Why Is It So Hard to Stay in Positive Behaviour Support?

Or AKA, why most of us don’t survive in this field long-term.

Introduction

Bit of an ominous start, I know! But I think this is a topic we need to explore in greater depth and across various platforms. Hopefully, by sharing our experiences and perspectives, we can better understand why it can be so difficult to stay in this field — and start talking about what we can do to make things better.

I've been working in Positive Behaviour Support for nearly 7 years now, and many people have been around for much longer. However, I sometimes joke that 1 year working as a Behaviour Support Practitioner (BSP) equals 5 years in another field because of how quickly knowledge and experience seem to disappear from our workforce.

There may actually be something behind that feeling. Australian research involving 392 NDIS Behaviour Support Practitioners reported that the PBS workforce had an average of only 1 year of experience. The same research found that practitioners experienced significant barriers relating to service systems, engaging and collaborating with stakeholders, and limited PBS expertise across the sector. Importantly, practitioners also identified organisational supports, quality training and professional development, and good practice supervision as things that helped enable good practice.

In my experience, this points to a significant underlying issue — or, more accurately, a number of overlapping issues that can build up over time. Across my experience as a BSP, Supervisee, Supervisor and leader of a PBS team, I've personally noticed a number of factors that seem to come up repeatedly when practitioners are struggling in the field. These include:

1. Minimal access to training and resources

2. Lack of access to a qualified, experienced Supervisor

3. Difficulties related to having no Senior BSP within the organisation

4. Minimal caseload and referral management processes

5. Focus on billing as the key KPI for successful PBS

6. Getting stuck in the middle between stakeholders, organisations and the NDIS

7. Isolation

8. Emotional overwhelm and lack of positive recognition

There are, of course, innumerable factors that may contribute to any BSP's decision to leave the field. However, I see the above come up over and over again in my work, and I've started to use my own BSP skills to hypothesise that there might be a pattern here.

So let's chat through each of these factors, and I'll offer any advice I can about how they might be tackled — both proactively and reactively. We can treat it like our very own PBSP against the risk of withdrawal from the field.

Minimal Access to Training and Resources

I've worked with a lot of people entering the field and commencing their careers as a BSP. Many of these people come with amazing skills and knowledge from related fields and already have much of what they need to become great practitioners.

The difficulty is often learning how to translate those existing skills into the BSP role.

In my work with new practitioners, I regularly hear about onboarding and training that has been relatively short or basic. There may be limited role-specific training around things like how to move through the PBS process from initial referral through to case closure, how to conduct a good functional behaviour assessment, or how to write a meaningful PBSP rather than simply filling in a template.

A manager may be able to provide some of this support, but we also need to recognise that not every manager overseeing a BSP team has extensive experience in Positive Behaviour Support themselves. This can leave a new practitioner trying to learn a complex role while simultaneously working out what they don't yet know.

You may also receive a professional development budget, which is fantastic, but then you need to know what training and resources are available, which ones are relevant to your development, and which are actually worth your time and money.

As the saying goes: how do you know what you don't know?

This is where structured onboarding, access to good resources, ongoing professional development and guidance from experienced practitioners can make an enormous difference. New BSPs don't necessarily need to start from scratch — they need support to connect what they already know with what good PBS practice requires.

Lack of Access to a Qualified, Experienced Supervisor

A good Supervisor can help address some of the training and resource gaps I've talked about above. They may recommend resources and professional development, provide training themselves, review your work, help you develop your clinical reasoning, or simply help you work out what you need to learn next.

However, I think there may be a cyclical problem here. If we continually lose experienced BSPs from the field, we also reduce the number of practitioners who may eventually develop into experienced Supervisors for the next generation of BSPs.

Experienced Supervisors are definitely out there, but I've had new Supervisees tell me that it took them months to find someone suitable who also had availability. I suspect this can be particularly difficult for people entering the field because, understandably, they may not yet know exactly what they need from Supervision, what to look for in a Supervisor, or even what questions to ask.

