INCREASING UPTAKE OF ADOLESCENT VACCINES IN NC SCHOOL HEALTH CENTERS

Ashley Leighton, MPHCervical Cancer-Free NC

Cathy DeMason, RN, BSNDirector, 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 FrameworkSchool Health Center SurveyIntervention Planning & PartnershipsIntervention

Background and FrameworkSchool Health Center SurveyIntervention Planning & PartnershipsIntervention

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 FrameworkSchool Health Center SurveyIntervention Planning & PartnershipsIntervention

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 existBarrier

(%)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 FrameworkSchool Health Center SurveyIntervention Planning & PartnershipsIntervention

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 FrameworkSchool Health Center SurveyIntervention Planning & PartnershipsIntervention

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! Info@ccfnc.org

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