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Nursing guidelines

Behaviour Support Profile



  • Background

    The Behaviour Support Profile (BSP) is an Electronic Medical Records (EMR) tool used to document non-clinical needs, to support holistic, family-centred and trauma-informed preventative care. It details psychosocial needs, including communication preferences, sensory sensitivities, expressions of distress, and coping strategies. The BSP supports proactive planning and collaboration with children, young people, and their families. This helps reduce distress, prevent escalation, and ensures that care is responsive to each child’s unique needs.

    In most instances, patient behaviours are positive, enhancing partnership and communication between the patient, the family and care providers. However, when a child becomes overwhelmed or distressed their behaviour may:

    • create barriers to required healthcare, or
    • raise safety concerns, for the child, family, staff or others

    Key Points

    • Infants, children, and young people experience illness, injury, and disability differently than adults
    • They are vulnerable in healthcare due to developmental immaturity and adult dependence
    • Children may express distress, discomfort, or unmet needsthrough behaviour rather than words
    • Clinical tools and approaches help overcome communication barriers experienced by infants, children, young people and their caregivers

    Aims

    This guideline will support staff to:

    • Access and use the BSP
    • Identify patient’s non-medical needs
    • Proactively plan for regulation and partnership in care

    By supporting behaviours, we can improve patient, family and staff experiences while strengthening collaborative practice. Evidence shows that empowering patients and families to share their differentiated needs improves trust, partnership and a sense of safety in healthcare. Inviting active participation and providing choices to address non-clinical needs can also assist in navigating situations which, without consideration and support, may cause distress or dysregulation. Support for distress or escalation can be found in the following guidelines:

    Definition of Terms

    Communication Challenges Refers to barriers to care that exist due to differing intellectual abilities, verbal and non-verbal abilities and languages spoken.
    Behaviours of Concern (BOC) When behaviour impacts care and/or safety it is referred to as a “behaviour of concern”. This is not a diagnosis, but a sign of unmet needs, indicating that a patient and their family would benefit from differentiated support. Behaviours and needs evolve as children grow.
    Neurodivergent Nonmedical term describing people who experience the world differently than others. This may be because they live with a condition such as Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD) or differences in cognitive processing or developmental ability.
    Trauma Refers to an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening, and that has lasting adverse effects on their functioning and mental, physical, social, emotional, or spiritual wellbeing (SAMSHA, 2014).
    Trauma-informed Preventative Care (TIPC) A proactive approach used in paediatric healthcare, that recognises the impact of trauma and prioritises physical, emotional and psychosocial safety.
    Paediatric Medical Traumatic Stress (PMTS) Refers to the psychosocial and physiological responses children, siblings or caregivers may have to pain, illness, medical procedures or distressing healthcare experiences which can impact recovery, function and future care (NCTSN, 2018).

    Assessment

    The BSP should be driven by the patient/family and represent their voice and preferences. Research shows that staff may not know which patients would benefit from a BSP from how they present or what you can see. Asking about previous experiences and child specific non-medical needs will provide insights to inform a BSP.

    A BSP can be started for any patient, but it may be particularly helpful for those with:

    • Communication challenges
    • Previous BOC or distress-related behaviours
    • Sensory sensitivities
    • Mental health concerns
    • Disability
    • Neurodivergence
    • Social or behavioural differences
    • Previous negative hospital experiences
    • Specific care, communication or procedural preferences
    • Previous hospital or medical anxiety/PMTS
    • Previous traumatic experiences

    Screening

    Nursing Admission

    Refer to Nursing Admission EMR tip sheet (RCH only)

    During the Admission Assessment, nursing staff will be prompted to identify whether the patient has any communication challenges or behaviours of concern:

    If the nurse selects Yes for communication or behavioural challenges they will be directed to create or update a BSP.

    To note: Communication or behavioural challenges may not be known or shared during admission. A BSP can be started or updated at any point during an admission or outpatient episode.

    Assessment Tools

    Patients with the following EMR profiles/plans should have a corresponding BSP:

    • Disability Profile
    • Pain/Procedural Support Plan
    • Behavioural and/or social flags

    Starting a Behaviour Support Profile

    Refer to the EMR tipsheet (RCH only) for instructions to locate, start, update and share a BSP.

    Roles and responsibilities

    • The BSP can be started by any clinician, regardless of role
    • It can be offered to new patients and established patients
    • All staff interacting with the patient should routinely refer to the BSP, employ strategies and update as needed
    • It is ideal for treating teams, who know their patients well, to start and contribute to the BSP
    • Consultative services, such as Child Life Therapy or Comfort Kids, may assist clinicians to complete or update the BSP
    • The BSP can be started during any patient encounter, including an inpatient admission, during a phone or telehealth consultation, outpatient clinic appointment, community visit or emergency department visit.

    The BSP is a live document that can be updated at any time.

