Improving School Entry Immunization Rates in a Rural New York County

Working with staff of the immunization program to examine the poor school entry immunization rates, the team drilled down to find the schools for which rates were the lowest and tried to determine some of the root causes by using brainstorming and a cause-and-effect diagram. The team then sought to verify these causes through parent surveys. The team developed a parent survey tool that gave several choices of reasons why immunizations might have been delayed, based on the probable root causes identified through brainstorming and root cause analysis, and for 1 month, the team gave the surveys to parents whose children’s immunizations were delayed and who were attending the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); the Immunization Clinic; the Healthy Families of Sullivan program; and the Community Health Worker program. This survey was designed to help the team understand the true reasons for delayed immunizations. Interestingly, the team assumed that transportation was a major issue for low-income parents because there is no public transportation in the county, but the team found that this was a problem for very few. The main reason parents did not take their children in for immunizations was because they did not have a primary care physician. The team reviewed the school immunization reports in detail and narrowed down and planned to implement the most intensive targeted interventions to the five schools (two public and three private) that had the lowest up-to-date immunization rates for kindergartners entering school. From one particularly cooperative public school, the team obtained names of kindergartners entering in the fall and provided the parents whose children needed immunizations with targeted health educational materials about the importance of immunizations and where to get them. An immunization staff member with a background in art developed colorful information packets, and advertising was aimed at parents of preschoolers attending kindergarten registration days. The school nurses were provided with sturdy folders containing critical information needed to support improved immunization rates for entering kindergartners. The team added three special immunization clinics advertised widely and marketed as “last-minute clinics” (one subsequently was cancelled because of the weather). A highlight of this project was new communication with schools in the county with a specific religious affiliation (three of the five targeted schools with the lowest immunization rates fell into this category). The school officials there were not open to the team's visits and calls, and by including a staff team member who belonged to the same religious affiliation and by engaging a similar partner from the New York State Department of Health to accompany the team member (after multiple calls attempting to schedule a visit), not only was the team successful in having an on-site meeting, but they also engaged the school officials and succeeded in gaining their full cooperation. During the grant period, the team had several calls with a QI coach, which resulted in a few helpful suggestions.

The team measured the impact by comparing the annual kindergarten entry immunization rates by school before and after the intervention from the New York State Department of Health. The team will continue to use this measure going forward. It is released annually.