Child Care Immunization Ordinance

State: MO Type: Model Practice Year: 2006

Goals and objectives: Improve and maintain immunization rates in Independence child care facilities Assist in the prevention and control of vaccine preventable diseases Educate child care providers on methods to maintain immunization rates thus promoting accountability Build relationships between the health department and child care providers Gain community support for immunization compliance Ensure Independence child care facilities have a safe and healthy environment Immunization rates in Independence child care facilities have improved as evidenced by improved record keeping and higher compliance rates. There is an increased awareness by the child care providers for the need of surveillance and the reporting of suspected disease cases or outbreaks. Compliance and timely response has been noted with Health Department recommendations in Independence child care facilities when disease cases have occurred. Relationships between the Health Department and child care providers have strengthened. Community support for the ordinance was gained through education and collaboration.
The public health issue addressed is maintaining high immunization rates for all children in child care facilities thus preventing disease outbreaks. The goal of Healthy People 2010 is to maintain >95% immunization coverage of all children in child care centers; this is also the goal of the Independence Health Department. The process used to determine relevancy to the community was focused on requesting input from a variety of community partners. Collaborative meetings were held with child care inspectors, physicians, Jackson County Health Department, Independence School District, Independence Head Start, child care providers, Board of Health, the Legal Department, and the Independence City Council. Full support was gained from each group. The Child Care Immunization Ordinance directly addresses the public health issue of maintaining high immunization rates for all children in child care facilities. The ordinance duplicates child care immunization state law but provides the Health Department with enforcement procedures if child care facilities are not in compliance. By maintaining age appropriate immunizations, protection will be provided for all children attending child care facilities and the entire community. The ordinance also acts as a support tool for child care providers when dealing with parents of children that are not in compliance. Additionally, the ordinance increases the Health Department’s role in protecting the community from vaccine preventable diseases.
Agency Community RolesThe Independence Health Department took the lead role in the research, development, and implementation of the Child Care Immunization Ordinance. Nurses identified the problem, researched methods of other health department and coordinated with community partners to ensure common goals. Input was encouraged from many community partners with full support gained from each group. Child care inspectors provided guidance on the health permitting and revocation processes. Physicians were educated on the proposed ordinance and were surveyed to collect recommendations. The Jackson County Health Department provides the childhood vaccinations and serves as a resource and referral facility. The school district, Head Start, and other child care providers must be trained on immunization requirements and the ordinance since they will be maintaining the records and ensuring compliance. Education was provided via newsletters and educational sessions. The Board of Health is the Health Department’s advisory board; goals and implementation plans were shared with full endorsement. The Missouri Department of Health and Senior Services have the immunization law in place, but without adequate enforcement. The City of Independence Law Department reviewed the state law and proposed city ordinance. With the approval and encouragement of these community partners, the Independence City Council reviewed the proposed ordinance and passed it. ImplementationIn order to pass an ordinance that would enforce current state law that requires age appropriate immunizations and accurate records, many steps had to be taken. In February of 2003, the nurses performing the audits identified the problem, set goals, and developed an audit process that included education and enforcement. At this time, compliance for a child care facility was defined as all children enrolled having an age appropriate immunization record on file or having proper exemption documentation. Additionally, forms and letters were developed that would assist the Health Department and child care facilities in reading the immunization record and understanding immunization scheduling. Health Promotion nurses then met with the Health Department’s Food and Institution Division’s child care inspectors to discuss enforcement plans. It was decided that if a child care facility did not comply with the proposed Child Care Immunization Ordinance despite efforts of the Health Department to assist them, then their health permit could be revoked and their facility could be closed until they were in compliance. In March 2003, letters and surveys were sent to family practice physicians and pediatricians requesting input regarding the ordinance. Forty percent of the surveys were returned; all were in full support of our proposal. Additionally, Health Promotion nurses met with the Jackson County Health Department, Independence Head Start, and the Independence School District for input and were given full support. In May 2003, an open educational session was offered to all Independence child care providers to discuss immunizations, vaccine preventable diseases, and the proposed ordinance. No opposition to the ordinance was voiced. In May 2003, the Health Director presented the proposed ordinance to the Board of Health and was given full endorsement. In June 2003, the ordinance was presented to the Independence City Council and was passed on August 4, 2003.
Goal: Improve and maintain high immunization rates in Independence child care facilities using the Child Care Immunization Ordinance. Objective: Maintain current immunization records in order to prevent and control vaccine preventable disease outbreaks in child care facilities: Performance measures: Audits will be completed twice per year at all child care facilities. Immunization rates on initial audits will be greater than 90% with proper record keeping and understanding of immunization scheduling.  Data collection: Immunization records are reviewed to ensure age appropriate imunizations have been given. Nurses review each record and document the number of records reviewed and number in noncompliance.  Outcomes (intermediate): Immunization records are current and maintained. Average rates on initial audits are now 90%, compared to 64% in 2001. Child care providers verbalized importance of keeping records current to prevent outbreaks.  Objective: Increase the knowledge base of child care providers related to immunization scheduling and vaccine preventable diseases Performance measures: Education will be provided by May 2003 on the proposed ordinance and vaccine preventable diseases. Ongoing education will be offered to all child care providers.  Data collection: Information is collected at audits revealing an understanding of the audit process, immunization scheduling and the ordinance.  Outcomes (long-term): Child care providers frequently utilize the health department as an educational resource. One hundred percent of the providers reported an understanding of the ordinance process.  Objective: Build collaborative relationships between the Health Department and various community partners. Performance measures: By June 2003, all community partners will be notified of the Health Department's goal to improve immunization rates with their support and input will be elicited.  Data collection: The Health Department developed surveys that were collected from physicians requesting support and input on the proposed ordinance; surveys were returned to the health department by mail or fax. Input and support was also gained from the 7 other community partners.  Outcomes (long-term): Relationships with community partners have strengthened and continue to grow, outside of the realm of the immunization ordinance. 
The Child Care Immunization Ordinance was passed by the Independence City Council and is now therefore a part of city code. Because of this, immunization audits and enforcement are required to be implemented as written by city ordinance and will be city funded. Additionally, physicians, school nurses, child care providers, other health departments, and other community partners share the common goal of preventing disease outbreaks through high immunization rates. The immunization audit practice could be sustained with city funding. Each year brings an increased number of child care facilities and more children in daycares, requiring more staff and more time. In addition to city funding, the Maternal Child Health (MCH) grant is also utilized. The MCH grant is a five year grant with one of the two major objectives being immunization promotion, specifically goals related to the Child Care Immunization Ordinance. Also, education provided to child care facilities can be funded by our Child Care Nurse Consultant contract.