    Special Considerations

    • Aboriginal and/or Torres Strait Islander patients and families may feel more comfortable completing with Wadja Aboriginal Family Place support.
    • Interpreter services are available for culturally and linguistically diverse families and children
    • Unusual behaviours and emotional dysregulation (patients and caregivers) may signal social challenges unrelated to illness, injury or clinical interventions – consultative and referral services can be accessed through the Social work team

    Family Centred Care

    • Offering this tool for any patient is a proactive step to overcome clinician assumptions about patient and families' previous experiences and coping mechanisms
    • Offering this tool for patients with known communication needs aims to support equitable care and improve potentially traumatic experiences for patients, families and staff
    • The BSP should be shared with families through the EMR patient portal (RCH only)

    Guidelines and Standards

    Companion Resources


    *Please remember to read the disclaimer.

    The development of this nursing guideline was coordinated by Kelly Light, CNE, Ambulatory Services, and Alma Giborski, Senior Project Officer, Trauma Informed Prevention Care, and Emily Cull, Clinical Nurse Consultant, Comfort Kids, approved by the Nursing Guideline Committee. First September 2025.  

    Evidence Table

    Reference

    Source of Evidence

    		Key findings and considerations
    Australian Commission on Safety and Quality in Health Care. (2011). Patient-centred care: Improving quality and safety by focusing care on patients and consumers. Australian Government. https://www.safetyandquality.gov.au/publications-and-resources/resource-library/patient-centred-care-improving-quality-and-safety-focusing-care-patients-and-consumers Clinical guideline
    • Defines patient-centred care as respectful of and responsive to patients’ needs, preferences, and values.
    • Demonstrates strong evidence that patient-centred care improves outcomes, including adherence, satisfaction, and safety.
    • Emphasises shared decision-making and communication as essential components
    • Informs the background by positioning behaviour support as an extension of patient-centred care
    • Supports the TOR by highlighting partnership and inclusivity.
    • Reinforces the aim of the BSP in documenting non-medical needs to ensure safe, family-centred care.
     Australian Institute of Family Studies. (2024). Children with problematic and harmful sexual behaviours and their families. Australian Government. https://aifs.gov.au/research/research-snapshots/children-problematic-and-harmful-sexual-behaviours-and-their-families National report
    • Provides overview of prevalence, risk factors, and developmental contexts for children with harmful sexual behaviours
    • Distinguishes between typical sexual exploration and behaviours of concern
    • Emphasises therapeutic, family-focused responses over punitive approaches
    • Stresses the value of trauma-informed, multi-agency collaboration
    • Supports the assessment by justifying BSP use for children with distress-related behaviours or trauma histories
    • Informs the TOR (behaviours of concern) by showing behaviour can signal underlying needs rather than pathology
     Australian Institute of Health and Welfare. (2020). Adverse childhood experiences (ACEs). Australian Government. https://www.aihw.gov.au/reports/children-youth/adverse-childhood-experiences
    		 National report
    • Provides national prevalence data on adverse childhood experiences in Australia
    • Demonstrates strong links between aces and poorer long-term health, wellbeing, and social outcomes
    • Shows a dose–response relationship: more ACEs are associated with worse outcomes
    • Informs the background by framing children’s vulnerability in healthcare contexts
    • Supports the assessment by highlighting trauma history as an important reason to initiate a BSP
    • Reinforces the TOR (trauma, TIPC) by evidencing the need for preventative approaches  
     Early Childhood Australia. (2017). Supporting children’s behaviour. Early Childhood Australia. https://www.earlychildhoodaustralia.org.au/shop/product/supporting-childrens-behaviour-ebook-pdf Practice guideline
    • Promotes positive, strengths-based approaches to behaviour support
    • Recognises behaviour as communication shaped by relationships, environment, and development
    • Encourages strategies that foster resilience, regulation, and inclusion
    • Warns against punitive responses to children’s distress
    • Informs the background by supporting recognition of behaviour as a communication tool
    • Reinforces the supporting behaviours section by showing staff should support rather than suppress behaviours of concern
    Giborski, A., Cranney, M., Mckinlay, M., & Light, K. (2025). The Behaviour Support Profile Evaluation Report. Melbourne Children’s Campus Mental Health Strategy. https://mentalhealth.melbournechildrens.com/media/qpndz05i/the-behaviour-support-profile-evaluation-report-2025-version-10.pdf Organisational report 
    • Assesses the acceptability, usability, and effectiveness of the Behaviour Support Profile at the RCH to guide optimisation
    • Establishes the value of the BSP, which enables staff to confidently navigate complex patient interactions, consistently tailor care to individual needs, and mitigate the risk of harm
    • Demonstrates that using the BSP significantly increased staff understanding of patients’ non-medical needs, encompassing communication preferences, sensory sensitivities, and calming strategies (reported by 85% of BSP users)
    • Recommends measures to improve staff awareness, collaboration, confidence and engagement to increase BSP utilisation   
