Promoting Adolescent Immunizations Through Collaboration with Community Partners

The Florida Department of Health in Baker County is a small organization in a rural community serving a population of 28,000. Baker County has a population that is 82.5% white, 13.6% black, and 4% other or mixed race. 9.5% of families are under 100% of the base poverty level.  In Baker County, close relationships are had by the health department with community partners including the local school district, sheriff's office, and county and city officials. The Baker County School District and the Florida Department of Health in Baker County (DOH-Baker) partner to provide school health services including addressing compliance for school health immunizations.  For years, the school health program has faced challenges achieving compliance with adolescent immunizations, specifically the seventh grade Tetanus, Diptheria, and Pertussis (TDAP) vaccine.  In Florida, this vaccine is required prior to entry into the seventh grade for public and private schools. Each year, fliers, calls, and multiple reminders are made to students and parents in the fifth and sixth grade to prepare for this requirement and each year on the first day of school many students are sent home due to noncompliance.  With a total school district population of 5000, and a seventh grade population of nearly three hundred, having fifty students sent home the first day of school for noncompliance is a significant issue for this community.  This requires parents leave work to pickup their student and the student cannot return until proof of compliance is received by the school's guidance office.

In 2017, it was noted by the school health coordinator at the health department at the time, that the process currently implemented was not working and a meeting was held with the local school health liaison at the school district to discuss.  Out of this meeting came a plan to prevent students from receiving their schedule until compliance was achieved.  It is important to note that in Baker County there are no large media outlets thus most news and information comes from the local newspaper, The Baker County Press.  Each year a special edition is printed the week before school returns to session that lists open house events and students classroom assignment.  This is something that families look forward to each year.  It was determined that unless the student is compliant with required school immunizations their classroom assignment would be withheld from the paper.  Of course, this causes parents to call the school to determine why their child's name was withheld and they are told about their child's noncompliance for immunizations.  A practice was also implemented that if a student shows up for open house, their schedule will be withheld and they will be sent to the guidance office to discuss their immunization noncompliance.  The first year that this was implemented it was a great success and the number of students arriving to the first day of school in noncompliant status was greatly reduced from fifty down to ten.  However, one issue that was noticed was parents having a difficult time getting their child into get the vaccines prior to the first day of school.  In Baker County, the paper comes out on Wednesday, Open House is Thursday, and school starts Monday.  This does not leave much time for parents to achieve compliance before the first day of school.

To this end, in subsequent years, clinics were held during open house and the morning of the first day of school at DOH-Baker allowing for walk-in immunizations for school aged children.  This allows parents, once notified of their student's noncompliance, to take them straight over to the health department to receive their vaccine and shot record and return back to the school to receive their schedule or attend school. With the addition of this practice, in 2020 and 2021 only two to three students were still found to be noncompliant on the first day of school. 

This achievement was made through collaboration with multiple community partners including the Baker County School District and the Baker County Press. Without their involvement this practice could not have been successfully implemented. This practice makes immunizations available to all students at a location that is easily accessible and close to the school and allows parents to have minimal disruption to their work day.  It keeps students in school where they can learn and grow into successful adults in our community and reduces public health impacts by achieving increased immunity against vaccine preventable diseases. This practice has now been successfully implemented for four years and improved upon each year.  The final objective is to eventually reach 100% compliance with required school immunizations before the first day of school.

The Florida Department of Health in Baker County is a small organization in a rural community serving a population of 28,000. Baker County has a population that is 82.5% white, 13.6% black, and 4% other or mixed race. 9.5% of families are under 100% of the base poverty level.  In Baker County, close relationships are had by the health department with community partners including the local school district, sheriff's office, and county and city officials. The Baker County School District and the Florida Department of Health in Baker County (DOH-Baker) partner to provide school health services including addressing compliance for school health immunizations.  For years, the school health program has faced challenges achieving compliance with adolescent immunizations, specifically the seventh grade Tetanus, Diptheria, and Pertussis (TDAP) vaccine.  In Florida, this vaccine is required prior to entry into the seventh grade for public and private schools. Each year, fliers, calls, and multiple reminders are made to students and parents in the fifth and sixth grade to prepare for this requirement and each year on the first day of school many students are sent home due to noncompliance.  With a total school district population of 5000, and a seventh grade population of nearly three hundred, having fifty students sent home the first day of school for noncompliance is a significant issue for this community.  This requires parents leave work to pickup their student and the student cannot return until proof of compliance is received by the school's guidance office.

