When children are struggling in school, underlying causes often include physical or behavioral health problems, poverty, abuse, and/or neglect. Children's poor physical health status has been linked to deficits in memory and reading ability. Children with behavioral problems are much more likely than others to have lower grades, miss school, be suspended or expelled, and drop out. Access to needed health and human services is critical to vulnerable children's success in school. Yet, need often does not predict use. Even available services are often fragmented, making it more difficult for families both to access and utilize them effectively. Increasingly, the federal government, child advocacy groups, and private funders are therefore encouraging any organization that identifies an at-risk child, to convene a team including representatives of all relevant agencies. These teams should include parents as full partners to identify both child and parent needs and to build service plans on strengths as well as needs. Given their primary role in children's lives, schools are a logical base for such coordination. The current article describes an innovative effort in North Carolina to help at-risk children thrive academically and remain with their families: the school-based Child and Family Support Team Initiative (CFST). It provides an overview of the program and a profile of the children served in the program's first 2 years. (Contains 1 figure.)