Applying PBS Across Diverse Populations, Needs and Settings
-Blog Series with our PBS Practitioner, Darren Moyle-
Darren Moyle is a PBS Lead Practitioner with more than 30 years’ experience in education and support services for people with learning disabilities. He has practised Positive Behaviour Support (PBS) for over 18 years and has extensive experience supporting autistic and neurodivergent children and adults, people with behaviours of concern, and young people with complex mental health needs and trauma. He is a strong advocate for ethical, respectful support that improves quality of life and reduces restrictive practices through skill development and positive environmental change. Darren is also an experienced PBS practitioner, trainer and PROACT-SCIPr-UK® instructor.
Positive Behaviour Support is rooted in consistent values, but different stories, relationships, cultures, environments and experiences of the world shape people. For people who require complex care, good PBS begins by looking beyond diagnosis and recognising a simple human truth: no two people experience the world alike, and the Positive Behaviour Support they receive should reflect that individuality.
Can the Same PBS Approach Work for Everyone?
Positive Behaviour Support can be applied in a family home, a classroom, a supported-living service, a hospital or a secure setting. But if the same plan is carried unchanged from one person or environment to another, is it still person-centred? The strength of PBS lies in holding onto a consistent set of values while adapting assessments, communication, expectations and environments around the individual. This becomes especially important for people with multiple needs in complex situations, whose experiences may be shaped by several interconnected factors rather than one diagnosis or behaviour alone. In this article, we speak with Darren Moyle, PBS practitioner at Leaf Complex Care, about applying PBS meaningfully across diverse populations, needs and settings.
How do you adapt PBS when working with autistic people and people with learning disabilities without autism, or both?
Darren explains:
“The core principles of Positive Behaviour Support remain the same across groups: understanding the function of behaviour, improving quality of life, teaching skills, adapting environments and reducing reliance on restrictive practices. What changes is how the assessment and support are delivered.
With autistic people, I would pay particular attention to sensory processing, communication differences, predictability, social demands, intolerance of uncertainty and how perceived loss of control may influence distress. With people who have a learning disability without autism, the emphasis may be more on accessible communication, cognitive processing, skill development, pace of learning and ensuring expectations match the person’s level of understanding. Where autism and learning disability occur together, I would avoid assuming that all behaviour is explained by either diagnosis. The PBS formulation should identify the individual interaction between communication, sensory needs, health, relationships, environment, learning history and current demands. Assessment methods, communication tools and interventions should therefore be adapted to the person rather than to the diagnostic label, with family and staff knowledge used alongside direct observation and data.“
PBS Across Different Life Stages
Personalisation also means recognising that the right support today may not remain right throughout someone’s life. Communication, health, relationships, responsibilities and personal ambitions can all change, requiring PBS to develop alongside the person.
How should PBS be adapted as a person moves through childhood, adolescence, adulthood and later life?
“PBS should develop with the person rather than remain a static plan. In childhood, support may focus strongly on communication, emotional regulation, play, learning, family routines and school participation. During adolescence, puberty, identity, increasing independence and changing social expectations need to be considered, alongside preparation for transitions between education and adult services. The person should be given progressively greater involvement and control in decisions as their skills and autonomy develop.
In adulthood, PBS should increasingly reflect rights, choice, relationships, work or meaningful occupation, community participation and the person’s own long-term goals. In later life, the formulation may need to account for changes in mobility, sensory abilities, cognition, pain, bereavement, dementia or other age-related health conditions. At every stage, the plan should be reviewed when the person’s circumstances, abilities, preferences or risks change rather than simply carrying forward strategies that were designed for an earlier stage of life.“
How should PBS be adapted for people whose needs change because of puberty, ageing or deteriorating health?
“When needs change because of puberty, ageing or deteriorating health, I would revisit the functional assessment rather than assuming that an increase in distress or behaviour of concern represents a behavioural problem. Pain, sleep disruption, medication effects, hormonal changes, sensory changes, reduced mobility, constipation, dental problems, infection or cognitive decline can all alter behaviour and tolerance of demands. Health screening and multidisciplinary input should therefore sit alongside behavioural assessment, particularly where the person has difficulty communicating discomfort.
The PBS plan may then need to change expectations, routines, communication, staffing, sensory support or environmental demands. Strategies that previously worked may become ineffective or unnecessarily demanding as the person’s physical or cognitive abilities change. Good PBS should remain responsive, preserve dignity and independence wherever possible, and use ongoing data and regular review to distinguish changes in behaviour from changes in health, environment or quality of life.”
How PBS Changes Across Different Services and Secure Settings
A change of service can transform almost everything around a person, including how decisions are made, which relationships shape their support, how risk is understood, and how much freedom their environment allows. The values of PBS should not change with a birthday, a service transition or a locked door, but its application must.
How might the application of PBS differ between children’s and adults’ services?
”The underlying PBS framework should be consistent, but the systems around the person can differ significantly. In children’s services, parents or carers, education staff, and wider developmental goals often play a central role, and support may need to be integrated with school routines, family life, and safeguarding responsibilities. Intervention should still prioritise the child’s voice, assent, strengths and developing independence, rather than focusing only on adult-defined compliance.
In adult services, there is usually a greater emphasis on autonomy, consent, decision-making, personal relationships, tenancy rights, employment or meaningful activity, and least restrictive support. Capacity and best-interest processes may sometimes be relevant, but they should not replace efforts to involve the person directly. The transition between children’s and adults’ services is therefore a particularly important period for PBS, because inconsistent expectations, loss of familiar support and abrupt changes in environment can themselves become setting events for distress.”
Are there, and if yes, what particular considerations, risks or misconceptions may arise when PBS is used in forensic or secure settings?
”Yes. In forensic or secure settings, PBS is at risk of being misunderstood as a method of gaining compliance or controlling risk rather than improving quality of life and reducing the need for restrictive practice. Security procedures, limited choice, locked environments and offence-related risk management can all influence behaviour, so these factors must be included in the formulation. Behavioural function and forensic risk are related but not identical, and neither should be used to justify punitive or overly restrictive responses.
PBS in secure settings therefore needs strong human-rights safeguards, trauma-informed practice, clear clinical governance and regular review of restrictions. The team should actively look for opportunities to increase meaningful choice, relationships, activity, communication and skill development within the limits of the setting. Restrictive interventions should be monitored transparently, with attention to frequency, duration, proportionality and whether less restrictive alternatives are being developed.”
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