The purpose of this study was to explore the implementation of pre-referral intervention for maladjusted students in elementary schools in Taipei city. The participants were 98 elementary school guidance-teachers and data were collected through questionnaires and interviews. The main findings are as follows:(1) Of the students who received pre-referral intervention, 52% of students had external behavioral problems, 25% had internal behavioral problems and 23% had learning problems. (2) Seventy-six percent of the maladjusted students received pre-referral intervention for a period of one to six months. (3) Eighty-five percent of the elementary schools in Taipei had pre-referral intervention teams. Intervention implementers and evaluators were usually guidance-teachers and homeroom teachers. (4) The most common intervention strategies used were behavior management, instructional, environment modifications and consultation, whereas most the least common strategy was using psychology tests. (5) The more common evaluation methods used were interviews and observations while the use of questionnaires was uncommon. (6) Pre-referral solved 31% of maladjusted students problems. Also, it improved students performance immediately, reduced special education referrals, and effectively identified students with guidance needs.