The 1990's have seen a nationwide development of initiatives designed to provide school-linked comprehensive services to children and families. The level of collaboration among schools and community-based agencies required by such initiatives is unprecedented and offers an opportunity for systemic changes in the way professionals, families, and institutions work together. This study examined the implementation of the California-based Healthy Start at two elementary schools. Findings suggested that while the program was successful in increasing access to health and social services for low-income families, it was unable to achieve full interagency collaboration and fell short of the expected systemic reform. Separate institutional interests hindered the decision making process and limited the professionals' ability to escape traditional compartmentalization. These findings are discussed within the broader context of school reform and ongoing efforts to define the roles of school-based professionals. The study offers recommendations for policy and professional practice. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com.bibliotheek.ehb.be/en-US/products/dissertations/individuals.shtml.]