This article provides background on school mental health (SMH) programs in Baltimore and efforts to integrate evidence-based preventive interventions into the schools served by these programs. We describe the triangular model of SMH promotion, building at the base from environment and relationship enhancement, followed by universal and selective prevention, efforts taken at each of these levels, challenges experienced, and ideas for overcoming challenges. The agenda to integrate evidence-based preventive interventions into schools offers much promise for improving valued outcomes for students and schools. This is a difficult agenda, however, with many dimensions, including program infrastructure, training, building and sustaining school administrator and staff support, and addressing competing contingencies and tendencies toward drift. Better linkage between SMH, prevention science, and implementation science is called for. (Contains 1 footnote and 1 figure.)