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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