Program sites were selected based on diversity in client demographics, degree of urbanicity, geographic location, and number of students served. Each site's understanding of issues, strategies, obstacles, and solutions involved in providing school-based mental health and violence prevention services was assessed. Although the sites were located in vastly different communities, they served students who were frequently exposed to violent and disruptive circumstances in school, at home, or in their neighborhoods. Psychological and behavioral responses of students to the dangers they faced included depression, poor self-esteem, post-traumatic stress disorder, gang membership, disruptive and violent behavior, suicide ideation, drug and alcohol abuse, unsafe sexual activity, and dropping out of school. The analysis of key features of school mental health and violence prevention projects concluded that school health centers should incorporate mental health care from the beginning of center implementation and that the pre-existence of a school health center facilitates mental health efforts when violence prevention or mental health efforts are added to schools after other health care services. The analysis also determined that children should be exposed to school mental health and violence prevention efforts at an early age, that expanding a school health center to include more mental health services requires time, that educational components of violence prevention are as important as mental health services but tend to be less developed, and that informal organizational structures and management systems give school mental health projects the autonomy and flexibility they need to meet a variety of needs in an often chaotic environment. Implementation issues related to school-based mental health and violence prevention programs are addressed, as well as issues involving long-term sustainability. Detailed case studies of the three project sites are appended.