Transcript Update on BPHC Mobile Vaccination Program - Dana

Primary Cancer Prevention: A
Unique Partnership Model to
Promote HPV Education and
Vaccination in School Communities
Sarah Gunn, MS
Senior Community Outreach
Specialist
Dana-Farber Cancer Institute
Philomena Asante, MD, MPH
Director, Division of Child and
Adolescent Health
Boston Public Health
Commission
Disclosures
I, Sarah Gunn, have been asked to disclose any significant relationships
with commercial entities that are either providing financial support for
this program or whose products or services are mentioned during my
presentations.
I have no relationships to disclose.
I may discuss the use of vaccines in a manner not approved by the U.S.
Food and Drug Administration but in accordance with ACIP
recommendations.
Disclosures
I, Philomena Asante, have been asked to disclose any significant
relationships with commercial entities that are either providing financial
support for this program or whose products or services are mentioned
during my presentations.
I have no relationships to disclose.
I may discuss the use of vaccines in a manner not approved by the U.S.
Food and Drug Administration but in accordance with ACIP
recommendations.
Community Benefits Office
The role of Dana-Farber's Community Benefits office is to support the Institute's goal to
reduce cancer risk among medically underserved populations.
In collaboration with staff throughout Dana-Farber, we serve as a bridge with community
organizations and establish evidence-based and sustainable outreach programs.
Examples:
•
Skin Cancer and Sun Safety
•
Breast Cancer: Mobile Mammography Van
•
Tobacco Cessation
•
Government Relations and Legislative Action Network
•
Partnership with Whittier Street Health Clinic
•
HPV Related Cancers
All programs determined by Community Health Needs Assessment
In short, we are committed to making Dana-Farber's care and research findings more
accessible to everyone within and outside its walls.
Boston Public Health Commission:
Boston’s Public Health Department
• Boston Public Health Commission (BPHC)’s Mission: “protect, promote
and preserve the health of all Boston residents, particularly the most
vulnerable”
• Division of Child and Adolescent Health: Putting the mission into action:
– Division runs 7 programs for Boston youth in truancy case management,
health services and youth development: “Keep students in school, keep them
healthy and prepare them to be leaders in their communities and beyond.”
– Work closely with Boston Public Schools (BPS) and other community partners
– Majority of students served : low income, minority and English-language
learners
– $ 5 million budget, services offered free to students and their families
– Year-round Youth Development Program participants get paid the minimum
wage
– HPV education has been infused in most Division programming
– Presentation will focus primarily on the School Based Health Center Program
Background: HPV and Cancer Statistics
http://www.cdc.gov/cancer/hpv/statistics/cases.htm
Background: President’s Cancer Panel,
Healthy People 2020, Vaccination Rates
The President’s Cancer Panel and Healthy People 2020 share a goal of 80%
HPV vaccination rates for boys and girls. The Healthy People 2020 Task force
recommends using evidence-based methods for increasing vaccination
rates including combined interventions, as well as school vaccination
programs.
Recommendations include:
• Referral of under-immunized school or child care center attendees to
vaccination providers
• Reduce missed opportunities by vaccination providers
• Assessment and tracking of vaccination status
• Immunization education and promotion
• Provision of vaccinations
• Increase community demand
• Enhance access to vaccination services
Healthy People 2020 Goal
https://www.healthypeople.gov/2020/topics-objectives/national-snapshot/hpv-vaccine-adolescents2008%E2%80%932012
Adolescent Vaccination Coverage,
Massachusetts, 2008 – 2015
Tdap
MenACWY
1 HPV - Females
3 HPV - Females
1 HPV - Males
3 HPV - Males
% Vaccination Coverage
100%
91%
90%
80%
74%
63%
60%
53%
40%
35%
20%
0%
2008
2009
2010
2011
Year
2012
2013
2014
2015
Note: For the purposes of comparability to 2014 estimates, 2013 estimates were revised by retrospectively applying the revised
2014 provider data definition to the 2013 NIS teen data and as a result, differ from those previously published.
