The social emotional and mental health of students play a vital role in the academic, behavioral, and social emotional learning of students in school. The Multi-Tiered Systems of Support (MTSS) framework is recognized to be an effective mental health framework. The current study provided a summative evaluation of the status of mental health services and a MTSS framework at six comprehensive high schools in a single southern California district. The study also used the summative findings to make formative recommendations improve school’s MTSS framework efficiency and effectiveness. The data collected focused on how each school met the social-emotional and mental health needs of the students. Findings were generated by data obtained from surveys and interviews of principals, counselors, psychologists, teachers, students, and other providers. These data were analyzed in order to assess the status of a MTSS framework and the effectiveness of services being provided. The study found the six schools shared common accomplishments and challenges, but differed considerably in their MTSS model and service impact. Going forward districtwide and school specific improvements will require reexamination of policies, procedures, and systems. Recommendations included training needs, improved tracking and referrals, further investment in family resource centers and Tier 3 services, and a redesign of student study teams. Implications, limitations, and future directions for research and practice are provided. Key words: mental health, social emotional health, multi-tiered systems of support.