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Positive & Proactive Support Plan (PPSP)
Name: ……………………………………………………. DOB: …………….…..
NHS Number/ID: ………………………………..……………………..…………..…..
This plan should be implemented alongside a risk management
plan. The two plans will proactively and reactively manage risk and
support the reduction of restrictions. Restrictions include any
intervention (environmental, physical, relational, psychological or
pharmacological) that prevent a person in your care from pursing
free action.
This plan should be developed with support from a clinician with
behavioural expertise following an assessment and functional
analysis of the problem behaviour. All staff implementing this plan
should be supported via appropriate levels of training and
supervision.
Date of plan:
Last review of plan:
Named nurse/manager:
Part A: Background
1. Who
Name: ………………………………………………………………...……………
Date of Birth: …………………………………………………………………..…
Address: …………………..………………………………………………………
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Personal details
2. Where
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Place where the plan is to be used.
3. Background
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Pen picture of the person.
Background information & description of the person’s
baseline state.
How they are when they are not escalated?
4. How do we get it right?
What do we need to get right from beginning?
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What do we need to get right to support this person so that they
do not need to use this behaviour?
How do they like to be supported?
What are their communication preferences?
What do they like to do?
Who do they like to spend time with?
Part B: Assessment of Behaviour
5. What
What is the behaviour that places the person or others at
risk?
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Describe the behaviour.
Include risk to self and others and behaviours that risk the
person being denied access to everyday community living.
6. When
Activities: …………………………………………………………………………
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Places: …………………………………………………………………………
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Other people: ……………………………………………………………………
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Times of Day: ……………………………………………………………………
When does the behaviour tend to happen?
Are there triggers in terms of:
· activities
· places
· other people
· times of day
Use information from your assessment.
7. Why
Why does the person behave in this way?
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What are the triggers & consequences?
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What functions (e.g., attention, escape, sensory, access to an
object, expression of an internal state) does the behaviour serve
for the person?
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What are the reasons that these behaviours are displayed by this
person?
What do we know about the person’s history that could explain
these behaviours?
What are their preferences, needs and motivations that help to
explain the behaviours?
Work with a Behavioural Nurse or Clinical Psychologist to
complete:
Behavioural problem monitoring looking at behaviour type,
frequency, intensity & duration.
Antecedent – Behaviour – Consequence (ABC) recording.
Weekly time and day scatter plots.
Analysis of environmental mediators.
Analysis of the function and motivation driving behaviour.
Part C: Restrictions
8. Restrictions
What restriction are being placed upon this individual
currently?
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Examples include:
Detention under MHA, seclusion, deprivation of liberty, physical
restrictions, and pharmacological restrictions?
9. Reducing restrictions
What strategies are in place to monitor, evaluate and reduce
restrictions for this person.
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How is the use of restrictions being measured?
How are restrictions being evaluated and reviewed over time?
How are we learning together with the patient and their
family?
Part D: Positive Behavioural Support
10. Coping better
What focussed support or coping skills do they need to reduce
the frequency, intensity or duration of problem behaviour?
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What can we do to support the person to cope better?
Can we teach them relaxation or anger management to help them
cope?
Can we teach them alternative ways of expressing their
needs?
Is there a role for medication?
11. Reinforcing the positive.
Outline plans to reduce negative behaviour and reinforce
positive behaviour here. (Include input from Clinical
Psychology/Behavioural Nurse Specialist)
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Plans that reinforce positive behaviours by:
Using prompts,
Praise
“Catching the person doing well”
Offering rewards for positive alternative behaviours
Offering rewards when periods of time have been achieved where
positive behaviours have been evident.
Plans that match progress with reduced restriction and increased
opportunity.
12. Positive life skills
What life skills or supports can we offer that will help the
person enjoy a better quality of life?
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What does the person want to achieve in life?
What would a person good future look like for them?
What can we do to support the person to have fun and enjoy
life?
Can we support access to opportunities that will help them build
self-esteem, pleasure and mastery?
Can OT or Social Services offer support, skills training and
access to new opportunities?
Part E: Risk Management
13. Early signs
What are the early signs that we need to respond?
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What are the early signs that something is wrong?
What does the person do? (e.g., pace, frown, scratch self
etc).
14. Prevention
What actions should we take to keep the person and other people
safe?
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If the behaviour continues, how will we keep the person and
other people safe?
What primary prevention measures can we use?
What helps calm the person?
Would distraction, redirection, active listening or
de-escalation strategies help?
Describe who should do this and how it should be done.
Think about what should be communicated and how this
communication should be given.
Write the actions in a clear way that any member of staff could
understand.
15. Reactive strategies
What PRN medication can be used?
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What planned breakaway techniques are in use?
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What reactive strategies can be used as a last resort?
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If medication is to be used include or reference a PRN/rapid
tranquiliser protocol developed by nursing/medical staff. Be clear
about how it is to be given and what it is aiming to achieve.
Name the breakaway techniques and the holds that are to be
used.
Be clear about who is responsible for making decisions about
what should be done and when.
Highlight where supporting documents regarding these techniques
and those who are trained to use them can be found.
16. Escalation traffic lights
Response:
Supportive action
Observation:
What is seen & heard
Indicators that the person is in crisis and out of control.
Behaviours that represent real and significant risk to self and
others.
