WIC Immunization Screening and Referral

1
WIC Immunization Screening and Referral

• Staff Training Guide
• Developed by
• The National WIC-Immunization Workgroup
• USDA/Food and Nutrition Service
• CDC/National Immunization Program
• National WIC Association
• American Academy of Pediatrics
• Association of State and Territorial Health
  Officials
• Association of Immunization Managers
• Every Child By Two
• OCTOBER 2002

2
Training ObjectivesThis training will help you
to

• Understand how vaccines can help prevent
  life-threatening diseases
• Understand the recommended childhood immunization
  schedule
• Relate the importance of immunizations to keeping
  WIC infants/children healthy and to WIC program
  goals
• Understand the the new USDA Immunization
  Screening and Referral policy and identify policy
  requirements
• Screen immunization records using an easy tool
  Easy IZ Guide
• Talk to parents about their childs immunization
  status
• Determine effective ways to refer patients to
  immunization services

3
Module 1Communicable Diseases and Vaccines

• Why Immunize Infants and Children?

4
Not long ago, parents lived in fear of diseases
we can now prevent

• The vaccine became available in 1955 now no
  polio in the U.S.!
• Polio still exists in other parts of the world
  easily imported
• In 1916, polio killed 6,000 people paralyzed
  27,000

5
Measles

• Today, many do not know measles can be serious
• For every 1,000 infants/children who have
  measles
• 50 get pneumonia
• 1 gets brain inflammation
• 1 or 2 die
• During the U.S. outbreak in 1989-91 there were
• Almost 56,000 cases
• 123 deaths

6
Vaccines Prevent Serious Childhood Diseases

• Diphtheria
• Tetanus (lockjaw)
• Pertussis (whooping cough)
• Measles
• Mumps
• Rubella (German measles)

• Hib
• Pneumococcus
• Hepatitis B
• Hepatitis A
• Polio
• Varicella (chickenpox)

7
Even chickenpox is a serious illness

• Before the vaccine, almost everyone got
  chickenpox
• Six out of every 100,000 infants who get
  chickenpox die.

8
Vaccines Prevent Diseases that have no cure

• Some diseases prevented by vaccines cannot be
  treated when a person gets the disease
• Tetanus can be prevented by vaccine, but there is
  no medication that cures tetanus disease

9
We have (almost) forgotten some diseases like
diphtheria

• During the 1920s about 150,000 cases/year and
  15,000 deaths occurred
• Now in the U.S. a few cases occur, but there are
  outbreaks in countries of former Soviet Union

10
Complications from Hepatitis B infection can come
later in life

• Hepatitis B virus invades the liver causing
  cirrhosis and cancer
• Infected infants are at greatest risk for serious
  complications
• No cure
• In 1996, 4,000 to 5,000 deaths/year in US

11
Pertussis (whooping cough)

• After 1-2 weeks of cold symptoms, 1-6 weeks of
  coughing bouts
• Complications /1,000 cases
• Pneumonia 95
• Seizures 14
• Brain inflammation 2
• Death 2
• Hospitalization 320

12
All Preventable Diseases in Children are Serious

• Hib
• Pneumococcus
• Hepatitis B
• Hepatitis A
• Polio
• Varicella

• Diphtheria
• Tetanus (lockjaw)
• Pertussis (whooping cough)
• Measles
• Mumps
• Rubella (German measles)

13
Vaccines are Key to Prevention Measles,
1950-2000

• 1st Measles Vaccine
• Licensed in 1963

14
Why not wait?

• Infants and young children are very vulnerable to
  infectious diseases
• An outbreak can be anywhere.
• Disease is a plane ride away.
• If theres an outbreak, it may be too late.

