1. Implementing Expanding Influenza Vaccine Recommendations Schools

2. IssueApproach Consent forms Forms difficult to understand Language barriers with parents Forms sent home to students but never reach parents Schools need consent forms approved by legal consultant, often takes a long time - becomes a disincentive for schools to buy into holding clinics Parents do not understand the importance of annual seasonal flu vaccination Develop standardized consent form nationally approved by legal/school/public health associations to accelerate legal approval process o Immunization Action Coalition has model physician order forms; MedImmune has template consent forms Require all students return consent forms regardless of accepting or declining vaccination Provide incentives o MedImmune noted how offering children small prizes largely improved response rate among younger children in returning consent forms Improving social marketing/communication message on benefits of flu vaccination (e.g. parents miss fewer days of work to care for ill children, school sports coaches encouraging students to be vaccinated so that they miss fewer days in the season) o Need CDC/HHS to help identify effective messages

3. Communicating to parents the importance of annual flu vaccination Use existing tools/campaigns to deliver message o Say Boo to the Flu o Dont Get Sidelined by the Flu o Spread the Word, Not the Flu o National Influenza Vaccination Week Organize national focus groups to develop unified messages (e.g. Gardasil One Less campaign and I Choose commercial) Partner with local organizations and others (e.g. employers of parents) to develop messages appropriately target community being served Use multiple avenues of communication – email, reverse 911 communication system (Knox Co.), PIO o Differences among communities will require a menu of messages and approaches – necessary to make wide variety of messaging resources available to health depts, schools, and parents

4. Funding Paying for vaccine (challenges specific to universal and non-universal states) Covering administrative fees Billing for Medicaid Timing of funding – late notice does not allow enough time to plan clinics Have insurance companies invest $ in the state and have state purchase school clinic flu vaccines (option currently discussed in Vermont) RFA to identify ways to partner with 3 rd - party billing Advocate for flexibility in federal/state grant funding Sustainability Additional challenges with annually vaccinating children; sustaining interest/awareness Competition with other public health interests within schools and health depts (asthma, obesity, physical inactivity) RFA for LHDs/schools to build infrastructure to conduct annual clinics Very important to consider annual occurrence of flu vaccination when building infrastructure Infrastructure would include ability to provide shots and ensure staffing Some approaches have been to follow public health preparedness infrastructure and integration with those services

5. Logistics Finding appropriate school space Receiving vaccine in time for clinics Scheduling Staffing (1 nurse serves multiple schools) Coordinate with schools in advance so space can be reserved and clinics do not overlap with field trips, school exams, etc… o Could allow teachers to coordinate flu- focused lessons Team up nurses serving multiple schools Clinic in a Bag – Anne Arundel County Utilize HD sanitarians, parent volunteers, high school students to carry out logistics of clinic set-up o Especially beneficial for high school students needing to earn volunteer/service hours o Could use residents, nursing school students, MRCs for one-time clinics but liability, supervision, and training are issues

6. School buy-in/Competing priorities Some school health programs are under DOE School nursing is sometimes housed in public health and sometimes in the school district Make immunization compliance a performance measure Garner administrative support from school district and individual schools (e.g. superintendents, school board representatives, and principles) Partner with National Education Association (NEA), National Association of State Boards of Education (NASBE), National Association of School Nurses (NASN), and other professional associations to deliver effective messages to school districts and schools Increased collaboration between CDC/HHS and Department of Education (DOE) to develop coordinated support and resources Advocate for standardized method to provide or oversee school health services o Barriers arise w/ larger school districts (e.g. Seattle/King County) Letter from superintendent/principal recommending vaccination.

7. Assessment/Evaluation No comprehensive sense of: o Current school practices o What is the actual coverage of students in schools (tracking who is not immunized, who is immunized in schools, or who is immunized in another healthcare setting) o What is the public health impact of the school-based clinics Universal states have not observed higher immunization coverage – why? Establish central system for collecting best practices Promote use of registries Shot cards (though may not be appropriate for all) Advocate for: o Integration of immunization registries with student databases IT capacity among HDs and schools is major barrier o More systematic collection of student data and immunization information Would require major software overhaul and pose challenges when system/software updates occur o Improved data collection