The demand for mental health counseling services has surged, but the capacity of college counseling centers to meet this demand has not kept pace. The effects of COVID-19 have exacerbated this already fragile system of care. College students are enrolling in college with increased levels of anxiety, depression, disordered eating, suicidal ideation, and substance use. College counseling center staff are facing burnout. The waitlist to receive mental health services is at critical capacity. This multi-site case study was designed to foster an understanding of two college counseling centers' implementation of the stepped care approach as a mental health service delivery model. By interviewing seven college counselors at two universities and reviewing public and internal documents, this study developed an in-depth exploration of the cases. As a result of this study, there is an increased understanding of how the stepped care model has been conceptualized at each university. Results from this study indicated that implementing the stepped care approach will decrease the waitlist time for students to receive mental health services, decrease counseling staff burnout, and provide limited mental health resources efficiently and effectively. [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.]