School psychologists are tasked with ensuring treatment integrity because the level of intervention implementation affects decisions about student progress. Treatment integrity includes multiple dimensions that may impact the effectiveness of an intervention including adherence, dosage, quality, and engagement. Unfortunately, treatment integrity is not routinely monitored in consultation. A systematic framework is needed to better prepare practitioners to assess, analyze, and intervene when there are treatment integrity failures. A framework for monitoring and improving multiple dimensions of treatment integrity in natural settings is proposed to provide guidance to practitioners through two phases. The first phase focuses on improving initial treatment integrity and the second phase outlines a problem-solving process for improving treatment integrity.