National and state surveys over the past several decades have concluded that school social workers, despite an awareness of and training in macro level practice strategies, are highly individualistic in their practice focus. Although clinical skills are necessary, they are insufficient for effective school social work practice in the 21st century. No studies have moved beyond asking what tasks school social workers perform to asking what predicts these tasks. The purpose of this study was to explore which factors appear to shape and influence school social work practice in Tennessee. The authors found no evidence that school social workers' characteristics (for example, gender, race, education, grade levels served) affect their choice of interventions, but they did find evidence that organizational and systemic sociocultural factors affect the types of interventions that school social workers perform. The authors discuss the implications for practice and organizational change.