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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