Quality improvement (QI) activities, designed to enhance program evaluation efforts and to improve quality of care, have become increasingly important in children's services research. QI activities examine outcomes and provide accountability data that can be very useful for telling the story of the development, implementation, and effectiveness of expanded school mental health (ESMH) programs. This article discusses the implementation and results of QI activities for two ESMH programs, one relatively new program, and one with 10 years of experience. When presenting each case example, the authors review key QI activities such as developing new measures and interventions, evaluating costs of care, and disseminating results to clinicians, program administrators, and funders. The article concludes with a discussion of the importance of QI in school-based mental health and reviews directions for future research and program development.