At PBS4, Positive Behaviour Support (PBS) is the foundation of our approach to delivering high-quality, ethical, and person-centred care. As with many neurodisability services across the UK, we embrace PBS as a respectful, rights-based framework that champions dignity, autonomy, and authentic improvements in quality of life.
The purpose of this position statement is to clarify the application of PBS and the ethical standpoint across several key areas.
PBS and Supporting Neurodivergence
The roots and evidence base for PBS is firmly embedded within support for people with learning disabilities. There are decades of research into how this promotes rights, reduces restrictive interventions, and avoids aversive or “punishment” based interventions. PBS brings the science of behavioural approaches together with the values of learning disability support.
PBS is one of several approaches that can support neurodivergent people to live the lives they choose. There is a breadth of evidence for PBS being used to support autistic people with learning disabilities. The State of the Nation Report (Gore et al., 2022) acknowledges the potential of PBS beyond these settings and encourages further research into its application for neurodivergent individuals without learning disabilities. There is no evidence to suggest that PBS would not be suitable in any way for individuals who are neurodivergent without a learning disability.
There is growing interest in how PBS can be used more broadly with neurodivergent people without learning disabilities. We welcome this and recognise the need for more inclusive research to explore what is most helpful and when. Any intervention must be approached with consideration to consent, best interests, and least aversive approaches.
The UKSBA’s statement on neurodiversity, equity, equality and inclusion, and the requirement within their ethics code to respect and value neurodivergent identities are examples of how PBS and other behavioural practices are evolving to ensure practices are neuro-affirming.
We still have a lot to learn in ensuring our practices are neuro-affirming and we will continue to listen to feedback from those who have and continue to receive Positive Behaviour Support. There is a recent increased focussed on ensuring social validity measures are included as part of research and intervention recommendations. This includes gaining feedback before, during and after. This must be a standard part of effective PBS.
It’s also vital to acknowledge that PBS may not be the right fit for everyone. Our commitment is to meaningful, collaborative support that is grounded in respect and consent. If someone we support is clear that they do not want support underpinned by a PBS framework then we ensure that the PBS framework is not used for that individual.
PBS and Human Rights
At its core, PBS is a human rights-driven approach. The UK-Society of Behaviour Analysis (UK-SBA) provides the professional registration for Behaviour Analysts in the UK. They have a Code of Ethical and Professional Conduct which all certified individuals must adhere too. Throughout the code there is a focus on the core principles of human rights including specific sections focussing on Respect and Autonomy. All regulated professionals will have similar codes of conduct.
We acknowledge that any approach, if misapplied, carries risks. We believe it is essential that when PBS is used it is overseen by a regulated/certified professional who are trained to a high level of PBS who apply the framework safely, ethically, and with integrity.
PBS is fundamentally about creating environments where people can thrive. This includes recognising and responding to communication, supporting self-regulation, and honouring individual rights and preferences. When working with individuals and their circle of support, skills teaching is carefully considered in partnership with the person and their family. The principles of assent and consent are considered at every step of assessment and ongoing intervention. PBS uses functional assessments to understand the purpose of behaviours and collaboratively supports the evolution of new skills the person can use to meet these needs.
Rather than suppress behaviours—even those that may challenge us—we aim to expand individuals’ skillsets to meet their needs in effective and meaningful ways. Often people with a disability in learning have learnt fewer behaviours to meet their needs, so further reducing their “toolkit” of skills would be silencing the person’s voice. Instead, the focus must be on increasing what is within the person’s repertoire to meet their needs and wishes. This is supported by information included within the UK-SBA code for Ethical and Professional Conduct:
“1.4. Registrants do not support efforts to suppress self-regulatory behaviours except in rare cases when the behaviour poses harm or a significant risk to wellbeing. In such cases, the registrant must first ensure that the risk cannot be ameliorated by reasonable changes to the environment. The registrant acknowledges the function of the self-regulatory behaviour and always prioritises the wellbeing of the client by ensuring that functionally equivalent alternative behaviours are supported and encouraged.”
PBS and Trauma
Understanding a person’s trauma is a fundamental part of getting to know any person that is supported using Positive Behaviour Support. Trauma informed Care is a relatively new term first articulated in 2001 and more widely used in the past decade. This means it may not be discussed specifically in historic articles relating to Positive Behaviour Support, but understanding a person’s history is part of the formulation for developing a functional understanding and will be considered in any interventions and support recommendations. Close attention to physical and mental health contexts has been emphasised within UK literature on PBS relating to both assessment, intervention and evaluation.
PBS originated as a shift away from aversive and restrictive interventions for people with learning disabilities. Strategies that are considered aversive or abuse e.g. withholding preferred items, ignoring communication attempts and enforcing compliance are not practices that are associated with Positive Behaviour Support. If people have experienced these practices or witnessed these practices occurring, the individual acting in this way should be reported to the professional or safeguarding boards. PBS practitioners must take a trauma-informed approach—being sensitive to a person’s experiences and tailoring interventions to support healing, trust, and emotional safety.
PBS and Racism
The NHS reported that black individuals are disproportionately detained under the Mental Health Act and are more likely to be subjected to restrictive practices (NHS, 2022). This data is of serious concern and action must be taken to address this in all areas of practice. We are not aware that there are specific concerns regarding systemic racism within PBS, but we need to consider if this has been examined in detail and open to addressing any concerns that arise.
