Transcript Slide 1
INCREASING UPTAKE OF
ADOLESCENT VACCINES IN
NC SCHOOL HEALTH CENTERS
Ashley Leighton, MPH
Cervical Cancer-Free NC
Rockingham County
Student Health Centers
Cathy DeMason, RN, BSN
Director, Rockingham County Student Health Centers
Conflict of Interest Statement
CCFNC is funded by an
unrestricted educational grant
from GlaxoSmithKline.
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
Carolina Framework
The Carolina Framework identifies 4 main causes
of cervical cancer deaths:
HPV infection
•Lack of screening
•Screening errors
•Not receiving follow-up care
•
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 consent
while they are at school
42%
Printing and mailing letter
endorsing adolescent vaccines
82%
Parent reminders that children
are due for adolescent vaccines
SHC survey results
Several barriers still exist
Barrier
Greatest
(%)
Concern (%)
Cost
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
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
Strong
to CCFNC office
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
Cognitive interviews
9 parents
4
Rockingham
3 Durham
2 other counties
Online survey
12 SHC staff
7
directors or
managers of
SHCs
5
nurses and
other clinical staff
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