NIAM Blog Series 2017: Increasing Immunization through School-Located Clinics

Throughout the month of August, NACCHO’s National Immunization Awareness Month (NIAM) Blog Series highlights the importance of immunizations across the lifespan. In this week’s post, we sat down with Denver Public Health’s (DPH’s) Alejandra Santisteban, MPH, ‎Program Assistant for the Immunizations Program, to discuss DPH’s in-school immunization program.

Tell us about your in-school immunization program – what sparked the need to establish such a program and how did you identify what schools should participate?

Denver’s In-School Immunization Program (ISIP) began in 2009 when Denver Public Health (DPH) received two grants from the Centers from Disease Control and Prevention (CDC) to assess the feasibility and cost of providing vaccines in schools and billing third-party payers for vaccinations. ISIP is a collaborative effort between DPH and Denver Public Schools (DPS). Since the completion of these grants in 2011, ISIP has continued to conduct school-located vaccine (SLV) clinics with support obtained through grant funding and billing.

The goal of ISIP is to provide required and recommended vaccines to children at select DPS elementary and middle schools to improve access and decrease noncompliance rates. Vaccines from the federal Vaccines for Children (VFC) program are used for eligible students such as those who are underinsured, uninsured, and covered by Medicaid. Third-party payers are billed for insured students; parents are not billed for services.

Schools are selected to participate in ISIP based on low compliance rates and school willingness to participate in this program. DPH and DPS nurse administration meet yearly to discuss schools with lower compliance and a general need for services to eliminate barriers to health services. Once schools agree to participate, we continue working with them as long as there is a need and they remain engaged and committed to making this program succeed.

How does offering immunizations in school-located vaccination (SLV) clinics help to increase the number of school-aged children you can reach? As a result, how have you seen immunization rates change in Denver’s schools?

Providing vaccines in alternative settings such as schools expands access to children who might not otherwise have the opportunity to be vaccinated, and offers a convenient option for parents to have their children get vaccinated without having to arrange for a healthcare provider visit and take time off of work or school. Providing this service has contributed to up to an 80% reduction in noncompliance at the participating schools. We often hear from parents that it’s a great option for their child’s follow-up doses of vaccines such as the HPV vaccine, or for their annual flu vaccine which may not have been available when they were at their doctor’s office for their back to school visit. By ensuring that students at these participating schools are vaccinated, we are contributing to the protection of the greater community against vaccine preventable diseases.

The concept of the “immunization neighborhood” is becoming increasingly popular. What role does the local health department play in creating immunization neighborhoods in Denver’s communities?

The immunization neighborhood aims to create a culture of collaboration using a network of vaccine partners, and the role of the local health departments is to connect these resources. By offering school-located vaccine clinics, we as the local health department can support a child’s primary care medical home to facilitate immunization and completion of vaccine series.

What partnerships have you established to help better implement the SLV clinics, and how has building these relationships enhanced the success of the in-school immunization program?

We have established a great partnership with Denver Public Schools and their nurse administration, as well as the school nurses. They are extremely committed to making sure their students are up-to-date with required and recommended vaccinations, and help to ensure that our school-located clinics run smoothly. A DPS paraprofessional assists in the coordination and data entry of the program to overcome Family Educational Rights and Privacy Act (FERPA) restrictions and facilitate information sharing between DPS and DPH.

What challenges did you face in establishing and implementing the in-school immunization program, and how did you overcome those obstacles?

Because of FERPA regulations, DPH is not allowed to review immunization records until receiving parental approval. To address this barrier, DPH funds a paraprofessional hired by the school district to support activities for this program. The paraprofessional has the ability to review immunization records and consents and be the liaison for this program. This paraprofessional works closely with the ISIP team to support all activities and ensure that clinics are conducted smoothly and assists with pre/post-clinical duties.

Minimal time for planning and implementing is required of the DPS school nurses for each of the clinics. That being said, having the school nurse and administration as an advocate for the program has proven success in participation. School staff and nurses have many other priorities on a day-to-day basis, so support is sometimes a challenge.

Another barrier we have faced is the printing cost of the consent forms. Because we are required to give informed consent, the consent packets contain vaccine information sheets of all vaccines we offer along with information about ISIP and the information we need to collect. As of now, we do not have a method of electronic consent, therefore printing costs of these consent packets are high. This is one challenge we have yet to overcome, but we are exploring the possibility of online consents to decrease this cost.

What recommendations do you have for other local health departments who want to use school-located vaccination clinics to increase immunization rates of school-aged children?

Denver Public Health is unique in that we are part of a large hospital system with the ability to bill both Medicaid and private insurances. We understand that not all health departments have this capability, so we recommend starting small; if a department has the ability to bill Medicaid, schools with a large amount of Medicaid insured students could be prioritized. Planning far in advance is crucial to establish the partnership between the health department, the school district, and school nurses. It takes a couple years to establish that relationship and trust within a school and its parents, but this program is viewed as a valuable resource to help eliminate barriers to vaccination and keep children healthy.

NACCHO is pleased to support local health departments in their participation of NIAM. Click here to find resources that can be utilized by your local health department and be sure to check out our previous posts in the NIAM Blog Series:

For more information about vaccines for teens and preteens, check out resources from the Centers for Disease Control and Prevention

About Kim Rodgers

Kim Rodgers serves as a Communications Specialist at NACCHO. Her work includes promoting local health departments' best practices, as well as partner tools and resources, in infectious disease and preparedness through NACCHO's communications channels, storytelling, and outreach to various audiences.

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