Guide to Reaching and Engaging


BARNSTABLE COUNTY BOARD OF HEALTH



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BARNSTABLE COUNTY BOARD OF HEALTH

Immunization Equity TA FY14 Case Study

Goal

  • Educate adults about new and recommended vaccinations.

  • Raise awareness and increase immunization rates of Tdap in adults over 18.

Target Population

  • Adults 18 and older

  • First responders

Partners

  • Fire Training Academy

Activities

  • Reached out and provided Tdap to first responders (frequent contact with public).

  • Recommended and provided Tdap as a one-time dose in place of the regular tetanus shot for clients who came to the health department.

  • Promoted Tdap vaccination at the TB testing clinic at the fire department, and at the Blood-borne pathogens training in Cape Cod.

Progress/

Outcomes

  • More Cape Cod fire departments requested TB testing and Tdap immunizations for their employees and first responders.

Challenges
  • Often working as the only Public Health Nurse in the area.


  • Many primary care doctors “just don’t carry vaccines, or are not aware of the recommendation and don’t offer Tdap to their patients.”

Learning

  • Education about the value of Tdap is critical for increasing acceptance of Tdap, especially for those working with vulnerable populations, like children.

Recommendations from mentor

  • Work with school districts to ensure teachers working with children are up-to date with their immunizations.

  • Develop Public Safety Guidelines, which include immunizations.

Recommendations for TA

  • This is a good model. It was difficult to visualize at first but now I see how valuable it is to set goals and keep record of progress; and revisit our work to see what works and what doesn't.

PLAN, DO, STUDY, ACT

PLAN (the idea, a specific thing to address a specific issue)

  • Raise awareness and increase immunization rates of Tdap in adults 18 and older.

DO (list a specific activity "For 3 weeks we will…")

STUDY (Analyze what happened as a result of the activity, the "do")

  • Offer more education to increase acceptance of Tdap.

ACT (what you will adopt, adapt or abandon as a result of the “study”)

  • Continue promoting Tdap in place of the regular Tetanus shot

CHELSEA BOARD OF HEALTH

Immunization Equity TA FY14 Case Study

Goal

  • Increase Tdap and Shingles vaccination among seniors.

Target Population

  • Undocumented immigrants

  • Seniors 60 and older

Partners

  • Directors of the medical/hospital community who serve the immigrant community

Activities

  • Advertised at the senior center and adult practices; and OB and pediatric practices in the city.

  • Placed an ad in the senior newspaper.

  • Advertised and provided Tdap and Shingles vaccines at health fairs held in May and June.

Progress/Outcomes

  • Distributed vaccines at the health fair. Hoped to complete all available vaccine; unfortunately, the freezer broke down, the vaccine was destroyed and the program stopped.


Challenges

  • Vaccine is not sufficient or affordable for the large population of undocumented workers in the community.

  • Poor reimbursement rates of Commonwealth Medicine Insurance Company make it impossible for CBH to purchase vaccines.

  • The amount of paperwork needed for the Mass Health and Medicare application for reimbursement is a barrier to increasing vaccinations.

  • Slow response to Tdap among potential clients

  • Clients fear shots and vaccines.

Learning

  • Vaccine uptake was increased when doctors advised and referred patients.

Recommendations

  • Secure funding to repair or replace freezer.

  • Work with MDPH to streamline Medicare and Mass Health paperwork.

  • Enable use of tax ID numbers instead of one person’s SSAN on Medicare applications.

PLAN, DO, STUDY, ACT

PLAN (the idea, a specific thing to address a specific issue)

  • Promote and provide Tdap /Shingles vaccines among uninsured and underinsured seniors 60 years of age and over.

DO (list a specific activity "For 3 weeks we will…")


  • Partner with the medical/hospital community.

STUDY (Analyze what happened as a result of the activity, the "do")

  • Clients are more likely to accept vaccines when vaccines are referred by medical practitioners.

ACT (what you will adopt, adapt or abandon as a result of the “study”)

  • Work with the medical community to advise and refer clients to the BOH.

FRAMINGHAM BOARD OF HEALTH

Immunization Equity TA FY14 Case Study

Goal

  • Improve vaccine uptake of recommended immunizations among eligible residents. Focus on HPV vaccine beginning in February.

Target Population

  • Uninsured/underinsured residents, students

  • Predominantly Portuguese-speaking clients

Partners

  • Parents

  • School Nurses

Activities

  • Wrote return visit reminders on VIS.
  • Made immunization cards showing (#1, #2, or #3 finished!); also including "next one due on..."


  • Discussed VPD when offering Flu and HPV vaccines to clients.

Progress/Outcomes

  • During the measles outbreak, clients were offered Flu vaccine as well, and 30% of those vaccinated with MMR accepted the flu vaccine at the same time.

  • We had great return for second, and in some cases, 3rd dose of the HPV vaccine.

  • Since the increased focus on serial vaccinations of HPV in February, we expect to see high HPV vaccination rates in August.

Challenges

  • Language and cultural barriers limit understanding of the value of vaccination.

  • Limited eligibility criteria for VFC vaccines can make promotion difficult.

