School-wide positive behavior support (SWPBS) has an established evidence base in general education settings, and emerging evidence suggests that SWPBS may be effective in alternative settings (e.g., alternative, residential, or hospital schools; psychiatric hospitals). Given the intense educational and behavioral needs of students typically served in these settings, the critical features of SWPBS (i.e., outcomes, data, practices, and systems) need to be intensified across the implementation continuum (e.g., three tiers) of support. In this article, we document common features of alternative settings and suggest strategies to modify, enhance, and extend the existing practices, structures, and processes in SWPBS to fit alternative settings.