The COVID-19 pandemic has negative effects on children, adolescents, and adults. Despite these effects, information about the nature of mental health concerns and services provided to address these concerns by elementary school counselors is unknown. The purpose of this generic qualitative study was to examine mental health concerns elementary school counselors observed among kindergarten through fourth grade students in urban Oklahoma during the COVID-19 pandemic, how they described clinical services provided to address these concerns, and how they decided to provide these services. The study was grounded in Bronfenbrenner's ecological systems theory and Erikson's theory of psychosocial development to explore psychosocial factors that may contribute to students' mental health problems as a result of the COVID-19 pandemic. Thematic analysis of semi-structured interviews with 10 school counselors was performed. Findings suggested that school counselors witnessed struggles involving social and emotional regulation, anxiety and depression, and behavior and adjustment difficulties among students, addressed concerns using multiple methods that included counseling, social-emotional learning, and parent engagement, and reached decisions to address identified concerns using referrals, universal screeners, professional judgment, and directives from leadership. The study promotes positive social change by guiding school counselors on intervention and prevention strategies and drawing attention to the need for a compelling and sustainable framework for addressing mental health needs of children during a pandemic. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]