Since implemention, this practice has decreased the number of students who are sent home the first day of school from fifty to only one or two.  Offering vaccines at the health department during the open house period and on the first day of school also incorporate principals of health equity as this gives parents an opportunity to receive the vaccine quickly and without needing to drive a long distance.  Transportation is frequently a barrier in our community.  Many parents don't have transportation to Jacksonville which is the nearest large city and where most pediatricians offices are.  The health department is in walking distance of the middle school in our community so every parent and child has a reasonable way to get to the health department, receive their vaccine, and return to school in a  timely manner.

In 2017, it was noted by the school health coordinator at the health department at the time, that the process currently implemented was not working and a meeting was held with the local school health liaison at the school district to discuss.  Out of this meeting came a plan to prevent students from receiving their schedule until compliance was achieved.  It is important to note that in Baker County there are no large media outlets thus most news and information comes from the local newspaper, The Baker County Press.  Each year a special edition is printed the week before school returns to session that lists open house events and students classroom assignment.  This is something that families look forward to each year.  It was determined that unless the student is compliant with required school immunizations their classroom assignment would be withheld from the paper.  Of course, this causes parents to call the school to determine why their child's name was withheld and they are told about their child's noncompliance for immunizations.  A practice was also implemented that if a student shows up for open house, their schedule will be withheld and they will be sent to the guidance office to discuss their immunization noncompliance.  The first year that this was implemented it was a great success and the number of students arriving to the first day of school in noncompliant status was greatly reduced from fifty down to ten.  However, one issue that was noticed was parents having a difficult time getting their child into get the vaccines prior to the first day of school.  In Baker County, the paper comes out on Wednesday, Open House is Thursday, and school starts Monday.  This does not leave much time for parents to achieve compliance before the first day of school.

In an effort to assist parents with getting their child's adolescent immunizations without them needing to take additional days off from work or travel to their pediatrician's office, vaccine clinics were setup at the health department during open house and on the first day of school.  This allows the parent to bring their child to the health department, receive their adolescent immunizations, and return to school in a timely manner.  This was a great success and the number of students starting school without their adolescent immunizations reduced again down to only a few. 

There was little to no cost associated with this effort as the health department participates in Florida's Vaccines for Children program which provides free vaccines to under or uninsured children.  Only the time of the clinic staff giving the vaccine and the time coordinating the effort by school officials was required to implement this successfully. 

This practice makes immunizations available to all students at a location that is easily accessible and close to the school and allows parents to have minimal disruption to their work day.  It keeps students in school where they can learn and grow into successful adults in our community and reduces public health impacts by achieving increased immunity against vaccine preventable diseases.

Data sources include number excluded from the first day of school as collected by the school nurse at the Baker County Middle School.  This data is then transmitted to the Florida Department of Health in Baker County's school health coordinator who is responsible for collecting school health data.  After the first year, it was determined that exclusion from receiving the schedule was not enough to completely eliminate students from missing the first day of school.  It also did not offer a solution to the problem which is a lack of adolescent immunizations.  The objective was not only to have every child in school the first day, but to have them there fully immunized.  This is why the addition of the vaccine clinics during Open House and on the first day of school were so pivotal to the success of the practice. 

Since very limited resources are needed for sustaining this practice, the practice should be able to continue indefinitely.  Community partners continue to be fully engaged and in agreement that practice is successful and should be continued.  Without the help and collaboration with our community partners, this practice would not have come to fruition.  We are so grateful for both our school district as well as our local media partner who made this possible.