Early adolescence is a time of rapid cognitive, psychosocial, and physical development, and an array of contextual factors, such as systemic racism, exert significant influence. Universal behavioral health screening data of 4,234 middle school students were examined to explore the influence of demographic (e.g. ethnicity, race) and contextual factors (e.g. school configuration). Findings suggest that middle school students are rated as having higher levels of behavioral concerns and lower adaptive skills compared with elementary and high school students and are influenced by both factors. Implications for universal screening, critical analysis of structural inequities, and district practices are also examined.