15
You dont always know when a child has been
exposed to a disease. Protect them first
rather than wait!
16
Immunizations are one of the most important ways
to protect children!
17
Module 2Recommended Childhood Immunization
Schedule
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Vaccines that prevent disease

• Diphtheria
• Tetanus (lockjaw)
• Pertussis (whooping cough)
• Measles
• Mumps
• Rubella (German measles)

• Hib
• Pneumococcus
• Hepatitis B
• Hepatitis A
• Polio
• Varicella

19
Vaccines that prevent disease

• Diphtheria
• Tetanus (lockjaw)
• Pertussis (whooping cough)
• Measles
• Mumps
• Rubella (German measles)

• Hib
• Pneumococcus-PCV7
• Hepatitis B
• Hepatitis A
• Polio-IPV
• Varicella (chickenpox)

DTaP
MMR
20
Recommended Childhood Immunization
Schedule United States, 2002
preadolescent assessment
range of recommended ages
catch-up vaccination
Age
1 mo
2 mos
4 mos
4-6 yrs
6 mos
12 mos
15 mos
18 mos
24 mos
11-12 yrs
13-18 yrs
Vaccine
Birth
Hep B 1
only if mother HBsAg ( - )
Hep B series
Hepatitis B1
Hep B 2
Hep B 3
Diphtheria, Tetanus, Pertussis2
DTaP
DTaP
DTaP
DTaP
Td
DTaP
Haemophilus influenzae Type b3
Hib
Hib
Hib
Hib
Inactivated Polio4
IPV
IPV
IPV
IPV
Measles, Mumps, Rubella5
MMR 1
MMR 2
MMR 2
Varicella6
Varicella
Varicella
Pneumococcal7
PCV
PCV
PCV
PCV
PCV
PPV
Vaccines below this line are for selected
populations
Hepatitis A8
Hepatitis A series
Influenza9
Influenza (yearly)
This schedule indicates the recommended ages for
routine administration of currently licensed
childhood vaccines, as of December 1, 2001, for
children through age 18 years. Any dose not given
at the recommended age should be given at any
subsequent visit when indicated and feasible.
Indicates age groups that warrant special
effort to administer those vaccines not
previously given. Additional vaccines may be
licensed and recommended during the year.
Licensed combination vaccines may be used
whenever any components of the combination are
indicated and the vaccines other components are
not contraindicated. Providers should consult the
manufacturers' package inserts for detailed
recommendations.
21
Hepatitis B vaccine

• Dose 1 - Birth or up to 2 months
• Dose 2 - 1 to 2 months
• Dose 3 - 6 to 18 months
• Catch up as soon as possible.
• The series never needs to be restarted when
  there has been a long time between doses.

22
Recommended Childhood Immunization
Schedule United States, 2002
preadolescent assessment
range of recommended ages
catch-up vaccination
Age
1 mo
2 mos
4 mos
4-6 yrs
6 mos
12 mos
15 mos
18 mos
24 mos
11-12 yrs
13-18 yrs
Vaccine
Birth
Hep B 1
only if mother HBsAg ( - )
Hep B series
Hepatitis B1
Hep B 2
Hep B 3
Diphtheria, Tetanus, Pertussis2
DTaP
DTaP
DTaP
DTaP
Td
DTaP
Haemophilus influenzae Type b3
Hib
Hib
Hib
Hib
Inactivated Polio4
IPV
IPV
IPV
IPV
Measles, Mumps, Rubella5
MMR 1
MMR 2
MMR 2
Varicella6
Varicella
Varicella
Pneumococcal7
PCV
PCV
PCV
PCV
PCV
PPV
Vaccines below this line are for selected
populations
Hepatitis A8
Hepatitis A series
Influenza9
Influenza (yearly)
This schedule indicates the recommended ages for
routine administration of currently licensed
childhood vaccines, as of December 1, 2001, for
children through age 18 years. Any dose not given
at the recommended age should be given at any
subsequent visit when indicated and feasible.
Indicates age groups that warrant special
effort to administer those vaccines not
previously given. Additional vaccines may be
licensed and recommended during the year.
Licensed combination vaccines may be used
whenever any components of the combination are
indicated and the vaccines other components are
not contraindicated. Providers should consult the
manufacturers' package inserts for detailed
recommendations.
23
DTaP

• DTaP stands for
• Diphtheria, Tetanus, acellular Pertussis
• The first 4 doses are usually given at ages
• Dose 1 - 2 months
• Dose 2 - 4 months
• Dose 3 - 6 months
• Dose 4 - 15 to 18 months (or 12 months)
• The first booster is usually given before school
• when the child is 4-6 years of age.

