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| Practice Type: |
Model |
| Program Name: |
Immunization Community Based Outreach Program (CBO) |
| Organization: |
Philadelphia Department of Public Health, Immunization Program |
| Web site: |
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| Overview: |
The Immunization Community Based Outreach (CBO) program targets children, aged 10-24 months, who are behind for recommended immunizations according to the Philadelphia KIDS Immunization Registry. The Immunization CBO Program works to ensure that preschool children in Philadelphia are properly immunized against the following vaccine-preventable diseases: measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, haemophilus influenza type b, hepatitis B, hepatitis A, rotavirus, pneumococcal infections, and varicella so as to prevent outbreaks of these diseases.
The goal of the CBO Program is to protect the children of Philadelphia from vaccine preventable diseases by ensuring high immunization coverage levels citywide. Philadelphia Department of Public Health (PDPH) is able to track immunization coverage levels at the city, neighborhood, provider, and child level by the evaluating data maintained in the KIDS Immunization Registry. The CBO Program works to ensure all children have complete immunization records in KIDS Immunization Registry and targets those who are not up to date with age appropirate immunizations for education and outreach services. Outreach workers deliever key immunization education messages to families in the city of Philadelphia and provide assistance in helping parents get their children into the doctor's office for immunizations.
Through community health educators, the CBO Program delievers important health education information and services to parents and gaurdians in the city of Philadelphia. This program has helped the city of Philadelphia increase immunization coverage levels for preschool children from a low of 46 percent coverage among children 19-35 months for the 4:3:1:3 series (Four or more doses of DTP, three or more doses of poliovirus vaccine, one or more doses of any measles containing vaccine, and three or more doses of Hib) in 1992 to 80 percent coverage in 2005. The CBO Program has and will continue to help Philadelphia maintain immunization coverage levels above the national average.
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| Year Submitted: |
2007 |
| Responsiveness and Innovation: |
Low immunization coverage levels leave populations susceptible to vaccine preventable diseases as evidenced by the 1990 measles outbreak in Philadelphia. Beginning in October 1990, a large measles outbreak involving predominantly unvaccinated preschool age children occurred in Philadelphia. Between October 1990 and March 1991, there were 9 measles-associated deaths and a total of 1500 confirmed measles cases.
Outbreaks such as this are reminders of the importance of vaccinating infants and young children; when public health officials and systems are working and outbreaks don't occur, it is easy for parents to forget about the importance of immunizations. The CBO Program is a vehicle through which the PDPH can continue to remind parents about the importance of immunizations and work with them to get their children up to date for immunizations. Moreover, the CBO Program ensures that PDPH is aware of community responses to immunizations and can prevent clusters of unvaccinated children.
The CBO Program builds upon the principles of infectious disease case investigation, social work case management, as well as the fundamentals of immunization reminder-recall programs. The CBO Program relies heavily on the Immunization Program's KIDS Immunization Registry. The Philadelphia KIDS Immunization Registry is a computerized database, containing immunization information for all children living in Philadelphia. The KIDS Registry has been collecting immunization data since 1994 and provider practices are required by Philadelphia Health Code §6-210 to report all ACIP/AAP recommended immunizations administered to children under the age of seven. The registry serves as a repository for the immunization data that are reported, and automatically calculates each child’s up-to-date status, including series completion and next due dates, based on the immunizations contained in the registry. Algorithms programmed into the registry also enable outreach staff to target specific age cohorts missing specific vaccines for outreach and assign them to the correct outreach organization based upon the patient's address.
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| Agency and Community Roles: |
The PDPH Immunization Program is responsible for CBO Program planning, management, case assignment, and evaluation. PDPH has a contractual relationship with two large Philadelphia community-based health and human service organizations that conduct the community outreach and education for children, their parents, and community members in the zip codes and/or census tracts assigned by PDPH. The community organizations are recognized as leaders in their respective communities and reflect the cultural diversity of the communities they serve. Each organization is staffed with one program coordinator, one administrative assistant, and numerous outreach workers.
The community outreach workers are responsible for contacting providers, parents, and guardians through phone, fax, letters, and home visits to determine the child’s immunization status. The outreach workers review immunization histories and ensure the complete history is captured in the KIDS Immunization Registry. In cases where the child is not up-to-date, the outreach workers educate the family on the importance of timely immunizations, the appropriate immunization schedule, and resources available to aid the family in securing primary healthcare and immunization services. If necessary and agreed to by the parent or guardian, the outreach worker will facilitate the healthcare visit, including scheduling the appointment, arranging for transportation, and accompanying the parent or guardian. The community organizations are also responsible for representing PDPH at various health fairs and health education events in their community.
