To identify the changes associated with the school turnaround process, this article reviewed 15 case studies of elementary school turnaround initiatives that sustained improvements for at least two years. Changes were clustered into eight categories: leadership, school policy, programs, organizational processes, staffing, classroom practices, parent and community involvement, and school facilities. The findings suggest that sustaining improvements in student achievement depends on comprehensive change, customization, and a core of essential reforms. The findings also reveal that the organization of elementary schools is becoming much more complex. (Contains 2 tables, 2 endnotes and 6 resources.)