Policies and procedures, funding, and partners influence whether your SBHC and school will maintain or expand the efforts over time. Developing sustainability strategies to address these three components makes it possible for school wellness work to continue, grow, and improve well into the future.

Hallways to Health sites changed school- and district-level wellness, discipline, nutrition, and physical activity policies and expanded school curricula to include social and emotional learning throughout schools. They created infrastructures like classroom reflective areas, staff wellness rooms, and school gardens, and promoted policies to utilize them. They instituted ongoing practices like alternative breakfasts, restorative justice initiatives, and fitness clubs. Hallways to Health sites also established protocols to increase student access to services by bringing offsite organizations onto school campus for support groups, and by co-locating SBHCs with nurse offices.

Hallways to Health sites created procedures for food insecurity and BMI screenings; procedures for warm hand offs; and follow up procedures for social service referrals. Sites also created procedures for collecting parental consents for youth participation in school-wide screenings and risk assessments, and enrollment in ongoing school wellness efforts.

Sites identified grants, in-kind donations, and health reform efforts like Medicaid reimbursement as possible funding sources to sustain their Hallways to Health efforts.

Hallways to Health sites worked with school wellness teams to adapt action plans and develop sustainability strategies for school-wide wellness work. Sustainability strategies may help:

  • Replicate or expand your school-wide wellness work.
  • Create the conditions necessary for school-wide wellness for current and future students and school staff.
  • Ensure continuity as staff transitions occur where there is the potential to lose historical knowledge.

Best Practices

  • Policies and Procedures provide the guidance and accountability to ingrain school wellness throughout school culture.
    • Create MOUs among your SBHC, school, medical sponsor, and CBOs to sustain your partnerships. MOUs include the purpose and scope of the partnership, articulate timelines, assign joint roles and responsibilities, and identify joint policies and protocols. Click to see examples of SBHC MOUs:
    • Policies and procedures have the details to operationalize an MOU. They should evolve over time as needed.  Review them annually and adapt the MOU accordingly.
  • Policies are a set of organizational rules and requirements governing a process. Health and wellness policies should include expectations and provisions to create and ensure physical and social and emotional wellness for students.

    Health policies can dictate the types of foods and beverages available before, during, and after school- in the cafeteria, for birthday and other celebrations, during fundraisers, etc. Health policies can also include recommendations for physical activity and recess.
  • Procedures outline how staff should implement the rules (policies) by providing step-by-step instructions, and following the instructions is called a procedure.

Finding funds for your school-wide wellness efforts will provide additional support to enhance your current programs and infrastructure; it can also allow you to expand or replicate your efforts at other sites.

  • Funding includes personnel budget items like salary, benefits and indirect costs associated with staffing your school-wide wellness efforts. Funding also includes travel, materials, and more.
  • In your action plans, include possible funding sources. Your team should discuss different health and education, and even business-related, funding visions. These could include grants and maximizing billing.
    • Funding sources can include donations, grants, community benefit dollars, allocated funds, or funded staff positions from universities, schools, districts, and SBHC medical sponsors.
    • Other possible funders include local legislators, community businesses, private donors or foundations, and health plans.
  • Payment Reform and Billing:
    • Many payment reform and health care delivery pilots are currently underway, with the goal of addressing high healthcare costs and poor health outcomes.
      • Payment reform efforts are geared toward achieving the Triple Aim [xix], — better health for a community, improved patient experiences, at a lower cost.
      • SBHCs have the opportunity to participate in payment reform in multiple ways– serving youth in underserved communities to address health disparities, providing preventive and primary care services encouraged in payment reform, conducting school-wide screenings, and offering whole school populations access to health education opportunities supported by payment reform.
        • SBHCs must secure timely and accurate data on the population they serve and the quality of care they provide.
        • SBHCs should assess, collect, and track social determinants of health (SDOH) such as food insecurity and homelessness of their patients and where possible, the entire school population. There are a number of risk assessment tools available. Some are comprehensive and include sections on Adverse Childhood Experiences (ACES) or Social Determinants of Health (SDOH) and some are specific to SDOH and ACES. Some of these are already included in Electronic Health Records (EHRs).
          • Use EHR diagnostic codes on ACES and SDOH to tell your SBHC and school-wide wellness story. These powerful data collection tools can meet performance measures and show quality improvement, leading to increased payer engagement, and possibly funding.
  • Partners serve a key role in sustaining school-wide wellness efforts, connecting schools with resources and expertise, and providing or supplementing services. They can also advocate for the continuation or expansion of your school-wide wellness efforts. Working with partners can provide information and insight; foster other partnerships and/or funders; and lead to financial and non-financial resources to continue the work.
    • Revisit the stakeholder engagement sections and accompanying tools to identify who to engage and the best strategies to do so.
  • Expanding partners beyond your initial groups can help bring in more resources and support for your work. Sustainability stakeholders may include:
    • School-wide wellness recipients or participants: students and schools staff.
    • Stakeholders who oversee these individuals: parents, school leaders and school district leaders, such as the School Board.
    • Organizations with goals of school wellness: community- based organizations like food banks, and before- and after-school programs.
    • Funders may also share common goals with your wellness team: foundations, health plans, and Medicaid.
    • Health care providers who share a similar mission or goal: hospitals, mental health centers, and even your SBHC Sponsor organization.
  • Use the message box and other supporting data and communications to build your case to stakeholders for sustaining school-wide wellness work:
    • Why school-wide wellness is needed, who benefits from it, and the value it creates for your school and community.
    • What problems your efforts address or conditions they create, and how your school-wellness work will help them achieve their priorities.
    • Give a reason to care about sustaining these efforts, and a specific way they can assist.
  • Identify your partners, policies, and funds to ensure your school-wide wellness work continues, or grows, in the future. All plans should be realistic, effective, and meaningful.


