Description of LHD: Seminole County is located in East Central Florida just north of Orlando. With an estimated population of 455,479 in 2016 it ranks as the 13th most populous county in Florida, per the U.S. Census Bureau. Seminole County is also the most densely populated county in Central Florida with a total land area of 309.5 square miles and a population density of 1,413.17 per square miles. The racial and ethnic makeup of the county consists of Whites (79.6%), Blacks/African Americans (11.6%), Asians (4%), Native Americans (0.2%), and Native Hawaiian and Other Pacific Islanders (0.1%). The population identified as Multiple Races comprises 3%. Hispanic origin of any race comprised 18.7% of the population. Languages other than English are spoken in 19% of homes. Families living below poverty level in 2013 ranged from 4% to 13% by zip codes.
The Florida Department of Health in Seminole County (DOH-Seminole) has four service centers located in Sanford (2), Casselberry and through our Mobile Health Unit. DOH-Seminole offers clinical services through the main Sanford location which include family planning, immunizations, STD/HIV prevention and treatment, breast and cervical cancer early detection, men's health screenings, school health screenings and dental care services. A total of 14,638 clients received clinical services during the 2015-16 fiscal year with just over a third (35.6%) being children under the age of 13. Additional services provided by the health department include the Florida Healthy Babies program, Environmental Health, Women Infants and Children (WIC), Vital Statistics, Tobacco Prevention, Refugee Health, Tuberculosis, Epidemiology, Hepatitis, School Health, Public Health Preparedness, Insulin and Epilepsy Medication Distribution. Supporting departments include Health Promotion and Education, Clinical and Non-Clinical Internships, Quality Improvement and Performance Assessment, Information Technology and Workforce/Employee Wellness.
Additional information regarding DOH-Seminole can be found at our website: http://seminole.floridahealth.gov/index.html
Public Health Issue: Ensuring adequate vaccination coverage among children reduces the risk of vaccine preventable illness. The state of Florida requires that
prior to entry, attendance or transfer to preschools, schools (K-12), licensed childcare facilities, and family daycare homes, each child shall have on file a Florida Certification of Immunization, DH 680 Form documenting required vaccines. The School Health Program at DOH-Seminole monitors private school immunization compliance rates for KG and 7th grade and provides support to public and private schools with vaccine preventable disease outbreaks. Immunization compliance ensures schools are aware of student population immunization status and, in the case of disease outbreak, they can determine which students may be under or unvaccinated, so they can be removed from campus. Data from the immunization compliance reports for KG and 7th grades, prior to 2013, showed variation over the years ranging from 4% of the student population being out of compliance to close to 9% in school year 2011-2012.
This project focused on ensuring private school staff were informed about immunization requirements and had the resources they needed to keep their records up to date, reducing the number of students out of compliance with immunization requirements.
Goals and Objectives: The purpose of this project was to reduce the increasing rate of KG and 7th students in private schools out of compliance with immunizations.
Two of our objectives for this project are:
- Provide education to administrative or health services staff in all private schools who have KG and 7th grade students regarding immunization requirements, best practices to encourage parents to keep immunizations up to date, and tools to increase compliance with immunization records.
- By school year 2016-2017, decrease by 3% the number of private students in KG and 7th who are out of compliance with required vaccines (from 8.6% in 2011-2012 to 5.6% in 2016-2017).
Implementation: To address our goals, the School Health team developed a plan which included:
- Connecting with private school staff to identify needs and knowledge about immunization requirements.
- Develop an education kit, based on the needs assessment to support private schools in increasing compliance.
- Provide technical support to schools regarding immunization requirements.
In school year 2012-2013 the DOH-Seminole School Health team assessed factors that were decreasing compliance through site visits to private schools and phone conversations. Some of the challenges identified included high staff turnover rates, limited understanding of immunization guidelines, balancing multiple duties within the school, limited follow up with parents, lack of nurses or staff with health services background and unawareness of compliance tools, goals, among others. The team also noticed several private schools were not reminding parents to bring vaccination records prior to the beginning of the school year.
Based on this information, the school health team created a packet of information for private schools, which included links to the Florida Immunization Guidelines, flyers for parents from the Florida Department of Health Vaccine Immunization bureau with updated vaccine requirements, tips for schools on how to maintain records up to date, and links to helpful on-line resources as well as our team's contact information. In the spring of 2013-2014 the team began delivering the information packets to the private schools, to help them be better prepared for school year 2014-2015. This was followed by an e-mail to all private school principals with this same information in the summer. Finally, the nurses conducted site visits and provide technical support at the beginning of the school year between the months of August -October to help the schools review immunization records and answer questions. In the spring of 2014-2015, a newsletter was e-mailed to all private schools recognizing all the schools who achieved 100% compliance by the deadline and provided tips to help encourage compliance. The team continues to monitor compliance rates every year and provides the immunization education kit and technical support to private schools as needed.
Results/Outcomes: Since implementation of immunization education and support strategies in 2013-2014, every school year private schools with KG and 7th grade students have received the immunization information packet. Since our team implemented the practice, the rate of non-compliant KG and 7th grade students decreased from 8.6% in 2011-2012 to 2.6%. Furthermore, this practice has increased awareness of vaccination requirements and importance among private school staff, strengthen public health relationship with private schools, increase support for vaccination coverage and increased readiness of private schools in case of outbreaks. It also reduced the time spent by public health school nurses following-up with private schools and tracking immunization records by 50%, leading to an estimated annual cost savings of $5,124.
Public Health Impact of Practice: This project impacts the following essential public health services:
- Inform, educate and empower people about health issues- By creating immunization education kits for private school staff and providing technical support and assistance in reviewing the student immunizations our team raised awareness about the immunization requirements and about the importance of keeping compliance with record keeping.
- Mobilize community partnerships and action to identify problems- This project helped our team build stronger partnership bridges with our private schools. Collaborating with private school staff was crucial to the success of this initiative, form conducting the initial assessment to identifying needs and best practices that could be shared with other private schools.
- Enforce laws and regulations that protect health and ensure safety- This project increased KG and 7th grade student immunization compliance rates from 91.4% in 2011-2012 to 97.4% 2017-2018.