24
Recommended Childhood Immunization
Schedule United States, 2002
preadolescent assessment
range of recommended ages
catch-up vaccination
Age
1 mo
2 mos
4 mos
4-6 yrs
6 mos
12 mos
15 mos
18 mos
24 mos
11-12 yrs
13-18 yrs
Vaccine
Birth
Hep B 1
only if mother HBsAg ( - )
Hep B series
Hepatitis B1
Hep B 2
Hep B 3
Diphtheria, Tetanus, Pertussis2
DTaP
DTaP
DTaP
DTaP
Td
DTaP
Haemophilus influenzae Type b3
Hib
Hib
Hib
Hib
Inactivated Polio4
IPV
IPV
IPV
IPV
Measles, Mumps, Rubella5
MMR 1
MMR 2
MMR 2
Varicella6
Varicella
Varicella
Pneumococcal7
PCV
PCV
PCV
PCV
PCV
PPV
Vaccines below this line are for selected
populations
Hepatitis A8
Hepatitis A series
Influenza9
Influenza (yearly)
This schedule indicates the recommended ages for
routine administration of currently licensed
childhood vaccines, as of December 1, 2001, for
children through age 18 years. Any dose not given
at the recommended age should be given at any
subsequent visit when indicated and feasible.
Indicates age groups that warrant special
effort to administer those vaccines not
previously given. Additional vaccines may be
licensed and recommended during the year.
Licensed combination vaccines may be used
whenever any components of the combination are
indicated and the vaccines other components are
not contraindicated. Providers should consult the
manufacturers' package inserts for detailed
recommendations.
25
Recommended Childhood Immunization
Schedule United States, 2002
preadolescent assessment
range of recommended ages
catch-up vaccination
Age
1 mo
2 mos
4 mos
4-6 yrs
6 mos
12 mos
15 mos
18 mos
24 mos
11-12 yrs
13-18 yrs
Vaccine
Birth
Hep B 1
only if mother HBsAg ( - )
Hep B series
Hepatitis B1
Hep B 2
Hep B 3
Diphtheria, Tetanus, Pertussis2
DTaP
DTaP
DTaP
DTaP
Td
DTaP
Haemophilus influenzae Type b3
Hib
Hib
Hib
Hib
Inactivated Polio4
IPV
IPV
IPV
IPV
Measles, Mumps, Rubella5
MMR 1
MMR 2
MMR 2
Varicella6
Varicella
Varicella
Pneumococcal7
PCV
PCV
PCV
PCV
PCV
PPV
Vaccines below this line are for selected
populations
Hepatitis A8
Hepatitis A series
Influenza9
Influenza (yearly)
This schedule indicates the recommended ages for
routine administration of currently licensed
childhood vaccines, as of December 1, 2001, for
children through age 18 years. Any dose not given
at the recommended age should be given at any
subsequent visit when indicated and feasible.
Indicates age groups that warrant special
effort to administer those vaccines not
previously given. Additional vaccines may be
licensed and recommended during the year.
Licensed combination vaccines may be used
whenever any components of the combination are
indicated and the vaccines other components are
not contraindicated. Providers should consult the
manufacturers' package inserts for detailed
recommendations.
26
Recommended Childhood Immunization
Schedule United States, 2002
preadolescent assessment
range of recommended ages
catch-up vaccination
Age
1 mo
2 mos
4 mos
4-6 yrs
6 mos
12 mos
15 mos
18 mos
24 mos
11-12 yrs
13-18 yrs
Vaccine
Birth
Hep B 1
only if mother HBsAg ( - )
Hep B series
Hepatitis B1
Hep B 2
Hep B 3
Diphtheria, Tetanus, Pertussis2
DTaP
DTaP
DTaP
DTaP
Td
DTaP
Haemophilus influenzae Type b3
Hib
Hib
Hib
Hib
Inactivated Polio4
IPV
IPV
IPV
IPV
Measles, Mumps, Rubella5
MMR 1
MMR 2
MMR 2