Your Supervisor can make an incredible difference to your experience as a BSP. I've written an entire article about picking a good Supervisor if you'd like some guidance on what to look for.

Importantly, Supervision shouldn't only be about meeting registration or compliance requirements. You need someone you can go to when you're stressed, confused or uncertain — someone who can be a sounding board, help you reflect on a difficult situation, provide reassurance when you need it, and sometimes simply give you a straightforward answer about what to do next.

Debriefing and reflection are crucial survival skills for BSPs. Without opportunities to process the difficult parts of this work, the emotional load created by all these other factors can gradually become emotional overwhelm.

Difficulties Related to Having No Senior BSP Within the Organisation

Not every organisation employing BSPs has an experienced Senior BSP available internally. In fact, this may be more common than you think — otherwise there probably wouldn't be much need for external Supervisors like myself!

Sometimes there is a Senior BSP, but they may have limited capacity for leadership or mentoring because they're managing their own participant work. They may also be more interested in direct practice than leadership, or they might move on while newer practitioners are still developing. In other organisations, there may be no Senior BSP at all. Instead, a BSP might report to a line manager from another allied health or disability background who isn't a registered Behaviour Support Practitioner themselves.

I want to be clear that this isn't necessarily a problem. A good manager doesn't need to be a BSP to provide good leadership and support. The difficulty arises when PBS-specific decisions need to be made and there isn't someone with enough experience in the field to guide them.

This can include decisions about what a realistic BSP caseload looks like, when an Interim PBSP may be required, what appropriate KPIs should measure, what good-quality PBS practice looks like, how practitioner development should be supported, or even which systems and processes will actually work for a PBS team.

Without that PBS-specific perspective, there can be a mismatch between what an organisation expects from its practitioners and what practitioners actually need to deliver safe, sustainable and high-quality Positive Behaviour Support.

This doesn't necessarily mean employing a Senior BSP is the only solution. Depending on the organisation, PBS-specific expertise may come from an experienced external Supervisor, consultant, Clinical Lead or another suitably experienced practitioner. What's important is that someone with a strong understanding of PBS is helping inform the systems and expectations surrounding the BSP role.

Minimal Caseload and Referral Management Processes

In my work managing a BSP team, I spend a surprising amount of time thinking about caseloads and working out where a new referral would be best placed. Honestly, that could be an entire article of its own because there are so many participant-related and practitioner-related factors that come into it.

If nobody is actively overseeing caseloads and new referrals simply come your way by default, it might not create an immediate problem. The difficulty is what can build up over time.

You might end up with too many participants, participants who live too far away from each other, multiple PBSPs due around the same time, several participants requiring more intensive support than initially anticipated, or simply not enough capacity left when an existing participant suddenly needs significantly more support.

This is why I don't think a sustainable caseload can be defined by a single number. Two BSPs might have exactly the same number of participants and have completely different workloads depending on complexity, location, funding, reporting timeframes, restrictive practices, stakeholder needs and where each participant is within the PBS process.

It can also be uncomfortable telling your organisation that you need a break before accepting another participant. I've been there myself — I like being the no-problems worker who keeps saying yes and finds a way to make it work. However, one thing I've learned is that it's much easier to build up a caseload than it is to bring one back down.

Reducing a caseload usually means transferring one or more participants to another BSP, and I don't think that should be taken lightly. To us, it might look like moving a name from one caseload to another. For the participant and their supporters, it can mean ending an established professional relationship, explaining their history again, adjusting to another practitioner and rebuilding trust.

I'd much rather identify a capacity problem before accepting another referral than wait until the caseload becomes unsustainable and somebody has to be transferred. This is why I recommend regularly reflecting on your caseload rather than waiting until you feel overwhelmed. I use factors such as participant complexity, location, funding, upcoming deadlines and current support needs alongside the overall number of participants to get a more realistic picture of capacity.

You can use a Caseload Manager to help make those factors visible, and I've also written more about this in my article on managing a sustainable PBS caseload.

Most importantly, be open about your capacity when new referrals are being considered. Caseload management works much better as a preventative process than as something we only start thinking about once a practitioner is already overwhelmed.

