Students in vocational programs have lower qualifications and more difficulties with successful entry into the labor market if they graduate without a diploma. The aim of this study was to describe the student - environment fit for high school students who are struggling with their studies in vocational programs, in terms of their perceived adjustment needs, and to describe planned interventions based on the students' needs. The aim was also to investigate whether there was a relationship between students' perceived adjustment needs and students' self-reported mental health. The study included 25 students in six vocational programs at three different high schools in Sweden. The School Setting Interview was used to identify adjustment needs, and mental health problems were identified using the Strengths and Difficulties Questionnaire. Results showed that students identified adjustment needs to increase their participation in several school activities, and that academic school activities had the most identified needs. Interventions related to planning and organizing were most common. Results also showed a correlation between self-perceived adjustment needs and mental health. By identifying students' adjustment needs, the chances of succeeding with student-centered interventions are increased, which in turn can support educational achievement.