COMMUNITY-BASED STRATEGIES FOR IMMUNIZING THE HARD-TO-REACH CHILD - THE NEW-YORK-STATE IMMUNIZATION AND PRIMARY HEALTH-CARE INITIATIVE

The 1989-1991 measles epidemic in New York City drew attention to the low immunization coverage rates found in urban neighborhoods, This art icle describes a joint initiative of the New York State Department of Health and the Columbia University School of Public Health to mobilize parents to fully immunize their children. Eleven community-based orga nizations (CBOs) used a variety of outreach strategies to identify and enroll underimmunized children in primary care. They enrolled 4,555 c hildren, of whom 75% needed at least one basic vaccine dose to be up-t o-date for their age. Enrolled children were followed by CBOs to ensur e compliance with appointments. After nine months of program operation , 73% of children in an evaluation sample were up-to-date for age for their immunizations. Immunization coverage increases were greatest for the youngest children, for whom coverage rates more than doubled in t he first nine months of program operation. Ninety-one percent of these ''hard to reach'' children were tracked successfully by CBOs. This ar ticle compares the strategies used by the community organizations and concludes with suggestions for improvements of future community-based mobilization programs.