STRIVE FOR 95. A Model for Community-Based Integrated Quality Improvement

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2 STRIVE FOR 95 A Model for Community-Based Integrated Quality Improvement

3 STRIVE FOR 95 Steven C. Barkley, MD Daniel Brennan, MD David Fisk, MD Charity Dean, MD, MPH Bill Cirone, Superintendent

4 THE HISTORICAL PERSPECTIVE Immunization Activism in Santa Barbara

5 IMMUNIZATIONS IN SANTA BARBARA COUNTY Immunization Rates in many parts of Santa Barbara are at levels that will not confer immunity or protect the members of the community that have medical contraindications for vaccination. About 1/2 of schools have appropriate levels of Immunization In some areas, the rates are strikingly low, and cluster in the south.

6 Falling Immunization Rates Mirror the Increase in Personal Belief Exemptions Statewide Measles, mumps and rubella requirement Measles outbreak Hepatitis B requirement Varicella requirement Source: CDPH, Immunization Branch

7 Source: washingtonpost.com from CDPH

8 Am J Public Health September; 104(9): e3 e6.

9 Source: Graphiq, Dunn & Bradstreet, et al

10 A HIGH RATE OF POPULATION IMMUNITY IS NECESSARY TO PROTECT THE VULNERABLE

11 IMMUNIZATION RATES BY SCHOOL SB COUNTY

12 IMMUNIZATION RATES BY SCHOOL SB COUNTY Kindergarten Seventh Grade

13 PROPOSAL To develop a wide coalition of community resources with the goal of bringing countywide rates of immunization to the goal standard of 95%. To develop a strategy to avoid the persistence of pockets of extremely low immunization rates.

14 PROPOSAL Approach the problem of low vaccination rates as a Quality Improvement (QI) opportunity.

15 QI Identify an area of potential improvement. Historically low Immunization Rates Obtain pre-intervention metric. Reported Iz rates from CDPH data

16 QI Develop a set of potentially better practices Repeat the metric post intervention. Reported Iz rates,

17 PROGRAM DEVELOPMENT Identification and meeting with stakeholders Area Physicians Public Health School Administrators

18 PROGRAM DEVELOPMENT Asked the questions: What doesn t work? What do you think would work?

19 WHAT WE LEARNED Data only gets you so far. There is a real, but limited role for the physician community in this conversation. The closer the messaging is to the grass roots, the better. School Nurses Informed and respected parents

20 WHAT WE LEARNED Adult Immunization Rates need to be improved, and the campaign needs to address this as well. Conversations need to be open, but science based. Unequal megaphones. We should appeal to the better angels of our natures. Emphasize the principle that all members of the community need to be immunized, in order to protect the members who cannot be.

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22 INTERVENTIONS Support Peer Relationships and Communication Strive for 95 stickers Parent-to-Parent interactions The Whole Foods Effect

23 INTERVENTIONS Develop a campaign supporting the positive messaging of: School Nurses Parents School Administration Physician and Clinic Offices Adult Immunization Compliance

24 INTERVENTIONS Seek unanimous support from local physicians that they will not sign Personal Belief Exemptions (PBEs). Support legislation aimed at eliminating the PBE in California. Encourage schools to exclude school nurses from signing PBEs.

25 INTERVENTIONS Met with Communications and Marketing of Coalition Partners Outlined our Proposal, Message, and Target Population Got out of their way.

26 INTERVENTIONS Marketing returned with a plan for: A Kickoff Event for the Public and Media Targeted Messaging A Media Campaign

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30 RADIO CAMPAIGN Santa Barbara Santa Maria KTYD KSNI KSBL KSMY July 29-September 13, 2016

31 PRINT CAMPAIGN Montecito Journal Lompoc Record Santa Barbara Santa Maria Times Independent Santa Ynez Valley Santa Barbara News News Press

32 DIGITAL CAMPAIGN strivefor95.org Strive for 95 enewsletter to 7,000 households Facebook EdHat Noozhawk

33 strivefor95.org Unique visits since 6/2015: 6500 Average time on page: 6 minutes

34 strivefor95.org Vaccine Information Finding a Provider

35 SUPPORT MATERIALS Developed themed handout materials Bilingual Colors chosen to copy to B&W well

36 SUPPORT MATERIALS Fliers distributed to: Schools Summer camps YMCA

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41 IS IT WORKING?

42 S B COUNTY CHILDCARE,

43 IMPROVING RATES IN LOW IMMUNIZATION SCHOOLS

44 IMPROVING RATES IN LOW IMMUNIZATION SCHOOLS

45 IMPROVING RATES IN LOW IMMUNIZATION SCHOOLS

46 IMPROVING RATES IN LOW IMMUNIZATION SCHOOLS

47 IMPROVING RATES IN LOW IMMUNIZATION SCHOOLS Wilcoxon signed rank test p= p= p=0.0039

48 LESSONS LEARNED Changing Immunization Compliance is a multi-year project. There is evidence that targeted, positive messaging does affect parental decision making. Communication and Marketing skills are essential elements of program design.

49 LESSONS LEARNED QI Approaches to Community Challenges provides an effective framework for measuring and evincing change. Developing effective networks of community stakeholders can provide a framework for cooperative initiatives in the future.

50 MANY MANY THANKS Kurt Ransohoff, MD Takashi Wada, MD Collette Brier Marjorie Newman, MD Mary Louise Scully, MD Jill Fonte Susan Klein- Rothschild Adriana Almaguer Cathy Breen Katy Bazylewicz Bob Behbehanian William Banning, Superintendent, GUSD Margaret Faleh

51 MANY MANY THANKS S. Rao Jammalamadaka, Ph.D. Aruna Jammalamadaka, Ph.D.

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54 S B COUNTY CHILDCARE,

55 PME, SB COUNTY