In 2021, the U.S. Surgeon General declared a children's mental health crisis, and the Centers for Disease Control and Prevention (CDC) reported an increase in the prevalence of youth mental health needs stating that adolescents are in crisis (Reinert et al., 2021). Since 2021, a significant amount of literature has been published, indicating that, to fulfill the growing requirements of students in U.S. public schools must employ more school-based mental health (SBMH) specialists (Golberstein et al., 2023). With fewer SBMH employees, public schools were trying to support more students with mental health issues. The purpose of this qualitative study was to examine the factors that SBMH providers in one district in Nebraska describe as influencing the delivery of mental health services to students. I conducted a single-embedded case study. I used Bandura's (1977) social cognitive theory and the tenet of reciprocal determinism as the theoretical framework for the study. I collected data using a questionnaire and semi-structured interviews. I used criterion sampling to select the participants. Participants had to meet two criteria to take part in this study: they worked as SBMH professionals at a Title 1 public elementary school and had been employed in the district for over a year at the time the study took place. I employed inductive coding and followed a thematic analysis process to produce themes to answer the research question (Saldana, 2016). The following question guided this study: What environmental, cognitive, and behavioral factors do SBMH providers in one district in Nebraska describe as influencing the delivery of mental health services to students? My findings revealed that SBMH practitioners identify a variety of factors influencing their ability to effectively provide mental health care. I separated the factors into environmental, cognitive, and behavioral categories. My research focused on SBMH professionals' perceptions of what they need to improve their ability to provide more efficient and effective services to students. The findings showed that SBMH professionals felt the need for more time and resources, process adjustments to match the changing type and intensity of student needs, and greater clarity and conciseness in communication and MTSS procedures. [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.]