NVPO Webinar Series: Project Successes and Challenges June 24, 2013

Welcome and Overview Bruce Gellin, M.D., M.P.H. Shary M. Jones, Pharm.D., M.P.H., BCPS CDR— U.S. Public Health Service National Vaccine Program Office Alaysia Phillips, M.P.H.—JBS International, Inc.

Presenters Paula Price—Weber Human Service Agency Elaine Darling—Center for Rural Health Development Jill Foster, M.D. and Tiffany Lovett —Drexel University College of Medicine/St. Christopher's Hospital for Children

Bruce G. Gellin, M.D., M.P.H. Deputy Assistant Secretary for Health and Director National Vaccine Program Office U.S. Department of Health and Human Services Insert video here

Weber Human Services Adult Immunization Community Intervention Project Paula Price Weber Human Service Agency

Successes Community Support Northern Utah Immunization Coalition Material Availability Nurse Knowledge and Expertise Newspaper Article Increase in participant knowledge about disease, vaccine availability, and importance of immunizations

Challenges Some immunizations are not covered Support from some housing organizations in distributing and posting materials Participation at presentations Outreach to the Hispanic Community Tracking immunizations given outside of clinics (doctor, Health Dept. etc.)

Lessons Learned/Best Practices Develop creative presentations Provide shots at presentation times if possible Identify which immunizations are covered by insurance at the beginning of the grant process Have a process for collecting evaluations Provide incentives for immunizations

Evaluation/Measurable Outcomes Number of participants attending presentations Increase in participant knowledge about disease Increase in participant knowledge about vaccines Increase in participant knowledge about the importance of vaccinations Increase in likelihood of participants being immunized Number of seniors receiving immunizations

Closing Next Steps ‒Continue providing presentations ‒Increase outreach to the Hispanic community ‒Continue providing immunizations ‒Compile data

The Center for Rural Health Development, Inc. WV Adult Immunization Project Elaine Darling Program Manager The Center for Rural Health Development, Inc.

Take Your Best Shot Projects: Adolescent and Adult Immunization Improving IZ rates through the use of evidenced based practices Adult IZ Project currently being implemented in 20 counties and will expand into several more in July Components: ‒Mini-grants used to support implementation of best practices by lead agencies ‒Quarterly trainings ‒Educational materials developed and distributed

Successes Quarterly trainings held to date: -Dr. Gary Marshall, The Roots of Vaccine Hesitancy -Dr. Ari Brown, Talking to Patients with Vaccine Concerns -WV Immunization Summit (250+ attendees) Educational materials distributed: Pap -Faces of Vaccine Preventable Diseases -Adult IZ brochure -Adult IZ Posters Launched blog and improved website

Challenges We are a small organization WIN is one of four programs that we manage

Lessons Learned/Best Practices Must be VERY efficient with time A strong coalition can make a big impact

Evaluation/Measurable Outcomes Strategies are still being implemented, so final evaluation has not yet taken place.

Closing Next steps: Continued development of adult IZ and Faces of VPDs videos Continued distribution of educational materials

Center for the Urban Child at St. Christopher’s Hospital for Children Training Health Navigators as Home Visitors to Improve Adult Immunization Rates Jill Foster, M.D. Chief of Immunology and Director of Center for the Urban Child and Dorothy Mann Center and Tiffany Lovett Health Navigator Center for the Urban Child

Project Goals and Objectives Component I: Health Navigator Curriculum Design and Delivery – Develop and Deliver Immunization Training to expand the knowledge of community health workers (i.e. - Health Navigators) to provide health education/promotion to the people they serve (i.e. – consumers) Component II: Health Navigator Interventions with Consumers – Health Navigator to improve immunization knowledge and vaccine receipt among their consumers during home visits Component III: Health Provider Education – To increase Health Provider awareness of common and systemic barriers to immunization and create solutions

Successes Jill Foster, MD (Pediatrician/Infectious Disease Specialist) has a 23+ year history in working with residents/patients/families from an urban community. This experience enabled her to design a curriculum for lay health workers that was informative, useful, interactive and memorable (i.e. – fun)!!! Partnered with Temple University – CHW’s program to deliver 2-hour immunization training with their graduate cohort (N=11) & incoming class (N=26) *Bonus* - delivered training at a health literacy event in May (First St. Chris) to a group of 35 people consisting of healthcare staff, patients, parents and general community CUC Health Navigator has cumulatively met with 24 (8 in June) consumers during their home visits to assess their beliefs/perceptions about immunizations and provide health education/promotion and resources

Challenges Currently, we are on track with our timeline and well positioned to meet the goals and objectives of this project However, we anticipated having a total of 2 CUC Health Navigators conducting home visits which would increase our home visit totals but due to contract issues with external agencies that staff will not begin work until July or August In addition, we are unable to track the total number of home visits conducted by non-CUC Health Navigator staff

Lessons Learned/Best Practices Component I: Immunization Curriculum Design and Delivery: As a result of the pre- and post- test surveys/evaluations from cohort I and II, we learned that training was well received, improved their knowledge about immunizations (specifically around HPV). Both cohorts entering the training (100%) correctly felt that they did not have sufficient knowledge to engage with clients about immunizations. But by the end of the training ALL experienced an increased awareness, knowledge and skill set that made them feel much more likely to engage with clients about this topic. As a result of the 1-month follow up survey (from cohort I), most participants (95%) retained their knowledge from the training and indicated that they have engaged clients and in some instances their own families about immunizations. Interestingly, there was a 27% decrease in knowing that males and females are eligible for HPV vaccine (91% - 64%). However, participants scored at or above 82% in flu vaccine safety in pregnancy (82%), vaccines not causing autism (100%), knowing that 25 year olds are eligible for HPV vaccine (82%) and that cervical cancer is preventable (82%).

Lessons Learned/Best Practices (continued) Component II: Health Navigator Interventions with Consumers: During home visits with consumers, our Health Navigator seeks to learn about their beliefs, perceptions and behaviors around immunization for all members in the household. She administers a survey and based on the responses creates a customized presentation. In many cases, Tiffany spends most of her discussion addressing common myths and providing resources/referrals but overall her efforts serve as a catalyst for adults to improve child and adult immunization outcomes.

Closing Next Steps: Administer post-training follow up surveys to Cohort I (3-month) & Cohort II (1 and 3 month) ‒Provide participants with incentives, score and summarize results Design & Deliver “Refresher” Immunization Training to both cohorts combined in August ‒Based upon survey results, feedback and classroom observations Conduct presentations for internal/external Health Care Providers about common and systemic barriers to immunizations and create solutions ‒Use results and outcomes of this project to raise awareness and serve as a collaborative partner to remedy problems

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Please visit to view Webinar recordings and presentations. Next Webinar: July 18, 2013, 2:00 p.m. (ET)