Future of Schools

State law and school outreach both levers for boosting immunization rates

This vial contains the DTaP vaccine, which prevents whooping cough.

Kathy Hill is a health clerk at Central Elementary School in Longmont. With a few clicks of her mouse, she can find out which of the school’s 340 kindergarten through fifth-grade students are up to date on their immunizations and which ones have “personal belief exemptions” because their parents have opted them out of some or all of their shots.

On a recent day, she did just that using the Infinite Campus data system. Her search revealed that 14 students, or about 4.1 percent, have no immunizations due to personal belief exemptions and 27 students have exemptions for certain immunizations, often Hepatitis B or chicken pox, but are up to date on others.

Hill’s data queries, which she efficiently sandwiched between helping a student with an itchy patch of skin and another who came in with a headache, provide exactly the sort of data that schools will be required to disclose by law beginning next year with the passage of House Bill 14-1288 last Friday. Originally, the bill also contained a provision to make it harder for parents to obtain personal belief exemptions, but a Senate committee stripped the bill of that measure last month.

In addition to requiring schools to disclose vaccination and exemption rates upon request, the bill requires the Colorado Department of Public Health and Environment to create a website with immunization information and to help schools analyze student immunization data. Also, it requires the State Board of Health to establish rules on the frequency with which parents have to submit exemption forms to schools or child care centers.

While some public health advocates are disappointed that a parent’s signature will continue to be all that’s required to get a personal belief exemption, they hope that requiring schools to disclose vaccination and exemption rates will bring more transparency to a historically murky area.

They say such information will arm parents, especially those with children who can’t get vaccinated for medical reasons, with valuable information that could figure into school choice decisions. In addition, the information might also nudge schools to improve their rates.

“We think it could be almost like a consumer-driven force rather than a mandate,” said Stephanie Wasserman, executive director of the Colorado Children’s Immunization Coalition.

The idea is that parents with concerns about vaccine-preventable illness–perhaps those with infants or immunosuppressed children or family members–will actively seek out school immunization information and could send their child to the local school where rates are highest and therefore herd immunity strongest. In turn, schools with low immunization rates might make extra efforts to push their rates up so they are on par with the competition.

“Schools are playing such an important role in enforcing immunization policy,” said Wasserman.

Mary Beth Rensberger, director of health services in Aurora Public Schools, said her staff can pull up vaccination data within five minutes, but she’s never heard of a parent request for such information.

“Once that hits the headlines that might be happening more.”

Unimpressive immunization rates

Colorado, which is one of 18 states to offer parents the option of a personal belief exemption, lags behind most other states when it comes to childhood immunization rates. While many have rates in the 90-95 percent range for three common kindergarten vaccinations, Colorado and Arkansas bring up the rear with rates in the low to mid-80s.

These low rates are a concern for public health experts, particularly because of outbreaks of whooping cough in recent years. The highly contagious disease, also known as pertussis, can be deadly for babies and young children.

The problem is most people don’t know whether the vaccination rates in their schools and communities are high enough to offer herd immunity, which usually requires immunization rates of 90-95 percent. Statewide  immunization numbers don’t help much because they are based on surveys with relatively small sample sizes so they don’t reveal much about risk in individual communities. That’s where school immunization data may help.

“Theoretically, every school is supposed to have this information on hand,” said Wasserman. “It’s just that it’s not collected in a uniform way.”

State officials say district’s like St. Vrain Valley, where Hill works, are exemplars when it comes to immunization policy, but many districts lag behind. Part of the problem is that schools vary widely in how they collect, confirm and store immunization information. Results can depend on a health clerk’s or nurse’s hours, the type of student data system used, whether districts are signed up to access the state’s immunization registry, and how deeply principals care about the issue.

Other immunization levers

School staff members like Hill are on the front lines when it comes to improving immunization rates. Not only are they charged with tracking down missing or incomplete immunization records, they’re often the ones to remind and encourage parents to get their children up to date on shots. Sometimes, they also help families address financial or logistical barriers.

It may not be glamorous work, but there is evidence it makes a difference. The Boulder County Public Health department worked with the St. Vrain Valley and Boulder Valley school districts to study the impact of school outreach to families during the 2012-13 school year. At the time, there were a number of whooping cough cases among school-aged children and Boulder health officials secured a state grant to look DTaP vaccination, which protects children from the disease.

