Targeted Tier 2 interventions are critical to supporting students with challenging behavior and decreasing the resources associated with highly individualized and intense interventions. This study extends findings from recent single-case design studies and case example applications of the Tier 2 Identification and Intervention framework with the first large-scale evaluation of school-level outcomes following district implementation. We employed a pretest-posttest design within one large urban school district (N = 23,042 students) to evaluate school-level discipline outcomes for elementary schools who received training and coaching on the Tier 2 framework. Fidelity (i.e., Tiered Fidelity Inventory) and school-level demographics (e.g., poverty status, race) were entered as covariates into the generalized linear models. Results indicated statistically significant decreases in office discipline referrals and in-school suspensions for schools with adequate Tier 2 fidelity. Implications, limitations, and future directions are discussed.