This paper describes implementation (fidelity, perceived acceptability) and tier 1 and Tier 2 outcomes of school-wide positive behavior interventions and supports approach including mental health supports at Tier 2 in two K-8 urban schools. Interventions for Tier 2 consisted of three manualized group cognitive behavioral therapy (GCBT) protocols for externalizing behavior problems, depression, and anxiety. Tier 1 and Tier 2 interventions were implemented with fidelity but program feasibility for Tier 2 was in question because school personnel needed a great deal of external support to implement the interventions. Tier 1 interventions were associated with a decrease in office discipline referrals. Students participating in GCBT showed a significant decrease in mental health diagnostic severity at posttreatment. A discussion of perceived and actual implementation barriers and how they were addressed is provided. Implications for practice in low-income urban schools are discussed.