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Example #1: Achieving Regulatory Change: The Kansas Asthma Coalition

Sometimes “Plan B” works best for making positive policy change.

If you determine that introducing legislation is not practical or not likely to succeed, consider seeking a change in practice or regulations.While this type of change is often a compromise, it can accomplish the desired goals more quickly than attempting to pass or amend a bill.

In Kansas, a coalition of groups and individuals working to improve children’s health wanted to introduce a bill that required screening all children in public schools for respiratory illness, a process similar to the screenings that are conducted for vision and hearing.Asthma causes more lost school days and pediatric emergency room visits than any other chronic disease in the U.S., so the supporters felt their case for screening was strong.

But the Kansas Asthma Coalition members also realized that unfunded mandates are not popular, so they took a different strategy. They proposed that the state add these four “yes/no” questions to the school health assessment form that is used by Social and Rehabilitation Services (SRS):

  • Has your child ever been diagnosed by a doctor as having asthma?
  • Has your child ever been prescribed an inhaler?
  • Has your child had an episode of wheezing in the last 12 months?
  • In the last 12 months have you heard your child wheeze or cough after running or crying?

The questions are a meaningful addition to the health form because they screen for children with asthma, whose records can then be flagged to alert school nurses and other school staff to the need for preventing asthma attacks. In addition, the questions did not create any new expenses or require new training and processes for the people who conduct the screening.

The advisory board that was responsible for making such decisions approved adding the questions to the health form. While this change in regulatory practice is not as far-reaching as a statewide law for screening, it is progress toward a system-wide improvement in preventive health care for children with asthma.

This example also illustrates the fact that it usually takes a collaboration to make policy change. The Policy Committee of the Kansas Asthma Coalition drove this effort to improve care for children with asthma. The coalition included concerned physicians, along with representatives of the American Lung Association of Kansas and the Kansas Department of Health and Education.

Coalition member Judy Keller, executive director of the Lung Association of Kansas, summarizes the steps included in making this type of policy change:

  1. Collect and analyze data.
  2. Bring various stakeholders together to form a coalition to help in the process as early as possible.
  3. Determine whether change is needed and how that change will take place.
  4. Enlist support.
  5. Implement change.
  6. Evaluate.
  7. Revise.
  8. Work for continuous improvement as related to the coalition’s mission.


Is there a better way to influence policy? - American Psychological Association.

Global Development Network.

Example #2: Evidence-Based Environmental Strategies to Prevent Underage Drinking

Preventing Underage Drinking: Using Getting To Outcomes™ with the SAMHSA Strategic Prevention Framework to Achieve Results describes 10 environmental strategies for reducing underage drinking that have the strongest evidence base. Each example includes a brief research summary and additional text that describes issues related to planning, implementing, and evaluating the strategy. The examples also include samples of tools, worksheets, or ordinances to facilitate the community’s work. The ten strategies are briefly described below.

  • Responsible beverage service is a merchant education program designed to reduce sales to minors and intoxicated adults. It involves media advocacy to promote policy changes, manager training, and server/seller training.
  • Alcohol compliance checks are thought to be most effective when they are frequent and well publicized, solicit community support, and involve penalties for the licensed establishment rather than just the server.
  • Happy hour restrictions eliminate one of the environments most conducive to overconsumption of alcohol.
  • Controls on alcohol outlet location and density reduce the accessibility of alcohol to young people by making it less prevalent in their immediate environment.
  • Sobriety/traffic-safety checkpoints, which are very effective in reducing alcohol-related traffi c accidents, injuries, and deaths, are even more effective when combined with a vigorous public awareness campaign.
  • Graduated drivers’ licensing laws, which entail clearly specified learner, intermediate, and full license phases, are effective in reducing crashes among teen drivers, but they need to be adequately enforced.
  • Social-host liability laws state that adults providing alcohol to minors or those who are obviously intoxicated are legally liable if the person is killed or injured, or kills or injures another person.
  • Keg registration is intended to prevent friends or relatives of legal drinking age from buying beer kegs for teen parties. Registration can be achieved in a number of ways, for example, permanent markings on each keg that identify where and when it was purchased or a requirement that keg delivery requests be made in person at the store.
  • Restricting sales of alcohol at public events controls the availability of alcohol at gatherings such as concerts, street fairs, and sporting events.
  • Increasing taxes on the sale of alcohol leads to reductions in the levels and frequency of drinking and, especially, heavy drinking among youth, as well as lower traffic accident fatality rates and reduced incidence of some types of crime. Several surveys indicate that most Americans support increased alcohol taxes.

For more in-depth information on these evidence-based environmental strategies to prevent underage drinking, please see the full manual Preventing Underage Drinking: Using Getting To Outcomes™ with the SAMHSA Strategic Prevention Framework to Achieve Results.

Phil Rabinowitz
Val Renault