School personnel often take on ancillary responsibilities that extend beyond their role as educational professionals, including supporting students who have parents suffering from substance use disorders (SUDs). Our objectives were to use the experience of these school personnel to better understand how healthcare professionals can support school personnel and affected adolescent students. We recruited 21 school staff from public and private high schools in a metropolitan US city. Interested personnel were then screened and scheduled to participate in either a public urban, public suburban, private, or mixed school virtual focus group. An iterative process was used to generate codes, categories, and ultimately themes from each of the four focus groups. Final themes were grouped into major and minor themes with subsequent comparison between school typologies. Two categories arose from analysis of major themes: (1) school personnel’s perceptions of students experiencing parental substance abuse and (2) school personnel’s personal experiences with these students. Major themes included extreme shifts in adolescent behavior, adolescents’ need for trusted adults, adolescents’ expression of familial shame, school personnel’s desire for evidence-based SUD resources, and feelings of helplessness related to students’ home situations. Minor themes included forced maturity and normalization of substance use. The overarching comparison between typologies revealed difficulty connecting students whose parents abused substances with appropriate resources. Enhanced communication between school personnel and mental health providers, in addition to wider utilization of school-based mental health resources, is needed to recognize and address the gaps in care for youth impacted by familial substance abuse and for the school personnel who support them.