School-based mental health programs (SBMHP) are vital to providing youth access to mental health services. This study aims to characterize changes in therapy encounters and psychotropic medication prescriptions in an urban SBMHP during the COVID-19 pandemic. We used electronic medical records to extract demographic, clinical, and utilization data from encounters through a SBMHP associated with an urban mid-Atlantic academic medical institution from September 2019 to September 2021. We compared encounter trends in the 3 months preceding the onset of the COVID-19 pandemic (December 2019-February 2020) and the first 3 months of the pandemic (March-May 2020). Using all data from the study period, we plotted encounter statistics and conducted an interrupted time series analysis to examine longitudinal trends in encounter type and attendance, psychotropic medication prescriptions by therapeutic indication, and medication dosage increase before and after schools closed due to COVID-19 pandemic-related restrictions. A total of 625 students with 25,641 encounters were included. Students had a median age of 11 years (range 5-18 years) and the majority identified as Black (57.9%), and non-Hispanic (74.4%). Average monthly encounter volume increased by 557% from March to May 2020 compared to the prior 3 months, 88.6% of which were video encounters, compared to 0% previously. In contrast, psychotropic medication prescriptions decreased by 7.4%. Medication dosage adjustments declined in the period after March 2020, when a state mandate to close schools was ordered due to COVID-19, with the most prominent decline being in ADHD medication prescriptions, which averaged 6 increases per month pre-pandemic versus 1 per month during the pandemic period. In this SBMHP, encounters increased during the pandemic period, primarily in video encounters, while psychotropic medication prescriptions, mostly ADHD medications, declined during the pandemic. Reasons for this decline warrant further study.