Improving the childhood immunisation uptake

1
Improving the childhood immunisation uptake

• Flintshire Local Health Board
• Clare Powell
• Leigh Pusey

2
The scale of the problem

• Flintshire was the worst performing LHB for all
  antigens in 2003
• MMR uptake 69

3
Assessing the situation

• Cross referenced Child Health data compared to
  Exeter target payments from the BSC
• Visited all GP practices completed a
  questionnaire and presented them with the data
• Health Visitors completed a questionnaire to
  identify problems they encountered.

4
Main factors affecting uptake in Flintshire

• Under reporting of immunisation event
• Build up of queues for immunisation appointments
• Some GP practices unaware that Child Health and
  BSC were not electronically linked to update
  demographic data
• Loss of faith in the Child Health System
• Unscheduled forms were not audited by Child
  Health
• Lack of opportunistic immunisation
• PCTs have different criteria for inclusion for
  COVER data. No longer contribute data to Wales
• Presumption that low uptake was the norm
• Parental refusal

5
Data quality and under reporting

• Failure to return immunisation forms at all
• Forms returned several weeks/months after the
  immunisation
• Forms completed incorrectly
• Multiple names on the immunisation sheet for
  different vaccinations forms kept until last name
  attended
• Opportunistic appointments unscheduled forms not
  completed
• Lack of understanding of the process

6
Solving the problems

• A concerted education programme to
• Help staff complete forms correctly,
• Ensure the forms are returned weekly
• Understand about the queue system
• Help staff understand the importance of Child
  Health

7
Other solutions

• Audit the scheduled immunisation green forms
• Set up additional sessions
• Check if no consent status is still valid at
  every opportunity - people change their minds
• Health visitors checking on the 8 month
  development form for immunisation status

8
What can you do?

• Notify child health or health visitor of new
  registrants/changes of address/deductions
• Get to know your Child Health Department
• Review your appointment set up with Child Health
• Audit accuracy of the data
• Know what your own uptake is per practice/per
  health visitor
• Send forms in a timely manner
• Health visitors check all development forms,
  follow up unimmunised children
• Encourage a team approach for opportunistic
  immunisation

9
Improve Data Quality

• Develop use of current information systems
• Identify key personnel to supply data
• Improve working relationship with Child Health
  Department
• Provide practice data to surgeries
• Produce target lists
• Record single antigen where known

10
Where are we now?
11
Consultation with service users

• We asked parents their views on the immunisation
  service they receive in Flintshire?
• Sessions conducted within mother and toddler /
  Surestart groups across Flintshire.

12
What parents said

• Discussion groups on MMR needed
• Increased flexibility re clinic times/settings
• Provide balanced information
• Information needed before MMR vaccine
  appointment, possibly at the 8 month contact with
  the Health Visitor
• Information good but could be simplified
• Waiting along time to go in for vaccine so
  appointment feels rushed
• Time needed to talk about the vaccines before
  appointment

13
Community initiatives

• Established networks with key partnership
  agencies.
• Examined the literature relating to effective
  initiatives.
• Identified projects

14
Editorials written for key publications

• Balanced articles informing parents about key
  facts.
• Editorials also written for
• Flintshire Local Voluntary Council
• Children's Information Bureau

15
Teddy Bear Randomised Control Trial

• Novel way of providing information to parents
  about the MMR vaccine.
• Collaboration with the National Public Health
  Service.
• Partnership working with Flintshire Health
  Visitors and Flintshire Child Health Department.

16
Peer led education Initiative

• HomeStart - Lay family workers.
• Whittaker, A 2002
• Lay workers for improving the uptake of
  childhood immunisation.
• SureStart- Community
• Mothers Programme.
• Johnson, Z et al 2000
• Community Mothers Programme- seven year
  random control trial.
• Volunteers provided with a
• resource pack and training
• programme.

17
Calendar to remind parents of the immunisation
schedule

• Calendar produced with the childhood immunisation
  schedule printed on the backboard to remind
  parents of when vaccines are due.
• Distributed via Surestart /Homestart health
  visitors and family support workers

18
Increasing the knowledge of the child care
workers of the future

• Provide annual sessions on childhood immunisation
  to the CACHE and BTEC students in child care at
  Deeside college.
• Students are keen to increase their knowledge in
  this area and evaluation of the sessions has been
  positive.

19
Improving information-developing strong links
with Flintshire library services.

• Developed partnership working with Flintshire
  library co-ordinator
• INITIATIVES
• MMR videos/posters now in
• all Flintshire libraries.
• Immunisation newsletter to
• be given out to parents with
• book bags.
• Recommended to library service
• that books should be available on
• immunisation within childcare section.

20
Community discussion/information sessions

• Parents are asking for more information and an
  opportunity to talk about the risks and benefits
  of immunisation, particularly the MMR vaccine.
• Sessions offered within
• SureStart facilities Buckley/Aston
• Homeless unit Flint
• Womens refugee
• Mother baby groups across Flintshire
• Community First groups Mold, Flint Holywell

21
Immunisation resource folder/posters

• Evidence based resource developed.
• Poster produced.
• Posters and folder delivered to all clinic/GP
  practices and pharmacies in Flintshire.

22
Taking the public health message to the community

• Health promotion stand taken to key community
  venues across Flintshire
• Mold Market
• Asda Queensferry
• Tesco Broughton
• Radio advert
• Poster displays and stickers in clinics /GP
  practices, local librarys

IMMUNISATION AWARENESS WEEK 20th - 24th June 2005
23
Improving PSB uptake in Flintshire

• Collaborated with local Surestart team, GP
  practice/School nurse Health visitor- session
  held in local primary school 21 PSBs outstanding
  17 children immunised at session.
• WHAT WORKED?

24
Improving PSB uptake in Flintshire

• Seven south Flintshire schools targeted
• S1 14 identified, 4 not reported to CHS 10
  outstanding 10 immunised.
• S2 33 identified, 16 not reported to CHS 17
  outstanding 8 immunised.
• S3 17 identified, 7 not reported to CHS 10
  outstanding one immunised, one Mother came for
  information.

25
FINAL THOUGHTS

• IMMUNISATIONS
• SAVE LIVES.
• DONT BE AFRAID
• TO TRY A NEW
• APPROACH
• BE POSITIVE.