One in five children birth to 18 has a diagnosable mental disorder and 1 in 10 youth has serious mental health problems that are severe enough to impair how they function at home, in school, or in the community (SAMHSA, 2003). Reduced funding and movement from residential and inpatient treatment to lesser restrictive settings have made schools the “de facto” mental health service provider (Roberts, Vernberg, Biggs, Randall and Jacobs, 2008; Splett & Maras, 2011). Furthermore polices such as Individuals with Disabilities Education Act, No Child Left Behind as well as incidents such as the Virginia Tech, Columbine, Sandy Hook, and Isla Vista shootings have charged schools and mental health organizations with the responsibility for the provision of adequate mental health services. “This “perfect storm” of a confluence of critical social, legal, and medical issues demand an array of therapeutic responses that schools were never designed or funded to do” (Lemon, 2015). According to the U.S Department of Human Services, Substance Abuse and Mental Health Services Administration (2012), there were 2.9 million youths aged 12 to 17 in 2010 who received mental health services in the educational setting. Through in-depth semi-structured interviews with 12 community based providers of an intensive school-based mental health program, Therapeutic Day Treatment (TDT); it was the aim of this qualitative study to examine the training needs of community mental health providers whose provision of services occur in a school setting. Given the limited literature on the topic, this study provided first hand accounts from direct providers not only of their needs, but how their setting impacts the provision of service. This study examined TDT clinicians’ perceptions of mental health concerns for children in their program, barriers to service provision, the preparedness and roles, and the perceived gaps in services and training. Five major themes, each comprised of a number of interrelated sub-themes, were identified: role/service clarification, preparedness for the school environment, practice techniques, family dynamics, and conflicts within the school context. Results of this study suggests that the delivery of an intensive community mental health program in school settings poses a unique set of challenges and points to the lack of adequate training. The data underscores the training needs of TDT clinicians and interventions tailored to suit the school context in order to improve care for children with serious emotional disturbances (SED).