LPHA Collaboration with Public School District to Improve Student Immunization Rates

State: WI Type: Model Practice Year: 2008

Goal: Improve public school student immunization rates and compliance with State of Wisconsin Immunization Law through LPHA-School District Task Force's (i.e., MPS Imms Task Force) creation and development and implementation of interagency strategic plan and recommendations. Objectives: 1. Create fully functional interagency Immunization Task Force consisting of local public health agency (LPHA), State Public Health Agency, Public School District, Mayoral and County District Attorney representatives. 2. Improve student immunization recordkeeping through reconciliation of LPHA Immunization Registry with Public School District student database. 3. Align timeline of School District and District Attorney notification to parents of non-compliant students with current State Immunization Law provisions and requirements. 4. Clarify and improve School District policy between administration and school principals related to notification and enforcement of State Immunization Laws. 5. Conduct on-site LPHA immunization clinics at student open enrollment venues within the Public School District calendar. 6. Conduct joint LPHA and County District Attorney School visits and meetings with principals to assess and discuss barriers to compliance with State Immunization Law. 7 . Develop an LPHA and School District joint media campaign to build awareness on student immunization compliance. 8. Convene a summit of key stakeholder executives, including Mayor and State Health Officer, to endorse Task Force recommendations and strategic plan.
Immunization rates in urban public school district settings tend to lag suburban counterparts by as much as 15-30%. In the City of Milwaukee, Milwaukee Public School District student immunization rates were estimated to be 45% in 2006 as compared to 95% in surrounding suburban areas and 86% in the state overall. Low student immunization rates result in a disproportionate burden of student morbidity associated with vaccine-preventable diseases; vulnerability and substantial impact during outbreak situations (e.g., recent pertussis and mumps nation-wide outbreaks); lost school days; and economic impact on parents and guardians in term of lost workdays to ensure appropriate medical treatment and childcare. The creation of an interagency Immunization Task Force chaired by the Public School District and composed of key stakeholders was the first step in developing a cohesive and consensual strategy along with specific and time-based recommendations for improving public student immunization rates both short- and long-term. The School District provided the administrative support for the Task Force, which met monthly throughout the two school calendar years highlighted.
Agency Community RolesThe Immunization Task Force was chaired by the Milwaukee Public School District with representatives of the MHD, State Public Health Agency, County District Attorney, and City of Milwaukee Budget Office (representing the Mayor). The MHD provided key input and leadership in assessing best practices in other jurisdictions, identifying internal and external obstacles in current processes and systems, and providing logistical and personnel support for all on-site immunization open-enrollment and school clinics. The MHD was represented by three members to the Task Force, including nursing, epidemiological, and administrative/medical staff. The MHD coordinated public health input with the state public health agency and arranged for on-site school visits with the County District Attorney. Costs and Expenditures Start-up costs = $0. Implementation Costs = $0. In-kind costs = $1,000-$3,000 per on-site clinic; $1,000-$5,000 administrative staff time (Task Force Meetings, School site visits with District Attorney and Executive Summit) per year. ImplementationThe primary implementation strategy was the development of an interagency Task Force of key stakeholders that included the City of Milwaukee Health Department (MHD) as the primary LPHA, State Public Health Agency, Milwaukee County District Attorney, City of Milwaukee Mayors Office and Milwaukee Public School (MPS) District representatives. The Task Force, chaired by MPS, facilitated discussion and consensually identified and prioritized key challenges to achieving compliance with State Immunization law including technological reconciliation of State and LPHA Immunization Registry and School District databases to establish baseline compliance rates; lack of standardized policy between School District policy and individual school enforcement of student notification and exclusion criteria; and lack of School District compliance with State Immunization Law notification and enforcement timelines. The Task Force developed recommendations for presentation at a "Summit" to Executive leadership of each represented agency for review and concurrence. In addition, the MHD and MPS co-sponsored on-site immunization clinics during student open enrollment periods to stimulate parental awareness related to low student immunization rates and conducted numerous on-site school visits with the County District Attorney that involved meetings with individual school principals to better assess barriers to compliance with State Immunization Laws. Finally, a joint back-to-school media campaign was developed between the LPHA and School District to build awareness of student immunization compliance prior to the start of the school calendar year. All of the above activities occurred during and in preparation for the 2006-07 and 2007-08 school years.
15-20% cumulative increase in City of Milwaukee Public School District student immunization rates between 2006-07 and 2007-08 school years.
There appears to be sufficient stakeholder commitment to continue participation in the MPS Immunization Task Force and to expand the membership to include other agencies, such as managed healthcare, physician-based medical societies, members of the public (e.g., parents and teachers), and healthcare finance. The commitment of the key stakeholders was confirmed through the convening of an Executive Leadership Summit in 2008 to review Task Force's short- and long-term recommendations and to discuss progress to date and potential benchmarks in the future. Each key agency represented (LPHA, State Public Health, Public School District, Mayor's Office, and County District Attorney) concurred that resources would continue to be identified and leveraged in each respective organizations to ensure Task Force success in achieving recommendations set forth and further improving student immunization rates and compliance with minimum standards. The Task Force has since been charged with implementing short-term recommendations, evaluating implementation of strategies in achieving stated objectives, and providing a report to the executive group at a later date. The state public health agency has agreed to explore potential funding that could be used to conduct additional school immunization clinics, improve technological access by private healthcare and school staff to the State Immunization Registry, and broaden public media campaigns.