Adolescent Immunization Delivery in School-Based Health Centers: a National Survey

Background:
Vaccinating adolescents in a variety of clinical settings may be necessary to achieve high national vaccination coverage. School-based health centers (SBHCs) have been identified as a vaccination setting, but little is known about immunization delivery in SBHCs.

Objectives:
In a national random sample of SBHCs, to assess adolescent immunization practices and perceived barriers to vaccination.

Methods:
One thousand SBHCs were randomly selected from a national database. Surveys were conducted between November 2007 and March 2008 by a combination of internet and standard mail.

Results:
Of 815 survey-eligible SBHCs, 521 (64%) responded. Eighty-four percent of SBHCs reported vaccinating adolescents, with most offering tetanus-diphtheria-acellular pertussis, meningococcal conjugate, and human papillomavirus vaccines. Among SBHCs that vaccinated adolescents, 96% vaccinated Medicaid-insured and 98% vaccinated uninsured students. Although 93% of vaccinating SBHCs participated in the Vaccines for Children program, only 39% billed private insurance for vaccines given. Sixty-nine percent used an electronic database or registry to track vaccines given, and 83% sent reminders to adolescents and/or their parents if immunizations were needed. For SBHCs that did not offer vaccines, difficulty billing private insurance was the most frequently cited barrier to vaccination.

Conclusions:
Most SBHCs appear to be fully involved in immunization delivery to adolescents, offering newly recommended vaccines and performing interventions such as reminder/recall to improve immunization rates. While the number of SBHCs is relatively small, with roughly 1800 nationally, SBHCs appear to be an important vaccination resource, particularly for low income and uninsured adolescents who may have more limited access to vaccination elsewhere.