delay, not only whether the delay was unavoidable.

Operational Example 3: Waiting for Staff Attention During Handover

Step 1 – Pattern noticed: In a residential service, a person became distressed during staff handover and repeatedly knocked on the office door. Staff viewed this as interruption.

Step 2 – Meaning considered: The provider recognised that the person did not know when staff would be available again. The closed office door and lack of information increased uncertainty.

Step 3 – Support response: Staff introduced a pre-handover check-in, a visual “handover now, check-in next” cue and a named staff member responsible for follow-up.

Step 4 – Practice made reliable: Staff avoided promising immediate availability if this was unrealistic. The agreed check-in happened at the visible time so the person could trust the system.

Step 5 – Evidence reviewed: Door knocking reduced, handovers became calmer and the person used the visual cue more independently. The provider evidenced that reliable waiting support reduced anxiety and staff interruption.

Governance and Evidence

Governance should show how waiting-related behaviour is identified, planned for and reviewed. Providers should be able to evidence PBS plan updates, appointment plans, transport records, incident analysis, communication tools, supervision notes and outcome monitoring.

Strong governance connects behaviour to delay and uncertainty. Records should show what the person was waiting for, how waiting was explained, what support was offered and whether outcomes improved. This creates a clear line of sight from behaviour to waiting-related distress, from distress to support action, and from action to improved access.

Commissioner and CQC Expectations

Commissioners expect providers to support people through ordinary service delays without avoidable escalation or unnecessary cancellation. They need assurance that providers can maintain access to health, community and daily routines through proactive planning.

CQC will expect care to be person-centred, responsive and well led. Inspectors may review whether staff communicate clearly, whether routines are personalised, whether appointments are supported and whether incidents lead to learning. Strong services demonstrate that waiting is planned, communicated and governed.

Common Pitfalls

Using vague phrases such as “soon” or “later” when the person needs clear information.
Assuming waiting distress is impatience rather than uncertainty or anxiety.
Providing updates that staff cannot reliably keep.
Leaving people without a meaningful waiting activity or visual structure.
Recording appointment refusal without reviewing the waiting environment.
Failing to plan for predictable delays such as transport, handover or clinics.

Conclusion

Understanding behaviour through waiting helps PBS teams recognise how uncertainty, delay and loss of control can increase distress. Behaviour may communicate that the person needs clearer information, structured time and reliable follow-through.

Strong providers make waiting understandable and manageable. They evidence how visual support, realistic updates and planned alternatives reduce escalation and protect access. This gives commissioners and CQC confidence that PBS is practical, proactive and embedded in everyday service delivery.