Virginias Stay on Track Daycare Initiative Susan A

Virginia’s Stay on Track Daycare Initiative Susan A. Tweed, MS, RN, Sentara Healthcare Sarah Nasca, MPH, CHES Project Immunize Virginia Center for Pediatric Research

Stay on Track Goals • To assist daycare providers with immunization record keeping to ensure children under 24 months of age are appropriately immunized. • To benefit children enrolled in daycare facilities through decreased exposure to vaccinepreventable illness. • To allow daycare staff more time with regular daycare activities rather than issues related to sick children or potential for illness.

Background • Immunization Action Plan (IAP) Coordinators from 5 cities in Hampton Roads, Virginia identified priority daycare centers. • Mentored by IAP’s, nursing students from Old Dominion University contacted each daycare center to interview director and educate staff on importance of timely immunizations. • CDC Immunization Scheduler was used to determine immunization schedule for each enrolled child. • A tickler file system was initiated to track immunization compliance for each enrolled child.

Program Structure • Funded by a generous grant from America’s Health Insurance Plans (AHIP) 2003 Innovations in Immunization Practices. • Partnership of key stakeholders from Sentara Healthcare, Old Dominion University, and the Virginia Department of Health was formed to pilot this initiative. • All stakeholders are members of the statewide immunization coalition, Project Immunize Virginia.

Methodology • Stay On Track Initiative received Institutional Review Board approval from Eastern Virginia Medical School. • 17 total daycare facilities from Newport News, Hampton, Portsmouth, Norfolk, and Virginia Beach were enrolled. • 299 children under 24 months of age were eligible to participate in the study. • 197 children under 24 months were consented and enrolled in Stay on Track -response rate of 66%.

Intervention Steps • Daycare Directors were interviewed and needs assessments were preformed at each center. • Daycares received a “Tracker Paw of Approval” Certificate for participating in Stay on Track. • Three assessments of immunization records completed to determine up-to-date (UTD) status: – If UTD, congratulatory letter and age appropriate incentive items (bibs, rattles, sippie cups, growth charts, immunization schedule, etc. ) were sent home. – If not UTD, reminder letter and immunization schedule sent home with child.

Intervention Steps • Immunization Storyboards were designed by nursing students and displayed at each daycare center to educate parents. • Storyboards were revised on monthly basis.

Next Steps • Final assessments will be completed June 2004. • Exit focus groups will be conducted with daycare staff to ascertain value and sustainability. • Project Immunize Virginia will issue news release highlighting the Stay On Track program and participating daycare centers. • Article about Stay On Track will be prepared for publication to share outcomes and lessons learned with the immunization community.

Anticipated Impact Outcomes • The Stay on Track Daycare Initiative is anticipated to: 1) Increase immunization coverage among children enrolled in daycare facilities; 2) Reduce vaccine-preventable illness in daycare centers; and 3) Improve parent provision of child's current, time appropriate immunization record to daycare center.

Future Initiatives • Project Immunize Virginia is currently planning an expansion of Stay on Track to other VA localities. • Create partnership with Social Services, the daycare licensing agency, to improve the awareness of need to obtain immunization records every 6 months for children under 24 months. • Clarify daycare immunization licensing standards for daycare for children between 2 and 4 years.

For More Information… Susan Tweed Sentara Healthcare satweed@sentara. com Sarah Nasca Project Immunize Virginia Nasca. SR@chkd. org