Eliminating Disparities in Childhood Immunization:

The TIKE Story

Anne Bailowitz, MD, MPH Baltimore City Health Department

September 23, 2004

BALTIMORE DEMOGRAPHY - 1

2000 Census – 651,1542000 Census – 651,154 64.3% African-American64.3% African-American 1.7% Hispanic1.7% Hispanic 1.5% Asian1.5% Asian 25% 0-17 yrs; 6.4% <5 yrs.25% 0-17 yrs; 6.4% <5 yrs. Median household income = $30,078 Median household income = $30,078

BALTIMORE DEMOGRAPHICS - 2

% of families earning below the family self % of families earning below the family self sufficiency standard (unmarried with 1-5 sufficiency standard (unmarried with 1-5 children) = 81.7% (U.S. Census 2000)children) = 81.7% (U.S. Census 2000)

Unemployment rate = 10.9% (U.S. Census Unemployment rate = 10.9% (U.S. Census 2000)2000)

Percent below poverty = 22.9% (1999) Percent below poverty = 22.9% (1999)

PROBLEM DEFINITION - 1

Why are immunization rates low?Why are immunization rates low? Missed opportunities Missed opportunities Due to health care system/provider:Due to health care system/provider: “ “cost”/scheduled appointments cost”/scheduled appointments

only/inconvenient hours/location/lack only/inconvenient hours/location/lack reminder recallreminder recall

Due to parentDue to parent

PROBLEM DEFINITION - 2

Low immunization areas (“pockets of Low immunization areas (“pockets of need”) assessed by the Baltimore need”) assessed by the Baltimore Immunization Registry (BIRP)Immunization Registry (BIRP)

TIKE sites corresponding to the pockets of TIKE sites corresponding to the pockets of need need

TIKE - 1 T.I.K.E. To Immunize Kids EverywhereT.I.K.E. To Immunize Kids Everywhere A gift to the children of Baltimore from the Rotary A gift to the children of Baltimore from the Rotary

Club of BaltimoreClub of Baltimore Collaborators in a major fund raising effort:Collaborators in a major fund raising effort: Rotary, Health Department, BCBS, WICRotary, Health Department, BCBS, WIC Collaborators for immunization goals (in-kind): Collaborators for immunization goals (in-kind): Baltimore City Public School System/BCHD - ASCHBaltimore City Public School System/BCHD - ASCH TIKE provides free walk-in immunizations to TIKE provides free walk-in immunizations to

children several times a weekchildren several times a week

TIKE - 2 History: “Kids Express” donated to Health History: “Kids Express” donated to Health

Department during 1991 measles outbreakDepartment during 1991 measles outbreak 1991-1996: Kids Express1991-1996: Kids Express 1995: Rotary and Health Department officials 1995: Rotary and Health Department officials

meet to plan for a new van meet to plan for a new van 1998: April 21 TIKE unveiled at Inner Harbor1998: April 21 TIKE unveiled at Inner Harbor 1998 - 2004:Van scheduled for regular weekly, 1998 - 2004:Van scheduled for regular weekly,

biweekly or monthly sitesbiweekly or monthly sites

TIKE - 3 Sites include malls, refugee resettlement Sites include malls, refugee resettlement

centers, Hispanic cultural centers, WIC centers, Hispanic cultural centers, WIC Apart from fixed sites, TIKE is available Apart from fixed sites, TIKE is available

from community health fairs, interagency from community health fairs, interagency events and special projects such as the events and special projects such as the “Back-to-School” campaign“Back-to-School” campaign

TIKE provides a dependable presence forTIKE provides a dependable presence for clients plus mobility to go where the need isclients plus mobility to go where the need is

TIKE - 4

StaffStaff Emergency medical technician/driverEmergency medical technician/driver performs registration, initial assessment performs registration, initial assessment Nurse(s) reviews the information andNurse(s) reviews the information and immunizes the childimmunizes the child

TIKE - 5

Scheduling: fixed schedule Scheduling: fixed schedule Additional schedule: requests by phone, faxAdditional schedule: requests by phone, fax Access to TIKE schedule: Access to TIKE schedule: phone 410-396-4454phone 410-396-4454 e-mail e-mail www.birp.netwww.birp.net

TIKE - 6

Publicizing TIKE: print, radio, TV, “e”Publicizing TIKE: print, radio, TV, “e” Pluses of TIKE: mobile, multipurpose,Pluses of TIKE: mobile, multipurpose, memorable memorable Problems of TIKE: space Problems of TIKE: space mechanical problemsmechanical problems garagesgarages

Patient Volume by Fixed Sites vs. TIKE Mobile Van

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TIKE Patients by Age 4%

5%3%

21%

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19%

12%

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0-11 Mo1 Yr2 Yr3-4 Yr5-6 Yr7-12 Yr13-18 Yr19+ Yrs

OUTCOMES

Improved preK-12Improved preK-12thth grade immunization grade immunization rate: August 2004 = 99.7% rate: August 2004 = 99.7%

Improved immunization rates 19-35 m.o.Improved immunization rates 19-35 m.o. TIKE can’t take all the credit - essential role TIKE can’t take all the credit - essential role

of private providers in immunizationof private providers in immunization Staff energy, caring and continuity are alsoStaff energy, caring and continuity are also critical for successcritical for success

THE FUTURE

Funding: grant fundsFunding: grant funds otherother Rethinking the format: van vs. buildingRethinking the format: van vs. building Entering technologyEntering technology Raising the bar: renewing the focus on 0-3Raising the bar: renewing the focus on 0-3 year oldsyear olds Early Head Start partners Early Head Start partners

SUMMARY - 1

TIKE, a mobile immunization van which TIKE, a mobile immunization van which offers free walk-in childhood offers free walk-in childhood immunizations, has been an effective tool to immunizations, has been an effective tool to improve immunization rates in an urban improve immunization rates in an urban settingsetting

Collaboration between private and public Collaboration between private and public sectors is an essential feature of the TIKE sectors is an essential feature of the TIKE approachapproach

SUMMARY - 2 Advantages of a van include mobility, flexibility, Advantages of a van include mobility, flexibility,

and easy recognitionand easy recognition Disadvantages of a van include space limitations, Disadvantages of a van include space limitations,

mechanical failure, garaging considerationsmechanical failure, garaging considerations Future directions include a renewed focus on the Future directions include a renewed focus on the

0-3 year old population, increased use of 0-3 year old population, increased use of technology, and consideration of fixed site(s)technology, and consideration of fixed site(s)