This manuscript describes an implementation of a new model for integrated school mental health services. By incorporating trauma-informed practices with universal screening and teacher coaching, this study examined the processes and procedures necessary to deliver school-based mental health services across Tier I and Tier II within a Multi-Tiered Systems of Support. Developed through an iterative process, this decision-making framework was designed based on feedback from school-based partners, periodic and planned review of program effectiveness, and collecting of data to inform key decisional cut points. A middle school within a large, urban school district was selected as the demonstration site. Teachers received in-service training on both universal mental health screening and effective classroom management practices. Teachers screened students in the fall, winter and spring to assess class and school-wide risk levels. A group of coaches then conducted weekly observations of teachers and provided visual and written performance feedback facilitate development of teachers' classroom management skills. Preliminary data suggests a significant reduction in suspensions and disciplinary infractions. Implications for school psychological services will be provided, as well as future implementation plans including data to inform Tier II intervention selection.