Focus on Billing as the Key KPI for Successful PBS

I've lost count of the number of times someone has said “KPI” to me when what they really mean is “billables.” Of course, billing matters. Organisations need to remain financially sustainable, practitioners need to generate enough revenue to support their role, and billing is relatively easy to measure. So I'm certainly not suggesting that organisations shouldn't monitor it.

The problem comes when billing becomes the main — or sometimes only — indicator of whether a BSP is doing a good job.

If we only look at one number, we're getting a very limited picture of the quality and sustainability of the PBS services being delivered. A practitioner might consistently reach their billing target while falling behind on PBSP deadlines, struggling with the quality of their work, receiving little professional development, becoming disconnected from their team, or gradually becoming overwhelmed by their caseload.

Conversely, there may also be very good reasons why someone's billables fluctuate. Their participants may be experiencing changes in funding, they may be completing important non-billable professional development or team activities, or the particular stage of their caseload may temporarily affect how their working hours are distributed.

In my work as a Clinical Lead, billing is only 1 of 16 KPIs I use to look at how things are going. The others span different parts of the BSP role, including meeting compliance timeframes, engaging in professional development, contributing to team culture, reviewing and improving the quality of our work, and other indicators of good practice. That's because I want to know more than whether we're charging enough money. I want to know whether we're delivering good-quality PBS, whether we're meeting our responsibilities, whether practitioners are continuing to develop, and whether we've created a team that people actually want to remain part of.

Billing can tell us something important about a PBS service. It just can't tell us everything.

Getting Stuck in the Middle Between Stakeholders, Organisations, and the NDIS

I think getting stuck in the middle is an almost universal experience for BSPs. It's probably not unique to our profession, but there are some particular ways it tends to happen in our work.

As a BSP, you're often trying to balance the needs, priorities and responsibilities of multiple people and systems at the same time.

You might find yourself:

• Working with stakeholders who have different goals or perspectives that don't necessarily align with the PBS approach, or who aren't bound by the same requirements as you

• Trying to address concerns within a service provider when there are barriers to implementing PBS strategies or providing adequate training to staff

• Balancing NDIS compliance timeframes and restrictive practice requirements — and, where relevant, State or Territory authorisation requirements — against practical barriers that may be outside your control (e.g. medication!)

• Trying to keep the participant's needs, rights and quality of life at the center while different people and systems around them are pulling in different directions

Sometimes there isn't a perfect solution available to you. You can understand everyone's perspective, advocate for what you believe is needed, fulfill your own professional responsibilities, and still find yourself caught between competing priorities.

Experiences like these can become exhausting when they happen repeatedly. Over time, I've seen practitioners become more defensive, frustrated or jaded, or begin anticipating problems before they've actually occurred. For me, that's an important sign that it's time to talk.

These are exactly the situations I think we need to be able to take into Supervision — not necessarily because our Supervisor will have a magical solution, but because we need somewhere safe to unpack what has happened, consider whether there is anything within our control, reflect on our own response, and work out what we're going to do next.Otherwise, we risk carrying the frustration from one difficult situation into the next one.

Isolation

I have quite a few Supervisees who tell me they feel like they're working in a silo. This might sound strange because, as a BSP, you can spend a huge amount of your day communicating with people. You're calling participants, emailing stakeholders, attending meetings, training support teams, speaking with families and coordinating with other professionals.

But being surrounded by communication isn't necessarily the same as feeling connected.

Most of those conversations are related to the participants you're supporting. They're purposeful, professional interactions — and often billable ones. You may even be conscious that the participant is paying for your time, and potentially somebody else's time as well, so you're naturally trying to make those conversations efficient and focused.

That doesn't necessarily give you the opportunity to say, “That was a really difficult meeting. Can I talk to someone about what just happened?” Or, “I've been stuck on this problem all morning — what would you do?”

