Effectiveness of Community-based Strategies for Promoting Immunizations

1
Effectiveness of Community-based Strategies for
Promoting Immunizations

• Sally Findley, Martha Sanchez, Michelle Sajous,
  Letty Guzman, Matilde Irigoyen
• Northern Manhattan Start Right Coalition
• Columbia University

2
Our Challenge

• Immunization rates remain low, with practice
  assessment rates of 57.
• Many children start the immunization series on
  time, but then fail to complete the series.
• Efforts to improve immunizations solely through
  changes at the doctors office are not enough
  we must make changes in how families seek care
  and obtain immunizations.

3
Northern Manhattan Start Right Coalition
Background

• Community of Northern Manhattan includes Harlem
  and Washington Heights/Inwood
• Coalition of 23 community organizations, led by
  Mailman School of Public Health
• Supported by CDC as part of the Reach 2010 program

4
Northern Manhattan Start Right Coalition Goals

• Target Population Under-immunized children
  under age 3 (33 of the total cohort of 35,000)
• Goal To enroll and bring up-to-date 2,000
  children per year (UTD per 43133 series)

5
How We Integrated Immunization and Service
Activities

• Worked with ongoing coalitions of organizations
  committed to improving immunizations
• Reviewed regular service activities to identify
  strategies for integrating immunization outreach
• Identified five program areas where immunization
  outreach can be incorporated into regular work
• Developed a training program to enable staff to
  carry out this work

6
Start Rights Five Strategies

• Co-madre or peer-led parenting classes
• Child care providers
• WIC linkage
• Housing or tenants associations
• Facilitated Enrollment

7
Start Right Training Process

• Bilingual training manual
• Contains the topics for each session and
  supporting reference material
• In-house training
• Our own staff, complemented by New York City DOH
  health educators
• Convenient training sessions
• Training offered frequently and on-site to
  respond to staffing changes
• Pre- and post-test for each session
• Feedback and course evaluation after each session
• Periodic refreshers

8
Start Right Training Sessions

• Immunization 101 Introduction to childhood
  illnesses and immunizations
• Card Reading Immunization schedules and
  determining current status
• Parent Empowerment How to work with parents to
  keep kids up-to-date
• Implementation The five Start Right strategies
• Tracking our Work Follow-up and Evaluation

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Coalition Members Trained, n610
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Immunization 101 Post-Test Scores
(n98)
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Completion of Training

• Training certificate from Mailman School of
  Public Health
• Start Right Coalition T-shirt
• Start Right attache case

12
Feedback on the Training

• Because I have had the training I have been able
  to make sure my child is up-to-date and other
  participants children are up-to-date and can
  explain the importance of being up-to-date.
• The training has helped me in many ways, such as
  learning to read the immunization card. Also, the
  training gave me the information to help clarify
  the myths regarding illnesses and immunizations.

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Confidence from Training Pays Off

• Outreach workers have been able to organize
  events and enroll families.
• They are creating innovative ways of working with
  parents and integrating the immunization message
  into their regular work.
• They have the facts about diseases and they use
  them to convince parents to have their children
  vaccinated.

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How Start Right Outreach Workers Recruit Parents
(n38)
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Enrollment by Start Right Strategy





(n 1989)
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How Start Right Outreach Workers Empower Parents

• Parent empowerment sessions
• Individual
• Group
• Reminders When Next Shot Is Due
• Many informal reminders when ever parent is at
  program, phone calls, post cards, home visit, at
  program events

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Feedback from Parents

• The program made me more aware about my childs
  immunization and how important it is to have them
  done on time. My child has some of his shots,
  but the program help me to make and keep
  appointments for the rest of my childs shots.
• It helped me understand more about the shots. I
  liked most learning what the shots are for, what
  diseases they prevent. Before I did not know
  what the shots prevented and when to get them.

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Thanking Parents for Participation

• Enrollment gifts
• Personalized calendar with baby photo
• Milestone gifts (at 6 12 months)
• Completion certificate and gift
• Holiday parties and special events

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Impact on Immunization Status
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Conclusions

• Community social service organizations can
  integrate immunization outreach into regular
  program activities.
• Training has empowered community workers to be
  advocates for immunizations with parents.
• Tailoring the actual strategy elements to the
  program is key to effective outreach and
  follow-up.
• This integration has payoffs Parents are getting
  enrolled.