If your scope of work in your MOU does not include school-wide wellness efforts (serving on wellness teams etc.), you may want to revise.


Share policy drafts with leaders and partners who will be implementing the policies. Submit proposals for new policies, programs, or protocols with school/district leaders and other influential stakeholders with enough time for review and approval.


When you formulate or propose your policies, track when and how the policy is adopted or enacted. Your wellness team can advocate for policy implementation, establish accountability and enforcement, and can document the impact of the policies.


Be sure to identify who is responsible for implementing the procedure.


Identify local organizations that have grant and funding opportunities that align with population health work and encourage SBHC wellness teams to apply.


Additional funds can help enhance your efforts; hiring staff to run health education and yoga sessions, offering Fitbit™ tracking physical activity, funding staff wellness breakfasts, offering participation incentives, and building a new track or playground.


Use these data to demonstrate the value of SBHC services and school-wide efforts to patients, communities, partners, policy makers, and payers. These data can demonstrate improved health outcomes of patients and populations following health care delivery transformations, and make a case for the type and amount of payment to request from payers. It can also lead to maximizing billing and reimbursement.


Your stakeholders may change over time as organizations shift priorities, staff change, or you realize that a different person or organization may be more influential or interested in sustaining school-wide wellness. You can modify your stakeholder list and engagement plan to accommodate any of these shifts.


SBHCs must first have efficient clinical operations before moving outside of the clinic walls.


Sustainability depends on having a strong wellness program in place. Not all components of your school wellness efforts will be sustainable. Consider which are the most important to your students and school community.

Related Information

Hallways to Health sites codified clinical procedures for screening for food insecurity. The American Academy of Pediatrics teamed up with the Food Research and Action Center to create a guide for health providers on conducting the Hunger Vital SignTM Food Insecurity Screen and connecting patients with additional resources to address food insecurity. Click here for the resource. [xx]

Stories from the Field

For Hallways to Health sites, school transitions (new leadership, location changes) were the biggest challenge for sustainability. SBHC staff created transition plans to share their institutional knowledge on school wellness with incoming team members. They also recruited annually for school wellness teams.

At Milwaukie High School, Milwaukie, OR, the SBHC medical sponsor organization agreed to incorporate the SBHC wellness coordinator position and the stipend for the faculty liaison to the SBHC as a part of the general operating budget. While the sponsor incorporated the wellness coordinator position, the North Clackmus district nutrition services, Chartwells, took over full funding, ownership, and operation of the alternative breakfast initiative started by the Hallways to Health team so it is sustainable and accessible to all students moving forward.

At Roosevelt Middle School, Oakland, CA, the SBHC team asked their medical sponsor to continue supporting school-wide wellness efforts by applying for grants to fund school level interventions. With additional grant funding, the SBHC would be able to continue offering services like healing circles. They also asked their sponsor for continued support demand maximized reimbursement from health insurers for population-level programs. The site already receives reimbursement for some of the school-level wellness initiatives they provide.

The staff from the SBHCs at John F. Kennedy High School (Richmond, CA), Lake Forest Elementary (Sandy Springs, GA), Turner Elementary (Albany, GA), Whitefoord Elementary (Atlanta, GA), Washington Middle School (Seattle, WA), and Northwood High School (Silver Spring, MD) are training other local SBHCs on implementing the school-wide wellness model at their schools. The PA at Turner works with five new SBHCs that share the same medical sponsor and provides training and technical assistance on developing and implementing school wellness action plans. YMCA East Bay’s SBHC Coordinator, the former JFK SBHC Director, provides tools to train all of her sponsor organization’s SBHCs on implementing the Hallways to Health model as well. The health educators at Lake Forest and Washington lead health education, neighborhood safety, and food access efforts at other schools they serve.  At Northwood, the Nurse practitioner will facilitate a course to train 30 faculty members and after-school providers on teaching mindfulness. And, at Whitefoord, the health educator facilitates mini workshops on health and wellness for school staff in her local area, and speaks about the benefits of having a staff wellness room to promote staff wellbeing.

The Dougherty County District wellness team, Albany, GA, proposed a policy to reintroduce recess on the master schedule throughout Dougherty County School District. The wellness team had successful coalition-building and advocacy activities to encourage the school board to adopt the policy. They shared literature and resources to encourage buy-in and support from administrators, teacher, and parent and community groups. After the wellness team spent months building coalitions and drafting policy language, the district adopted a policy promoting recess. The language was not as strong as the policy the wellness team proposed. Nevertheless, the team considered this a huge win. They will continue to monitor and enforce the policy to ensure students have ample opportunities to be physically active.

The school wellness committee at Turner Elementary in Dougherty County also successfully advocated for the school to follow USDA smart snack guidelines—another health policy win within the district. Additionally, the school wellness team acquired funding to support a culture of healthy eating and active living throughout the school with grants to purchase equipment and build a track to improve the school facility. They also held a daily fundraiser for the school by selling healthy breakfast foods and snacks. These efforts increased interactions and strengthened relationships with school and district leadership and staff throughout the year to enhance the visibility of and appreciation for Hallways to Health. Through partnerships, funding, and policies at the school and district level, the site was able to sustain and expand their school wellness efforts.


Sara Trivette talks about changing school and district level wellness policies. She describes the critical role her wellness teams played in improving school health and wellness.


[xix] IHI Triple Aim Initiative. Institute for Healthcare Improvement Website. http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx. Accessed April 3, 2018.

[xx] Ashbrook A, Hartline-Grafton H. Addressing Food Insecurity: A Toolkit for Pediatricians. Food Research & Action Center Website. http://www.frac.org/wp-content/uploads/frac-aap-toolkit.pdf. Published February 2017. Accessed April 3, 2018.