BACKGROUND:
During the late 1990s, Columbus, Ohio saw a rapid increase in population of immigrants/refugees from around the world. Somali and Latino immigrants/refugees currently constitute approximately 10% of the Columbus metropolitan area population. This diversity in language and cultures has profoundly affected the delivery of immunization services.

OBJECTIVE:
To provide the highest level of services to all clients with adequate staffing and culturally appropriate materials.

METHOD:
Multiple modalities have been used to improve outreach to immigrant/refugee communities with varying degrees of success. Efforts were made to objectively quantify the cultural complexity of client needs by consulting with established community programs, offering cultural diversity training for staff, using medical interpreters and translators, learning key phrases in different languages, and developing an acuity system to validate the complexity of each client encounter. This system objectively quantifies age, language proficiency, number of vaccines received and family size. The professional nurse subjectively quantifies the complexity of each encounter, totals the components, and assigns an acuity score.

RESULT:
Staffing levels remain fluid as acuity levels change among clinic sites and periodic influx of new immigrants/refugees. Trends of high acuity at specific clinics have resulted in staffing changes including increased numbers of interpreters and the periodic addition of special clinics to accommodate large groups of clients.

CONCLUSION:
Social and cultural issues will continue to be major factors/barriers in planning immunization activities and staffing needs.

LEARNING OBJECTIVES:
Public health clinics must continue to objectively evaluate their services by measurable criteria and to be innovative in order to meet the needs of their clients