Middle school teachers without level-specific certification, preparation, and training from universities lack foundations for best practices in connecting students with course material. Foundations include recognizing the educational, emotional, and social needs of early adolescents. The three-pronged purpose of this qualitative instrumental case study was to explore how teacher preparation programs impacted teachers' daily practice by providing typical middle school experiences for pre-service teachers; to explore whether teachers perceived self-efficacy concerning meeting students' educational, emotional, and social needs through the implementation of the middle school concept framework; and to explore whether professional development and mentor programs enhanced teacher self-efficacy. In this study, 60 participants from a school district in Southeast United States with at least one year of middle school experience responded to a questionnaire about preparation and perceptions of how well-equipped participants were to teach middle school. Of the 60 questionnaire participants, 11 agreed to phone interviews. I categorized and coded data by college courses, internships, mentors, alternative entry, and professional development. Participants certified by middle school pedagogy programs at universities perceived higher self-efficacy in the first few years of teaching middle school. Participants who had direct experience with early adolescents through internships, observations, and informal situations had increased perceptions of self-efficacy. Teachers without proper preparation for middle school had a higher potential for perceived failure. Proper preparation includes participation in level-specific internships, interactive mentorships, tailored professional development, and professional learning communities. [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.]