Treats are good, Trust is better

School-based COVID-19 vaccine clinics succeed through dedicated staff, community relationships

This spring, Lisa Howard, Quality Assurance and Improvement Director, the St. Croix Regional Family Health Center—a fixture in the rural town of Princeton, Maine—was one of two staff members managing the health center’s COVID vaccine distribution. Howard’s team annually holds flu clinics throughout the state, so her relationships with superintendents, school health workers, and community members helped assure a quick and relatively smooth distribution of COVID-19 vaccines.

The green light for vaccinating children 12 and older came just as the 2020-2021 school year ended, so Howard moved quickly. In fact, with so many parents and students already in St. Croix’s central system, Howard was able to onboard students, get permission slips signed, and arrange bus transportation—all within five days.

But still, the process took all hands-on deck.

“One school is a 40-minute drive from our clinic, and still our nurse practitioners were willing to go and administer the vaccine,” Howard told School-Based Health Alliance (SBHA). In total, the team worked with five schools, holding clinics in three different buildings during regular school hours, and arranging for rides to the vaccine clinics if needed.  

Howard notes that having a relationship with the school nurses saved time and effort. Nurses distributed consent forms and related paperwork, and got the names back to the St. Croix staff to enter into the state of Maine Immpact (Maine Immunization Information System) vaccine system within 24 hours of administering the vaccine.

The St. Croix team did discuss offering incentives to students at vaccination sites, but it all came together too quickly to implement raffles or larger-scale giveaways. However, to encourage a safe summer and promote the clinic, the team passed out tic spoons with the clinic’s logo and contact information. In addition, students received a sticker to help promote others to “save the world” by getting vaccinated. Each student received a flyer with cartoons of what to expect after the vaccine (symptoms), and a contact number for a provider in case of any follow-up questions.

Howard admits to making staffing compromises on the days of in-school clinics. One provider, with support staff, delivered care at the health center while three or four staff members went to each school to efficiently vaccinate students and decrease the time students were out of class (and time St. Croix staff was away from the office). Plus, providers had to work several late nights to pick up the triaged cases in their absence. Howard and other key members of the St. Croix staff found themselves driving to far-out locations to split up federally allocated vaccine doses.

“Initially, Covid-19 vaccine doses were at one location in our 3,258-square-mile county, so we would travel a long way to get our vaccine state allocations,” Howard said. “FQHCs worked together and transferred vaccines when needed. Our little practice administered over 1,500 doses and only wasted one dose!”

For other health centers looking to implement vaccines within schools, Howard recommends asking the principals first.

“Rather than following the normal protocol for school vaccine health clinics and contacting the superintendents, we went directly to principals and school nurses who paved the way with top administration so we could move fast. Our goal was to get two doses in before summer break,” Howard said.

So how was St. Croix able to move so quickly through the permission channels? Howard can’t stress enough the need for health centers to embed themselves into the community so that people already know and trust the health center during a crisis like COVID.

“We go to open houses, health fairs, parades, we show up for everything. They know we care, and we are a trusted presence in the community,” she added. Plus, the clinic engages in social media, radio shows, and even newspaper ads.

For Tammy Greenwell, the Chief Operations Officer at Blue Ridge Health in Western North Carolina, working within both rural and urban schools made the task of vaccinating students a bit more challenging. Blue Ridge Health runs 13 school-based health centers (SBHCs) in six counties. And while many of the students have access to the SBHCs, not all children are using the services.

COVID-19 greatly impacted her SBHCs. The SBHCs serviced about 5,700 kids during the school year versus about 11,000 in a typical year. As soon as the FDA approved a vaccine for ages 16 and up, Greenwell prepared for vaccine clinics in anticipation of approval for ages 12 and up.

Greenwell’s team held school vaccination clinics from 5 to 7 p.m. so that parents/guardians could join children and get themselves vaccinated.

“When we’ve done vaccine clinics, we’ve done them in the school lobby or gym. We do it quickly, with a large number of staff to make it as efficient as possible. All of the school-based nurses attend, and we aim to get people in and out in 15 minutes,” Greenwell said.

Also, she suggests making the process as fast and simple for parents/guardians as possible. That means emailing the paperwork or making it available through electronic health records for completion ahead of vaccine clinics.

As far as messaging goes, Greenwell is using materials from the CDC, a trusted source. Plus, she provides as much information as possible on the health center’s website to handle a large volume of patients, including times and locations of pop-up vaccine clinics.

While Blue Ridge Health initially did not offer student incentives, that may change as they prepare to set up back-to-school vaccine clinics later in the summer. And the incentives will most likely vary by population—for some it may be a meal, for others, a gift card.

Since the county is hosting summer school, Greenwell says there are more opportunities for vaccine clinics within the schools. She also plans to market to children who are catching up on well-care visits missed during the pandemic.

Greenwell agrees that establishing relationships with the community is vital, and so is flexibility. For example, Blue Ridge Health bought a mobile sprinter van to drive the vaccines out to the schools and quickly set up.

“As part of social determinants of health, we don’t want transportation barriers. And kids have transportation already to school,” she said.

Through partnerships and trust, FQHCs and school-based health centers can make vaccinations easy, accessible, and probable for children throughout the country.

This publication is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $156,250 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

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