Varicella6
Varicella
Varicella
Pneumococcal7
PCV
PCV
PCV
PCV
PCV
PPV
Vaccines below this line are for selected
populations
Hepatitis A8
Hepatitis A series
Influenza9
Influenza (yearly)
This schedule indicates the recommended ages for
routine administration of currently licensed
childhood vaccines, as of December 1, 2001, for
children through age 18 years. Any dose not given
at the recommended age should be given at any
subsequent visit when indicated and feasible.
Indicates age groups that warrant special
effort to administer those vaccines not
previously given. Additional vaccines may be
licensed and recommended during the year.
Licensed combination vaccines may be used
whenever any components of the combination are
indicated and the vaccines other components are
not contraindicated. Providers should consult the
manufacturers' package inserts for detailed
recommendations.
27
Recommended Childhood Immunization
Schedule United States, 2002
preadolescent assessment
range of recommended ages
catch-up vaccination
Age
1 mo
2 mos
4 mos
4-6 yrs
6 mos
12 mos
15 mos
18 mos
24 mos
11-12 yrs
13-18 yrs
Vaccine
Birth
Hep B 1
only if mother HBsAg ( - )
Hep B series
Hepatitis B1
Hep B 2
Hep B 3
Diphtheria, Tetanus, Pertussis2
DTaP
DTaP
DTaP
DTaP
Td
DTaP
Haemophilus influenzae Type b3
Hib
Hib
Hib
Hib
Inactivated Polio4
IPV
IPV
IPV
IPV
Measles, Mumps, Rubella5
MMR 1
MMR 2
MMR 2
Varicella6
Varicella
Varicella
Pneumococcal7
PCV
PCV
PCV
PCV
PCV
PPV
Vaccines below this line are for selected
populations
Hepatitis A8
Hepatitis A series
Influenza9
Influenza (yearly)
This schedule indicates the recommended ages for
routine administration of currently licensed
childhood vaccines, as of December 1, 2001, for
children through age 18 years. Any dose not given
at the recommended age should be given at any
subsequent visit when indicated and feasible.
Indicates age groups that warrant special
effort to administer those vaccines not
previously given. Additional vaccines may be
licensed and recommended during the year.
Licensed combination vaccines may be used
whenever any components of the combination are
indicated and the vaccines other components are
not contraindicated. Providers should consult the
manufacturers' package inserts for detailed
recommendations.
28
Recommended Childhood Immunization
Schedule United States, 2002
preadolescent assessment
range of recommended ages
catch-up vaccination
Age
1 mo
2 mos
4 mos
4-6 yrs
6 mos
12 mos
15 mos
18 mos
24 mos
11-12 yrs
13-18 yrs
Vaccine
Birth
Hep B 1
only if mother HBsAg ( - )
Hep B series
Hepatitis B1
Hep B 2
Hep B 3
Diphtheria, Tetanus, Pertussis2
DTaP
DTaP
DTaP
DTaP
Td
DTaP
Haemophilus influenzae Type b3
Hib
Hib
Hib
Hib
Inactivated Polio4
IPV
IPV
IPV
IPV
Measles, Mumps, Rubella5
MMR 1
MMR 2
MMR 2
Varicella6
Varicella
Varicella
Pneumococcal7
PCV
PCV
PCV
PCV
PCV
PPV
Vaccines below this line are for selected
populations
Hepatitis A8
Hepatitis A series
Influenza9
Influenza (yearly)
This schedule indicates the recommended ages for
routine administration of currently licensed
childhood vaccines, as of December 1, 2001, for
children through age 18 years. Any dose not given
at the recommended age should be given at any
subsequent visit when indicated and feasible.
Indicates age groups that warrant special
