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This paper presents a case study that examines the outcomes of specific policies and initiatives related to student health at an urban high school. We considered publicly available school and district data (e.g., School Board meeting minutes, policy, demographics, etc.), cultural artifacts (e.g, websites, social media, news stories, podcasts, etc.) and first-hand accounts from a year-long collaboration with the school’s principal and advisory team to understand how the school addresses student mental health. We first present a rich description of the context and school to anchor the discussion of three emergent findings, which illustrate the ways in which the school’s approach operates across interrelated contextual layers to address: 1) culture, 2) policy, and 3) practice.