building immunity

New Chalkbeat database spotlights wide gulfs in Colorado schools’ vaccination rates

PHOTO: Lindsay Pierce/Denver Post
Nyah Ojeda, 6, offers her hand to her four-year-old brother, Elija Ojeda, while nurses prepare him for a round of vaccinations in 2012.

A newly updated immunization database created by Chalkbeat reveals that Boulder remains a hotspot for the anti-vaccination movement, students in districts with racial and income diversity are more likely to get their shots and nearly half of schools in the database did a better job this year tracking students’ immunization records.

The database, which includes more than 1,200 schools in Colorado’s 30 largest districts, is the largest collection of school-by-school immunization data available in the state.

New rules that take effect Friday will make it harder for parents to opt their children out of shots and lay the groundwork for a more comprehensive state-run database expected to go live next spring. That database, available to the public, will include immunization and exemption rates for not just Colorado schools but also licensed child care providers.

The new rules come about two years after the passage of a state law that required schools to release immunization and exemption rates upon request and instructed the State Board of Health to determine how often parents should submit exemption forms.

Public health advocates say giving parents access to immunization data helps them gauge the risk of communicable disease outbreaks and make informed choices about where to send their children for school or child care. Colorado has one of the lowest immunization rates in the country, partly because it’s relatively easy to opt children out of shots.

There’s a huge push to make Colorado healthier and embed health and wellness into schools, said Stephanie Wasserman, executive director of the Colorado Children’s Immunization Coalition.

“Immunization is kind of foundational to all that,” she said.

Boulder County mom Lindsey Diamond, a vaccine advocate living in a community where many parents do not give their kids shots, agrees.

When considering where to send her 2-year-old son next fall, she asked every provider for their immunization rates. Diamond settled on a preschool where just one child was exempt from shots for medical reasons.

Elementary school is still a few years away, but she and her husband are keeping an eye on the rates at nearby schools in the St. Vrain Valley district—where immunization levels are all over the map.

“It’s been on our radar,” she said.

Data highlights

This is the second year Chalkbeat has built a database of immunization rates. A review of the new data reveals that many of last year’s findings persist. (See this story for charts illustrating the trends.)

Vaccination policy timeline

May 21, 2014 — House Bill 12-1288 is signed into law. It requires schools to release immunization rates upon request and directs the State Board of Health to consider how often exemption forms should be submitted.

April 15, 2015 — State Board of Health votes to increase the frequency with which parents submit personal belief and religious exemption forms and allow the creation of a database of school-by-school immunization rates.

April 25, 2015 — A bill that would have required parents to submit immunization exemption forms centrally to the state health department instead of their child’s schools dies in the State House.

July 1, 2016 — New State Board of Health rules on exemption frequency and the immunization database take effect.

Dec. 1, 2016 — Schools and child care centers must submit immunization rates to the state health department for inclusion in the new database.

Among the highlights:

  • Three-quarters of Boulder Valley’s 65 schools have exemption rates of 10 percent or higher and 13 schools have exemption rates of 25 percent or higher.
  • Outside of Boulder County, most districts have relatively few schools where large numbers of parents exempt their children from shots.
  • In many Colorado districts, exemption rates tend to be higher in some charter schools or schools with alternative philosophies such as Montessori or Waldorf.
  • Just over half of schools in Chalkbeat’s database have immunization rates of 90 percent or higher. (Immunization rates of 90-95 percent within a group help protect that group from disease, especially people who can’t be vaccinated because they are too young or have a medical condition.)
  • Districts where a large majority of schools have high immunization rates run the gamut, suggesting that socioeconomic status is not the only factor at work. The top district is Cherry Creek — which is often portrayed as wealthy but is increasingly diverse. Meanwhile, most schools in poorer districts such as Pueblo, Mapleton and Westminster also have high immunization rates.
  • In Denver, about 56 percent of more than 200 schools have immunization rates of 90 percent or better, and only six schools have exemption rates higher than 10 percent.
  • In neighboring Aurora, nearly two-thirds of more than 50 schools have immunization rates of 90 percent or better, and only one has an exemption rate higher than 10 percent.
  • Compliance rates—an indicator of how hard schools are working to make sure they have students’ immunization or exemption paperwork—improved at about 45 percent of schools in 2015-16.
  • Compliance rates worsened at just over 40 percent of schools—many of them high schools.