Depending on your role and where you sit within an organisation, there may also be very limited opportunities to connect with colleagues who understand your work. I notice this particularly with subcontractors, team leaders and business owners. You might have plenty of people around you but still be the only person “at your level”, which naturally creates boundaries around what you can discuss and with whom.

The structure of BSP work can unintentionally contribute to this as well. Most of us manage our own participants rather than working alongside another BSP on the same caseload. There are certainly situations where two practitioners may be involved with the same person, but it isn't generally how our day-to-day work is structured. So you can end up working independently, managing difficult decisions independently, travelling independently and processing challenging experiences independently — while technically talking to people all day.

That's how you can end up feeling like you're working in a silo despite being surrounded by others.

For me, the answer isn't necessarily more meetings. It's meaningful professional connection. Having other BSPs you can talk to, opportunities to share ideas and resources, Communities of Practice, supportive team environments and good Supervision can all help create that sense that you're part of something rather than doing this work alone.

Emotional Overwhelm and Lack of Positive Recognition

The work we do as BSPs can sometimes be incredibly serious and heavy. We may be supporting people through dangerous or high-risk situations, significant changes in their lives, escalating behaviours, restrictive practice concerns, family stress, service breakdowns, and other situations where the decisions we make really matter.

Thankfully, most of our participants aren't experiencing a crisis at the same time, so there are usually periods where things settle back into our normal working baseline. Although, I have absolutely no evidence to support this next statement, but I swear our participants somehow coordinate their crises. Sometimes everything seems to happen at once. One participant suddenly needs significantly more support. Another has an incident. Someone else's PBSP is due. A stakeholder needs an urgent meeting. You've just accepted a new referral. Something unexpected happens with a restrictive practice.

Then add in some of the factors we've already talked about — an unsustainable caseload, limited support, stakeholder conflict, isolation or pressure around billables — and your capacity to cope can disappear surprisingly quickly. Sometimes it only takes a few particularly difficult weeks. This is why I don't think we should look at emotional overwhelm as an isolated problem or simply assume that an overwhelmed practitioner needs to become more resilient. Sometimes overwhelm is the cumulative result of multiple pressures that have been building around them for quite some time.

There's another part of this work that I think contributes to the emotional load too: BSPs don't always receive much positive recognition. Of course it happens. A participant might thank you after a helpful conversation. A family might tell you something has finally started working. A service provider might contact you to say they're seeing a positive difference from the strategies you've introduced.

Those moments are gold in this profession, and I think we need to hold onto them tightly.

But think about when people are most likely to contact their BSP. Usually, something has happened. A strategy isn't working. There's been an incident. Someone is worried. Medication has changed. A new behaviour has emerged. A stakeholder is unhappy. Something needs to be reviewed.

Meanwhile, there might be some wonderful things quietly happening in the background. Maybe your participant independently used a communication skill you've been working on. Maybe they've attended school for longer than they have in months. Maybe staff are responding more consistently and incidents are gradually reducing. Unless somebody deliberately notices and tells you, you might never hear about those things.

Over time, that can create a strangely distorted picture of your own work. You spend your days hearing about problems while many of the successes you're contributing to happen quietly in the background.

That's why I think we need to become much more deliberate about noticing and celebrating progress — for our participants, for ourselves and for the other practitioners around us.

So, What Can You Do as a BSP?

Not everything I've talked about above is within your control — and I think it's important to acknowledge that before we talk about what you can do.

You can't single-handedly change your organisation's systems, create more experienced practitioners in the field, control what stakeholders do, or magically increase the number of hours available in your week. But there are some things you may be able to influence, and small changes can sometimes prevent these pressures from accumulating over time.

Keep Building your Knowledge

Seek out good-quality training, resources and professional development rather than relying entirely on what happens to be available within your organisation. The NDIS Quality and Safeguards Commission provides resources and updates for Behaviour Support Practitioners, and there are also professional networks, Communities of Practice and external training opportunities available across Australia.

If you have a professional development budget, use it strategically. Think about where the gaps in your practice actually are and choose training that helps you address them.

