Overview of activity
The Minnesota Immunization Program worked with the Minnesota State High School League to update language related to vaccines on their standard pre-participation sports physical examination form.
Students in grades 7-12 who participate in school-based athletic activities.
Background/impetus for the activity
In Minnesota, any student in grades 7-12 participating in school-based sports must have documentation on file with his/her school of a physical examination done within the past three years. The Minnesota State High School League (MSHSL), a voluntary association of public and private schools that supports interscholastic athletic and fine arts programs, provides a standardized form for sport physicals that schools can make available to parents. For the 2015-16 school year, MSHSL-sponsored activities involved 525 member schools and over 300,000 students, a portion of which would be completing the physical form on a 3-year cycle.
The 3-page physical form includes two areas that address immunizations. These sections would typically be completed by a healthcare provider. Updating the immunization sections of the sports physical form was one of many ideas generated by a workgroup of diverse stakeholders, formed through the Minnesota Immunization Practices Advisory Committee (MIPAC), that was focused on ways to improve adolescent immunization rates.
Description of activity
Several years ago, the adolescent immunization coordinator initiated contact with MSHSL’s Medical Director to discuss potential changes to the immunization sections of the form. At the time, the form did not list all of the vaccines recommended for adolescents, and among those listed, it made a distinction between vaccines that were required for school and those that were simply recommended.
To implement changes, the coordinator worked with an MSHSL Associate Director. The language was initially changed to add MCV4 and HPV to the list of vaccines, and was subsequently changed to remove the distinction between recommended and required vaccines.
Role of Immunization Program and other agencies/groups involved
The Minnesota Immunization Program worked with the MSHSL to periodically update the immunization language on the form. The MSHSL reviews and updates the form annually and promotes its use statewide. Language changes must be approved by an MSHSL committee.
The MSHSL promotes use of the form among its member schools. The MSHSL website is public, and non-member schools can use the form as a template.
Intersection with other program activities
Although not the main purpose of this form, school nurses have noted that they use the form as a last resort to collect general vaccination information for students who have not turned in immunization records to school or have data missing in the state’s immunization information system. However, because the form does not record detailed immunization data (i.e., provides checkboxes rather than space to record vaccine administration dates), the forms cannot be used to update students’ immunization records.
Funding for this activity, which covers the staff time to coordinate with MSHSL, comes out of the Immunization Program’s regular CDC immunization cooperative agreement.
The adolescent immunization coordinator is the main Immunization Program staff person involved in this activity, which is incorporated into the coordinator’s regular responsibilities.
The Immunization Program will revisit the form with MSHSL as needed when recommendations change (as they recently have with the HPV recommendation changing from 3 doses to 2 doses).
- The form now specifically identifies vaccines that are recommended across the adolescent years. Many families will interact with a healthcare provider to get this form completed during the middle and high school years, typically in 7th and 10th grades. It is one more way to bring attention to adolescent immunizations among families and providers.
- This form is also available to parents of homeschooled children who participate in extracurricular sport activities, which helps to raise awareness of immunization requirements among a population that is typically hard to reach with this information.
- Keys to success included creating a mockup of the form to show MSHSL exactly how the Immunization Program wanted the form to change and being persistent with follow-up.
- The impact of the form on the immunization status of student athletes cannot be readily gauged. Schools do not have to use the MSHSL form, though according to the school health consultant for the Minnesota Department of Health, it is widely used by schools throughout the state.
- School nurses have expressed the concern that the checkbox format may collect less accurate data (i.e., more susceptible to being checked without verification) than if the form asked for actual vaccination dates.
Other lessons learned/Advice to other programs
- Having a diverse group of stakeholders involved in generating ideas for addressing adolescent immunization can help immunization programs think “outside the box.” Making the change to this form is not something that the Immunization Program would likely have thought of on its own.
- Incremental improvements can be a valuable goal of immunization activities. The form is very dense and hard to read, and there are tight space constraints that limit the extent to which the Immunization Program can request changes. The current form is not ideal, but it is better than it was.
- Other immunization programs could consider requesting that vaccine administered dates be recorded on school physical forms rather than simple checkboxes, if possible.
For more information
Contact Denise Dunn, Assistant Section Manager, Vaccine-Preventable Disease Section, at (651) 201-5560 or firstname.lastname@example.org.