Outcomes for students in special education continue to be disappointing and those having emotional disturbances (ED) continue to lag behind the other disability groups. In this study, school reform activities and the effects on students who are educated in special education programs for students who have ED were examined. Demographically similar elementary, middle, and high schools in urban communities were classified as either actively engaged in (HI) or not very engaged in (LO) reform activities. Findings indicated students with ED in the HI schools spent more time in academic general education classes with non-handicapped peers; had significantly higher achievement scores in math; and were more likely to receive mental health services from community agencies compared to students in the LO schools. Implications are discussed in terms of current developments in the school-based mental health services research and provider communities to refocus interventions on learning, the core function of schools.