Engaging child care workers as key immunisation stakeholders in the ACT Hailey Shaw, Immunisation Program Officer

1. Engaging child care workers as key immunisation stakeholders in the ACTHailey Shaw, Immunisation Program Officer A presentation for the General Practice Queensland Immunisation/NiGP network meeting, May 2010

2. 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

3. 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.

4. National policy initiatives – healthImmunise Australia: 7 Point Plan launched Feb 1997 For parents: Maternity Immunisation Allowance Paid for those fully immunised or with an approved exemption – non means tested. Child Care Benefit Lawrence et al. (2003)79% of parents with children fully immunised indicated that it was unlikely they would be able to afford child care without CCB assistance For GPs: Financial incentives to report childhood immunisations to the ACIR For general practices: Financial incentives to achieve childhood immunisation coverage rates >90% For Divisions of General Practice: Targeted funding for immunisation specific activities Including: Increase average childhood immunisation coverage for the 60-<63 months age group within the Division.

5. National policy initiatives – child care National Childcare Accreditation Council- Quality Improvement and Accreditation SystemQuality 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.

6. 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.

7. How is Canberra going? Source: Australian Childhood Immunisation Register http://www.medicareaustralia.gov.au/provider/patients/acir/files/acir-vaccine-coverage-30sep09.pdf

8. 2008 – New Key Guidelines released 1 January 2009 – Let’s try to improve timeliness Policy change for Maternity Immunisation Allowance and due/overdue rules.

10. Engaging key identified but unengaged stakeholders in immunisation...

11. 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.

12. The process

13. Immunisation “in general” Why? How does it work? Successes and challenges? Who are the unimmunised, underimmunised or “hard to reach” groups? • Recommendations for child care worker immunisation as per the Australian Immunisation Handbook, 9th edn. • dTpa • MMR • VZV • Influenza • Hep A Local and national coverage and timeliness issues of childhood immunisation coverage.

14. 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

15. 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

16. 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

17. 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 tothe retrospective nature of ACIR.

18. 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 How can you make this work for you?

19. 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

20. Acknowledgements Senior management and the Board at the ACT Division of General Practice for supporting the project. Dr Greg Rowles and Dr Phil Toua for their clinical expertise. Kirinari Early Childhood Centre and my little girl for “getting me in” to engage the sector. All the long day care centres who have listened to me.