NIS Data, CDC
MDPH 2016
9
DFCI: HPV & Related Cancers
Outreach
2014 – 2015
DFCI and Team Maureen developed validated HPV/Cancer curriculum for
youth and adults:
Knowledge ↑ 207% ●
Intention ↑ 203%
●
Speaking ↑ 29%
• Conducted workshops at community organizations
• Trained Youth Peer Leaders at Sociedad Latina
2015
• MDPH added HPV vaccine to state-supplied immunization program
• DFCI and BPHC partner to provide educational and interventional outreach
program with School-Based Health Centers at Boston Public Schools
Boston Public Health Commission’s
School Based Health Center Program
• Clinical entity run by a public health department : licensed under
Boston Medical Center (BMC) but operated by the Commission
• Don’t replace a student’s health provider, rather serve as partners
in their care; only open when school is open
• All students enrolled at the school are eligible to register at their
school based health center
• Comprehensive adolescent health clinic in the school setting
• Services offered free to student, do bill insurance if a student has
insurance but insurance is never a barrier to care—we see
everyone!
• Our strengths: mental health support, urgent care, chronic disease
case management, family planning and vaccine administration and
management
• SBHC have an advantage over community health centers with multidose vaccines—higher completion rates (students don’t miss school
and parents don’t missed work)
BPHC School-Based Health Center
Program
• 6 full service school based health centers serving 8
Boston Public Schools
• 2,000 -2500 students enrolled, 10,500 visits yearly
• SBHC Team: Nurse practitioner, Mental Health
Clinician, Family Planning Health Educator and an
Administrative Assistant
• Students had to be enrolled in the health center to
receive the HPV vaccine on site: better monitoring,
less liability
School Based health Center Schools
Hyde Park- Pilot Sites
• New Mission High School
• Boston Community
Leadership Academy
Roxbury
• Boston Latin Academy
• Madison Park High School
Back Bay
• Snowden International School
Brighton
• Brighton High School
Dorchester
• Jeremiah E. Burke High School
• Dearborn Stem Academy
BPHC’s 2015-2016 HPV Initiative in
School Based Health Centers
• Three Key Components:
• Student Education
–
–
–
–
In-class: Workshops DFCI Validated HPV Curriculum for Youth
Assembly: Cervical Cancer Survivor’s story (Christine Baze)
School Outreach: lunch tables
HPV Poster Contest (12/15)
• Parent Education
– Parent Information Packet (sent home to all parents):
Headmaster Letter
SBHC Enrollment form
CDC HPV Info Sheet for Parents
HPV Consent
HPV VIS
MIIS Info Sheet
– Table and Information Packets given to parents at Parent Council
Meetings and Open Houses
• Opportunities to get the HPV vaccine:
– At the School Based Health Center by appointment
– Mobile Van Vaccination Days
BPHC’s 2015-2016 HPV
Initiative
Pilot Program: Education & Vaccination
2015 - 2016
Pilot Program Goals
• Feasibility test of offering HPV vaccine in a school-based, mobile clinic
setting
• Increase HPV vaccination uptake and completion among Boston Public
School students with access to School-Based Health Centers
• Increase knowledge of HPV and related cancers, the HPV vaccine among
parents and vaccine-eligible youth in priority neighborhoods
• Increase SBHC enrollment
• Reduce barriers to vaccine access: cost, convenience, knowledge
Process
1. Dr. Asante and DFCI introduce program to Headmasters
2. DFCI meets SBHC and school staff
3. Schedule created
4. Outreach activities planned
5. Clinic protocol established
6. Evaluation Plan
MDPH
Boston
Public
Health
Commission
SchoolBased
Health
Center
7. Recruitment
Boston Public Schools
8. Clinic preparation
9. Clinic operation
10. Data entry
11. Follow-up
Team
Maureen
Dana-Farber
Cancer
Institute
Resources and Preparation
BPHC/SBHC
• Order and store vaccines from
MDPH
• Student vaccine status,
register and enroll students
