The need for school social workers and other mental health providers to move away from specialist oriented services to comprehensive general programmatic approaches has been gaining increasing support among leaders in education and mental health. The "clinical quadrant" highlighted in this article is offered to better conceptualize the complex and varied tasks and interventions required of school social workers and other mental health providers in the changing landscape of education reform. The proposed conceptualization takes into account ecological aspects of the complex clinical knowledge and skills necessary for effective school social work practice in the 21st century. The clinical quadrant provided here allows for a wide range of multilevel interventions and allows school social work to differentiate itself from other student support service disciplines and become a key player in school reform efforts. Several barriers and challenges that school social workers face in carrying out a broader approach to practice are discussed, and recommendations are made for school social work practice and education.