The PDPH Immunization Coordinator meets with each of the community organizations on a monthly basis to discuss program operations, program outcomes and measurements, in addition to immunization updates and best practices in providing outreach services. The CBO community organizations are key partners in determining best practices, opportunities for program improvidement, opportunities to reach new or difficult populations, and developing appropriate education materials. Quarterly meetings and trainings are also provided for all immuniation outreach workers as an opportunity for each outreach organization to discuss their successes and challenges and share opinions and strategies.
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| Costs and Expenditures: |
The funding source of this practice is the Centers for Disease Control and Prevention. The CBO Program budget represents 30 percent of the Immunization Program operating budget.
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| Implementation: |
Low immunization coverage levels leave populations susceptible to vaccine preventable diseases as evidenced by the 1990 measles outbreak in Philadelphia. Beginning in October 1990, a large measles outbreak involving predominantly unvaccinated preschool age children occurred in Philadelphia. Between October 1990 and March 1991, there were 9 measles-associated deaths and a total of 1500 confirmed measles cases.
Outbreaks such as this are reminders of the importance of vaccinating infants and young children; when public health officials and systems are working and outbreaks don't occur, it is easy for parents to forget about the importance of immunizations. The CBO Program is a vehicle through which the PDPH can continue to remind parents about the importance of immunizations and work with them to get their children up to date for immunizations. Moreover, the CBO Program ensures that PDPH is aware of community responses to immunizations and can prevent clusters of unvaccinated children.
The CBO Program builds upon the principles of infectious disease case investigation, social work case management, as well as the fundamentals of immunization reminder-recall programs. The CBO Program relies heavily on the Immunization Program's KIDS Immunization Registry. The Philadelphia KIDS Immunization Registry is a computerized database, containing immunization information for all children living in Philadelphia. The KIDS Registry has been collecting immunization data since 1994 and provider practices are required by Philadelphia Health Code §6-210 to report all ACIP/AAP recommended immunizations administered to children under the age of seven. The registry serves as a repository for the immunization data that are reported, and automatically calculates each child’s up-to-date status, including series completion and next due dates, based on the immunizations contained in the registry. Algorithms programmed into the registry also enable outreach staff to target specific age cohorts missing specific vaccines for outreach and assign them to the correct outreach organization based upon the patient's address.
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| Sustainability: |
Through ongoing evaluation and increasing immunization coverage levels, PDPH has demonstrated the success of the program to CDC and city officials and consequently, the program has remained funded for over 10 years. The flexibility of the program's structure has enabled the CBO Program to evolve as needed to address coverage of new immunization recommendations and/or new age cohorts. In 2004, PDPH implemented a suplemental program, Provider Based Outreach (PBO) to help ensure the completeness of the KIDS Immunization Registry and decrease the number of children who were up to date for immunizations, but were refered to the CBO Program because their complete immunization history was not captured in the KIDS Immunization Registry. The implementation of this supplemental program has decreased false referrals to the CBO program by 40 percent between 2004 and 2006. This enhancement has enabled the CBO outreach workers to reach more families and PDPH expects that this will help increase immunization covereage levels in the near future.
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| Lessons Learned: |
Lessons learned include:
- Monthly closure reports are reviewed by the PDPH Outreach Coordinator as well as community organization managers. Closure reports help ensure worker productivity and have been essential in making adjustments to work load estimates allowing the program to adjust resources to target high-risk populations. PDPH has found that as the number of false referrals generated for the CBOs decreases - more time is needed for each outreach worker to work 80 true cases.
- Outreach workers are responsible to close each case with a specific outreach code in the KIDS Immunization Registry. By closing cases with a disposition of "1A - immunization history received from provider, child UTD", PDPH is able to track the number of false referrals.
The PDPH Outreach Coordinator began to look at the number of 1A disposition codes by provider and zipcode. By conducting this analysis, action was taken to help decrease reporting errors and increase data quality for providers causing false referrals to the CBO Program.
- Outreach workers are responsible to close each case with a specific outreach code in the KIDS Immunization Registry. By closing cases with a disposition of "2-child BTC -UTD", PDPH is able to track the number of kids brought to care. The PDPH Outreach Coordinator is able to look at all closure codes and has deemed the biggest barrier to reaching the objective (return all children 10-20 months, not up to date for age appropriate immunizations to their medical home for care) is the inability to locate 30 percent of the childen referred to the CBO Program.
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