Eliminating Disparities in Childhood Immunization: The TIKE Story Anne Bailowitz, MD, MPH Baltimore City Health Department September 23, 2004

BALTIMORE DEMOGRAPHY Census – 651, Census – 651, % African-American 64.3% African-American 1.7% Hispanic 1.7% Hispanic 1.5% Asian 1.5% Asian 25% 0-17 yrs; 6.4% <5 yrs. 25% 0-17 yrs; 6.4% <5 yrs. Median household income = $30,078 Median household income = $30,078

BALTIMORE DEMOGRAPHICS - 2 % of families earning below the family self sufficiency standard (unmarried with 1-5 children) = 81.7% (U.S. Census 2000) % of families earning below the family self sufficiency standard (unmarried with 1-5 children) = 81.7% (U.S. Census 2000) Unemployment rate = 10.9% (U.S. Census 2000) Unemployment rate = 10.9% (U.S. Census 2000) Percent below poverty = 22.9% (1999) Percent below poverty = 22.9% (1999)

PROBLEM DEFINITION - 1 Why are immunization rates low? Why are immunization rates low? Missed opportunities Missed opportunities Due to health care system/provider: Due to health care system/provider: “cost”/scheduled appointments only/inconvenient hours/location/lack reminder recall “cost”/scheduled appointments only/inconvenient hours/location/lack reminder recall Due to parent Due to parent

PROBLEM DEFINITION - 2 Low immunization areas (“pockets of need”) assessed by the Baltimore Immunization Registry (BIRP) Low immunization areas (“pockets of need”) assessed by the Baltimore Immunization Registry (BIRP) TIKE sites corresponding to the pockets of need TIKE sites corresponding to the pockets of need

TIKE - 1 T.I.K.E. To Immunize Kids Everywhere T.I.K.E. To Immunize Kids Everywhere A gift to the children of Baltimore from the Rotary Club of Baltimore A gift to the children of Baltimore from the Rotary Club of Baltimore Collaborators in a major fund raising effort: Collaborators in a major fund raising effort: Rotary, Health Department, BCBS, WIC Rotary, Health Department, BCBS, WIC Collaborators for immunization goals (in-kind): Collaborators for immunization goals (in-kind): Baltimore City Public School System/BCHD - ASCH Baltimore City Public School System/BCHD - ASCH TIKE provides free walk-in immunizations to children several times a week TIKE provides free walk-in immunizations to children several times a week

TIKE - 2 History: “Kids Express” donated to Health Department during 1991 measles outbreak History: “Kids Express” donated to Health Department during 1991 measles outbreak : Kids Express : Kids Express 1995: Rotary and Health Department officials meet to plan for a new van 1995: Rotary and Health Department officials meet to plan for a new van 1998: April 21 TIKE unveiled at Inner Harbor 1998: April 21 TIKE unveiled at Inner Harbor :Van scheduled for regular weekly, biweekly or monthly sites :Van scheduled for regular weekly, biweekly or monthly sites

TIKE - 3 Sites include malls, refugee resettlement centers, Hispanic cultural centers, WIC Sites include malls, refugee resettlement centers, Hispanic cultural centers, WIC Apart from fixed sites, TIKE is available from community health fairs, interagency events and special projects such as the “Back-to-School” campaign Apart from fixed sites, TIKE is available from community health fairs, interagency events and special projects such as the “Back-to-School” campaign TIKE provides a dependable presence for TIKE provides a dependable presence for clients plus mobility to go where the need is clients plus mobility to go where the need is

TIKE - 4 Staff Staff Emergency medical technician/driver Emergency medical technician/driver performs registration, initial assessment performs registration, initial assessment Nurse(s) reviews the information and Nurse(s) reviews the information and immunizes the child immunizes the child

TIKE - 5 Scheduling: fixed schedule Scheduling: fixed schedule Additional schedule: requests by phone, fax Additional schedule: requests by phone, fax Access to TIKE schedule: Access to TIKE schedule: phone phone

TIKE - 6 Publicizing TIKE: print, radio, TV, “e” Publicizing TIKE: print, radio, TV, “e” Pluses of TIKE: mobile, multipurpose, Pluses of TIKE: mobile, multipurpose, memorable memorable Problems of TIKE: space Problems of TIKE: space mechanical problems mechanical problems garages garages

Patient Volume by Fixed Sites vs. TIKE Mobile Van

ites

ient Residence By Age # # # N = 997

TIKE Patients by Age

OUTCOMES Improved preK-12 th grade immunization rate: August 2004 = 99.7% Improved preK-12 th grade immunization rate: August 2004 = 99.7% Improved immunization rates m.o. Improved immunization rates m.o. TIKE can’t take all the credit - essential role of private providers in immunization TIKE can’t take all the credit - essential role of private providers in immunization Staff energy, caring and continuity are also Staff energy, caring and continuity are also critical for success critical for success

THE FUTURE Funding: grant funds Funding: grant funds other other Rethinking the format: van vs. building Rethinking the format: van vs. building Entering technology Entering technology Raising the bar: renewing the focus on 0-3 Raising the bar: renewing the focus on 0-3 year olds year olds Early Head Start partners Early Head Start partners

SUMMARY - 1 TIKE, a mobile immunization van which offers free walk-in childhood immunizations, has been an effective tool to improve immunization rates in an urban setting TIKE, a mobile immunization van which offers free walk-in childhood immunizations, has been an effective tool to improve immunization rates in an urban setting Collaboration between private and public sectors is an essential feature of the TIKE approach Collaboration between private and public sectors is an essential feature of the TIKE approach

SUMMARY - 2 Advantages of a van include mobility, flexibility, and easy recognition Advantages of a van include mobility, flexibility, and easy recognition Disadvantages of a van include space limitations, mechanical failure, garaging considerations Disadvantages of a van include space limitations, mechanical failure, garaging considerations Future directions include a renewed focus on the 0-3 year old population, increased use of technology, and consideration of fixed site(s) Future directions include a renewed focus on the 0-3 year old population, increased use of technology, and consideration of fixed site(s)