This quasi-experimental study focused on 15 pairs of children with extensive support needs, matched across 12 characteristics based on their first complete Individual Education Program (IEP) in the school district. One child in each pair was included in general education for 80% or more of their day from their first IEP to the most current IEP at the time of the study. The other child in the pair was placed in a separate special education class, and was served there from the first IEP to the last IEP. All children were observed over a typical school day with time-sampling data collected on the types of activities, the contexts, and the types of engagement that occurred. In addition, outcome data from the first IEP to the most current IEP in the district were analyzed across three variables: communication levels, literacy levels, and numeracy levels. Results indicated that students in the general education classrooms had a significant, large effect size as compared with their pairs in separate classrooms on several variables. In addition, students in the general education classrooms demonstrated highly significant levels of progress as compared with the students in separate classrooms. Implications related to placement, disability characteristics, progress, and policy are discussed.