This article describes policy and practice changes brought about to sustain effective school-based asthma programs in 14 communities across the state of Missouri. Whereas there is much literature regarding institutionalizing and sustaining such programs, this project is unique in that it encompasses
a diverse range of agencies implementing school-based programs across many communities and settings. It provides a broad view of the types of policy and practice changes which may be achieved by those
implementing comprehensive school-based programs. Additionally, as the evaluation of the project includes child-level health outcomes data in addition to sustainability factors, this study adds to the literature around sustaining programs proven to be effective at improving health outcomes. Whereas other studies have taken a retrospective look at changes which have occurred, this study has tracked changes as they have taken place, providing more insight into the process of sustaining such programs.