Mental illness is an epidemic sweeping the nation and, more specifically, the world of education (Salerno, 2016). According to the Center for Disease Control and Prevention [CDC] (2020b), approximately 4.4 million children 3-17 years old in the United States have been diagnosed with anxiety, and approximately 1.9 million diagnosed with depression. Roughly half of the children nationwide have experienced at least one traumatic event in their life (Sacks & Murphy, 2018). For these and other reasons, Schmidt et al. (2015) asserted that mental health and suicide prevention are paramount concerns for schools and districts. Small rural districts and schools struggle with employing and contracting qualified school- and community-based mental health providers. This qualitative implementation case study examined how small rural school and district staff members understand and prioritize the components of an evidence-based mental health program within a multi-tiered framework being implemented, and sought to better understand how school administrators, teachers, and mental health providers perceived strengths and weaknesses of the interventions associated with this program. Eleven participants made up of teachers, administrators, and district- and school-based mental health providers were selected from an elementary, middle, and high school. After analyzing the district mental health plan and semi-structured interviews, the findings displayed evidence that Suncoast County district staff somewhat to fully understood the components of the plan being implemented. Six themes were extrapolated from participant responses related to strengths and barriers of the implementation of an evidence-based, multi-tiered mental health program. [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.]