1. Achieving coverage rate increases Closing the Gap

2. Our destinations

3. How the itinerary was chosen Grantees with greatest absolute % increase in coverage levels from 2001 to 2004 NIS were defined as “most improved” and received awards at NIC 2006 Visited all 7 awardees between September and November 2006

4. Study Objectives Meet with key staff and external partners Identify program characteristics and interventions that led to increased childhood immunization coverage levels Find common themes and share information with all grantees

5. What we heard…

7. Starting at the top Leadership is everything Identify trusted immunization leaders to continually promote importance of vaccination: – Political (governor, mayor, congress member, secretary of health, etc) – Medical provider (AAP member, local respected private physician)

8. The importance of “culture” Know your community Understand local attitudes and values – Public health – Medical practice – Community

9. Ah, relationships… Reach out and partner: – WIC practices – Private practices – AAP/AAFP – Hospitals – MCOs – Universities – Schools/daycares – Parent groups – Media reps. – Pharm. reps Build a coalition that extends access into your communities

10. Evaluate your VFC and AFIX programs – What is working? What could be better? Use VFC and/or AFIX visits to develop relationships with private practices Take all opportunities to educate Be a resource, not a regulator Be accessible and responsive Raising provider awareness

11. Data, data, data Understand it Use it Share it Improve it Collect it

12. What’s passion got to do with it? Devotion to the cause Like who? – Internal staff at all levels – External partners: Coalition leaders, local practitioners, organizations, and service clubs (Kiwanis, Rotary) You can’t teach passion, but you can find it in your community

13. Maintaining visibility Through…… – Good leadership – Understanding your environment – Strong partners/collaborators – Raising awareness – Using data – Devoted staff and community members

14. Challenges we all face Could the immunization schedule be any more confusing? Getting accurate records & timely entry of data Access to provider offices (AFIX visits) Exemptors Immunization fatigue Working with daycare providers Reimbursement for providers

15. Next steps (2007) Visit programs with consistently high coverage levels – Identify factors that make that possible Visit program with lower coverage levels – Understand their barriers and challenges