The success of Positive Behavioral Interventions and Supports (PBIS) in typical schools has led to interest in PBIS for alternative programs, including residential programs. In this brief, we describe PBIS as implemented in a therapeutic treatment home for adolescents with mental health needs. The PBIS framework enabled the program to add Tier 1 supports to increase consistency throughout the home, and to use behavioral data to integrate supports across tiers. We report fidelity scores across years of implementation as well as informal data reflecting staff and youth perceptions of PBIS.