State health officials say the lower compliance rates at many high schools likely resulted from a rule change that took effect last school year requiring all high-schoolers to have a second dose of the chickenpox vaccine. As a result, some students who would have been considered fully immunized in previous years were out of compliance in 2015-16. Eventually, as more parents learn about the two-dose requirement, health officials expect the problem to resolve.

Asking for the data doesn’t mean you’ll get it

Although Colorado law requires the the release of immunization rates to the public, they can still be hard to get.

Disease prevention

    Colorado law requires children attending school to have immunizations against these diseases or a signed parent exemption.
    • Hepatitis B
    • Pertussis (Whooping Cough)
    • Tetanus
    • Diphtheria
    • Haemophilus Influenza Type B (HIB)
    • Pneumococcal disease
    • Polio
    • Measles
    • Mumps
    • Rubella
    • Varicella (Chickenpox)

This year, Chalkbeat requested immunization and exemption rates in January. Several districts, however, declined to release them until March or April because district officials said they were waiting on fixes to a commonly used student data system where immunization information is housed.

But by late spring, even as most districts were reporting that the glitches had been fixed, there was still some pushback. For example, officials in the Lewis-Palmer district near Colorado Springs said they could offer only inaccurate data for their schools.

Later, they provided some updated information, but said it was only accurate for three of nine schools where a nurse had carefully tallied the rates and not relied on the student data system.

Next year, not only will the state health department compile immunization rates for the new statewide database, there will be a Dec. 1 due date for districts to submit the information.

“We’re already geared up for that,” said Julie Stephens, Lewis-Palmer’s public information officer.

While some school health leaders say they like the idea of sharing school immunization rates with the public, it can be a lot of extra work for school nurses.

Jean Lyons, nursing supervisor for Denver Public Schools, said she’s torn.

“I think we have to look at it as an opportunity to make our community healthy,” she said.

At the same time, she called the reporting requirements an unfunded mandate, saying, “I really empathize with the small districts that have fewer resources internally.”

Stricter requirements for opting out

In addition to the new state database, new immunization rules taking effect Friday will require parents who excuse their children from shots for personal or religious reasons to do so more often.

Starting in the 2016-17 school year, parents of K-12 children will be required to submit the exemption forms annually and parents of younger children will need to submit the forms up to five times prior to kindergarten. (There will be no change to the process for claiming a medical exemption from shots.)

Previously, parents often had to submit the forms only once during their child’s educational career.

Public health experts say the more stringent requirements will help reduce exemptions claimed out of convenience rather than conviction and help push down Colorado’s higher-than-average exemption rates. Parents opposed to the change have argued that they think carefully about their vaccine decisions and shouldn’t have to jump extra bureaucratic hurdles.

Other efforts to change the exemption process in Colorado have failed in recent months, highlighting the state’s vocal anti-vaccine constituency. Last spring, a bill that would have required parents to submit exemption forms centrally to the state health department instead of their child’s school drew emotional testimony and was eventually killed in the State House.

Not long for this world

Denver teen pregnancy prevention organization to close its doors at the end of the year

PHOTO: freestocks.org

A Denver-based nonprofit focused on teen pregnancy prevention and youth sexual health will close its doors at the end of 2017 after losing two major grants.

Andrea Miller, executive director of Colorado Youth Matter, announced the news in an email to supporters Monday afternoon.

The organization, begun in the 1980s as a volunteer-run group, provides teacher training and assistance in picking sex education curricula for 10 to 25 Colorado school district a year.

Miller said she’s hopeful other organizations will pick up where Colorado Youth Matter leaves off — possibly RMC Health, the Responsible Sex Education Institute of Planned Parenthood of the Rocky Mountains or the state-run Colorado Sexual Health Initiative.

Colorado Youth Matter’s biggest financial hit came in July when federal officials announced the end of a major teen pregnancy prevention grant mid-way through the five-year grant cycle. That funding made up three-quarters of Colorado Youth Matter’s $1 million annual budget.

“It feels like we’re getting cut off at the knees,” Miller said.

About the same time, the organization lost a family foundation grant that made up another 10 percent of its budget.

Miller, who took the helm of the organization just 10 months ago, said one of her primary goals was to diversify funding, but there wasn’t enough time.

Miller said with a variety of factors playing into the state’s teen pregnancy rates, which have been at record lows in recent years, it’s hard to say what the impact of the organization’s dissolution will be.

She said Colorado Youth Matter has worked successfully with school districts with different political leanings to find the right policies and resources to address the sexual health of their students.

“We have been masters at meeting the school districts where they are,” she said.

Wanna go outside?

