This study examined issues of treatment integrity, systematic screenings, and access to reinforcement relative to school-wide positive behavior support programs (SW-PBS) implemented in two rural elementary schools during the first year of program implementation. Results suggested that treatment fidelity, as measured by self-report and direct observation methodologies, varied according to rater and method of measurement. Findings also illustrated techniques for using systematic screening tools implemented as part of elementary level SW-PBS programs to (a) assess the overall index of risk as well as (b) identify how different types of students respond to the SW-PBS plan over time, with an emphasis on how to identify students for targeted prevention efforts. Finally, results of multivariate analyses suggested that students' rate of access to reinforcement was significantly different between schools and between students with high and low risk status as measured by the Student Risk Screening Scale (SRSS; Drummond, 1994). Educational implications of the findings related to these issues are discussed, and directions for future research offered.