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