Adolescent immunization delivery in school-based health centers: a national survey.

Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado 80045-0508, USA.
Journal of Adolescent Health (Impact Factor: 2.75). 11/2009; 45(5):445-52. DOI: 10.1016/j.jadohealth.2009.04.002
Source: PubMed

ABSTRACT Vaccinating adolescents in a variety of settings may be needed to achieve high vaccination coverage. School-based health centers (SBHCs) provide a wide range of health services, but little is known about immunization delivery in SBHCs. The objective of this investigation was to assess, in a national random sample of SBHCs, adolescent immunization practices and perceived barriers to vaccination.
One thousand SBHCs were randomly selected from a national database. Surveys were conducted between November 2007 and March 2008 by Internet and standard mail.
Of 815 survey-eligible SBHCs, 521 (64%) responded. Of the SBHCs, 84% reported vaccinating adolescents, with most offering tetanus-diphtheria-acellular pertussis, meningococcal conjugate, and human papillomavirus vaccines. Among SBHCs that vaccinated adolescents, 96% vaccinated Medicaid-insured and 98% vaccinated uninsured students. Although 93% of vaccinating SBHCs participated in the Vaccines for Children program, only 39% billed private insurance for vaccines given. A total of 69% used an electronic database or registry to track vaccines given, and 83% sent reminders to adolescents and/or their parents if immunizations were needed. For SBHCs that did not offer vaccines, difficulty billing private insurance was the most frequently cited barrier to vaccination.
Most SBHCs appear to be fully involved in immunization delivery to adolescents, offering newly recommended vaccines and performing interventions such as reminder/recall to improve immunization rates. Although the number of SBHCs is relatively small, with roughly 2000 nationally, SBHCs appear to be an important vaccination resource, particularly for low income and uninsured adolescents who may have more limited access to vaccination elsewhere.

1 Bookmark
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose School-located vaccination programs may need to bill health insurance to be sustainable. This mixed methods study assessed parent attitudes about school-located vaccination and billing. Methods Seven public schools in Denver, Colorado, participated in a school-located adolescent vaccination program that billed students' insurance. From April through June 2010, a survey was administered to parents of 1,000 randomly selected sixth to eighth grade students in these schools. In March and April 2011, focus groups were conducted with a sample of parents of adolescents attending these schools to further explore and help explain patterns emergent in the survey data. Results Survey response rate was 66%. Among survey respondents, 56% strongly supported and 29% somewhat supported school-located vaccination. Forty-two percent reported concern about receiving a bill if their child participated in a school-located vaccination program that billed insurance, and 23% did not want to provide insurance information to the school. Four focus groups were conducted with English-speaking (n = 17) and Spanish-speaking (n = 14) parents. Focus group participants indicated strong support for school-located vaccination, emphasizing the convenience of the program for both parents and adolescents. These parents also appreciated the affordability of the program and reported feeling comfortable with in-school vaccination delivery. Very few participants indicated concerns about providing health insurance information to the school, but some expressed concern about potential record scatter. Conclusions Although some parents expressed concerns about billing health insurance for school-located vaccination, most parents indicated strong support for school-located vaccination.
    Journal of Adolescent Health 11/2014; · 2.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND Uptake of human papillomavirus (HPV) vaccine remains low among adolescents in the United States. We sought to assess barriers to HPV vaccine provision in school health centers to inform subsequent interventions.METHODS We conducted structured interviews in the fall of 2010 with staff from all 33 school health centers in North Carolina that stocked HPV vaccine.RESULTSCenters had heterogeneous policies and procedures. Out-of-pocket costs for children and youth to receive privately purchased HPV vaccine were a key barrier to providing HPV vaccine within school health centers. Other barriers included students not returning consent forms, costs to clinics of ordering and stocking privately purchased HPV vaccine, and difficulty using the statewide immunization registry. Most (82%) school health centers were interested in hosting interventions to increase HPV vaccine uptake, especially those that the centers could implement themselves, but many had limited staff to support such efforts. Activities rated as more likely to raise HPV vaccine uptake were student incentives, parent reminders, and obtaining consent from parents while they are at school (all ps < .05).CONCLUSIONS Although school health centers reported facing several key barriers to providing HPV vaccine, many were interested in partnering with outside organizations on low-cost interventions to increase HPV vaccine uptake among adolescents.
    Journal of School Health 06/2014; 84(6). · 1.50 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this article is to describe a pilot study of 16 Appalachian Kentucky school districts designed to gather information about their school vaccination and health education programs in relation to the Human Papillomavirus (HPV) vaccine. School district administrators were contacted by a professional telephone interviewer and asked to participate in a structured interview that also included open-ended questions. Results suggest that few schools have school-based vaccination programs, and of those that do, very few programs include the HPV vaccine. A majority of respondents reported that information leaflets about HPV are available in the schools, whereas few schools include discussions of HPV in their health programs. Almost all respondents reported an excellent relationship with their county health departments, school nurses, and school social workers, although most schools lacked the presence of a school social worker. Implications for social work practice and policy and directions for future research are also discussed.
    Social Work in Public Health 06/2014; 29(4):368-79. · 0.31 Impact Factor