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AIM Adolescent Immunization Resource Guide

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Overview of activity
The Rhode Island Immunization Program runs a program called “Vaccinate Before You Graduate” that offers all routinely recommended and required immunizations at no out-of-pocket cost to students in middle school and high school through onsite clinics at participating schools.

Ages targeted
Middle school through high school-aged students.

Background/impetus for the activity
The Vaccinate Before You Graduate (VBYG) program began in 2001 as a catch-up program for Hepatitis B vaccine for 12th grade students, to ensure that students were fully immunized prior to graduation. The decision was made to offer vaccination clinics during school hours to address the barrier of students missing school and their parents missing work to obtain vaccines.

Description of activity
The Rhode Island Immunization Program contracts with a local mass immunizer, The Wellness Company, to run vaccination clinics inside schools during school hours. The clinics are coordinated with school nurses, which every school employs. Students (with parental consent) are eligible to receive vaccines. The Wellness Company, which is awarded the contract through an RFP process, has been involved since the beginning of the program and has continued to be the vendor best suited to support this work. The Wellness Company staff includes an administrator, program manager, and four registered nurses.

The VBYG program expanded in 2010 to include 9th-12th graders in all private and public schools. In September 2015, the VBYG program further expanded to include middle school students.

The Immunization Program is able to offer all routinely recommended and required vaccines at no out-of-pocket cost because Rhode Island continues to be a universal vaccine state. To offset some of the cost of the VBYG program, The Wellness Company began several years ago to obtain provider status with some of the insurance companies so that it can bill insurers for vaccine administration fees.

Role of Immunization Program and other agencies/groups involved
The Immunization Program establishes a relationship with schools that choose to participate by working with the superintendent, principals, and school nurses to get everyone onboard. Then the Wellness Company works directly with the school nurses on every aspect of the school-located clinics. The number and frequency of clinics is determined by the participating schools. Doses administered data from these clinics must be submitted to the state immunization information system, called KidsNet, within 48 hours. The Immunization Program has a close relationship with contacts in the Rhode Island Department of Education, though the program is not directly involved with the VBYG program.

The Immunization Program supports a communications specialist dedicated solely to
the Immunization Program who assists in developing materials that are used for the VBYG program, such as the consent form and a program announcement provided in four languages. The School and Adolescent Services Coordinator regularly communicates with school nurses, principals, superintendents, and school committees, including sending reports of data from the VBYG program (e.g., doses administered data by school). The Immunization Program also has discussed the VBYG program at statewide school nurse conferences and healthcare provider conferences.

Intersection with other program activities
Regular provider communications (e.g., VFC site visits) include information about the
VBYG program. In a related effort, the Immunization Program holds school-located influenza immunization clinics during the fall that are open to the entire community and are typically held during after school hours. The Wellness Company is the mass immunizer for these clinics as well.

The contract with The Wellness Company is funded through the Immunization Program’s federal Vaccines for Children (VFC) grant. Immunization Program staff time is also covered via regular CDC cooperative agreement funding. The initial expansion to middle schools was funded with PPHF HPV funding.

The Immunization Program’s School and Adolescent Services Coordinator is responsible for interfacing with The Wellness Company, initiating contacts with schools that would like to participate, and regularly maintaining communication with participating schools about the VBYG program.

Implementation status
The VBYG program is ongoing.

-In the 2015-16 school year, 103 of 151 eligible schools participated in the VBYG program with almost 5,000 doses of vaccine administered.

-The VBYG program’s success has been built on frequent communication; Immunization Program staff are in touch with schools and the vendor every day. Transparency is important to keep things running smoothly and to maintain support for the VBYG program.

-Some school nurses do not want to participate because of the added burden, which the Immunization Program addresses by providing necessary resources such as running KidsNet reports, creating various templates, etc.

-Some providers have occasionally voiced concerns about students being immunized outside of their primary care offices. To help address this concern, the Immunization Program requires the vendor to report doses administered to KidsNet within 48 hours, communicates about the VBYG program regularly (e.g., during provider site visits, monthly newsletter), and has developed a report in KidsNet that providers can run showing which doses were given by The Wellness Company. Some providers still find it to be a barrier that they have to go in and choose to run the report, so this is still a work in progress. The Immunization Program believes that providers have come to appreciate that the VBYG program is catching up students that likely would not have come to the provider office.

Other lessons learned/Advice to other programs
-The most important thing is to get buy-in right from the top from school officials.

-Most of the first year of the VBYG program was devoted to planning and initial
conversations with all levels of school administrators and school nurses.

-For Rhode Island, it is important to use a local vendor so that clinics can be organized on very short notice.

-It is important to get the message across to providers that the Immunization Program is trying to complement the work that providers do, not replace it.

-Incremental expansions of the VBYG program have been a good way to work toward a sustainable model that works well for Rhode Island.

-Vendors need to be able to manage large quantities of vaccines, deal with proper storage and handling, be proficient in the logistics of running clinics, and be able to work well with school staff. It is very helpful if they can bill insurers.

For more information
Contact Kathy Marceau, School and Adolescent Services Coordinator, Rhode Island Office of Immunization, at (401) 222-4624 or


RI Resources: Vaccinate Before You Graduate

Item Name Posted By Date Posted
VBYG Consent- English.pdf PDF (67.02 KB) Administration 1/26/2017
VBYG Announcement- English.pdf PDF (174.63 KB) Administration 1/26/2017
Final 14-15 VBYG State Report (page1-2).pdf PDF (431.24 KB) Administration 1/26/2017
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