Building Core Policy Skills: A Discussion Guide for STI Prevention Efforts

February 26, 2026 | JoAnne Deehr, Lana McKinney

This discussion guide provides insight into and builds on the ASTHO Policy Academy On Demand training — deepening participant engagement through practical examples and reflection questions focused on real-world STI prevention challenges.

While the training provides foundational understanding of the policy development process and how it supports programmatic work across health departments, this guide helps translate those concepts into practice by: (1) prompting discussion, (2) exploring implementation scenarios, and (3) connecting policy tools to day-to-day decision-making in STI prevention efforts.

Module 1 – What Is Policy?

This module provides a foundation for understanding how policy serves as a tool for public health intervention and establishes a foundational understanding of the policy development process. It covers the spectrum of policy actions, from formal state laws to agency-level protocols.

• Question 1: How can internal policy tools (e.g., updated clinical protocols or statewide guidance for universal prenatal syphilis screening) help to create near-term protection while considering broader legislative or payer policy changes, and how do these different policy levers compare in speed and impact?
• Question 2: When you think about a change, like expanding prenatal syphilis screening or covering at-home STI test kits, what parts do legislation drive versus internal agency policy or payer rules? Which decisions occur at the federal, state, and local levels, and how do those layers of authority influence what can be changed through legislation versus agency or payer policy?

Module 2 – Problem Identification

Effective policy begins with using data to understand and define a public health problem and its impact on specific communities. This module focuses on using surveillance to explore the problem that you can use policy to address and tools you can use to analyze the root causes of the problem.

• Question 1: When confronted with rising STI rates or screening gaps, how do you integrate quantitative data (surveillance, claims, lab metrics) with qualitative input (provider or community feedback) to define the problem? And what additional information would strengthen your analysis?
• Question 2: If you apply a root-cause method like the "5 Whys" to rising STI rates or missed prenatal screening, what are underlying drivers that might emerge? How would you determine whether the root cause is workflow, funding, access, or policy structure?

Module 3 – Interested Parties Engagement and Education

Policy development is a team sport. This module focuses on identifying internal and external partners, from community-based organizations to legislative leaders needed to move a policy forward.

• Question 1: When advancing policies related to STI testing access, congenital syphilis prevention, confidentiality protections, or Medicaid coverage, which interested parties must be engaged for approval, implementation, and community uptake? How do responsibilities differ between those who make policy decisions (e.g., legislators, Medicaid leadership) and those who operationalize them (e.g., clinics, maternal and child health programs, community partners)? Where might you find champions on the issue, coordination challenges, competing priorities, or confidentiality concerns that create friction?
• Question 2: In a medication shortage where prioritization decisions are required, how would you include perspectives of highest-risk patients and frontline providers? How might priorities differ among payers, clinicians, and community organizations?

Module 4 – Policy Analysis

This module examines the legal frameworks that empower health departments to act. It introduces methods for evaluating which policy options are legally sound within a specific jurisdiction.

• Question 1: When using an impact matrix to compare policy options — such as screening requirements, coverage mandates, or partner services expansion — why is it important to include the “status quo” as a baseline? How does that help you weigh feasibility, cost, impact, and potential unintended consequences?
• Question 2: When weighing the status quo against a proposal, such as at-home STI testing coverage, how would you assess long-term health impact, tradeoffs, operational feasibility (e.g., provider capacity, lab processing, reimbursement workflows) and possible unintended consequences? What sources of evidence would guide your decision-making?

Module 5 – Policy Strategy and Design

Translating data into a compelling narrative is key to building support for a policy. This module covers how to tailor messages for different audiences, including the media and policymakers.

• Question 1: When developing and thinking of pitching a policy like at-home STI testing coverage, which partners could help sell the proposal, and how would you address real world implementation constraints?
• Question 2: When communicating urgency around medication prioritization during a national shortage, which messaging strategies are most effective? What supporting policy elements (e.g., provider guidance, prioritization protocols, or reporting expectations) should be built in from the start to make the strategy workable?

Module 6 – Policy Authorization and Enactment

This module focuses on the formal process of moving a policy from a proposal to an official law or regulation. It includes navigating the legislative calendar and understanding the rulemaking process.

• Question 1: What concerns might arise when proposing coverage mandates or new screening requirements, and how would you address them proactively?
• Question 2: If you were advancing a policy such as expanded prenatal screening requirements or broader congenital syphilis prevention efforts (i.e., closing gaps between screening, treatment, and postpartum follow-up), which key decision-makers would need to be engaged? At what level of government (federal, state, or local) do they operate, and how would that distribution of authority shape your strategy and cross-program collaboration (e.g. maternal and child health, Medicaid, community organizations)?

Module 7 – Policy Implementation

Enactment is only the first step; implementation involves turning policies and/or laws into functional programs. This module covers the creation of guidance documents and the training of staff to ensure a policy’s success.

• Question 1: After a policy like expedited partner therapy is approved, what operational steps (i.e., training, workflow updates, and coordination) are required for successful rollout?
• Question 2: What behind-the-scenes barriers — such as low provider awareness of new requirements (e.g., expedited partner therapy authorization or prenatal screening mandates) or limited public awareness of benefits like at-home STI test coverage — most often undermine implementation and how can early coordination, promotion, and targeted communication address them?

Module 8 – Developing the Evaluation Process Plan

The final module focuses on measuring whether a policy achieved its intended health goals. It emphasizes using data to refine and improve policies over time.

• Question 1: Following implementation of policies related to screening access, congenital syphilis prevention, confidentiality, or Medicaid continuity, what indicators would signal success? What frontline feedback would inform policy refinement?
• Question 2: What indicators would show at-home testing policies are reaching the high-need groups, and how would you respond if the impact differs from what is expected?