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									       Engaging child care workers as
  key immunisation stakeholders in the
                 ACT
              Hailey Shaw, Immunisation Program Officer


A presentation for the General Practice Queensland Immunisation/NiGP network
                               meeting, May 2010
                            Aims
  Use a health promotion framework (social marketing and health
  education) to:

• Increase knowledge in child care workers about the principles of
  immunisation and recommended vaccines for both children in their
  care and themselves.

• Maintain and improve immunisation coverage rates and timeliness
  of vaccination encounters in Canberra’s children
    Who is the ACT Division of General Practice?
•   Both a Division and a State Based Organisation (SBO) that is accredited
    through the Institute for Healthy Communities (AS/NZ IS0 9001:2000)

•   Over 500 GP Members
    Practice Nurses & Practice Managers - Associate Members since June 09

•   324 GPs in general practice over 100 practices
    212 weighted FTE workforce (60 below required)
    Many resident GPs work in public funded clinics, NFP sector, agencies,
    government and academia

•   The current estimated population within the Division's
    catchment is 374,900
    23 600 children aged 5 years and under.
          National policy initiatives – health
   Immunise Australia: 7 Point Plan launched Feb 1997
                                           For parents:
For GPs:
                                           Maternity Immunisation Allowance
   Financial incentives to report
                                             Paid for those fully immunised or
   childhood immunisations to the
                                             with an approved exemption – non
   ACIR
                                             means tested.

For general practices:
                                           Child Care Benefit
   Financial incentives to achieve
                                              Lawrence et al. (2003)79% of parents
   childhood immunisation coverage
                                              with children fully immunised indicated
   rates >90%                                 that it was unlikely they would be
                                              able to afford child care
For Divisions of General Practice:            without CCB
   Targeted funding for immunisation          assistance
   specific activities
   Including: Increase average childhood
   immunisation coverage for the 60-<63
   months age group within the Division.
       National policy initiatives – child care

                                   National Childcare Accreditation
                                   Council- Quality Improvement and
                                   Accreditation System
                                   Quality Areas 5 and 6*

                                   Child Care Benefit – as a fee
                                   reduction or lump sum payment

                                   Australia wide 90% of families using
                                   long day care access CCB.**

                                  *NCAC Quality Trends Report, June 2009
                                  ** DEEWR, Census of Child Care
                                  Services 2006

NHMRC, Staying Healthy in Child
  Care, 4th edition, endorsed
      December 2005.
Local policy initiatives - immunisation
               Objective 1:
               Maintain and enhance the immunisation
               coverage rates of children in the ACT.

               Objective 2:
               Increase immunisation rates amongst
               adolescents, adults and vulnerable people
               within the community, with special
               emphasis on Aboriginal and Torres Strait
               Islander people.
               Including: promote the uptake of recommended
               vaccines for health care, aged care and child
               care workers, and other occupations as
               appropriate.

               Objective 5:
               Increase the accessibility and
               provision of
               early childhood
               immunisations through
               General Practice.
                          How is Canberra going?




Source: Australian Childhood Immunisation Register
http://www.medicareaustralia.gov.au/provider/patients/a
cir/files/acir-vaccine-coverage-30sep09.pdf
             2008 – New Key Guidelines released




1 January 2009 – Let’s try to improve timeliness
Policy change for Maternity Immunisation
    Allowance and due/overdue rules.
               Pertussis notifications in Australia
                             Jan 2000-Sep 2009
                               Source: NNDS
23000
22000
21000
20000
19000
18000
17000
16000
15000
14000
13000
12000
11000
10000
 9000
 8000
 7000
 6000
 5000
 4000
 3000
 2000
 1000
    0
        2000   2001   2002   2003   2004   2005   2006   2007   2008   2009 (to
                                                                       end Sep)
Engaging key identified but unengaged
   stakeholders in immunisation...
 What’s needed from the Division?
• Establishment of a relationship with the child
  care sector
• Workplace flexibility around meeting times
• Staff member/team prepared to “see it through”
• Support from senior management and GP
  advisor
• Laptop and data projector
• Resource packs including staff certificates,
  Handbooks, Myths and Realities,
  sample newsletter articles on
  current/topical issues.
           The process
Requested to present staff CPD to a local day care centre




     Proposal presented to and supported by senior
                     management




    Mail out to all long day care centres in Canberra




Individual centre appointments made at a time and
             place convenient to each



Presentation endorsed by ACT Health and delivered
          to interested child care centres.
 Immunisation “in general”    Recommendations
          Why?               for child care worker
    How does it work?        immunisation as per
Successes and challenges?        the Australian
Who are the unimmunised,         Immunisation
underimmunised or “hard to    Handbook, 9th edn.
      reach” groups?                  •dTpa
                                      •MMR
                                       •VZV
                                   •Influenza
                                     •Hep A


                                  Local and national
                                    coverage and
                                 timeliness issues of
                                      childhood
                                    immunisation
                                      coverage.
              What has been found?
                  Presenter Observations
• Generally passive approach in long day care centres to
  immunisation updating process in child care centres despite
  existing legislation
• Of the centres who offered in house vaccination programs –
  uptake generally low and only included influenza
• Despite pertussis epidemic and infant deaths in 2009 – low
  awareness that adult boost required
• Only 1 long day care centre was completely aware
  of the current immunisation status of
  ALL children in their care
  They had been notified by ACT Health of a
  child pertussis case that day and were
  assisting with contact tracing
             What has been found?
                 Participant evaluations

On a scale of ☺ (OK) to ☺ ☺ ☺ ☺ (absolutely agree)
  93.4% absolutely agreed that the information about
  childhood immunisations was useful

  95.1% absolutely agreed that the information about child
  care worker recommended immunisations was useful

  Only 85.4% absolutely agreed that they
  were more likely to talk to their GP
  about their own immunisations
             What has been found?
                 Participant evaluations

  From free text responses about the 2 key points
  participants took away:

• The importance of “self” immunisation
• Adult dTpa – especially because of their occupation
  (flu, hep A and MMR for those born 1966-1980 were next
  most mentioned)
• The importance of communication with
  parents/carers about when childhood
  immunisations are due
        What has been achieved?
• 30% (35/115) long day care centres have been visited
  in period Feb-Nov 2009
• 15% (225/1500) long day care child care workers have
  heard about immunisation
• 21% of Canberra’s children attending day care
  between the ages 0-5 years old might be reminded
  about immunisation either through health promotion
  materials or child care worker reminders

  Any potential effects on childhood
  immunisation coverage will not be
  realised for at least 12 months due to
  the retrospective nature of ACIR.
How can you make this work for you?
             • Use the wider immunisation
               team to “share the load”
             • Run “local area sessions”
               rather than individual ones
             • Target areas of low
               coverage if resources are
               limited
             • Don’t reinvent the
               wheel
               2010 and beyond?
• Continue child care centre
  visits as requested

• Utilise this group to distribute
  important immunisation and
  other health messages

• Monitor childhood
  immunisation coverage
  rates – especially 4 y o
          Acknowledgements
 Senior management and the
 Board at the ACT Division of
General Practice for supporting
         the project.
                                         Kirinari Early Childhood
                                        Centre and my little girl for
                                        “getting me in” to engage
    Dr Greg Rowles and                          the sector.
 Dr Phil Toua for their clinical
          expertise.

                     All the long day care
                      centres who have
                         listened to me.

								
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