Family-centered service is a service delivery model that recognizes the central role of families, builds on their strengths, and seeks to fully involve them in all aspects of their child's health, learning, and development. Family-centered service has been associated with positive outcomes in health and education and has been viewed as best practice. This study examined school nurses' perceptions of their work practices with families and the implementation of family-centered services in the school health setting. An established instrument, the Measure of Processes of Care for Service Providers, was used to survey a convenience sample of school nurses practicing in California. Quantitative and qualitative results indicated that school nurses value family-centered service and use the core elements regularly in their work with families. Qualitative data further illustrated school nurses' solid commitment to families even in the face of challenges such as high student-nurse ratios, lack of time, and limited support. Suggestions for overcoming these barriers include development of parent centers, employment of school social workers/case managers, and advocating for changes in legislation to support the hiring of more school nurses. (Contains 3 tables.)