effort to administer those vaccines not
previously given. Additional vaccines may be
licensed and recommended during the year.
Licensed combination vaccines may be used
whenever any components of the combination are
indicated and the vaccines other components are
not contraindicated. Providers should consult the
manufacturers' package inserts for detailed
recommendations.
29
Recommended Childhood Immunization
Schedule United States, 2002
preadolescent assessment
range of recommended ages
catch-up vaccination
Age
1 mo
2 mos
4 mos
4-6 yrs
6 mos
12 mos
15 mos
18 mos
24 mos
11-12 yrs
13-18 yrs
Vaccine
Birth
Hep B 1
only if mother HBsAg ( - )
Hep B series
Hepatitis B1
Hep B 2
Hep B 3
Diphtheria, Tetanus, Pertussis2
DTaP
DTaP
DTaP
DTaP
Td
DTaP
Haemophilus influenzae Type b3
Hib
Hib
Hib
Hib
Inactivated Polio4
IPV
IPV
IPV
IPV
Measles, Mumps, Rubella5
MMR 1
MMR 2
MMR 2
Varicella6
Varicella
Varicella
Pneumococcal7
PCV
PCV
PCV
PCV
PCV
PPV
Vaccines below this line are for selected
populations
Hepatitis A8
Hepatitis A series
Influenza9
Influenza (yearly)
This schedule indicates the recommended ages for
routine administration of currently licensed
childhood vaccines, as of December 1, 2001, for
children through age 18 years. Any dose not given
at the recommended age should be given at any
subsequent visit when indicated and feasible.
Indicates age groups that warrant special
effort to administer those vaccines not
previously given. Additional vaccines may be
licensed and recommended during the year.
Licensed combination vaccines may be used
whenever any components of the combination are
indicated and the vaccines other components are
not contraindicated. Providers should consult the
manufacturers' package inserts for detailed
recommendations.
30
Recommended Childhood Immunization
Schedule United States, 2002
preadolescent assessment
range of recommended ages
catch-up vaccination
Age
1 mo
2 mos
4 mos
4-6 yrs
6 mos
12 mos
15 mos
18 mos
24 mos
11-12 yrs
13-18 yrs
Vaccine
Birth
Hep B 1
only if mother HBsAg ( - )
Hep B series
Hepatitis B1
Hep B 2
Hep B 3
Diphtheria, Tetanus, Pertussis2
DTaP
DTaP
DTaP
DTaP
Td
DTaP
Haemophilus influenzae Type b3
Hib
Hib
Hib
Hib
Inactivated Polio4
IPV
IPV
IPV
IPV
Measles, Mumps, Rubella5
MMR 1
MMR 2
MMR 2
Varicella6
Varicella
Varicella
Pneumococcal7
PCV
PCV
PCV
PCV
PCV
PPV
Vaccines below this line are for selected
populations
Hepatitis A8
Hepatitis A series
Influenza9
Influenza (yearly)
This schedule indicates the recommended ages for
routine administration of currently licensed
childhood vaccines, as of December 1, 2001, for
children through age 18 years. Any dose not given
at the recommended age should be given at any
subsequent visit when indicated and feasible.
Indicates age groups that warrant special
effort to administer those vaccines not
previously given. Additional vaccines may be
licensed and recommended during the year.
Licensed combination vaccines may be used
whenever any components of the combination are
indicated and the vaccines other components are
not contraindicated. Providers should consult the
manufacturers' package inserts for detailed
recommendations.
31
Module 3Facts about Vaccines Answers to
Common Vaccine Questions
32
Everyone should know key vaccine information!
33

