Background: The Centers for Disease Control and Prevention's School Health Index (SHI), a guide for completing a coordinated school-based program needs assessment relative to healthy eating, physical activity, a tobacco-free lifestyle, and prevention of other health risk behaviors and conditions, was used to assess current programming at 3 midwestern middle schools. Methods: Employing somewhat different procedures, data were collected from focus groups comprising school administrators, teachers, parents, community members, and students. Participants responded to SHI module questions and provided comments based on their perceptions. Both quantitative and qualitative data were recorded for each module, after which participants answered 3 planning questions intended to guide prioritization of actions to improve policies and programs based on importance, cost, time, commitment, and feasibility. Results: Each school developed recommendations and strategies based on highest priority needs related to community involvement, professional development, health screenings, and health education materials in classrooms. Conclusions: The experience of completing the SHI in 3 different schools provided important insights about the data collection process as well as assessment results that have implications for the design and implementation of prevention programs. (Contains 3 tables.)