    Graham, C., Thomson, A., Ryninks, S., et al. (2023). Why language matters: Examining the impact of terminology used to describe distressed behaviour in paediatric care. Archives of Disease in Childhood. Advance online publication. https://doi.org/10.1136/archdischild-2023-326153 Primary research - qualitative study
    • Demonstrates that deficit-based language can stigmatise children and families
    • Recommends neutral, descriptive, and collaborative terminology
    • Informs TOR (behaviours of concern) by evidencing the need for language change
    • Supports the supporting behaviours section by showing how terminology shapes staff perceptions and care responses
    • Reinforces BSP documentation to be family-inclusive and strengths-based  
     Healthdirect. (2024). Neurodiversity and neurodivergence. Australian Government. https://www.healthdirect.gov.au/neurodiversity-and-neurodivergence Government health information resource
    • Frames neurodivergence (e.g., autism, ADHD) as difference rather than deficit
    • Emphasises inclusive, respectful, and strengths-based approach
    • Informs the TOR (neurodivergent) by providing accessible language
    • Supports the assessment by justifying BSP use for patients with sensory, communication, or processing differences
     Hoysted, C., Babl, F. E., Kashef, R., et al. (2017). Emergency department staff perceptions of trauma-informed care and staff training needs. Emergency Medicine Australasia, 29(5), 558–564. https://doi.org/10.1111/1742-6723.12811 Primary research - descriptive exploratory study
    • Explores emergency department staff awareness and perceptions of trauma-informed care
    • Finds strong recognition of its importance but limited training opportunities
    • Identifies gaps in confidence and organisational support for staff
    • Informs the supporting behaviours section by highlighting barriers to trauma-informed care in practice
    • Supports the assessment by evidencing staff need for structured tools like BSP to guide practice
    Hughes, K., Bellis, M. A., Hardcastle, K. A., et al. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4 Systematic review
    • Confirms a strong dose–response relationship between aces and poor health outcomes
    • Demonstrates associations with chronic illness, mental health issues, and social disadvantage
    • Informs the TOR (trauma, TIPC) by evidencing the lasting effects of trauma exposure
    • Supports the assessment by reinforcing the need for BSP when children have trauma histories
    Koller, D., Espin, S., Indar, A., Oulton, A., & LeGrow, K. (2024). Children’s Participation Rights and the Role of Pediatric Healthcare teams: a Critical Review. Journal of Pediatric Nursing, 77(1), 1–12. https://doi.org/10.1016/j.pedn.2024.02.023 Systematic review
    • Highlights a lack of explicit reference to children’s participation rights, with paediatric patient involvement varying greatly depending on healthcare providers' practices
    • Found that asking children about their needs, providing them time to ask questions, offering medical information, addressing misconceptions (particularly for young children), ascertaining their need to know and be involved and providing choices increased involvement in shared decision making
    • Supports developmentally appropriate, tailored interactions to support children’s ability to take an active role in health care  
     National Child Traumatic Stress Network. (2018). Medical traumatic stress toolkit for health care providers. National Child Traumatic Stress Network. https://www.nctsn.org/resources/medical-traumatic-stress-toolkit-health-care-providers Clinical practice toolkit
    • Provides practical tools for recognising and responding to paediatric medical traumatic stress
    • Emphasises the role of healthcare providers in reducing distress during hospitalisation
    • Informs TOR by defining and contextualising PMTS
    • Supports the supporting behaviours section with strategies to prevent escalation and distress
    • Reinforces the purpose of BSP in documenting psychosocial needs to mitigate PMTS  
    Olweny, C., Elliott, K., Giborski, A., Thiraviarajah, A., & Goldfeld, S. (2024, November 11). Why we need trauma-informed preventative care in paediatric hospital settings. MJA InSight+. https://insightplus.mja.com.au/2024/44/why-we-need-trauma-informed-preventative-care-in-paediatric-hospital-settings/ Commentary/discussion article
    • Argues for trauma-informed preventative care as a system-wide approach in paediatrics
    • Notes high prevalence of trauma among children and families, and PMTS in hospital settings
    • Highlights the BSP pilot at RCH as a proactive planning tool
    • Informs the background by evidencing the organisational need for trauma-informed systems
    • Supports the supporting behaviours section by demonstrating benefits of embedding proactive care tools
    • Reinforces the assessment by linking BSP use to reducing distress and escalation in children with trauma histories
     Wilson, A. C. (2023). Cognitive profile in autism and ADHD: A meta-analysis of performance on the WAIS-IV and WISC-V. Archives of Clinical Neuropsychology, 39(4), 305–324. https://doi.org/10.1093/arclin/acad073 Meta-analysis
    • Reviews cognitive performance profiles in Autism and ADHD using WAIS-IV and WISC-V intelligence tests
    • Finds autistic children and adults show average reasoning with lower working memory and significantly slower processing speed (below 25th percentile)
    • Finds ADHD groups have less consistent profiles, with slightly reduced working memory and processing speed that may not be clinically significant
    • Confirms subtest-level analyses reflect the same cognitive patterns across groups
    • Informs the TOR (neurodivergence) by evidencing distinct cognitive differences
    • Supports the assessment by reinforcing the need for BSP documentation of communication, processing, and cognitive needs in neurodivergent patients