PBS Plan Form | Caring Alliance

Individual and Plan Details

Individual's Name

Date of Birth

Preferred Name

Date of Plan

Author / PBS Lead

Review Date

Setting / Service

Diagnoses (if any)

Understanding the Person

What is important to the person? (relationships, interests, values, routines)

What are the person's strengths, skills, and positive qualities?

How does the person communicate? (verbal, non verbal, signs, aids, behaviours)

What makes the person happy and content?

Who is important to the person? (family, friends, advocates, key relationships)

Understanding the Behaviour

Describe the behaviours that are causing concern. Be specific and objective.

Behaviour	Description (what it looks like)	Frequency	Duration	Intensity (Low/Med/High)	What it might mean (possible function)

Possible Functions of the Behaviour

Attention or social interaction
Escape or avoidance (task, demand, social situation)
Sensory stimulation or self regulation
Tangible (wanting an item, food, activity)
Pain or physical discomfort
Communication of an unmet need

Known Triggers and Setting Events

What typically happens before the behaviour occurs? (antecedents, situations, times of day, people, environments)

Setting events: are there underlying factors that make the behaviour more likely? (poor sleep, pain, changes, hunger, noise, transitions)

What typically happens after the behaviour? (how do others respond, what is the consequence)

Primary Prevention: Proactive Strategies

Strategies to prevent the behaviour from occurring in the first place by improving quality of life and addressing unmet needs.

Environmental adjustments (noise, space, lighting, routines, visual supports)

Communication support strategies (how to help the person express needs and choices)

Meaningful activity and engagement (what the person enjoys and finds rewarding)

Choice and control (how the person is supported to make decisions and have autonomy)

Skills development (what skills the person is building to reduce the need for the behaviour)

Staff approach (consistent responses, communication style, relationship building)

Secondary Prevention: Early Intervention Strategies

Strategies to use when early warning signs appear, to de escalate and prevent the behaviour from intensifying.

Early warning signs (what does the person do that indicates distress is building?)

De escalation strategies (what to do, what to say, what to offer, what to reduce)

Safe space and calming strategies (where the person can go, what helps them self regulate)

What staff should NOT do (approaches that are known to escalate the situation)

Tertiary Strategies: Post Incident Recovery

Strategies for safely managing the behaviour if it occurs and supporting recovery afterwards.

Reactive strategies (what staff should do to keep the person and others safe during an incident)

Recovery and reconnection (how to support the person after the incident has passed)

Post incident review (how incidents are reviewed, learned from, and fed back into the plan)

Support for staff (debrief, emotional support, supervision following incidents)

Restrictive Interventions

Restrictive interventions should only be used as a last resort when there is an imminent risk of serious harm. Record any restrictions and the justification for their use.

Type of Restriction	Description	Last Resort Justification	Frequency of Use	Reduction Plan

Restriction reduction plan: how will restrictive interventions be reduced and eliminated over time?

Is this plan compatible with the Mental Capacity Act and the least restrictive principle? If so, how?

Risk Assessment

Risk to Self

Risk to Others

Risk to Environment

Risk to Staff

Summary of key risks and mitigations in place

Monitoring and Review

Recording Method (ABC charts, incident reports, behaviour data)

Review Frequency

Who Monitors Implementation?

Next Review Date

How will the effectiveness of this plan be measured? (reduction in frequency, intensity, duration; improved quality of life; increased skills)

Sign-Off

Role	Name	Signature	Date
PBS Lead / Author
Registered Manager
Individual / Representative
Behaviour Specialist (if involved)

Positive Behaviour Support (PBS) Plan