Systemic racism is an issue across many sectors throughout the UK, and it is likely that there are some unconscious biases that remain in all practices, including Social Care which must be addressed. To support with this in behavioural practice in the UK, the UK-SBA have set up a taskforce focusing on racism, equality and diversity and all registered professionals are required to complete annual CPD in this area. We are committed to ongoing learning in areas including anti-racism, neurodiversity, and trauma-informed care.
Standards, Consistency and Impact of PBS
Consistency of implementation of PBS across the UK is currently difficult to measure. Until recently there has been no professional registration based in the UK for PBS professionals to register with. There is also no control over who can call themselves a PBS practitioner or similar title, which means that there are people practising under this title with no formal qualification or regulation from a professional body.
This is changing:
- In January 2023 the UK-SBA’s register was accredited under the Professional Standards Authority’s Accredited Register Programme. This provides additional peace of mind to anyone looking for a behaviour analytic practitioner, as it demonstrates that the UK-SBA’s register meets the Authority’s high standards in governance, standard-setting, education and training, management of the register, complaints handling and information. (UK-SBA website, 2025)
- The PBS Academy is currently updating their competency framework in line with Gore et al (2022) Positive Behavioural Support in the UK: A State of the Nation Report.
These combined efforts will provide a clearer framework to raise standards and improve consistency. However we must continue to help people receiving support, families and commissioners to ensure they can recognise what “good” PBS looks like to ensure informed choices and ethical delivery.
PBS is mentioned in NICE guidelines including guideline 93 and 11. In the NICE guideline 93 (learning disabilities and behaviour that challenges: Service design and delivery) Positive Behaviour Support is mentioned on seven occasions as recommendations of good practice with specific recommendations for ensuring quality implementation. It recommends levels of competency and aligning with the PBS Academy competency framework. In guideline 11 whilst further research is called for in certain areas (such as for children under five), the overall guidance supports PBS as a best-practice framework.
PBS and Consideration of Thoughts/Feelings
Positive Behaviour Support is underpinned by the principles of Applied Behaviour Analysis. This is the science of understanding behaviour. Behavioural approaches consider internal thoughts and feelings. B.F. Skinner first discussed private events (thoughts and feelings) as part of the concept of Radical Behaviorism in the 1930’s. 2nd and 3rd wave behavioural approaches have applied behavioural sciences directly to internal thoughts and feelings. For example, Cognitive Behaviour Therapy directly treats an internal thought as a behaviour and seeks to measure this and adjust variables that increase and decrease the occurrence of these thoughts. The challenge in learning disability support can often be how can we hear about these thoughts if the people we support are unable to articulate them?
There is work within the field of PBS and wider social care ensuring views, thoughts and feelings are heard from those who have limited means of communication. There are also branches of Behaviourism which primarily focus on internal thoughts (e.g. Acceptance and Commitment Therapy).
In addition to this, within Gore et al (2022) and the 12 key components of PBS states that PBS must include: Multi-profession and cross-discipline approaches are a core component of PBS. When support needs fall outside a practitioner’s expertise, it is essential to involve other professionals to ensure comprehensive, person-centred care.
Alternatives to PBS
There are alternatives that are evidence-based; as noted above we aim to work in collaboration with other approaches rather than as an isolated field. Many alternative approaches often share behavioural foundations e.g. Low arousal approaches typically have behavioural approaches underpinning them.
Whatever a practice is called, we believe it is important to have skilled professionals who understand the underpinning evidence to ensure approaches are delivered as safely and effectively as possible.
Summary
We believe PBS is a powerful approach for positive change. It is about understanding, respecting, and empowering people to live lives that make sense to them.
Ultimately our goal within PBS is to provide effective, evidence based, ethical support to those who require this support. We oppose and actively object to approaches that are not neuro-affirming and may pose a risk of harm whether this is physical or psychological. We have an ethical and moral obligation to renounce these approaches.
PBS is a framework based on the application of the science of Applied Behaviour Analysis. It is the responsibility of those who apply the science to ensure that they are working in an ethical and moral way. We use it to honour people’s rights, individuality, and potential.
We will continue to listen and learn from those with lived experience and continually reflect on our practices.
Written by: Sam Corbett UKBA(Cert) Head of Clinical and Training, PBS4
References
- Gore, N.J., Sapiets, S.J., Denne, L.D., Hastings, R.P., Toogood, S., MacDonald, A., Baker, P.A., Allen, D., Apanasionok, M.M., Austin, D. and Bowring, D., 2022. Positive Behavioural Support in the UK: A State of the Nation Report. International Journal of Positive Behavioural Support, 12
- NHS. (2022). Mental Health Act Statistics, Annual Figures – 2021-22. Retrieved from https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-act-statistics-annual-figures/2021-22-annual-figures/detentions-differences-between-groups-of-people
- NICE (2015). Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges. NG 11. Retrieved from https://www.nice.org.uk/guidance/ng11
- NICE (2018). Learning disabilities and behaviour that challenges: service design and delivery. NG 93. Retrieved from https://www.nice.org.uk/guidance/ng93.
- Schneider, S. M., & Morris, E. K. (1987). A history of the term radical behaviorism: From Watson to Skinner. The Behavior analyst, 10(1), 27–39. https://doi.org/10.1007/BF03392404
- UK-SBA (2024). UK-SBA Code of Ethical and Professional Conduct. Retrieved from https://uk-sba.org/wp-content/uploads/2024/03/UK-SBA-Code-of-Ethical-and-Professional-Conduct_Mar-2024.pdf
- UK-SBA. (2023). PSA Accreditation. Retrieved from https://uk-sba.org/psa-accreditation/
