WIC/Immunization “Record Round-up” Project: Filling the Gaps National Immunization Conference March 18, 2003 I am very excited to be here today to share our experiences with the WIC/Immunization “Record Round-Up” Project: Filling the Gaps”. We are fully aware that this project was not the sole reason for the increase in 4:3:1:3:3 completion rates Sheryl Pickering Local Program Consultant Washington WIC Program Pamela Johnson Program Linkages Coordinator Immunization Program

Overview Background Project Specifics Results Staff and Client Comments Lessons Learned Next Steps

Project Background Statewide WIC/IZ Planning Workshop established – October 2000 1999 NIS data (4:3:1:3:3, 19 – 35 mo.) WIC participants 63.1 (+ 6.6) Non-WIC participants 70.7 (+ 5.7) Five-Year Linkage Strategic Plan developed – March 2002 The Washington State DOH WIC and Immunization Programs have had a long history of collaboration. In October 2000 we established a statewide workgroup to develop a five-year plan for collaboration activities that expanded beyond what we had been doing the past few years. 1999 NIS data for WIC and non-WIC participants was considered in the work that resulted in the development of a 5-year strategic plan.

Project Background Plan includes specific goals and objectives to populate the registry Group recommended immunization record collection project USDA requirements to screen immunizations – March 2003

Main Project Goals Populate the registry Increase the percentage of children 19 – 35 months complete for 4:3:1:3:3

Secondary Project Goals Registry promotion Increased awareness about immunizations Strengthen partnerships

Project Specifics Time Frame: 9/2002 – 12/2002 WIC agencies given $2.00 for each infant/child in caseload + $500 for office supplies Data entry funded at $2.00 for 70% of caseload

Project Specifics Incentives given to parents Fruit/Vegetable Seedie CharactersTM Washington State Immunization Record Card and Plastic Sleeve

Selection of Project Sites 1/31/2002 CHILD Profile registry report information for: 19 – 35 months County specific 4:3:1:3:3

2002 WIC Roundup Project Sites Whatcom San Juan Okanogan Pend Oreille Skagit Ferry Stevens Island Clallam Snohomish Chelan Jefferson Douglas Kitsap Lincoln Spokane King Grays Harbor Mason Kittitas Grant Pierce Adams Whitman Thurston Pacific Lewis Franklin Garfield Yakima Columbia Wahkiakum Cowlitz Benton Asotin Walla Walla Skamania Klickitat Clark

Main Project Goals Populate the registry Increase the percentage of children 19 – 35 months complete for 4:3:1:3:3

Types of Records Collected Agency Total New Enhanced Complete Unreadable Other Benton Franklin HD 1443 24 1191 228 Cowlitz Family Health 592 27 259 97 1 209 Jefferson Co. HD 140 52 57 31 Kitsap Comm. Resources 743 493 108 2 Kittitas Co. HD 95 19 59 17 Lewis Co. HD 410 11 358 41 Peninsula CHS 669 112 400 153 3 San Juan Co. HD 49 6 29 14 Skagit Comm. Action 1296 44 1086 166 Spokane Co. HD 4698 1062 2874 753 Thurston Co. HD 553 42 408 101 Whatcom Co. HD 363 5 317 11,051 1544 7531 1750 8 14% 68% 16% < 1%

Types of Records Collected

Caseload and Records Collected Comparison Agency Caseload # of records collected % Benton Franklin HD 4130 1443 34% Cowlitz Family Health 1913 592 31% Jefferson Co. HD 395 140 35% Kitsap Comm. Resources 2844 743 26% Kittitas Co. HD 498 95 19% Lewis Co. HD 1921 410 21% Peninsula CHS 1509 669 44% San Juan Co. HD 49 Skagit Comm. Action 2458 1296 52% Spokane Co. HD 8090 4698 58% Thurston Co. HD 2037 553 27% Whatcom Co. HD 1875 363 Total 27,810 11,051 39%

Main Project Goals Populate the registry Increase the percentage of children 19 – 35 months complete for 4:3:1:3:3

Time Frames Used in Selection and Assessment January 2002 Used to determine counties selected August 2002 Pre-project cross-sectional comparison data December 2002 Post-project cross-sectional comparison data

Comparison by County Complete 4:3:1:3:3

Comparison by County 4:3:1:3:3 to 3:3:1:3:3

What Did Staff Say About the Project? Best thing about the project: Getting clients’ records updated in registry Got people thinking about immunizations Helping to make a difference One agency director is so enthused, wants WIC to continue to collect records

WIC Staff Loved the project Way to provide quality services Felt good seeing clients excited about incentives One more thing to do in a busy schedule, but worthwhile Since Immunizations was decreasing hours, WIC staff thought it was negative since they wanted to be able to refer clients for shots right away.

Immunization and Data Entry Staff Data entry was challenging at times Interpreting foreign records Difficult to read Poor copy quality Having complete immunization history helps all of us

WIC Clients They loved it Grateful for the help to get children in the registry Felt WIC and Immunization staff cared about their children's well-being Excited about the incentives

Lessons Learned Communication Project Timeline Funding and Contracting Implementation

Communication Notify appropriate administrators at state and local levels prior to project Develop system for consistent notification Set up primary contacts for: WIC Immunization Fiscal

More Lessons on Communication Set up multiple distribution lists for email and regular mail Communicate with CHILD Profile Communicate with healthcare providers

Project Timeline Clear beginning and ending dates Remember WIC clinics now see clients every 3 months Consider other events and requirements happening at the clinics

More Lessons on Timeline Include client notification period Include CHILD Profile training Remember agency’s procurement requirements

Funding and Contracting Develop spreadsheet with funding specifics Determine caseload numbers Coordinate “cross program” funding Coordinate different types of contracts Joint letter to help emphasize the WIC Immunization partnership

Implementation Parent letter needs to be short and easy to read Use “shot record” instead of “immunization record” Translations -- “mother’s maiden name” not understood

More Lessons on Implementation Incentives Assure they are age appropriate Assure they arrive at the clinic before project begins

More Lessons on Implementation Develop “Frequently Asked Questions” sheet to help WIC staff answer clients’ questions Assure there is coordination between WIC and data entry staff Get excited about the project – friendly competition among staff

What’s Next in Washington? Still have more work to do Conduct similar project in 2003 Will apply lessons learned Continue to work on strengthen our partnership Share our work locally and nationally

Program Contacts Pamela Johnson Sheryl Pickering Program Linkages Coordinator Washington State Department of Health PO Box 47843 Olympia, WA 98504-7843 (360) 236-3551 Pamela.Johnson@doh.wa.gov Sheryl Pickering Local Program Consultant Washington WIC Program PO Box 47886 Olympia, WA 98504-7886 (360) 236-3655 Sheryl.Pickering@doh.wa.gov