• Vaccines are one of the most important ways to
  protect children!

34
Vaccines are safe

• Many billion vaccinations have been given safely
• Every vaccine that is made meets strict safety
  requirements.

35
Disease risks outweigh Vaccine risks

• Vaccines have common side effects (such as fever
  or soreness at the injection site). These are
  mild.
• Vaccines can have more severe side effects (such
  as an allergic reaction). These are rare.
• The potential harm from the diseases far
  outweighs the potential for vaccine side effects

36
Waiting can be Risky

• Vaccinate early!
• You never know when an exposure or outbreak may
  occur
• Once an outbreak has been identified, it may be
  too late

37
Not vaccinating is risky

• The decision not to vaccinate is
• a choice to remain at risk for
• disease

38
Do vaccines overload the immune system?

• Infants/children are exposed to germs every day.
• The number of germs they get from vaccines is
  small compared with what they get from their
  daily environment.

39
Does MMR vaccine cause autism?
of Children receiving MMR vaccine Caseload of
autistic children by year of birth, California,
1980-94

• The apparent rise in autism didnt happen
  with the increase of MMR.

Dales, et al, JAMA, Vol 285, No. 9, March 2001
40
Some parents may have questions about vaccines
41
Module 4WICs Role Helping Kids Stay Healthy

• Did you know that
• Many low-income infants/children dont receive
  their immunizations on time or at all?

42
WICs Role Helping Kids Stay Healthy

• WIC is an adjunct to health care
• WIC supports immunization services
• WIC refers and educates
• WIC helps parents understand their childs need
  for immunizations
• WIC shares information on where infants/children
  can get their immunizations

43
WICs Role Helping Kids Stay Healthy

• Infants/children who are up to date on their
  shots are less likely to suffer from other health
  problems like anemia and lead toxicity
• Good nutrition and immunizations go hand in hand
  to help WIC children stay healthy

44
Breastfeeding and Immunizations

• Some interesting facts
• Breastfeeding babies first immunization
• Mothers who intend to breastfeed are more likely
  to get infant immunized
• Breastfed babies have better responses to
  vaccines
• Breastfeeding babies handle shots better while
  breastfeeding (less pain)

45
Breastfeeding and Immunizations

• WIC helps babies get their first immunization
  breastfeeding
• WIC can help babies further strengthen their
  immunity against disease by helping them get
  properly vaccinated

46
Breastfeeding and Immunizations

• WIC helps mom breastfeed. WIC helps kids get
  immunized. What a great combination!

47
Module 5New WIC Immunization Screening and
Referral Policy
48
Overview of December 2000 White House Memorandum

• Low-income infants/children are not as well
  immunized as higher income infants/children
• WIC has access to the largest number of
  low-income infants/children and holds great
  potential to improve immunization rates
• Immunization screening and referral should become
  a standard part of WIC certification. Screening
  should be conducted using a documented record of
  immunizations.
• WIC benefits are never to be denied for lack of
  immunization records or shots.

49
Overview of USDA Policy Memorandum (2001)

• Outlined a minimum immunization screening and
  referral requirement in WIC
• To be implemented in all WIC agencies by March 1,
  2003

50
WIC Minimum Requirement for Immunization
Screening and Referral

• Advise parents of any infant or child under two
  years of age to bring immunization records to
  certification
• Screen using a documented immunization record,
  rather than parents memory or verbal assurance
• Determine the childs age, then count the number
  of doses of DTaP vaccines the child has received
• Provide information on recommended immunization
  schedule
• Provide referral if needed
• Encourage parent to bring the immunization record
  to next certification visit

51
Diagram of the WIC Minimum Requirement For
Immunization Screening and Referral
52
Module 6Using Documented Immunization Records
for Screening and Referral in WIC
53
What is a documented immunization record?