Specifically, the project examined changes in DTaP vaccination rates after school staff contacted parents whose kindergarteners had received most but not all of the shots in the five-dose series. In the Boulder Valley district, 289 kindergarteners started school that year with four of the five shots and in St. Vrain, it was 137.

Soon, health clerks, nurses and sometimes even principals were e-mailing, calling and sending out letters to remind parents to get their children up to date on shots. In some cases, staff gave out vouchers for free immunizations or helped working parents figure out which providers had evening clinics. While such outreach efforts are routine in the two districts as well as many others, the DTaP project marked one of the rare occasions the results have been measured.

At the end of the project, the proportion of Boulder Valley kindergartners fully immunized against whooping cough rose from 75.4 percent to 86.2 percent, and in St. Vrain Valley, the numbers rose from 86.9 to 88.4 percent. In addition, both districts saw increases in the number of schools with DTaP vaccination rates of at least 90 percent, a guideline for herd immunity. In Boulder Valley, where there are 34 elementary schools, the number rose from 2 to 14. In St. Vrain Valley, where there 32 elementary schools, the number rose from 11 to 18.

Sophia Yager, immunization program coordinator at Boulder County Public Health, said, “The bottom line is we did see improvement.”

Plus, she added, “We were able to stomp the myth out that Boulder people don’t vaccinate.”

Hurdles for parents and schools

For harried parents, getting their kids up to date on shots can mean inconvenient appointments, confusing insurance coverage, and the hassle of submitting one more school form. And although students are required by Colorado law to have vaccinations or signed exemptions to attend school, those without the required documentation are rarely turned away.

“There’s not really any sanction or teeth in that law,” said Rensberger. “Sometimes, it just really, really tedious to have parents see the need to get their healthy kids in there.”

For that reason, some parents will simply sign a personal belief exemption even if they’ve already gotten their child partially vaccinated and have no philosophical objection to vaccines.

Hill said, “Unfortunately, when they sign their exemption, they’re like, ‘Oh well.'”

She said the timing of kindergarten registration is also a factor in parent follow-through. With some registration events now held in December, it’s easy for parents to forget about immunization forms over the next eight months.

“It’s much more difficult for some families to keep it together,” she said.

In Aurora, district staff try to make it easy for parents to get their kids vaccinated on-site. The district’s school-based health clinics vaccinate elementary children with parental consent and the district’s annual “Welcome Back” event in August often features a walk-in vaccination clinic operated in conjunction with the local health department. In previous years, up to 400 students have gotten shots at the clinic.

While a certain percentage of parents don’t follow through with vaccinations no matter how many reminders they get, others are amenable to getting their kids caught up. The problem is that over-taxed school staff don’t always have the time to contact those parents until the school year is almost over.

In Aurora, Rensberger said some schools weren’t reaching out to “non-compliant” families—those without required vaccinations or signed exemptions– until March. This year, she set an early November deadline for that work.

Susan Rowley, director of health services for the Boulder Valley district, said in schools where health clerks work a full day, the job gets done during the first semester. In schools where they’re on duty for just three or four hours a day, it takes longer.

“This is what the unfortunate economic downturn did,” she said.


Enrollment push

‘The pressure is on everyone’ as Detroit’s main district advertises to attract more students

PHOTO: Koby Levin
Detroit school board members stand with the students who will star in the district's summer ad campaign.

Detroit’s main school district has a new look.

Officials announced a new brand for the Detroit Public Schools Community District to real-live fanfare on Thursday, unveiling a new logo and tagline with a student brass band as backdrop.

After the announcement was made at Nolan Elementary School, students streamed out wearing blue tee shirts printed with the new logo, which depicts a rising sun.

“Students rise. We all rise,” reads the tagline, signaling that improvement  is coming to a district that is working to recover from decades of disinvestment and mismanagement.  Officials hope the campaign will bring Detroit families back to a district whose future depends in part on increasing enrollment.

That’s a sign of a new reality in public education, one that public relations professionals recognized around the time that policy shifts nationwide allowed more charter schools to open.

When school competition spread nationally, the phenomenon was especially pronounced in Michigan, where parents can enroll their children in charter schools or suburban schools that will accept them. State law puts few restrictions on where charter schools can be opened and who can open them.

