<p>Implementers of mental health interventions commonly make a host of modifications to interventions to enhance student engagement, implementation feasibility, contextual fit, and student cultural alignment. However, less is known about the ways in which school-based mental health providers approach intervention modifications to best support students placed at increased risk for social, emotional, and behavioral disorders. The present exploratory study aimed to better understand the types of modifications school-based mental health providers make to the interventions they implement with youth placed at increased risk for these disabilities, the reasons they make these modifications, and their goals for these modifications. Self-reported quantitative and qualitative data were collected from five school-based mental health providers delivering small-group and individual interventions with 30 students in grades 1–12 in one Midwestern state of the USA. Following descriptive statistics and rapid qualitative analysis, results indicated (a) providers made approximately 14 modifications for each intervention they implemented (the majority of which were planned rather than unplanned and most commonly included adding content to sessions) and (b) providers most often made modifications due to student factors with the goal of enhancing student engagement. Implications for practice and directions for future research are discussed.</p>