increasing uptake of adolescent vaccines in nc school health centers ashley leighton, mph cervical...
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INCREASING UPTAKE OF ADOLESCENT VACCINES IN NC SCHOOL HEALTH CENTERS
Ashley Leighton, MPH
Cervical Cancer-Free NC
Cathy DeMason, RN, BSN
Director, Rockingham County Student Health Centers
Rockingham County Student Health Centers
CCFNC is funded by an unrestricted educational
grant from GlaxoSmithKline.
Conflict of Interest Statement
Background and Framework
School Health Center Survey
Intervention Planning & Partnerships
Intervention
Background and Framework
School Health Center Survey
Intervention Planning & Partnerships
Intervention
Becoming Cervical Cancer-Free
Cervical cancer is fully preventable through screening and vaccination
Each year 300 women in North Carolina die from this preventable disease
CCFNC’s priorities are vaccination and screening
The Carolina Framework identifies 4 main causes of cervical cancer deaths:
•HPV infection•Lack of screening•Screening errors•Not receiving follow-up care
Carolina Framework
Becoming Cervical Cancer-Free
US uptake of HPV vaccine lags behind
Source: NIS-Teen 2010. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6033a1.htm?s_cid=mm6033a1_w
Let’s make HPV vaccine part of routine adolescent care.
Why schools?
Meet adolescents where they are
Adolescents least likely to see doctors
School health centers often already equipped to administer vaccines
Other countries with high rates of HPV uptake have utilized school settings
A step back
How can we help school health centers increase uptake of adolescent vaccines?
Let’s ask them!
School Health Advisory Board
Created Advisory Board with representatives from NCSCHA, DPH, DPI, Immunization Branch, school health center staff, and others with SHC expertise
Background and Framework
School Health Center Survey
Intervention Planning & Partnerships
Intervention
SHC survey
Fall 2010
Topics Barriers to HPV vaccine Potential interventions
Partnership with NCSCHA
33 SHCs offering HPV vaccine
SHC survey results
School health centers are already doing a lot!
37% Asking parents for consentwhile they are at school
42% Printing and mailing letterendorsing adolescent vaccines
82% Parent reminders that childrenare due for adolescent vaccines
SHC survey results
Several barriers still exist
Barrier(%)
Greatest Concern (%)
Out-of-pocket costs for children to receive privately purchased HPV vaccine 79 51
Upfront costs of ordering and stocking the privately purchased HPV vaccine 67 30
Inadequate reimbursement by insurance companies for providing privately purchased HPV vaccine
42 18
Out-of-pocket costs for children to receive VFC supplied HPV vaccine 33 21
Students not returning the consent form 76 21
Obtaining records of prior immunizations 61 6
School administrators’ concern that providing HPV vaccine will take students away from classes
21 0
Cost
SHC survey results
82% of school health centers interested in interventions but many had limited staff
Most do-able interventions: student incentives for getting adolescent vaccines printing and mailing letters endorsing adolescent vaccines
Interventions rated most likely to work: student incentives for getting adolescent vaccines parent reminders for adolescent vaccines asking parents for consent while they are at school
Background and Framework
School Health Center Survey
Intervention Planning & Partnerships
Intervention
Creating an action plan
Demonstration project…
Cost barrier…
Consent barrier…
Bringing on partners
School health centers with Interest in
partnership Proximity to CCFNC
office Strong leadership
Rockingham County Student Health
Centers
Designing an intervention
Create materials that make the consent process easier for parents
Make sure the materials Are easy to use (especially consent form) Promote adolescent vaccines Highlight convenience of SHCs Use voices and images of parents and
students
Testing materials
9 parents 4 Rockingham3 Durham2 other counties
12 SHC staff7 directors or managers of SHCs
5 nurses and other clinical staff
Cognitive interviews Online survey
Background and Framework
School Health Center Survey
Intervention Planning & Partnerships
Intervention
Other elements
STAMPED and addressed return envelope
Movie ticket drawing
Other incentives
Implementation
CCFNC printed and prepared packets
Implementation
Rockingham SHCs took the lead from
there
Distribution and mailing of packets
Reminder auto-calls
Implementation
Surprising amount of phone calls regarding cost of vaccines
Additional letter sent to parents with private insurance
Materials needed to make costs clearer
Evaluation: Process
CCFNC tracking hours, costs, time
Rockingham staff tracking Packet and letter distribution Data from received consent forms Costs Hours
Bi-weekly partner meetings
Evaluation: Process
Phone interviews with parents are underway
Evaluation: Outcome
Tracking Doses
Comparison sites
Results forthcoming
Challenges
Phone calls from parents Cost Vaccine history
Time
Ordering vaccines
Incidental change in Health Choice insurance from BC/BS to Medicaid caused confusion
Successes
A good amount of forms have come back to SHCs
Children are getting vaccinated
Strong partnership
Parents are asking questions and getting educated
Next Steps
Results and materials will be available next year
Implementation Guide
Research-to-Practice Report
Next Steps
We hope materials will be useful for… School health centers Mass vaccination clinics Future partnerships
Contact us if you are interested! [email protected]
Acknowledgements
Rockingham County Student Health Centers staff
Rockingham County parents and students
SHC staff who took time out of their busy schedules to participate in interviews
School Health Center Adolescent Immunization Advisory Committee Amanda Dayton (NC Division of Public Health) Cathy DeMason (School health center representative) Anne Derouin (School health center representative) Dan Garsen-Angert (NC Division of Public Health) Chris Minard (NC Department of Public Instruction) Connie Parker (North Carolina Community School Health Alliance) Carol Tyson (NC Division of Public Health)
CCFNC staff and students