An estimated 5.2 to 7.8 million children with significant chronic health problems attend school every day in the United States requiring interventions in the school setting. A majority of these students will be from ethnic minority or low-income groups within two decades. Providing culturally competent interventions in schools is critical to optimize the health, educational, and psychological outcomes of children with significant health problems. This article underscores the culture and health connection and presents a 5-step model for providing culturally competent services for health problems in schools. The article is intended to help school personnel to determine if, when, and how to incorporate cultural issues in assessment, treatment planning, and intervention. © 2007 Wiley Periodicals, Inc. Psychol Schs 44: 389–396, 2007.