Although the presence and practice of school psychology around the world has expanded considerably over the last 10 years, in Italy the profession is still in the process of development. The aim of the present study is to investigate the presence and practice of school psychologists in an Italian district, using a mixed-methods research design including a questionnaire survey of all schools in the district (N = 83), and seven semistructured interviews to school stakeholders and key informants (i.e., principals, parents, teachers, school psychologists and a representative of the local education authority). The results showed that school psychologists are present in the majority of schools, that the greatest proportion of their work involves consultation with students and intervention in classes, and that teachers appreciate the services they provide. However, there are significant barriers that limit the impact of their work in supporting students, teachers, and families. In the light of the findings, the future development of school psychology in Italy is discussed, and global implications for school psychology are considered.