Strategy
The primary goals and objectives of this project are to assess and translate immunization records and enter them into the Massachusetts Immunization Information System (MIIS) and offer routine pediatric catch-up vaccination.
Challenge
Massachusetts is a Right-To-Shelter state for families experiencing homelessness, through the use of the Emergency Assistance (EA) shelters. Beginning in late 2022/early 2023, newly arrived families from Haiti and Central America came to Massachusetts in large numbers, soon placing the EA shelter system at capacity. While great effort was made to connect families to services and routine care, many families found themselves waiting months for primary care at a community health center. To best protect this population against vaccine-preventable diseases and bring the children in compliance with school immunization requirements, the Department of Public Health (DPH) implemented a support program to review immunization records and provide needed immunizations.
Solution
The Immunization Division contracted with John Snow Inc. (JSI) who provided culturally competent nurses fluent in Haitian Creole and Spanish to visit the EA shelters and review the immunization records of all the children at each shelter. Records were translated as needed and entered into the MIIS. After record review was complete, DPH would deploy a contracted mobile vaccination service provider to the shelter, who would provide and administer needed vaccinations, focusing on those required for school entry in Massachusetts (DTaP/Tdap, polio, MMR, HepB, varicella, meningococcal). The target population for this initiative is newly arrived families residing in the EA shelters.
Initial record reviews and immunizations began in the fall of 2023. Starting in January 2024, direct supervision of the project moved to the immunization division and is ongoing at present. Record reviews and immunizations were conducted on site at 55 of the EA shelters.
This project required part-time involvement from three immunization division staff members, who averaged between 25% and 60% of their weekly time on this project. JSI hired six full-time nurses for record reviews and education and provided three staff members for administrative support, and vaccination services were provided by two contracted companies with approximately six staff members per company.
State funding was provided for this project as a part of the larger Emergency Assistance program. Costs included the contracted nurses to complete record reviews, and providing a per-clinic payment for the mobile vaccination providers.
Multiple partnerships were developed for this initiative including work with John Snow Inc. for program support and contracted nursing staff, and Cataldo Ambulance and CDR Health as mobile vaccination providers. Routine updates were also provided to the Office of Preparedness and Emergency Management and the Office of Local and Regional Health.
Outcome
As of August 30, 2024, over 2,900 immunization records were reviewed, translated, and entered into the MIIS. About 3,600 people were vaccinated with 9,827 vaccines, the majority focused on routine childhood vaccinations. The timeframe of this initiative began in January 2024 and is ongoing.
Having a strong team with culturally competent staff was key to the success of clinics. All staff needed access to materials and schedules, and the immunization division was able to effectively use Teams and SharePoint to ensure that all staff were able to access appropriate documents. Ongoing education, both during the assessments and ahead of immunization clinics, were critical for ensuring participation by as many residents as possible. Flexibility was also shown to be critical for success – there was a need to shift the timing and location of some clinics to respond to potential varicella outbreaks within tight time constraints, as well as a need to adjust standard operating procedures as new roadblocks or challenges arose.