Improving the childhood immunisation uptake Flintshire Local Health Board Clare Powell Leigh Pusey

The scale of the problem Flintshire was the worst performing LHB for all antigens in 2003 MMR uptake 69%

Assessing the situation Cross referenced Child Health data compared to Exeter target payments from the BSC Visited all GP practices completed a questionnaire and presented them with the data Health Visitors completed a questionnaire to identify problems they encountered.

Main factors affecting uptake in Flintshire Under reporting of immunisation event Build up of queues for immunisation appointments Some GP practices unaware that Child Health and BSC were not electronically linked to update demographic data Loss of faith in the Child Health System Unscheduled forms were not audited by Child Health Lack of opportunistic immunisation PCT’s have different criteria for inclusion for COVER data. No longer contribute data to Wales Presumption that low uptake was the norm Parental refusal

Data quality and under reporting Failure to return immunisation forms at all Forms returned several weeks/months after the immunisation Forms completed incorrectly Multiple names on the immunisation sheet for different vaccinations forms kept until last name attended Opportunistic appointments: unscheduled forms not completed Lack of understanding of the process

Solving the problems A concerted education programme to: Help staff complete forms correctly, Ensure the forms are returned weekly Understand about the queue system Help staff understand the importance of Child Health

Other solutions Audit the scheduled immunisation green forms Set up additional sessions Check if no consent status is still valid at every opportunity - people change their minds Health visitors checking on the 8 month development form for immunisation status

What can you do? Notify child health or health visitor of new registrants/changes of address/deductions Get to know your Child Health Department Review your appointment set up with Child Health Audit accuracy of the data Know what your own uptake is per practice/per health visitor Send forms in a timely manner Health visitors check all development forms, follow up unimmunised children Encourage a team approach for opportunistic immunisation

Improve Data Quality Develop use of current information systems Identify key personnel to supply data Improve working relationship with Child Health Department Provide practice data to surgeries Produce target lists Record single antigen where known

Where are we now?

Consultation with service users We asked parents their views on the immunisation service they receive in Flintshire? Sessions conducted within mother and toddler / Surestart groups across Flintshire.

What parents said: Discussion groups on MMR needed Increased flexibility re clinic times/settings Provide balanced information Information needed before MMR vaccine appointment, possibly at the 8 month contact with the Health Visitor Information good but could be simplified Waiting along time to go in for vaccine so appointment feels rushed Time needed to talk about the vaccines before appointment

Community initiatives Established networks with key partnership agencies. Examined the literature relating to effective initiatives. Identified projects

Editorials written for key publications Balanced articles informing parents about key facts. Editorials also written for: Flintshire Local Voluntary Council Children's Information Bureau

Teddy Bear – Randomised Control Trial Novel way of providing information to parents about the MMR vaccine. Collaboration with the National Public Health Service. Partnership working with Flintshire Health Visitors and Flintshire Child Health Department.

Peer led education Initiative HomeStart - Lay family workers. Whittaker, A 2002 ‘ Lay workers for improving the uptake of childhood immunisation.’ SureStart- Community Mothers Programme. Johnson, Z et al 2000 ‘Community Mothers Programme- seven year random control trial.’ Volunteers provided with a resource pack and training programme.

Calendar to remind parent’s of the immunisation schedule Calendar produced with the childhood immunisation schedule printed on the backboard to remind parents of when vaccines are due. Distributed via Surestart /Homestart health visitors and family support workers

Increasing the knowledge of the child care workers of the future Provide annual sessions on childhood immunisation to the CACHE and BTEC students in child care at Deeside college. Students are keen to increase their knowledge in this area and evaluation of the sessions has been positive.

Improving information-developing strong links with Flintshire library services. Developed partnership working with Flintshire library co-ordinator INITIATIVES: MMR videos/posters now in all Flintshire libraries. Immunisation newsletter to be given out to parents with ‘book bags.’ Recommended to library service that books should be available on immunisation within childcare section.

Community discussion/information sessions Parent’s are asking for more information and an opportunity to talk about the risks and benefits of immunisation, particularly the MMR vaccine. Sessions offered within: SureStart facilities: Buckley/Aston Homeless unit: Flint Women’s refugee Mother & baby groups across Flintshire Community First groups: Mold, Flint Holywell

Immunisation resource folder/posters Evidence based resource developed. Poster produced. Posters and folder delivered to all clinic/GP practices and pharmacies in Flintshire.

Taking the public health message to the community Health promotion stand taken to key community venues across Flintshire: Mold Market Asda Queensferry Tesco Broughton Radio advert Poster displays and stickers in clinics /GP practices, local library’s IMMUNISATION AWARENESS WEEK 20 th - 24 th June 2005

Improving PSB uptake in Flintshire Collaborated with local Surestart team, GP practice/School nurse & Health visitor- session held in local primary school 21 PSBs outstanding 17 children immunised at session. WHAT WORKED?

Improving PSB uptake in Flintshire Seven south Flintshire schools targeted: S1: 14 identified, 4 not reported to CHS – 10 outstanding – 10 immunised. S2: 33 identified, 16 not reported to CHS – 17 outstanding – 8 immunised. S3: 17 identified, 7 not reported to CHS – 10 outstanding – one immunised, one Mother came for information.

FINAL THOUGHTS IMMUNISATIONS SAVE LIVES. DON’T BE AFRAID TO TRY A NEW APPROACH BE POSITIVE.