Tribal, State and Federal Collaboration to Improve Immunization Coverage for American Indian/Alaska Native Children in Idaho, Oregon and Washington

Background:
The Portland Area Indian Health Service (PAIHS) oversees the immunization program for 43 federally recognized tribes in Idaho, Oregon and Washington. The federal government fulfills its treaty obligation to provide healthcare to American Indians/ Alaska Natives (AI/AN) through federally-funded facilities operated by the Indian Health Service (IHS) or through tribally-operated facilities. AI/AN children are eligible to receive immunizations through the Vaccines for Children program (VFC). In 2008, reported immunization coverage levels for PAIHS were among the lowest compared to other IHS areas (n=12).

Setting:
Ambulatory clinics in ID, OR and WA designated as IHS, Tribal, or Urban Indian health centers.

Population:
AI/AN children in ID, OR and WA.

Project Description:
We began an initiative to improve immunization coverage in the PAIHS by first engaging immunization coordinators through conference calls. Discussions identified barriers to immunization and reporting, tips for success, and recommendations for improving immunization coverage. This information was used to plan a three day summit and training for all immunization coordinators, in which IHS, tribes, and all 3 state immunization programs participated. Presentations were also made to IHS and tribal leaders to gain support and set goals for improvement.

Results/Lessons Learned:
Initial findings reveal that immunization coordinators often perceived that children were up-to-date but electronic systems available for documenting coverage were not being used properly. Experienced immunization information system users were more successful at overcoming reporting barriers. Provider reluctance to order and parent refusal to receive all indicated immunizations was seen as a barrier by some. Next steps include working with sites to implement and evaluate at least one strategy to improve coverage. This unprecedented effort to engage federal, state and tribal health leaders to improve AI/AN immunization coverage has resulted in a unique collaboration to provide resources, technical assistance and training to IHS and tribal programs.