This article addresses the effects of 3-tiered comprehensive reading and behavior interventions on K-3 student outcomes in 7 urban elementary schools with a high prevalence of students considered difficult to teach. Specific features of each level of the implementation are described including screening and tier placement procedures, scheduling and personnel supports, procedures for ensuring strong implementation with fidelity, procedures for student progress monitoring, and guidelines for instructional decision making. Early literacy skill outcomes for students were the primary dependent measures in reading; schoolwide office discipline referral rate was the dependent measure in behavior. Significant improvement was evident in phoneme segmentation and nonsense word fluency in reading and significant decreases were documented in office discipline referrals across treatment and comparison schools. Significantly higher outcomes were also recorded on required statewide end-of-grade assessments in treatment schools. Implications and caveats concerning effective implementation of the model in other settings are provided. The article emphasizes that changing schoolwide reading and behavior risk requires effective intervention, instruction, and support in both areas.