Location of Innovation:
Vancouver
Description of Innovation:
In 1999, the Vancouver/Richmond Regional Health Board took a big risk. They sent 14 nurses out onto the streets of Vancouver’s downtown east side (DTES) to deliver influenza and pneumococcal vaccinations in what they called a “vaccine blitz” approach.
The nurses worked in teams with volunteers from the community in single-room occupancy hotels, soup kitchens, food banks, needle exchange sites, drop-in-centres, pubs, medical clinics, the city jail, pre-trial and even right on the streets. They delivered over 15,000 shots that month in hundreds of different make-shift clinics – nearly as efficient as an office-based clinic would have been. They reached a population that is notoriously difficult to reach. And they were universally welcomed.
Key success factors were consulting stakeholders in advance, making use of existing networks to publicize the blitz, and using local volunteers to connect directly with the community. The nurses were also able to leverage the blitz to provide other public health services, including needle exchange, condom distribution, health education, and referral advice.
What was revolutionary about this approach was that it took vaccination out of the clinic and straight into the daily lives of the people who needed it most. The model has been called a “push” approach, rather than the “pull” approach of forcing people to come in to established clinics to get their shots.
The blitz model has been replicated in other places with similar success. A blitz in Niagara Region in 2007 provided several hundred pneumococcal vaccine shots in homeless shelters to a population that otherwise had very little access to preventive health care services.
The ‘push’ model is also used to reach marginalized and vulnerable populations beyond immunization strategies.
Home visiting is a commonly applied method in supporting early childhood development. Among the most cost effective interventions in all of public health – perhaps even of any type of programmatic intervention – is providing support to children under six years of age and their families. The vulnerability of this group is well documented, as is the effectiveness of certain interventions. Because the early years are so critical in predicting an individual’s success in life, the return on programming costs in this age group is as high as $17 for every $1 invested. And because the challenges of parenting often limits the feasibility of new parents attending clinic-based “pull” style programs, home visiting is an ideal approach.
The Nurse-Family Partnership is a home visiting program targeted at single, low-income, first-time mothers and their children. It enrolls the mother at the 18-20 week gestational age, and follows the family until the child’s second birthday, offering an intensive theory-based curriculum. The program has a well defined implementation methodology that ensures high quality. Several randomized controlled trials demonstrate the effectiveness of the program on health and social outcomes, including reduced childhood injuries, improved school readiness, and even improved maternal employment. Cost-effectiveness data is fantastic. It is used in dozens of states in the U.S., and is being piloted through a community partnership in Hamilton, Ontario led by the City’s Public Health Services Department with the goal of adapting the program to the Canadian context.
The vaccine blitz model and the Nurse-Family Partnership are two examples where the public health system has been able to reorient services around the needs of the target population. These innovative approaches are providing cost-effective preventive interventions to those who need them most and otherwise would be unable to access these services.
Population:
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Outcome measures:
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Evidence of success:
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Other sites that have adopted the innovation (if any):
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Website link:
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Supporting literature (if any):
1 Buxton J, et al. Influenza and pneumococcal immunization “blitz” in an inner city area: Downtown Eastside of Vancouver, British Columbia. Canadian Communicable Diseases Report. 2000 Jul 15;26(14):117-22.
2 Mackie, CAO. Effectiveness of the ‘vaccine blitz’ model in a new setting. Oral Presentation: Canadian Public Health Association Annual Conference, Ottawa, September 2007.
3 Olds D, Henderson CR Jr, Cole R, et al. Long-term effects of nurse home visitation on children's criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial. JAMA. 1998 Oct 14;280(14):1238-44.
4 Olds DL, Kitzman H, Cole R, et al. Effects of nurse home-visiting on maternal life course and child development: age 6 follow-up results of a randomized trial. Pediatrics. 2004 Dec;114(6):1550-9.
5 Olds DL. Prenatal and infancy home visiting by nurses: from randomized trials to community replication. Prev Sci. 2002 Sep;3(3):153-72.
Your Name:
Chris Mackie MD, MHSc, CCFP, FRCPSC |