Learning

  • Coupling recommended and required vaccines in one visit made parents feel I was not just “processing them for school entry,” but also thinking about their long-term health.

  • Adding check-off boxes on VIS’s is a helpful reminder and advances parental knowledge of the VIS.

  • When a health care provider recommends a vaccine, there is a stronger likelihood that clients will accept it.

Recommendations from mentor

  • Broaden the eligibility criteria for VFC vaccines.

Recommendations for TA
  • We appreciated and found useful the one-on-one calls, webinar, conference calls and, especially, learning from other Public Health nurses about their initiatives.


  • The PDSA tool and approach was very helpful.

Framingham Board of Health Immunization Equity FY14 Case Study (cont.)

PLAN, DO, STUDY, ACT

PLAN (the idea, a specific thing to address a specific issue)

  • Promote, offer and provide HPV vaccines to all eligible residents, regardless of the reason for the visit.

DO (list a specific activity "For 3 weeks we will…")

  • Add check boxes with dates on the VIS as reminders for 2nd and 3rd doses.

STUDY (Analyze what happened as a result of the activity, the "do")

  • We had great return for the 2nd and, in some cases, 3rd dose of the HPV vaccine even without making phone calls.

ACT (what you will adopt, adapt or abandon as a result of the “study”)

  • Offer and provide recommended vaccines, regardless of the visit.

  • Offer and provide Flu vaccine at any opportunity, regardless of event focus.

  • Add check boxes with dates as reminders on the VIS for all serial vaccines.
  • Couple required and recommended vaccines in the same visit.


  • "Every clinic visit is an opportunity to vaccinate."

PEABODY BOARD OF HEALTH

Immunization Equity TA FY14 Case Study

Goal

  • Improve immunization among poorly immunizing members of the community.

  • Promote and provide shingles vaccine among seniors in Peabody.

Target Population

  • Uninsured and underinsured seniors

Partners

  • Council on Aging and local Portuguese churches

  • Medical providers and pharmacies

Activities

  • Accepted vaccines that were not being used in neighboring towns.

  • Updated our contact lists for MD offices and pharmacies.

  • Reached out to Peabody providers asking for referrals of seniors unable to pay for vaccines.

  • Sent "ambassadors" to the local Portuguese churches to inform members of the availability of free shingles vaccine.

  • Placed an ad for the shingles vaccine in the Council on Aging Newsletter, the Housing authority Newsletter, the Electronic Billboard on Rt. 1, and on Facebook.

Outcomes
  • MD offices and pharmacies are aware of Zostavax at the Health Department.


  • All available shingles vaccine was used up before it expired.

  • Currently receiving 1- 4 calls a week regarding vaccine; created a waiting list for those interested in receiving the shingles vaccine.

Challenges

  • Running out of vaccine.

  • The complex Medicare system is difficult to understand and explain to seniors that have been referred to the LBOH by MD offices/pharmacies.

Learning

  • Working with MD offices and pharmacies is essential to increasing access to vaccines for uninsured and underinsured seniors.

Recommendations from mentor

  • Establish a revolving account to allow for purchase of small amounts of Zostavax if DPH is unable to provide more.

  • Reach out to urgent care clinics in the future.

  • A training or webinar on Medicare: what is covered and when, would be helpful.

Recommendations for TA

Peabody Board of Health Immunization Equity FY14 Case Study (cont.)

PLAN, DO, STUDY, ACT

PLAN (the idea, a specific thing to address a specific issue)


  • Promote and provide Shingles vaccine to uninsured and underinsured seniors.

DO (list a specific activity "For 3 weeks we will…")

  • Reach out to MD offices and Pharmacies to inform them of the availability of Zostavax.

STUDY (Analyze what happened as a result of the activity, the "do")

  • More uninsured and underinsured seniors were referred to LBOH for their shingles vaccine.

ACT (what you will adopt, adapt or abandon as a result of the “study”)

  • We will continue to work with MD offices and pharmacies to promote vaccination.

RANDOLPH BOARD OF HEALTH

Immunization Equity TA FY14 Case Study

Goal

  • Raise awareness and improve immunization among low immunizing members of the community.

Target Population

  • Vietnamese community

  • Haitian community

  • Latino community

Partners

  • Clergy Association

Activities

  • Reached out to the lead Pastor of the clergy association.


  • Attended a Haitian gathering where we offered free shingles vaccine.

  • Placed signs at the BOH and at the senior center.

Progress/Outcomes

  • We are more knowledgeable of our vulnerable populations.

  • We distributed all 40 doses of the shingles vaccine to appropriate residents.

Challenges

  • The biggest challenge remains that there is little time for one nurse to do everything in a 30 hr. position.

  • Our language capacity is inadequate overall

Learning

  • Outreach needs concentrated efforts to be effective.

  • Start with the "low-hanging fruit," such as placing signs at places where your target population lives or receives services.

Recommendations from mentor

  • For our language needs, working with the World Languages Department of the school department has been an asset especially in crisis situations (outbreaks).

  • To meet our staff needs, a resource person, such as a community health worker, would be very helpful.

Recommendations for TA

  • It was difficult to participate in the TA sessions due to time constraints.