• It is a record that has details of each
  immunization dose given
• Acceptable records are
• A personal immunization record carried by the
  parent that has been prepared by the provider
• A printout from an official source such as a
  registry, the health department, doctors office
  or clinic

54
Why is it important to use a documented
immunization record?

• A documented record of shots is more accurate
  than the parents memory.
• When asked, parents typically overestimate their
  childs immunization status

55
Advise parents to bring immunization records

• Make certification appointment
• Instruct parent/caregiver to bring the
  immunization record
• Explain importance

56
WIC benefits are not tied to immunization records

• Reassure parents that immunization records are
  requested as part of the WIC certification and
  health screening process, but are not required to
  obtain WIC benefits

57
Sample Script

• Please bring Miguels shot record to your
• appointment. Immunization records are
• not required to obtain WIC benefits, but
• they are an important part of the health
• screening WIC provides. We want to
• help you make sure your child is up to
• date on shots.

58
Help Parents Remember to Bring Record

• Helpful Tips
• Phone call indicating time of appointment and
  reminder to bring the shot record.
• Postcard indicating time of appointment and
  reminder to bring the shot record.
• Promotional posters in the waiting room reminding
  parents to bring shot record to WIC appointments.

59
Thank parent each time they bring record!
60
Module 7Counting DTaP Vaccinations

• What are the advantages of counting
• DTaP doses?
• How do I count DTaP doses?

61
What is a DTaP vaccine?

• The vaccine contains a combination of
• D Diphtheria Toxoid
• T Tetanus (Lockjaw) Toxoid
• aP Pertussis Vaccine
• (Whooping cough)

62
Why was DTaP selected?

• DTaP was selected to screen the
• immunization status of WIC infants/children
• under two years of age because
• It is a good reflection of the up-to-date status
  of the childs other immunizations
• It is easier and quicker than counting the doses
  of all 11 vaccines

63
Up-To-Date Means.
64
Personal / Hand Held Records
65
Variations on DTaP Vaccine

• DTaP (Diphtheria, Tetanus, acellular Pertussis)
• DTP (Diphtheria, Tetanus, Pertussis)
• DT (Pediatric Diphtheria Tetanus)
• DTaP/Hib (Diphtheria, Tetanus, acellular
  Pertussis Hib)
• Td (Adult Tetanus Diphtheria)

66
Close up View of an Infant/Childs Record
67
Module 8Talking to parents about their childs
immunization status
68
Congratulate Parent

• Sample Script
• Youre doing a great job of protecting your
• baby/child against very serious diseases like
• whooping cough. Please remember that there
• may be other vaccines, besides the one
• protecting him/her against Whooping Cough
• that your baby/child may not yet have
• received. Congratulations! Keep up the good
• work and remember to get each immunization on
• time.

69
Urgency MessageSample script

• Your baby/child has not received all the
  shots he/she needs to be protected from
  Whooping Cough and other very serious, and
  sometimes deadly diseases. You need to contact
  your doctor right away to schedule an appointment
  for immunizations.

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Providing Education

• Provide copy of recommended immunization schedule
  
• Provide other educational materials if desired

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Module 9Making Effective Referrals

• Referring WIC participants for
• Immunizations

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Barriers to Childhood Immunizations

• No health care provider
• Cost (money)
• Transportation (no car or bus)
• Waiting time for appointment
• Waiting time in office
• Not knowing what shots are due or when they are
  due

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Effective referrals

• Identify providers who offer immunizations
• Establish relationships with providers
• Help clients choose a provider

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Identify providers who offer immunizations

• With assistance from Immunization program,
• develop list of
• Private providers (pediatricians/family practice
  doctors)
• Walk-in clinics
• Appointment only clinics
• Mobile vans
• On-site immunization services

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Medical Home

• Why important?
• Comprehensive care in one location
• Child and family develop relationship with
  physician
• Better follow-up

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Vaccines for Children (VFC) Program

• Provides no-cost vaccines for children if they
  are at least one of the following
• Medicaid eligible
• Without health insurance or under-insured
• American Indian or Alaska Native
• Allows infants/children to receive immunizations
  at their medical home

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Establish Relationships

• Establish relationships with local providers,
  especially office staff
• Discuss appointment procedures and obtain other
  necessary information

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Be Specific

• Provide address, phone number, days/hours open
• Tell parent what to expect
• requires well child exam?
• has bilingual staff?
• appointment only?

