The purpose of this study was to examine the efficacy of the Family Check-Up initiated during kindergarten on teacher-report of children's emotional and behavior concerns in fourth grade. Participants were 57 primary caregivers, along with their children and teachers. Participants were randomized to a Family Check-Up condition or school-as-usual control condition. Teachers reported on children's emotional and behavior concerns at kindergarten and fourth grade. Findings suggested children whose caregivers were randomized to the Family Check-Up condition outperformed children in the school-as-usual control condition on moderate and serious emotional and behavior concerns in fourth grade. Implications for aligning and integrating family-centered assessment and treatment in schools are discussed.