welcome and keynote 2019 ipre training...dshs immunization ontractor’s guide for local health...

Welcome and Keynote

2019 IPRE TrainingNancy Ejuma, PhD, MBA

Immunization Unit DirectorTexas Department of State Health Services

Outline

1

2 Setting Priorities

Background

What To Expect This

Week

Communicating

Expectations:

Past, Present and Future3

42

Outline

1

2 Setting Priorities

Background

What To Expect This

Week

Communicating

Expectations:

Past, Present and Future3

43

Eligible Immunizer

StatisticsWelcome to Texas:

The Lone Star State

254

Counties

159 Local Public

Health Organizations

11 Health

Regions

8 DSHS

Region

Offices1,216

Incorporated

Cities

268,5961

sq miles

Total Population

~ 28,000,0002

10% of US

Births are in

Texas3

~ 72,601 Doctors

(MDs and DOs)4

~ 8,890 Nurse

Practitioners

(NPs)6

~ 450 Certified

Nurse Midwives

(CNMs)77%

19%

62%

12%

Age Groups

Under 5

Ages 5 - 18

Ages 18 - 64

Ages 65+

~ 6,650 Physician

Assistants (PAs)5

~ 21,500

Pharmacists8

Serving a Population this Large Requires Partnerships

Centers for Disease Control

• Advisory Committee on Immunization Practices (ACIP)

• Immunization Services Division (ISD)

State of Texas

• Governor’s Office

• State Legislature

• DSHS Immunization Unit

• DSHS Regional Offices

Local Health Departments & Community Partners

• Contracted Local Health Department Partners

• Engaged Partners Who Promote Immunization Best Practices

Texas Immunizers

• Administer public and private stocks of vaccines

• Engage in reminder/recall and other activities to keep Texans up to date on immunizations

• Report immunization information

Serving a Population this Large

Vaccine Recommendations

& Requirements

Fund and Design Operations

Fund VaccinesAssess

Effectiveness

Federal Government (Centers for Disease Control)

State of Texas Government

CDC Advisory Committee on Immunization Practices (ACIP) Recommends Vaccines

State of Texas Uses Laws and Rules to Require Vaccines in Specific Settings

Federal public health officials make national vaccine policy recommendations for children and adults.

With the approval of state legislatures, public health officials in state health departments make and enforce vaccine mandates. That is why vaccine laws and legal exemptions to vaccination vary from state to state.

Serving a Population this Large

Vaccine Recommendations

& Requirements

Fund and Design Operations

Fund VaccinesAssess

Effectiveness

Federal Government (Centers for Disease Control)

State of Texas Government

Gives states (grantees) funding to operate immunization programs• Funding comes with requirements

outlined in the CDC Immunization Program Operations Manual (IPOM)

Gives agency (DSHS) funding to operate the immunization program• Funding comes with requirements

outlined in strategic plans, state plans and directives from the Governor, State Legislature and State Health Commissioner

Serving a Population this Large

Vaccine Recommendations

& Requirements

Fund & Design Operations

Fund VaccinesAssess

Effectiveness

Federal Government (Centers for Disease Control)

State of Texas Government

Provides funding to cover the cost of vaccines for the most vulnerable population of children • $470M for Texas Vaccines for Children• $5M for Uninsured Adults

Provides funding to fill the gaps not met through federal funding • $30M for CHIP • $4M for Underinsured • $4.5M for Uninsured Adults • $1M for Emergency Response

Serving a Population this Large

Vaccine Recommendations

& Requirements

Fund & Design Operations

Fund VaccinesAssess

Effectiveness

Federal Government (Centers for Disease Control)

State of Texas Government

Assess how well states (grantees) are doing at meeting CDC goals through methods including:• Assessment of immunization coverage rates

(NIS)• Overseeing public vaccine programs and

providers (Reports/PEAR/AFIX)• Perinatal Hep B case management (Reports)• School Compliance Rates (Reports)• Utilization of the Immunization Registry (IIS

Business Plan)

Assesses how well we are doing at meeting specific objectives outlined by the Governor, the State Legislature, the Health Commissioner and other senior leaders across the state through methods including:• Performance Metrics (Reports)• Legislative Reports (VPD, Conscientious

Exemptions, State Plans)

Outline

1

2 Setting Priorities

Background

What To Expect This

Week

Communicating

Expectations:

Past, Present and Future3

410

Determining Our Priorities and Activities: Federal

January 1, 2013 to June 30, 2019Immunization Project Period

CDC Immunization Program Operations Manual (IPOM)

Immunization Program Operations Manual (IPOM) is a compilation of

resources to assist immunization program managers and their staff in

implementing the requirements set forth in their Immunization

Cooperative Agreement (CoAg) with the CDC.

