Increasingly, health care providers, educators, social service personnel, mental health and juvenile justice professionals, and others recognize that the discrete services they provide cannot meet the complex needs of today's youth and families. This paper presents findings of a descriptive case study that explored the interorganizational problems and solutions of three school-based health centers. Data were gathered through document review; observation; and interviews with a total of 24 school personnel, superintendents and other district administrators, health center staff, and sponsoring agency directors and program liaisons. The three school-based health centers encountered three major challenges: developing and maintaining relationships, maintaining confidentiality, and managing the referral process. The paper offers five recommendations for improving school-based health services: (1) include role counseling or clinical social workers in the services offered; (2) assign broad titles to group counseling sessions; (3) establish an advisory board or council with a broad representative base; (4) establish regular meetings among key members of the school-based program, the principal, and school administrative team; and (5) provide consistent funding. The paper advocates a model of "mandated collaboration," which contains a range of voluntary choices within the mandated structure, or bottom-up reform with top-down support. The program encourages local collaboration within a structure that maintains broad state-mandated requirements. One figure is included. (Contains 103 references.) (LMI)