Before you start
Formulation is a hypothesis, not a label.
The first quality marker is intellectual honesty: diagnoses can guide questions, but the person, context, observation and data decide the formulation.
This fictional resource deliberately separates what is known from what is hypothesised. Jordan’s diagnoses help the team anticipate possible barriers in executive functioning, communication, sensory regulation and health. They do not explain any individual behaviour on their own.
A high quality team keeps asking: What changed? What happened immediately before? What did the behaviour achieve? What did the person communicate? What did staff do next? What health, sensory, relational or environmental variables might also matter?
Training rule: if the evidence changes, the formulation changes. The plan serves the person — the person does not have to fit the plan.
The non-negotiables
Five rules that hold across good PBS.
Tap each card. These are the clinical habits that protect quality when a shift gets busy.
The formulation
Five systems, one person.
Select a point on the map, then move through the three questions that matter: what it may mean, what we might observe, and how support can respond without overclaiming.
Five interacting systems — not five labels stacked on top of each other.
Start anywhere on the map
Each system contributes something different. None is a complete explanation. Select a point on the map to begin.
Health before behaviour
Rule out the body before you blame the person.
An unexplained change in behaviour may be communication about pain, illness, fatigue, medication, sleep or seizure-related change. Support staff observe and escalate; they do not diagnose.
The risk is diagnostic overshadowing.
When a change is automatically filed as “behaviour” because a person has disability, the team can miss the real driver. A high quality PBS system makes health screening part of behavioural reasoning rather than a separate afterthought.
The comfort-first sequence
Choice and control
A quick “yes” is not always informed choice.
Good support makes the choice understandable, genuine and observable — especially where communication or suggestibility may affect the answer.
In this fictional case Jordan sometimes agrees quickly with the last option offered. The team does not assume this is refusal, compliance or incapacity. They improve the way the choice is presented and verify preference through action, repetition and accessible communication.
Functional assessment
Record the sequence, not the judgement.
A useful FBA record is specific enough that another practitioner can reconstruct what happened without having been there.
“Jordan refused” tells us almost nothing. “Asked Jordan to move from the lounge to the van using spoken instruction only; he covered his ears, moved behind the couch and repeated ‘no van’ for 80 seconds; staff paused the request and offered headphones; he approached the door two minutes later” gives the assessment something to work with.
Language that closes the file early.
Avoid labels such as non-compliant, attention seeking, manipulative, had a behaviour or refused for no reason. They are conclusions masquerading as observations.
Communication as prevention
The replacement response has to work better.
Select a communication function. The team’s job is to make the safer, clearer response easier and more reliable than escalation.
Choose a function
Select a communication function to see the implementation rule.
Practice under pressure
Six things you might actually see.
Choose the best immediate response. The point is not to guess the diagnosis — it is to reason safely from what is observable.
Reflective practice
Swap judgement for curiosity.
Tap each phrase to replace a closed conclusion with language that keeps assessment open.
Bottom line
The safest sequence when you are unsure.
A simple clinical pathway the team can return to when the situation is complex.
Knowledge check
Six questions. The reasoning appears immediately after each answer.
Completion
Record your reflective practice.
Completing an interactive module is not the same as demonstrating competency. Observation, supervision and practice evidence still matter.