Positive Behavior Supports (PBS) is a comprehensive framework that guides treatment for individuals with acquired brain injuries or intellectual/developmental disabilities. Through a dual focus on quantitative data and qualitative human experiences, it enhances Riverside’s long-standing commitment to neurodiversity-affirming care. At its core, PBS is about compassionately meeting people’s needs, promoting skill development, and creating supportive environments where people can thrive as their most authentic selves.
“Positive Behavior Supports is not just a regulatory framework, it is a movement of heart and mind,” says Maggie Marino, Assistant Vice President of Integrated Clinical Services and Chairperson of Riverside’s PBS Leadership Team. “It tilts the scales away from oppression and institutionalism, and toward dignity, autonomy, wholeness, and freedom. At Riverside, a commitment to PBS value-based services rooted in kindness, wellness, and belonging lights the path, reminding us that quality of life is not a goal or a privilege- it’s a right.”
A Three-Tiered Foundation
PBS’ three-tiered structure supports people served through a “least-to-most” restrictive approach focusing on environmental modifications rather than behavioral control. The progressive framework ensures each tier preserves and amplifies existing supports.
Tier 1: (Universal Supports) Ensures high-quality care for every individual served by Riverside’s Developmental & Cognitive Services (DCS) division. This evidence-based system emphasizes communication preferences and the right to make choices.
Tier 2: (Targeted Supports) Delivers proactive, individualized assistance including adapted schedules, enhanced visual aids, or specialized communication support.
Tier 3: (Intensive Supports) Provides structured assistance when needed while adding enhanced clinical oversight. Currently, no one in Riverside’s care requires Tier 3 supports—a testament to the effectiveness of the previous two tiers.
Data-Driven Compassion
PBS represents the union of strength-based care and comprehensive data collection. The model empowers staff with tools to measure treatment success and identify areas for ongoing improvement. Riverside meticulously tracks daily behavioral logs, Individual Support Plan progress, and satisfaction survey results. Beyond traditional metrics, staff evaluate the degree to which people served actively participate in their care and community life.This blend of clinical metrics and personalized observations helps to guide individuals toward their vision of a fulfilling life.
Transforming Daily Moments
PBS serves to reframe interactions between staff and those they serve. For example, when someone receiving treatment is acting distressed, they aren’t ‘giving’ their clinician a hard time. The upset individual is ‘having’ a hard time—a subtle but incredibly meaningful distinction.
PBS puts this philosophy into practice by having clinicians use the same coping skills that they teach. If someone appears to be seeking attention, assessing the situation through a PBS lens helps clinicians recognize these actions as connection-seeking. Instead of quick redirection, staff lean in with validation and kindness while working to understand the behavior’s underlying motivation.
This approach allows for genuine moments where staff can say, “The square breathing strategy helps me when I’m feeling stressed. Do you want to try it together?” These interactions naturally model resilience and create authentic connections.
Another example of PBS in action might involve a resident who becomes anxious when his routine changes. Staff respect his communication preferences by using a visual schedule with picture symbols to share daily plans. If schedule changes occur and anxiety arises, they use this visual tool to demonstrate what’s different and offer a choice between two alternatives. If the person is not ready to choose, the support team honors his emotional response and finds ways to help him regulate on his own terms. This approach validates his feelings, prevents crisis escalation, and preserves his sense of control.
A Vision for the Future
Riverside’s PBS journey began in 2022, focusing on 33 DCS residential group homes, and has significantly expanded in the following years. All DCS staff participate in Riverside’s comprehensive PBS training, and many receive monthly coaching sessions through a partnership with the May Institute. Later this month, a PBS module will be added to Riverside’s New Employee Orientation, ensuring that new team members are introduced to these principles from day one.
Positive Behavior Supports reflects Riverside’s longstanding belief that exceptional care means honoring each person’s unique story, strengths, and aspirations. The philosophy weaves dignity into every interaction while promoting safety and authenticity.