Superintendent Nikolai Vitti said the re-branding effort was inevitable in a state that fosters competition between school districts.  Vitti has criticized Michigan’s charter school laws, but has charged head-on into the battle to enroll students nonetheless.

“I think the pressure is on everyone,” Vitti said. “Students can move from one district to another. It’s incumbent on every school district and every school to go into a marketing mode.”

The district paid $100,000 for the campaign, which was put together by BLVD Content and Real Integrated, marketing and strategy firms that have worked for Ford, the City of Detroit, The Henry Ford, and the Detroit Opera Theater. The non-profit United Way chipped in another $200,000. The brand includes television commercials and a new logo and tagline.

PHOTO: Koby Levin
Detroit’s main district has a new logo.

This is not the first time Detroit’s main district has used advertising to attract students. In 2010, the “I’m in” campaign won a top national marketing award. The old Detroit school district, which now exists only to pay off legacy debt, reported that 830 students enrolled as a result.

Nora Carr, former president of the National Association of School Public Relations, says schools are “borrowing a page from the private sector” by investing in brands. “Rarely mentioned a decade ago, branding is becoming part of the educational lexicon,” she wrote in a 2009 article.

While enrollment in Detroit’s main district has declined, it remains the largest in the state. That makes it easier to raise funds, but harder to implement a brand widely enough that it will become ingrained in parents’ perception of the district.

Many charter schools in the city are far smaller. Take The Detroit Achievement Academy, a 200-student charter school on the city’s northwest side. Kyle Smitley, the school’s founder, said in a text that she does the branding herself. “We don’t pay anyone externally,” she added.

District officials say the brand projects “a new beginning for traditional public education in Detroit.” His administration has set lofty academic goals, which it hopes to reach through an overhauled curriculum, but it remains too early to judge whether these efforts will move the district forward.

Boosting enrollment is a crucial piece of the puzzle. A plan unveiled earlier this month called for commercials on television, billboards and buses, part of an effort to bring back some of the roughly 30,000 students who wake up every day in the city and go to school in the suburbs.

The commercials will be based on a promotional video, also released Thursday, in which rapper Big Sean, a graduate of Cass Technical High School, speaks over images of actual Detroit students playing sports and studying. They build on a tradition of commercials that emphasize Detroit’s hard-knock reputation, with the rapper dropping lines like “we are a city that runs on ambition and grit.”

The video and other advertising materials can be seen on the district’s website.

First Person

With roots in Cuba and Spain, Newark student came to America to ‘shine bright’

PHOTO: Patrick Wall
Layla Gonzalez

This is my story of how we came to America and why.

I am from Mallorca, Spain. I am also from Cuba, because of my dad. My dad is from Cuba and my grandmother, grandfather, uncle, aunt, and so on. That is what makes our family special — we are different.

We came to America when my sister and I were little girls. My sister was three and I was one.

The first reason why we came here to America was for a better life. My parents wanted to raise us in a better place. We also came for better jobs and better pay so we can keep this family together.

We also came here to have more opportunities — they do call this country the “Land Of Opportunities.” We came to make our dreams come true.

In addition, my family and I came to America for adventure. We came to discover new things, to be ourselves, and to be free.

Moreover, we also came here to learn new things like English. When we came here we didn’t know any English at all. It was really hard to learn a language that we didn’t know, but we learned.

Thank God that my sister and I learned quickly so we can go to school. I had a lot of fun learning and throughout the years we do learn something new each day. My sister and I got smarter and smarter and we made our family proud.

When my sister Amira and I first walked into Hawkins Street School I had the feeling that we were going to be well taught.

We have always been taught by the best even when we don’t realize. Like in the times when we think we are in trouble because our parents are mad. Well we are not in trouble, they are just trying to teach us something so that we don’t make the same mistake.

And that is why we are here to learn something new each day.

Sometimes I feel like I belong here and that I will be alright. Because this is the land where you can feel free to trust your first instinct and to be who you want to be and smile bright and look up and say, “Thank you.”

As you can see, this is why we came to America and why we can shine bright.

Layla Gonzalez is a fourth-grader at Hawkins Street School. This essay is adapted from “The Hispanic American Dreams of Hawkins Street School,” a self-published book by the school’s students and staff that was compiled by teacher Ana Couto.