PLAN, DO, STUDY, ACT (PDSA)


PLAN (the idea, a specific thing to address a specific issue)

  • Raise awareness and improve immunization among low immunizing communities in Randolph.

DO (list a specific activity "For 3 weeks we will…")

  • Reach out to the lead pastor of the Clergy Association

STUDY (Analyze what happened as a result of the activity, the "do")

  • We are more likely to reach more of our diverse populations through the Clergy Association.

ACT (what you will adopt, adapt or abandon as a result of the “study”)

  • Partner with the Clergy Association for all other health promotion activities.

WEBSTER BOARD OF HEALTH

Immunization Equity TA FY14 Case Study

Goal

  • Identify and reach low immunizing populations, especially young adults.

Target Population

  • Adults 18-34

  • People of low socioeconomic status

Partners

  • Worcester State University


Activities

  • Worked with an intern at Worcester State University to develop a community health survey.

  • Distributed survey and immunization fact sheets at the 7-Eleven, the barber shop, Food Share, and posted the survey on the town website where people could fill it out online and it would automatically go to my e-mail.




Progress/Outcomes

  • The community health immunization surveys revealed what immunizations were needed, for what age group, and the places these groups would find it easier to access an immunization clinic.




Challenges

  • The Mass Health and Medicare reimbursement process is very complicated and tedious. It is just too much paperwork.

Learning

  • Presence at a health fair or blood drive would have broadened the reach of the community health survey.

Recommendations for TA

  • I was thrilled to have worked on this survey and will continue to improve on it to assess the community’s needs. I also think it delved into a side of community needs that my interns don't usually think about or participate in.

PLAN, DO, STUDY, ACT (PDSA)

PLAN (the idea, a specific thing to address a specific issue)


  • Identify and reach low immunizing populations, especially those of low socioeconomic status.

DO (list a specific activity "For 3 weeks we will…")

  • Develop a community health survey that includes immunization questions.

STUDY (Analyze what happened as a result of the activity, the "do")

  • I learned that there is a need for immunizations in the town, which immunizations were needed, and the age groups needing them.

ACT (what you will adopt, adapt or abandon as a result of the “study”)

  • I began with the survey and stuck with it to help me move closer to my aim, which is finding out who in the lower socioeconomic population needs immunizations and what type of immunizations are needed.

WILBRAHAM & HAMPDEN BOARDS OF HEALTH

Immunization Equity TA FY14 Case Study

Goal

  • Test and refine our emergency preparedness plan and assess our capability to mass vaccinate in case of an emergency.

Target Population
  • Residents of Wilbraham and Hampden, mostly retired/live-alone seniors


  • A large transient Asian population

Partners

  • Hampden-Wilbraham Medical Reserve Corps (MRC) (partnership between Wilbraham and Hampden)

  • Emergency responders (Police, firefighters, ambulance services, volunteers)

Activities

  • Training in which we revisited the experience and challenges faced during the H1N1 epidemic.

  • Formulated an Emergency Dispensing Site Plan calling for the use of Minnechaug Regional High School.

  • Identified roles, engaged local chief & elected officials, clarified job descriptions and developed job action sheets.

  • Presented an overview of emergency preparedness to volunteers.

  • Deployed our working mobile food dispensing station, mobile pet shelter and a mobile shelter supply trailer.

Progress/Outcomes

  • Areas within our facility have been designated to meet the physical and psychological needs of our staff and volunteers.

  • A dispensing site layout plan is in place with a clearly marked EDS flow map including triage.

  • Our facility is ADA accessible.

  • A new generator will supply refrigeration, lighting, etc.

  • Ongoing facility assessment is in place.

  • Established key areas to meet anticipated tasks and the needs of our population, such as, identifying translators within our volunteer community and capacity for manual translation (flip charts) as well as electronic translation.

Challenges

  • Seniors, retired and live-alone in a place that is mainly rural


  • High-risk area for power outages from blizzards, ice storms and tornados

Learning

  • As a result of combining our towns’ resources, we feel better prepared to assist our population in an emergency.

Recommendations from mentor

  • We hope to have ALS translation available and possibly information sheets in braille.

  • We have plans and adequate space to implement Drive-Thru vaccination.

Recommendations for TA

  • The TA was great, however it was impossible to make it for conference calls, considering that I work 10 hours a week.

Wilbraham and Hampden Boards of Health FY14 Immunization Case Study (cont.)

PLAN, DO, STUDY, ACT

PLAN (the idea, a specific thing to address a specific issue)

  • Test and refine our emergency preparedness plan.

DO (list a specific activity "For 3 weeks we will…")

  • Reach out to our partners in Hampden (police, firefighters, ambulance services and volunteers).

STUDY (Analyze what happened as a result of the activity, the "do")


  • We needed a point person, or "go-to person," within our partner organizations. This would be really important during a crisis and power outages.

ACT (what you will adopt, adapt or abandon as a result of the “study”)

  • Maintain an updated contact list of our partners especially the "go to person" in the event of an emergency


Massachusetts Department of Public Health

25 Washington Street

Boston, Massachusetts 02108

(617) 624-6060

www.mass.gov/dph




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