Maximizing Participation, Logistics
School-Located Vaccination (SLV): Information for Planners
Maximizing Participation in the SLV Program
A variety of strategies for maximizing participation in SLV programs have been successfully implemented in past SLV programs. These strategies are summarized below.
Consent Form Dissemination, Collection, and Follow-Up
Consent forms and other SLV informational materials can be provided to parents/guardians using a variety of methods. For example, the materials can be sent home with students after having been distributed in class, sent to parents/guardians via US mail along with registration materials at the beginning of the school year, provided at registration or other school events, or posted on-line. Sending information packets home with students is common and appears to be effective relative to sending the information home via US mail (IZ Xtreme; El Amin, 2009). Schools also should consider making consent forms available on-line, either through the school website (if available) or via email (schools and/or parent organizations may have pre-established list serves for students’ families) (Boyer-Chu, 2008; National Association of County and City Health Officials [NACCHO] School-located Influenza Immunization School Kit). Additionally, high schools might want to make consent forms available on-site for eligible students who do not require parental consent (e.g., students aged 18 years or older) (National Association of County and City Health Officials [NACCHO] School-located Influenza Immunization School Kit).
Limited data suggest that return rates are higher when teachers (rather than nurses or other school staff) are responsible for collecting consent forms (Tung, 2005). To facilitate follow-up, schools may consider setting an absolute deadline for return of consent forms (Wilson, 2001).
If resources are available, school staff should attempt to follow up with students who do not initially return the forms (Boyer-Chuanroong, 1997). For this reason, consent forms should include an option for the parent/guardian declining vaccination so that school staff can easily identify students who have not returned consent forms and distinguish them from students whose parents/guardians declined vaccination. Also, including a “decline” option allows incentives (see below) to be based on the total number of forms returned, regardless of whether parents/guardians consented to or declined vaccination.
Student incentives can motivate students to return completed parental consent forms (Boyer-Chuanroong, 1997). Individual incentives for students who return completed consent forms or peer or group incentives for classes with a high proportion of students who returned completed consent (e.g., increased class recess time), may be considered (Boyer-Chuanroong, 1997; Uniti, 1997; Guajardo, 2008; Wilson, 2001; National Association of County and City Health Officials [NACCHO] School-located Influenza Immunization School Kit)
A randomized controlled study of different types of incentives found that peer or group incentives were more effective than individual incentives (Unti, 1997). To reduce or eliminate costs associated with providing student incentives, schools may consider approaching local merchants or community organizations for non-food-related donations, coupons, or gift certificates (Boyer-Chu, 2008).
Because teacher support has been identified as an important factor for maximizing participation in SLV programs (Tung, 2005; Goldstein 2001), when resources are available, teachers who actively participate in the vaccination program could be provided with appropriate incentives (Boyer-Chuanroong, 1997; Goldstein, 2001; Cassidy, 1998). A simple note expressing appreciation may also be an effective reward (Boyer-Chuanroong, 1997). In addition, it may be necessary to consult with local union representatives if an incentive system has an impact on staff members’ rights under a collective bargaining agreement.
As mentioned above, if planners decide to use incentives, they should be based on the number of consent forms returned complete, regardless of whether parents consented to or declined vaccination. Thus, in order to use incentives, consent forms must include an option for parents to either consent to or decline vaccination (see parental consent form discussion and templates in the section on “Preparing Forms and Letters to Provide to Parents/Guardians”).
SLV Clinic Day Logistics
Published guidelines for setting up large-scale vaccination clinics can be found on CDC’s influenza website. These guidelines were not developed specifically for influenza SLV clinics. However, most of the suggested approaches are relevant, especially to SLV clinics held during non-school hours. Additional considerations apply to SLV clinics held during school hours.
These challenges, along with tips and examples of how to manage them, are outlined below:
For SLV clinics held during school hours:
- Rules on who may be present in the school building during school hours may vary. Communicate well in advance about these issues and plan accordingly. Additional security staff to monitor safety and help with traffic flow may be necessary.
- Since parents/guardians may not be present when students are vaccinated, processes need to be in place to ensure that only children for whom parental consent was obtained are vaccinated. This process of confirming the identity of children is easiest if school staff (e.g., teachers and school nurses) are overseeing the process.
- Placing labels and/or name tags on children (usually younger students) can help reduce the risk of immunizing the wrong students (National Association of County and City Health Officials [NACCHO] School-located Influenza Immunization School Kit), although monitoring is suggested as these identifiers can be exchanged by children.
- Asking multiple questions in addition to the child's name (e.g., parent/guardian names, street address) may be helpful.
- If both types of influenza vaccine are being offered at the SLV clinic, a mechanism needs to be in place that ensures children get the appropriate vaccine. This can be done by color coding the consent forms for each type of vaccine or making sure vaccinators are assigned to administer only one type of vaccine.
- Processes need to be in place for orderly vaccination of children. Staff will be needed to escort students to and from the clinic site.
- Often, children are escorted classroom by classroom. For older students who change classrooms throughout the day, it may be helpful to focus on one particular class that is attended at some point by most or all students (e.g., Language Arts/English)
- Despite some parents/guardians providing consent for their child to be vaccinated, it may not be possible to vaccinate the child on clinic day for reasons such as illness, child refusal, or discovering a contraindication. In this case, it is essential that parents/guardians are informed that the child was not actually vaccinated. This could be accomplished by returning a form to parents/guardians via the child or via U.S. mail, sending the parent an email message, and/or calling the parent on the telephone. It may be helpful to designate one SLV clinic staff member to be in charge of this important task.
Materials to Send Home with Students Post-Vaccination:
An appropriate VIS (depending on which formulation of influenza vaccine is being offered–inactivated, injectable formulation or live, attenuated intranasal formulation) should be provided to parents/guardians after vaccine administration. Planners may also wish to consider distributing influenza vaccination record cards to vaccinees (e.g., to parents via vaccinated children). Information can be recorded on these cards about the vaccine provider, lot number, manufacturer, etc., which can be shared with the vaccinee’s primary health care provider. Information can also be recorded on the card about the potential need for a second dose and what to do in case of a possible adverse event.