Take an Honest Look at Your Supervision

Ask yourself whether your current Supervision is giving you what you need to develop and flourish as a BSP — rather than simply meeting a registration or compliance requirement.

Do you have somewhere to debrief? Can you ask questions when you're uncertain? Are you receiving useful feedback on your practice? Is your Supervisor helping you identify areas for development? Do you leave Supervision with greater clarity than you had when you arrived?

If not, it may be worth having a conversation with your Supervisor about what you need. I've written more about this in my article on maintaining the Supervision relationship.

Know What's Happening in Your Caseload

Don't wait until you're overwhelmed before looking closely at your caseload. Regularly consider the number of participants you're supporting alongside factors such as complexity, location, funding, upcoming PBSP deadlines, restrictive practices and the amount of support participants currently need.

You can use a Caseload Manager to make these factors easier to see, and as I mentioned earlier, I've written more about this in my article on managing a sustainable PBS caseload. This information also gives you something concrete to work from when another referral comes your way. If your caseload genuinely doesn't have capacity, raise that before automatically saying yes. There are other qualified BSPs who can support that person. You don't have to run yourself into the ground trying to support everybody.

Find Your People

If there are other BSPs within your organisation, reach out to them. Ideally, try to have at least one person you can regularly talk to who understands the work and isn't your line manager. That might be a colleague, another practitioner you've met through a Community of Practice, or someone elsewhere in the field.

Professional connection doesn't need to be formal. Sometimes simply having another BSP who understands what you mean when you say, “You will not believe the day I've just had,” makes an enormous difference.

Pay Attention to the Wins

And finally — this one is really important — notice and celebrate the wins that come your way. Especially the wins that have absolutely nothing to do with reaching a billing target.

Maybe Jeffrey stayed at school for the whole day for the first time in six months.

Maybe a participant independently used a new communication skill.

Maybe you presented your PBSP to that stakeholder who critiques absolutely everything...and they couldn't find anything to critique!

Write these things down. Share them with your team. Bring them to Supervision. Celebrate somebody else's success when you hear about it too. The difficult moments in this profession have a habit of demanding our attention. Sometimes we need to deliberately give the good moments some attention as well.

What Can You Do as a Line Manager?

If you're reading this as a team leader, line manager, business owner or someone else responsible for a team of BSPs, you may have much more influence over some of the factors I've discussed above.

I've spent a number of years leading and supporting BSP teams, and the recommendations below reflect approaches I've used within my own teams to support practitioner development, quality practice and sustainability.

Invest in Your BSPs

Look at your BSPs as professionals who need to be supported and developed over time. That means investing in good onboarding, ongoing professional development, access to resources, quality Supervision and opportunities to continue developing their skills.

Your new BSP might already bring fantastic knowledge from another profession. Your experienced BSP might be ready to develop leadership, mentoring or more advanced practice skills. Don't assume development stops once someone is registered or comfortably managing a caseload.

Create Opportunities for Genuine Connection

Encourage cross-team meetings, informal chats, Communities of Practice and occasional social opportunities. Your BSPs need opportunities to feel connected to each other and to the organisation — not just opportunities to discuss participant work or billables.

That sense of belonging needs to be deliberately supported, particularly if practitioners work remotely, travel frequently, subcontract, or spend most of their week working independently with their own participants.

Diversify Your KPIs

As I've discussed earlier, billing matters — but please don't let it become your only definition of a successful BSP. Look at a range of indicators that tell you whether you're delivering good-quality PBS and building a sustainable team.

Depending on your organisation, these might include things such as participant and stakeholder feedback, compliance timeframes, professional development, team engagement, quality improvement, errors or incidents, PBSP quality, supervision engagement and progress against the PBS Capability Framework.

A billing target can tell you whether someone is generating revenue. It can't tell you whether they're becoming a better practitioner and if that translates into best PBS practice.

Build and Share Good Resources

Create a central place where your BSPs can access and share the things they regularly need — templates, assessments, guidance, training materials, examples, processes and other useful resources. This saves every practitioner from independently searching for or recreating the same things and helps establish a culture where knowledge is shared rather than held by individual people.

