Background: While adolescent mental health needs have continued to rise, schools have become a central location for adolescents seeking support for mental health needs, and approximately 96% of public schools in the United States report providing some form of mental health care to students. This study aims to explore school social workers' current challenges and priorities in their roles. Methods: Qualitative focus groups with current school social workers in Virginia (N = 16) were conducted for this study. Participants worked in middle and high schools for a minimum of 3 years across the state. Braun and Clarke's steps for thematic analysis were used to guide coding and themes. Results: The current study found 3 primary themes: (1) role confusion due to vast scope of responsibilities within their schools; (2) a disconnect between desired roles and assigned roles and responsibilities; and (3) lack of formal model of service provision. Implications for School Health Policy, Practice, and Equity: Focus should be placed on the integration of current models of school social work practice to ensure the effective utilization of their services. Conclusions: The study reveals important information regarding the current and future state of school social work practice.