Aurora Firefighters Shots for Tots

State: CO Type: Model Practice Year: 2004

The Colorado Children's Immunization Coalition (CCIC) was funded by the Colorado Trust to develop immunization projects in five local areas of need. The Tri-County Health Department was selected as the lead agency for the local project in Aurora, Colorado. A local area advisory board was formed to look at the issues that impact under-immunization in the Aurora area and to develop projects that might positively impact immunization rates. The Aurora Firefighters Shots for Tots Clinic (AFSFT) is a joint effort between TCHD, the Aurora Fire Department (AFD) and CCIC. Colorado as a state has a low immunization up-to-date rate. This clinic targets two zip codes within Aurora that were identified as having up-to-date rates that are lower than the state, as identified in a retrospective study of school-aged children. The clinic is held one Saturday per month, and during 2003 it served 934 children. The key elements that would be needed to replicate this clinic would be a strong partnership between a local health department and a fire department or agency that employs trained paramedics. The state immunization coalition was instrumental in bringing the agencies together, and takes responsibility for promotion of the clinic. The primary goal of this clinic is to make immunizations more available to parents in an area where children have been identified as lacking needed immunizations. 2006 Update: Aurora Firefighters Shots for Tots The clinic that was created as a partnership between Tri-County Health Department (TCHD), the Aurora Fire Department (AFD), and the Colorado Children’s Immunization Coalition (CCIC) continues to be a strong collaborative effort. In addition to the original partners, members of two Rotary clubs in the vicinity of the clinic have also joined to take over some of the duties that were originally provided by CCIC. Once a month, every month since September of 2002 we have held a Saturday immunization clinic at the fire station location. During the period from 9/14/02 through 2/11/06 we have given over 15,000 immunizations to almost 6100 children. Of the children seen by this clinic, data continues to show that only 8-10% of them have a medical home or health care provider at the time they are seen in our clinic. This clinic continues to meet a community need for accessible, low-cost immunizations.
Immunization rates for children in Colorado have been low based on the National Immunization Survey data. The AFSFT clinic was created to provide immunizations in a way that addresses some of the barriers that parents face in immunizing their children. The clinic is held once a month on a Saturday, to help parents who are unable to leave work during the week. The clinic is held at a fire station in the center of two zip codes that have been identified as having a high number of low-income families, and a lower UTD rate than the state. 2001-2002 school retrospective study of rates for Aurora children in the 80010 and 80011 zip codes at 24 months of age were 51.6% and 54.9%, which was 12% lower than the state at that time. This clinic makes immunizations accessible for families with poor access to transportation, and those who are uncomfortable in a more traditional health care setting. TCHD brings VFC/317 vaccine and is able to offer it to families at low or no cost to address the cost barrier.
Agency Community RolesThis clinic is unique for TCHD in that it has created a strong partnership and allowed TCHD to provide immunizations for more children using less staff. The AFD participates in this clinic as part of their mission of community service, and to offer their staff opportunities to interact with children in situations that are not emergencies. TCHD provides training for the paramedics that work at this clinic so that they understand the vaccines and the diseases they prevent, and learn to give intramuscular and subcutaneous injections to children. The health department staff reads the immunization records, decides what vaccines each child needs, screens for contraindications, and counsels parents including after-care instructions. In addition to providing an opportunity for staff to work in this collaborative way, working together has given both the TCHD and AFD staff a better understanding of agency roles and expertise. This is helpful as they train staff in emergency preparedness. The Aurora CCIC advisory board, which includes the health department, local physicians, and representation from the local hospital and community health center, continues to review data collected at the clinics and to oversee this collaboration and the activities of the clinic.  Costs and ExpendituresCosts for the clinic were initially covered by a best practices grant from the Colorado Department of Public Health and Environment (CDPHE). This covered the costs of the CCIC staff time for development of materials and organizational details. TCHD and AFD staff the clinic as part of the routine activities for each agency, so no additional costs for staff are counted for either agency. TCHD provides all clinical supplies, and collects an administration fee from families who are able to pay. Partial payments are also accepted. Ongoing costs for the clinic cover CCIC staff time for one Saturday per month, and the cost of the lunch that is provided for all clinic staff. Average cost for each clinic is $300 per month.  ImplementationSix months prior to the opening of the clinic, the idea was developed, and CCIC staff approached the health department and the fire department for participation. The fire department obtained a waiver that would allow them to give immunizations since it is not in their routine scope of practice in Colorado. A clinic name was chosen, and dates were set. Three months prior to the opening clinic, meetings were held biweekly with all three partners to decide on logistics and responsibilities of each partner. Training materials were developed (health department staff provide training for paramedics that includes information about childhood diseases and vaccines, and administration techniques). Flyers and publicity materials were created and initial contacts were made with local media. CCIC staff began to look for donations for children attending the clinic. One month prior to the opening, the paramedics received training. Agencies arranged for staffing. CCIC distributed flyers to local pharmacies and community agencies. Two weeks prior, press releases were sent to local media, with follow-up calls. Donations were picked up. Staffing was confirmed, and clinic supplies were organized. Final meetings held between agencies.
PROCESS EVALUATION All tasks needed to produce an effective clinic were achieved. Clinic logistics have been refined over time, but the partner responsibilities assigned at the beginning have proved to be an effective division of responsibility. Current considerations include a new model of training (possibly a video or a presentation on the AFD website) to allow all paramedics to receive the basic immunization training. Ongoing meetings between clinic partners continue to be held every two to three months to ensure a solid partnership. OUTCOME EVALUATION The AF Shots for Tots clinic continues to serve an average of 70 clients per month, with some months considerably higher. During 10 of the 12 clinics in 2003, families were asked if they had a regular health care provider for their children. Only 21.5% reported that their child had a provider. A total of 430 children were seen in the first six months of the AF Shots for Tots (AFSFT) clinic. A random sample of 100 children was selected for evaluation. Beginning up-to-date (UTD) rates were determined by looking at these 100 children, and determining if they were coming on time for age appropriate immunizations, or if they were delayed in obtaining immunizations. Of the 100 children in the sample, 38 were coming for age appropriate immunizations and 62 were behind and coming late. Ending UTD rates were determined by looking at these 100 children at a point 9 months after their initial visit to the AFSFT clinic. Of the 100 children in the sample, 78 were UTD and 22 were not UTD. One additional variable was reviewed. Of the 100 children in the sample, 53 have had only one visit to the AFSFT clinic, and 47 have had two or more visits. Of the children with only one visit, 15 of them are still not UTD. UTD rates for children who came to the AFSFT clinic went from a pre-clinic rate of 38% UTD to a 9 months post clinic rate of 78% UTD, an increase of 105%.
SustainabilityThe clinic is sustainable through TCHD and AFD since it has been incorporated into the routine activities of each agency. However, without funding, volunteers might be recruited to replace the CCIC staff and lunch would no longer be provided. Key Elements ReplicationThe key elements that would be needed to replicate this clinic would be a strong partnership between a local health department and a fire department or agency that employs trained paramedics.