Number of Pages: 149 Pages

Annual Release Date: Early Release for Comments. Major 5 Year

Release with Annual Updates.

Effective Dates: Grant Years (July through June)

Note: The CDC has released a DRAFT of the new version of the IPOM which covers July 2019 through June 2024

Determining Our Priorities and Activities: State

DSHS Strategic Plan and Immunization-related State Plans

Many of the goals represent ongoing, mission-critical functions that will

continue during the five-year period of the strategic plan and beyond.

Number of Pages: 15 Pages

Annual Release Date: Major 5 Year Release with Annual Updates to

Operational Plans.

Effective Dates: Fiscal Years (September through August)

Note: We are currently operating under the FY 2017-2021 DSHS

Strategic Plan. We also conduct activities related to state plans such as the State Plan on Strep Pneumo, etc.

Other Strategies for Setting Priorities

• Use data to evaluate vulnerabilities and identify high risk vulnerabilities (i.e.

ImmTrac2)

• Identify knowledge gaps and invest in addressing them (i.e. VEO)

• Identify process gaps and invest in addressing them (i.e. Centralized calculation of

MSLs)

• Identify and invest in new key partnerships (i.e. Pharmacy immunizers and the Texas

Pharmacy Association)

• Research and invest in evidence-based interventions that will have a major impact

(i.e. Adult PPHF)

• Respond to immediate needs (ex. Hurricane Harvey and supporting unaccompanied

minor shelters)

Outline

1

2 Setting Priorities

Background

What To Expect This

Week

Communicating

Expectations:

Past, Present and Future3

414

DSHS Immunization Unit Oversight

Providers

Local Health Department

(50 LHD REs)

DSHS Regional Offices

(8 State REs)

DSHS Immunization

Unit

Immunization Unit Groups

Contract Oversight of LHD Activities and TA

Contract Management

Vaccine Safety Net (LHD Clinics)

Programmatic Activities

Management of TVFC and ASN

TVFC and ASN Providers

Vaccine Safety Net (DSHS

Clinics)

Programmatic Activities

Management of TVFC and ASN

TVFC and ASN Providers

Communicating Activities: The Past and Present (FY19)

Immunization Program LHD Statement of Work (SOW)

• A statement of work (SOW) is a document that defines contract-specific activities, deliverables and timelines for a vendor providing services to a client.

• Number of Pages: 9 Pages

• Annual Release Date: January for following FY

• Effective Dates: State FY (September through August)

Immunization Unit Inter-Local Agreement Work Plan

• The work plan serves as a reference document for LHDs that outlines general contract requirements and their associated activities.

• Number of Pages: 16 Pages

• Effective Dates: State FY (September through August)

DSHS Immunization Contractor’s Guide for Local Health Departments

• This manual is intended as a resource to contracted LHDs in implementing required activities under the immunization contract and describes contract monitoring activities that will be conducted during the contract period.

• Number of Pages: 51 Pages

• Annual Release Date: Ideally, August for following FY

• Effective Dates: State FY (September through August)

Communicating Activities: The Past and Present (FY19)Current Guidance Documents

1.Population Assessment Manual

(School & Daycare Audits)

2.TVFC and ASN Operations

Manual for REs

3.Emerging and Acute Infectious

Disease Guidelines (EAIDG)

4.Texas Perinatal Hepatitis B

Program Manual

5.TVFC and ASN Provider Manual

6.Texas Immunization Partnership

(TIP) Coalition Capacity

Building Handbook

Assessing Effectiveness: The Past and Present (FY19)

Immunization Unit Inter-Local Agreement Contractor Quarterly Report for Local Health Departments (LHDs)/ Quarterly Report for DSHS Regional Offices

• The LHD/regional quarterly report is a required survey of progress made towards the achievement of contract activities.

• Number of Pages: 16 Pages

• Effective Dates: State FY (September through August)

• Note: Reports are due in the month following each state FY quarter (December, March, June, October).

DSHS Immunization Program Contractor Onsite Evaluation Tool

• This tool is based on the FY2018 Immunization Work Plan activities, the DSHS Immunization Contractors Guide for LHDs, the Standards for Child and Adolescent Practices, and the Standards for Adult Immunization Practices.

