KEYWORDS:
Barriers, Compliance, School-Based Clinics

BACKGROUND:
The Gila River Indian Community is a federally recognized Indian Reservation located on 372,000 acres south of Phoenix, Arizona. There are approximately 2500 students from preschool through 12th grade attending reservation schools. The size of the reservation and lack of transportation proves to be a barrier to routine vaccinations.
In 1998, reservation schools had an average immunization rate of 43% (range 16% to 73%) for state required school immunizations. Review of records identified 2,159 school children in need of 4,829 immunizations. The School Nurse Program was asked by Tribal Council to bring immunization rates into compliance.

OBJECTIVE(S):
To improve compliance rate of required school immunizations for the children of the Gila River Indian Community to 90%.

METHOD(S):
1. Develop and implement school-based clinics to offer the following vaccinations: DTaP, Td, Polio, Hib, MMR, Hepatitis B, Hepatitis A.
2. Schedule three clinic dates (0 months, 3 months, and 6 months) at each school.
3. Obtain parental consent. Consent forms and Vaccination Information Statements (VIS) forms were sent home for parent signature.
4. Utilize a needle-free single use injection system to administer vaccines.

RESULT(S):
In one school year, 1,282 students were immunized with 3,638 vaccinations. The average immunization rate increased from 43% to 91% (range 60% to 100%) in June 2001.

CONCLUSIONS(S):
1. Compliance with state required school immunizations could be increased by utilizing school-based clinics.
2. Using a needle free system improved acceptance of vaccinations by students and increased safety for students and staff.

LEARNING OBJECTIVES:
1. Describe effective methods to increase compliance rates for state required school immunizations.
2. Describe methods of improving acceptance of vaccinations by students.