Urban communities are disproportionality impacted by issues such as community violence, leaving children at higher risk of trauma, and increased adverse childhood experiences. This applied study addresses a research-to-practice gap by demonstrating the longitudinal impact of a district-initiated, school-wide multitiered systems of support approach to universal instruction, intervention, and assessment--the Comprehensive Behavioral Health Model. Results from more than 1200 students over a 3-year period indicate that this universal, integrated approach is associated with improved outcomes for students with a demonstrated level of risk, with the greatest impact on students with risk of internalizing behaviors. The findings of this applied study highlight the benefits of a systemic approach and enhance the discourse on robust universal screenings that can identify needs and assets of children within urban communities.