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Follow-up with WIC parent if possible

• Ask if child received shots
• If no, find out if there was a barrier.
• Ask for assistance from immunization staff at
  local health department

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Help problem-solve

• Share what clients are telling you about barriers
  encountered
• Let the immunization program know about the
  barriers that WIC clients are facing.

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Diagram of the WIC Minimum Requirement For
Immunization Screening and Referral
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Module 10Hands-On Practice

• Screening Immunization Records and
• Comparing to the Recommended
• DTaP Schedule

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Hands-On Practice

• During the practice use the Easy IZ Tool or an
  Immunization Schedule
• Compare an immunization record to the recommended
  Easy IZ Tool or schedule
• Determine if the infant/child is likely to be
  underimmunized.

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Easy IZ Tool

• 1. Ask for the infant/childs immunization
  record.
• 2. What is the age of the infant/child in months?
• 3. Count the number of entries in the DTaP, DTP,
  DT and DTaP/Hib sections on the infant/childs
  immunization record.
• 4. Look at the DTaP doses column of the Easy IZ
  tool
• 5. Does the infant/child have all of the doses
  due now for his or her age?
• 6. Look at the Action column and follow the
  actions described on the back side of the form.

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Back of Easy IZ Tool

• Urgency Message
• Congratulate Parent
• Refer for Immunizations
• Remind parent to bring immunization record to WIC
  visits
• Provide immunization schedule to parent

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Example One of an Infant/Childs Record
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1 - Close up view of Infant/Childs record
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Example Two of an Infant/Childs Record
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2 - Close up view of Infant/Childs record
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Module 11Hands-On Practice

• What To Do When
• Situations and Possible Responses

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What To Do WhenParent forgets to bring record

• Educate about importance
• Encourage to bring next time
• Provide immunization schedule
• Provide referral

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When parent forgets to bring record

• Sample Script
• The WIC program is required to screen
• immunization records for all infants/children
  under
• age two at WIC certifications. Vaccines can help
  
• prevent serious diseases. We want to make sure
• your child is up to date. Please bring your
  childs
• shot record to your next WIC appointment.

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Important Reminder

• WIC benefits are never to be denied for lack of
  immunization records or shots.

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What To Do WhenParent cannot find record

• Educate about importance
• Encourage parent to talk to provider
• Provide immunization schedule
• Provide referral

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Sample Script

• It is important to have a personal record of
  your child's vaccinations. If you don't have a
  record, ask your child's health care provider to
  give you one. Bring this record with you every
  time you seek medical care for your child. Make
  sure your health care provider records all your
  child's vaccinations on the record. Your child
  will need it to enter daycare, kindergarten,
  junior high, etc.

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What To Do WhenParent skips WIC appointment
because of no IZ record

• Encourage parent to always come to her scheduled
  appointments even if she cant locate the
  immunization record.
• Assure her that WIC benefits will never be denied
  for lack of immunization records.

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What To Do WhenParent brings multiple records

• Encourage her to talk to her provider about
  consolidating the records onto one.
• Provide referral

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What To Do WhenRecord lists incomplete dates

• Screen record for appropriate number of DTaPs
• Encourage parent to review record with health
  care provider

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What To Do WhenEntries are hard to read

• Encourage parent to talk to provider
• Do not screen record
• Make referral

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What To Do WhenParent does not want WIC to
screen childs record

• Educate about importance
• Provide referral
• Provide appropriate materials

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What To Do WhenRecords are from another country

• Encourage parent to talk to childs health care
  provider.
• Do not screen record if hard to interpret.
• Provide referral.

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Congratulations!

• Youve completed the immunization screening and
  referral training.

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Thank you for all you do for WIC participants

• We appreciate your hard work and dedication to
  the infants and young children served by WIC.
• Your efforts will help improve immunization
  rates and keep kids healthy.

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