<p>School-based mental health services (SBMHs) have been suggested as an alternative to traditional services that can reduce service gaps by gender, race, and special education status. The current study examines whether such gaps exist in SBMHs in treatment retention and success. We examined the treatment trajectories of 520&#xa0;K-12 students (55% male, 83% Black, 16% special education) as reported by an urban U.S. school district. Using a set of logistic regressions, we compared the probabilities of starting treatment and successfully engaging in treatment by gender, race, special education status, and reason for referral. We also compared the changes in the risk for externalizing or internalizing issues among the different demographic groups over time. Females and students referred due to internalizing issues were more likely to start services after referral, while students referred due to a recent traumatic event were less likely to start services than other students. Special education status predicted lower treatment retention. Engaging in treatment was associated with a significantly lower externalizing risk among females, and with a significantly lower internalizing risk among those referred due to externalizing concerns and among those with a recent traumatic event. The findings point to gaps not only in access to SBMHs but also in treatment retention and outcomes, particularly gender based. Practitioners may, therefore, want to focus efforts on eliminating barriers faced by young boys and men when accessing psychological treatment (e.g., reducing stigma) and improving the efficacy of treatment among male students (e.g., training school mental health staff in gender-aware treatment strategies).</p>