Key points on how to positively and proactively manage the
crisis, follow a risk management plan, utilise assistance, take
control and actively keep person and others safe.
Indicators that the person is continuing to escalate but still
has the potential to calm and resume control.
Behaviours that represent indicators of risk.
Key points on how to positively and proactively support &
deescalate, manage the environment, seek assistance and keep person
and others safe.
Indicators that the person is leaving baseline.
Behaviours that represent early indicators and precursors to
challenging behaviour.
Key points on how to positively and proactively support,
distract, redirect, problem solve or actively engage.
Overview of baseline information.
Key points on how to positively and proactively support and
engage.
This section provides a summary of the escalation signature of
the person.
Information from this section should be mapped onto a more
detailed risk management plan.
The traffic light format (green to red) shows how the person’s
behaviour becomes more risky as it escalates.
It provides a one page overview of the key behaviours in each
stage.
It also provides the key supportive actions that staff can
undertake to respond.
Part F: Post Incident
17. After
What should happen after the behaviour has stopped?
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What learning can take place to improve future practice?
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How should the service user and those affected be supported
after the event?
How will staff be debriefed and supported to process the
emotional reaction and clinical learning post incident?
Who should be informed and what paperwork should be done?
What learning can take place?
Does this plan need updating to include new insights?
18. Inform
Who do you need to inform about incidents? Which colleagues,
managers and professionals need to know if the behaviour has
happened?
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Are there any major unmanaged risks?
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Who is taking responsibility for these?
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DO YOU NEED TO INFORM SAFEGUARDING?
Communication is the key to sharing good practice and keeping
people safe.
Who needs to know behaviour has occurred?
Have any other risks been identified that remain an ongoing
worry?
Identify staff who will take responsibility to develop a plan
for these risks.
Has a senior carer, nurse or manager been informed of any
safeguarding issues?
Part G: Quality & Standards
19. Quality checklist
YES [ ] NO [ ]
YES [ ] NO [ ]
YES [ ] NO [ ]
YES [ ] NO [ ]
YES [ ] NO [ ]
1. Does the plan clearly indicate how restrictions placed on the
individual are being monitored and evaluated?
2. Is the plan reviewed with the patient and where appropriate
family/carers to ensure it is working?
3. Are records being kept up to date that enable you to see if
the plan is working and restrictions are being reduced safely over
time?
4. If the plan is not helping or the person is facing increased
restrictions is this being proactively raised with senior
professionals involved in the person’s care?
5. Are there any safeguarding concerns that need to be raised
regarding this plan?
Keep records and track improvement.
Meet and review care to ensure joint learning is taking
place.
Refer to your policy and guidance and ensure all recording and
reporting has been completed.
Part H: Consent, Capacity & Best Interest
Check the person understands the content of this plan before
they are asked to sign it*.
I agree with the use of this plan
Signed Service User:…………………………..…………………Date: ………………
If you are not happy with this plan or do not consent to it
please talk to staff.
Staff will listen to you and try and make the plan better.
If you are detained under the Mental Health Act the plan may
still be used to keep other people safe.
If you are still unhappy staff will support you to talk to an
advocate and use the accessible complaints procedure if needed.
Signed named nurse/manager:………………………..………… Date: ………………
Signed:……………………..………………………..……………… Date: ………………
Signed:……………………..………………………..……………… Date: ………………
Signed:……………………..………………………..……………… Date: ………………
* If the person cannot understand the plan please use MCA
paperwork to record the assessment of capacity and best
interest decision making. Consider Deprivation of Liberty
assessment and safeguards where appropriate.
Part I: Plan Evaluation & Review
REVIEW 1
Completed By:
Date:
Number of incidents since last review?
Has frequency of behaviours decreased?
YES
NO
Details here:
Has severity of behaviours decreased?
YES
NO
Details here:
Has duration of behaviours decreased?
YES
NO
Details here:
Is there a full record of each incident and the interventions
used?
YES
NO
Details here:
Were interventions used effective?
YES
NO
Details here:
Have there been any changes in behaviours?
YES
NO
Details here:
Is there evidence of a reduction in restrictions?
YES
NO
Details here:
Have all reasonable measures been put in place to safeguard the
well-being of the person and other people?
YES
NO
Details here:
If you have answered ‘No’ to any of the above questions please
escalate your concern to a senior professional/MDT.
Are changes to this plan or the risk management plan needed? If
YES please state:
YES
NO
Details here:
Responsible Person:
Date:
REVIEW 2
Completed By:
Date:
Number of incidents since last review?
Has frequency of behaviours decreased?
YES
NO
Details here:
Has severity of behaviours decreased?
YES
NO
Details here:
Has duration of behaviours decreased?
YES
NO
Details here:
Is there a full record of each incident and the interventions
used?
YES
NO
Details here:
Were interventions used effective?
YES
NO
Details here:
Have there been any changes in behaviours?
YES
NO
Details here:
Is there evidence of a reduction in restrictions?
YES
NO
Details here:
Have all reasonable measures been put in place to safeguard the
well-being of the person and other people?
YES
NO
Details here:
If you have answered ‘No’ to any of the above questions please
escalate your concern to a senior professional/MDT.
Are changes to this plan or the risk management plan needed? If
YES please state:
YES
NO
Details here:
Responsible Person:
Date:
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PPSP developed by Dr D Newman [email protected]
CONFIDENTIAL