DFCI
• Information packets
• Student vaccine status,
organize list
• Provide Blum Family Resource
Van and nurses
• Provide on-board education
Mobile Clinic Operation
•
Vaccines transferred to van
•
AA entered appointments into Epic
•
Staff called for 3 students at a time
•
Students checked into SBHC and took admin record to van
•
Van nurses drew up vaccines as students were checked in
•
Vaccine administered on van
•
Students observed 10-15 minutes on van and completed survey
•
Van staff collected admin records and returned to office
•
SBHC staff completed data entry; Epic and MIIS
•
Some students received vaccines in office
Pilot Program Highlights
Mobile clinics: 1/25/16, 3/7/16, and 5/26/16
• 52 doses administered
• 35 students vaccinated
• 5 students completed vaccine series
• 16 students started vaccine series
• 18 students received follow-up doses (started at SBHC or
elsewhere)
• Primary motivation for participating was cancer
prevention, secondary motivators were convenience and
cost
• Even distribution of males and females
• In class workshops recruited most participants
• Positive image of DFCI/SBHC “That’s so cool, you’re
saving us.”
• Presented at NCI Cancer Centers Summit
• Presented at APHA conference
HPV Initiative: Challenges
• Stakeholder engagement:
– Get buy in from school administrators(all levels) school staff, parents and
community partners
– Engage stakeholders early
– Know school calendar
• MIIS:
– Encourage more providers to use system
• Budget additional time for acquiring vaccine records:
– HPV not a required school vaccine, students change providers, incomplete BPS
records
– Confirming HPV vaccination status often required contacting student’s health
provider
– Had very motivated students who enlisted but were completely vaccinated
HPV Initiative: Challenges
• Parent Engagement
– Limited opportunities to engage parents
– Embed outreach to parents in regularly scheduled school events
(parent council meetings and open houses)
• Messaging
– Emphasize clinic convenience for parents and students (some unaware
of SBHC existence)
– Clear and consistent cancer prevention messaging between all
stakeholders
• Early development of a communication plan among partners
– Discuss protocols and policies
• Sustaining enthusiasm for duration of initiative
– From 1st to 3rd mobile vaccine clinic day
– Student incentives for series completion
HPV Initiative:
2016-2017 Strategies
• Focus on one or two grade levels instead of entire school
– Next SBHC: Boston Latin Academy (9th grade)
• Creative campaigning for sustained enthusiasm
– Consider engaging students in schools as program
advocates/youth ambassadors
• Tracking/Evaluation—still a challenge; enlisting help of Dana
Farber and BPHC’s Office of Research and Evaluation
• Evaluate program as national model
BPHC Youth HPV Public Service
Announcement
• The Boston Area Health Education Center(BAHEC) is a youth
pathway to health careers program whose mission is to increase the
number of youth from underrepresented populations who pursue
careers in health and public health
• HPV video was written and produced by BAHEC students during a
film elective in Spring, 2015
• Video translated into Spanish with a grant from the American
Cancer Society
• September 2016: BAHEC received a State Farm Youth Advisory
Board grant to implement its HPV Youth Ambassadors Project.
• English Video:
https://vimeo.com/145564922
• www.bphc.org/bahec
Acknowledgements
Community Benefits
Magnolia Contreras
Sarah Gunn
Boston Public Schools
BCLA
New Mission
Perini Clinic – Pediatric
Oncology
Eileen Duffey-Lind
Jill Brace-O’Neal
Boston Public Health
Commission
SBHC team
Nursing & Patient Care
Services
Kathleen Houlahan
Office of General
Counsel
Krietta Bowens Jones
Blum Family Resource
Van
BPS Health and Wellness
Jill Carter, Director
Suzy Spressert, Sexual Health
Education Project Manager
BPS Health Services
Linda Grant, MD
BPS Medical Director