It also means that when an experienced practitioner eventually leaves your organisation, not all of their knowledge walks out the door with them.

Celebrate Good Work

Look for ways to regularly recognise what your BSPs are doing well. That doesn't necessarily need to mean formal awards or grand gestures. It might simply mean making discussion of a participant success or practitioner win part of your regular team meeting.

Ask what's gone well.

Share positive feedback when you receive it.

Notice improvement.

We're often contacted when something needs fixing, so organisations have an important role in making sure practitioners also hear when they're doing good work.

Actively Manage Caseloads and Referrals

Please have a system for seeing what's happening across your BSP caseloads. Don't rely solely on the number of participants allocated to each practitioner. Consider funding, geography, complexity, restrictive practices, upcoming PBSP deadlines, current support intensity and other factors that influence workload.

And importantly, check this information before allocating another referral. Good referral allocation isn't simply finding the practitioner with the fewest names on their list. It's finding the practitioner who has the capacity and, where possible, the appropriate experience and circumstances to support that person well.

Make Space for Regular 1:1s

Have regular individual check-ins with your BSPs and create space for them to raise concerns. Sometimes they'll have nothing significant to discuss, and that's okay. The important thing is that the opportunity exists before something becomes a major problem.

Regular 1:1s can also encourage practitioners to collect their questions, reflect before bringing something to you and develop possible solutions themselves, rather than only seeking support reactively whenever a problem arises.

Make Sure They Have Good Supervision

Finally, make sure your BSPs have access to quality Supervision — and enough of it to actually be useful. Supervision should be frequent enough for practitioners to regularly reflect, debrief and seek advice. Where possible, there should also be capacity for Supervisors to review work, provide feedback and support development rather than using every available minute responding to urgent problems.

I'd also encourage organisations to provide enough Supervision support for practitioners to periodically review their development against the PBS Capability Framework. Supervision shouldn't simply help your BSPs remain registered. It should help them become better practitioners — and give them another reason to remain in the field.

Conclusion

So, why is it so hard to stay in Positive Behaviour Support?

I don't think there's one simple answer. The work itself can carry a significant emotional load, but that load doesn't exist in isolation. It can become much harder to carry when it's combined with limited training, inadequate professional support, unsustainable caseloads, organisational pressures, competing stakeholder demands, isolation and a lack of recognition for the good work being done.

And importantly, I don't think the responsibility for addressing these things should sit entirely with individual BSPs. As practitioners, there are things we can do to protect our own sustainability — seek good Supervision, keep developing our skills, monitor our caseloads, connect with other practitioners and remember to notice the wins. But organisations have a responsibility too. The systems surrounding a BSP can either make an already challenging role more sustainable, or make it considerably harder than it needs to be.

I've been fortunate enough to experience this field from a number of different perspectives — as a BSP, Supervisee, Supervisor and leader of BSP teams — and the longer I'm in it, the more strongly I believe that good practitioners need more than knowledge and good intentions to stay. They need an environment that allows them to keep being good practitioners.

There are some incredibly skilled, thoughtful and passionate people working in Positive Behaviour Support. I want us to get better not only at bringing great people into this field, but at creating the conditions that make them want to stay.

Want some support to make PBS more sustainable?

Whether you're a Behaviour Support Practitioner trying to build a sustainable career, or you're responsible for supporting a team of BSPs, you don't necessarily have to work all of this out on your own.

I provide PBS Supervision for practitioners who want a space to reflect, debrief, develop their skills and work through the challenges that come with this role. Supervision can also include practical training, feedback on your work and support with your ongoing development against the PBS Capability Framework.

I also provide Business Consultation for organisations wanting to strengthen the systems surrounding their BSPs — including caseload and referral management, realistic KPIs, practitioner development, supervision structures, PBS resources and understanding what good support for a BSP team can look like.

If you're not sure what kind of support would be useful, you're welcome to schedule a free, no-obligation chat with Rebecca. We can talk through what's happening for you or your team and see whether I might be able to help.