Strengthening Practice Through Reflection: What We Learned from the PBS Peer Review Process
Author: Mike Bloodworth
Background
At the Estia Centre, part of South London and Maudsley NHS Foundation Trust, we deliver a range of Positive Behaviour Support (PBS) training programmes designed to strengthen practice across health and social care.
Our training is led by a multidisciplinary team, including a PBS practitioner, Psychologist, Speech and Language Therapist and PBS Coach. Our core offers include:
- Using Positive Behaviour Support when Supporting Adults with a Learning Disability - A City & Guilds Assured programme mapped to the First Steps to Foundation framework, delivered over 2.5 days (in person and online)
- Positive Behaviour Support Awareness for Team Leaders
A one-day, in-person course
Alongside this, we are also delivering a PBS Culture and Practice Improvement Programme; a year-long pilot using action learning methodologies to strengthen PBS leadership, culture and practice within the not-for-profit sector. The programme is designed to move beyond “train and hope”, supporting organisations to embed PBS more consistently through reflective practice, shared learning and real-world application.
Overview of the Skills for Care PBS Peer Review process
The PBS peer review process ensures high-quality training by reviewing organisations against PBS Academy training standards. It involves a self-reflection checklist, peer-to-peer assessment, and quarterly meetings to check if PBS training is person-cantered, evidence-based, and focused on improving quality of life. Find out more
Why we chose to take part in the PBS Peer Review process
At the heart of the Estia Centre is a clear commitment to support high-quality, person-centred care that improves the lives of people with a learning disability and autistic people. Through co-produced learning, collaboration and evidence-informed training, we aim to build a workforce that is confident, capable and compassionate. Participating in the PBS Peer Review process therefore felt like a natural extension of these values. Rather than viewing it as a compliance exercise, we saw it as an opportunity to:
- Reflect on the quality of our training
- Learn from others in the field
- Strengthen our offer to maximise impact in practice
“It’s such a privilege to have an external perspective when reviewing our courses, because when you are reviewing your own training there is always a risk that confirmation bias can influence what you see.”
What we learned - and what we changed
Although we met the required standard, our intention was never simply to achieve a rating. For us, quality assurance is not an endpoint, it is part of an ongoing responsibility to improve, adapt and evolve. Following the review, we developed a detailed action plan to strengthen key areas of our training. The focus throughout was clear: improving practice, strengthening reflective capability and ultimately enhancing outcomes for the people being supported.
Clarifying course structure and expectations
We refined the course to make it clearer who it is for, what it covers and when onward referrals may be appropriate. There is now greater emphasis on what learners should be able to do differently in practice, particularly in applying primary PBS strategies to improve quality of life and reduce escalation.
Strengthening capable environments and prevention
While capable environments were already included, we increased their prominence across the programme. We strengthened:
- Focus on Tier 1 preventative strategies
- Everyday good practice that reduces the likelihood of distress
- Practical tools and workbooks to support teams to reflect on and improve their environments
Developing reflective practice and practical PBS skills
Recognising that reflective supervision is not always embedded in social care, we introduced additional resources to support reflective practice with an emphasis on Capable Environments. This includes:
- Structured workbooks
- Practical tools to support reflection in both training and supervision
- Greater emphasis on applying PBS thinking in real-world contexts
Strengthening learning around ABC analysis
We enhanced how ABC charts are taught and used in practice. The focus has shifted from simply completing charts to:
- Developing meaningful analysis
- Supporting reflective thinking
- Using insights to inform better support strategies
Deepening learning on quality of life, rights and person-centred practice
We expanded content to further emphasise:
- Human rights and dignity
- Meaningful activity and quality of life
- Understanding sensory differences
- Person-centred approaches that go beyond compliance
Strengthening co-production and lived experience
Co-production is central to our approach. We strengthened this further through the inclusion of:
- A co-produced film: ‘Daniel’s Story - A Whole New World’
- Reflective activities that connect PBS principles to real-life experiences
This helps learners bridge the gap between theory and the lived realities of the people they support.
Reflections: getting the most from the peer review process
The PBS Peer Review process is something to be celebrated. To get the most from it, it helps to start with a simple question: ‘What are my motivations, and what are my values?’
If the goal is genuinely to improve practice, then the process requires more than participation, it requires engagement. That means:
- Being open and curious
- Being willing to reflect honestly
- Being prepared to feel a little uncomfortable at times
- Being reviewed can feel exposing. But when approached with honesty and a degree of vulnerability, it creates the conditions for genuine learning.
‘We are not aiming for perfection - we are aiming for progress.’
For many, it may take more than one attempt to fully understand and benefit from the process. Having an experienced and communicative co-reviewer can make a significant difference here.
Final thoughts
At its best, the peer review process becomes a shared learning experience.
It brings people together with a common purpose to strengthen practice, improve quality and ultimately enhance the lives of the people we support.
Alongside this, initiatives such as our PBS Culture and Practice Improvement Programme are helping to extend this learning beyond training environments and into organisational culture - supporting teams to embed PBS through action, reflection and collective problem-solving over time.
For us at the Estia Centre, the peer review process has been a valuable opportunity to reflect, learn and continue evolving our offer—ensuring that our training remains meaningful, practical and impactful where it matters most: in everyday practice.
Find out more
If you’re interested in strengthening PBS practice within your organisation, we offer a range of training opportunities designed to build confidence, capability and real-world application:
- Using Positive Behaviour Support when Supporting Adults with a Learning Disability - a City & Guilds Assured programme focused on applying PBS in practice, with an emphasis on prevention, quality of life and person-centred support.
Positive Behaviour Support Awareness for Team leaders - designed for supervisors and managers, this course focuses on leading PBS in practice, supporting teams, and embedding reflective and values-led approaches.
We are also currently delivering our PBS Culture and Practice Improvement Programme, a year-long pilot using action learning methodologies to support organisations to embed PBS more consistently across teams and systems. To find out more about any of our programmes, or to discuss how we can support your organisation, please visit the Estia Centre website or email estiacentre@slam.nhs.uk
About the author
Mike is the Head of Education and Training at the Estia Centre. He specialised in action learning, leadership and organisational development programmes.
