Positive behavioural support (PBS) is a non-aversive, preventive approach to behavioural management. The use of proactive approaches such as PBS has been suggested for multiple contexts and client groups as part of the restraint-reduction, ‘positive-and-safe’ agenda in the UK. PBS was introduced into a psychiatric intensive care unit (PICU) in a south Wales forensic service. However, the approach employed needed to be adapted to improve ‘goodness of fit’ for the PICU setting. This article describes the actions taken in the service to improve the fit of PBS in the PICU.

The aims of this paper are to outline some of the barriers to effective implementation of PBS experienced in the PICU and describe what was done to improve implementation and fidelity to the model in this setting.

The goodness of fit of PBS in PICU can be improved with some simple adaptations. The value of the PBS model is its flexibility but further evaluation of PBS approaches in PICUs are needed.