Adolescent Immunization Recall in School-Based Health Centers: A View From Inside

Background: During the 2008-2009 school year, recall for adolescent immunizations was conducted in four Denver Public middle school school-based health centers (SBHCs).  Findings revealed that recall was effective at increasing immunization rates through a SBHC, but little is known about the issues that affect the sustainability of recall in this setting.

Objectives:  To assess the facilitators for and barriers to conducting recall for adolescent immunizations in a SBHC setting. 

Methods:  Field notes from direct clinic observations and weekly updates were collected throughout the study, and key informant interviews were conducted at the end of the study.  Two observations spaced one month apart were completed at each center and weekly in-person or phone updates were collected over a 10-week period to document the process involved in implementing recall and the issues that arose.  Eleven in-depth structured interviews were conducted with key informants including the overall SBHC program manager, the SBHC operations manager, the SBHC staff manager, 3 SBHC providers, 3 SBHC staff and 2 school nurses to assess facilitators for and barriers to sustaining recall activities within SBHCs.  All data were transcribed verbatim and analyzed using Atlas.ti software using constant comparative technique with a team-based analytic process.

Results:  SBHCs were able to incorporate recall into their daily clinic operations.  The main facilitators for conducting recall included the inherent advantage of being physically co-located in the school and having a pre-printed list indicating which students needed immunizations.  The barriers included lack of resources (i.e. space and staffing), logistical issues (i.e. resistance from teachers to interrupt their classes to release students to the SBHC), and competing health care priorities at each school. 

Conclusions:  Despite the advantages of implementing recall when the students are ‘in-house’, there are challenges that must be addressed in order to make these efforts sustainable within a SBHC setting.