Less plastic, more trees: New effort seeks to reinvent preschool playgrounds and capture kids’ imaginations

This play structure at Step By Step Child Development Center in Northglenn will go away under a plan to create a more natural and engaging outdoor play space.

Michelle Dalbotten, the energetic director of a Northglenn child care center called Step by Step, doesn’t like her playground.

Sure, it’s spacious, with a high privacy fence bordering an adjacent strip mall parking lot. It’s also got a brightly colored play structure surrounded by lots of spongy rubber mulch.

But Dalbotten and her staff have long noticed that the kids get bored there. They clump together in the small shady area or on a few popular pieces of equipment. Sometimes, they start throwing trucks off the play structure or shoving their friends down the slide.

Something about it just doesn’t work.

Recently, Dalbotten found a solution in the form of a new grant program called the ECHO initiative, which aims to reinvent more than 100 preschool and child care playgrounds across Colorado over the next few years. Think mud kitchens, looping tricycle trails, vegetable gardens, stages, shady reading nooks and dump truck construction zones.

The idea is to create outdoor spaces that capture kids’ imagination, connect them with nature and keep them active in every season. Such efforts grow out of a recognition in the education field that healthy habits start early and boost learning.

The current preschool playground at Step by Step is covered by rubber mulch.

Step by Step staff members had talked many times about their stagnant play space. But it was hard to envision anything different until they attended a design workshop with experts from ECHO, a partnership between the National Wildlife Federation, Qualistar Colorado and the Natural Learning Initiative at North Carolina State University.

“We knew we were missing the boat somewhere because (the children) weren’t super-engaged and we had a lot of behavioral issues,” Dalbotten said. “But we just couldn’t see past it, I guess.”

For child care providers, it’s a common challenge, said Sarah Konradi, ECHO program director with the regional office of the National Wildlife Federation

“This is a very new idea to a lot of folks,” she said. “It’s hard to sort out as a layperson.”

ECHO, borne out of a decade of research from the Natural Learning Initiative, will hand out $355,000 in grants over the next three years. The initiative prioritizes centers that serve children from low-income families or other vulnerable populations.

Fourteen centers — Step by Step and Wild Plum Learning Center in Longmont are the first two — will get $10,000 awards for serving as demonstration sites willing to host visits for other Colorado providers.

Leaders at Step by Step say kids and teachers often congregate in the limited shady spots.

Around 100 other centers will receive ECHO’s $5,000 seed grants and expert assistance to revamp their outdoor spaces.

Such transformations can have a big impact on children who may spend thousands of hours a year at such centers, said Nilda Cosco, director of programs at the Natural Learning Initiative.

“When we do a renovation of the outdoor learning environments as we call them — not playgrounds — we see increased physical activity … more social interactions among children … less altercations,” she said.

“The teachers have to do less because the children are so engaged. There is so much to do.”

ECHO, which stands for Early Childhood Health Outdoors, is the latest iteration of a program Cosco started a decade ago called “Preventing Obesity by Design.” That effort revamped outdoor space at about 260 child care centers in North Carolina, South Carolina and Texas.

Cosco said such makeovers can ”prevent obesity by counteracting sedentary lifestyles. Children walk more, exercise more, are conversant with healthy eating strategies.”

Dalbotten and her staff have big plans for their play areas, which sit behind a plaza that houses a bingo hall, Dollar Tree and Big D’s Liquor store. They’ll get rid of the colorful play structure and the rubber mulch in favor of a more natural look. There will be trees, shrubs, small grassy hills and a winding trail leading to a wide array of activity areas.

This porch will get new lighting, fencing and foliage to make it a more attractive outdoor space at Step by Step.

The center’s smaller toddler playground will get a similar reboot and its tiny yard for babies — mostly bare except for a couple low-hanging shade sails — will be expanded to include a shaded deck where teachers can sit or play with babies. A barren concrete porch on the side of the building will be remade into a cozy activity area decorated with bird houses, planter gardens and butterfly-attracting foliage.

At the recent design workshop Dalbotten attended, ECHO leaders displayed photos from other centers around the country that have gone through outdoor transformations. She saw one that stuck with her.

“There were kids everywhere,” she said. “It was super cool looking. I was like, ‘Oh look, we can be that. We can have kids everywhere.’”

PHOTO: Natural Learning Initiative
The play space at Johnson Pond Learning Center in Fuquay-Varina, NC, after a makeover.
PHOTO: Natural Learning Initiative
The outdoor play space at Spanish For Fun Academy in Chapel, Hill, NC, after a makeover.