• Number of Pages: 37 Pages

• Annual Release Date: June for following FY

• Effective Dates: State FY (September through August)

Project Launch:Six (6) Steps to an Updated and Simplified FY20 SOW

Assessment of Effectiveness of Current Tools: Step 1

Identified 7 high level categories (Areas of Work) in which to distribute all current immunization program activities:1. Program & Contract Management2. Facility Immunization Assessments3. Managing TVFC and ASN Providers4. Epidemiology & Surveillance5. Providing a Vaccine Safety Net6. Increase the Use of the Texas Immunization Registry7. Education and Partnerships

Assessment of Effectiveness of Current Tools: Step 2

Reviewed the following documents and identified every instance where an action or standard was communicated:• CDC Immunization Program Operations Manual (both 2013-2019 and

2019-2024)• DSHS Strategic Plan (2017-2021) and immunization-related state plans• FY19 LHD Statement of Work• FY19 Contractor’s Guide, FY19 Quarterly Reports• FY19 On-site Tool

Assessment of Effectiveness of Current Tools: Step 3

Categorized each activity into one of the 7 Areas of Work

Assessment of Effectiveness of Current Tools: Step 4Created a Crosswalk Between Current Activities and the Specific

Document Requiring the Action or Standard

Assessment of Effectiveness of Current Tools: Step 5

Met with DSHS Regional Immunization Program Managers To Make Decisions Regarding Which Activities We Should Keep, Modify, Add or Remove.

Assessment of Effectiveness of Current Tools: Step 6

• Final activities organized by “Area of Work” and

associated sub-category.

• All activities were given an SOW ID #.

• All activities further identified as:

• Required Activity

• Suggested Activity

• Universal Standard

• Conditional Standard

Met with DSHS Regional Immunization Program Managers To Make Decisions Regarding Which Activities We Should Keep, Modify, Add or Remove. Drafted Final FY20 SOW.

Communicating Activities: The Future (FY20 and Beyond)

Immunization Program LHD Statement of Work (SOW)

• A statement of work (SoW) is a document that defines contract-specific activities, deliverables and timelines for a vendor providing services to a client.

• Number of Pages: 31 Pages

• Annual Release Date: December for following FY

• Effective Dates: State FY (September through August)

DSHS Immunization Contractor’s Guide for Local Health Departments

• Annual Release Date: Ideally, March for following FY

• Effective Dates: State FY (September through August)

Communicating Activities: The Future (FY19)Future Guidance Documents

1. NEW: Program and Contract Management Guide2. Population Assessment Manual (School &

Daycare Audits) 3. NEW: Texas First Responder Immunization

Toolkit (FRIT)4. TVFC and ASN Operations Manual for REs5. Emerging and Acute Infectious Disease

Guidelines (EAIDG)6. Texas Perinatal Hepatitis B Program Manual7. TVFC and ASN Provider Manual8. TIP Coalition Capacity Building Handbook9. NEW: Guidelines for Increasing the Use of the

Texas Immunization Registry (GIUTIR)10. NEW: Texas Immunization Program

Communications Guide

Assessing Effectiveness: The Past and Present (FY19)

Immunization Unit Inter-Local Agreement Contractor Quarterly Report for Local Health Departments (LHDs)/ Quarterly Report for DSHS Regional Offices

• The LHD/regional quarterly report is a required survey of progress made towards the achievement of contract activities.

• Number of Pages: TBD

• Effective Dates: State FY (September through August)

• Note: Reports are due in the month following each state FY quarter (December, March, June, October).

DSHS Immunization Program Contractor Onsite Evaluation Tool

• This tool is based on the FY2018 Immunization Work Plan activities, the DSHS Immunization Contractors Guide for LHDs, the Standards for Child and Adolescent Practices, and the Standards for Adult Immunization Practices.

• Number of Pages: TBD

• Annual Release Date: June for following FY

• Effective Dates: State FY (September through August)

Outline

1

2 Setting Priorities

Background

What To Expect This

Week

Communicating

Expectations:

Past, Present and Future3

429

This Week

• Follow along using the FY20 SOW (Main presentations are in

the order shown in the SOW)

• Ask lots of questions

• Provide comments throughout (using paper and online

surveys)

• Network with others in your Region and from across the state

(Look for the same color folders)

• Get to know the campus