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Assessment Activities in Preschool Facilities
Grantee:  
 
Name:  
Title:  
Email:  
Telephone Number: () -  
 
The words “preschool programs” used in the survey refer to daycare facilities, Head Start programs and prekindergarten programs. Do not include information on “after school daycare” in responding to the questions in this survey.  
 
1. What kind of preschool programs does your state immunization law cover?  
     
  1. Licensed daycare programs  
  2. Head Start programs  
  3. Non-church prekindergarten programs  
  4. Church prekindergarten programs  
  5. Family daycare programs  
  6. Other (describe below):  
 
     
     
 
2. What ages of preschool children do you include in your assessment?  
 
Check all that apply
 
  1. All ages before kindergarten  
  2. Other, Explain below:  
     
     
 
3. Does the law specify the vaccines and/or antigens to be included in the assessment of immunization status of children in preschool programs?  
     
  Yes  No, it just requires that a child is up-to-date (skip to 4, monitored column)  
     
 
4. What vaccines are required by law for children in preschool programs? What vaccines are you able to monitor among children in preschool programs?
 
 
Vaccine Required by law
(Skip if #3=No)		 Monitored/ Assessed
ACIP list  Yes  No   Yes  No 
Polio  Yes  No   Yes  No 
Diphtheria  Yes  No   Yes  No 
Tetanus  Yes  No   Yes  No 
Pertussis  Yes  No   Yes  No 
Measles  Yes  No   Yes  No 
Mumps  Yes  No   Yes  No 
Rubella  Yes  No   Yes  No 
Hepatitis A  Yes  No   Yes  No 
Hepatitis B  Yes  No   Yes  No 
Hib  Yes  No   Yes  No 
Pneumo-coccal PCV  Yes  No   Yes  No 
Varicella  Yes  No   Yes  No 
     
 
5. Which of the following exemptions are allowed by your state/territory law?  
 
  Check all that apply.  
 
  1. Permanent medical  
  2. Temporary medical  
  3. Religious  
  4. Philosophical  
     
 
6. How is the immunization status of a preschool child documented in the facility’s records?  
 
Check all that apply.
 
  1. A standardized form signed by a health care professional (doctor, nurse, health department official)  
  2. A standardized form signed by a parent or guardian.  
  3. A standardized form completed by the daycare facility  
  4. Record of the parent’s statement that the child is up-to-date  
  5. Affidavit signed by parent stating that the child is up-to-date  
  6. Other, describe below:  
 
     
     
 
7. How frequently are you required to assess the immunization status of children in preschool programs?  
     
  1. Annually (yearly)  
  2. Biennially (every other year or every two years)  
  3. State law does not specify frequency  
  4. Other (Please be specific):  
     
     
 
CENSUS ASSESSMENT
 
We would like to get some understanding about the methodology employed in conducting your preschool CENSUS assessments—the assessments you do check on the immunization status of all the children in preschool. Please answer the following questions based on the way your assessment plan is designed to be carried out. For example, if your assessment is designed to capture information on 100% of preschool children in 100% of the eligible facilities, then you should answer the following questions based on this design, even if your actual survey does not routinely capture 100% of the information from targeted children or facilities.  
 
8. Does your “census assessment” methodology require you to collect data from 100% or fewer than 100% of the preschool facilities?  
   
  100% (skip to question 10) Fewer than 100%  
     
 
9. If your methodology includes fewer than 100% of facilities, how do you select the facilities to be included in the annual assessment?  
 
1. Probability sampling procedures (e.g., simple random sample, stratified random sample, random cluster sample). Describe briefly:  
 
     
 
2. Non-probability procedure (e.g., convenience sample, sample of facilities who respond to the assessment request, sample of facilities that have had problems in the past). Describe briefly:  
 
     
 
     
 
10. Of facilities included in your “census assessment,” do you collect information on 100% or fewer than 100% of the preschool children in each facility?  
 
100% (skip to question 12) Fewer than 100%
     
 
11. If your methodology includes the records of fewer than 100% of the preschool children, how do you select the children to be included in the preschool coverage assessment?  
 
1. Probability sampling procedures (e.g., simple random sample, stratified random sample, random cluster sample). Describe briefly:  
 
     
 
2. Non-probability procedure (e.g., convenience sample, sample of children based on a particular characteristic). Describe briefly  
 
     
 
     
 
  ALL GRANTEES ANSWER THE REMAINDER OF THE QUESTIONS BELOW.  
 
12. What information is “assessed” or reviewed during the assessment activities?  
 
Check all that apply
 
  1. Date of Birth  
  2. Age at time of assessment  
  3. Required vaccinations  
  4. Date of required vaccinations  
  5. Exemption status  
  6. Other, describe:  
 
     
     
 
13. Does the assessment report form that you send to NIP reflect preschool assessment results before or after “follow-up” of children who are not up-to-date? Follow-up refers to any activities or interventions implemented in order to ensure that noncompliant students become compliant.  
 
Before follow-up  After follow-up:
 
     
 
14. Estimate the number of weeks or months that your public health assessment team is involved in collecting and reporting data for the census assessment?  
 
 <1  2  3  4  5  >6
 Weeks  Months
     
 
15. Approximately how many full and part-time public health staff members are involved in the collecting and reporting process?  
 
Full-time Staff: 0   1-4   5-9   10-14   15-19   20+
Part-time Staff: 0   1-4   5-9   10-14   15-19   20+
     
 
VALIDATION ASSESSMENT
 
16. Do you conduct a VALIDATION assessment or additional survey to verify the results of your previous assessment of coverage in preschool facilities?  
 
Yes (Continue with questions 18-23) No:(skip to question 24)
     
 
17. If your methodology includes fewer than 100% of facilities, how do you select the facilities to be included in the annual assessment?  
 
1. Probability sampling procedures (e.g., simple random sample, stratified random sample, random cluster sample). Describe briefly:  
 
     
 
2. Non-probability procedure (e.g., convenience sample, sample of facilities who respond to the assessment request, sample of facilities that have had problems in the past). Describe briefly  
 
     
     
 
18. How do you select the children to be included in the preschool validation survey?  
 
1. Probability sampling procedures (e.g., simple random sample, stratified random sample, random cluster sample). Describe briefly:  
 
     
 
2. Non-probability procedure (e.g., convenience sample, sample of children based on a particular characteristic). Describe briefly  
 
     
     
 
19. Who actually implements the validation survey?  
 
  1. State, local or other health department personnel (including school nurses employed by these entities)  
  2. Contractors hired by the state, local or other health department.  
  3. Other, describe:  
     
     
 
20. What information is “assessed” or reviewed during the validation survey?
If the information is not “assessed” or reviewed, could you assess this information?
 
 
Information to assess: Do you assess this? Could you assess this?
Date of Birth  Yes  No   Yes  No 
Age at time of assessment  Yes  No   Yes  No 
Required Vaccinations  Yes  No   Yes  No 
Date of Required Vaccinations  Yes  No   Yes  No 
Exemption status  Yes  No   Yes  No 
Other, describe below  Yes  No   Yes  No 
Other Information to assess: 
     
 
 
21. Are there consequences for facilities whose reports seriously or continually deviate from the validation study results?  
 
Yes, (please specify below)  No:
 
     
     
 
22. How frequently do you conduct a validation study?  
 
  1. Annually,(yearly)  
  2. Biennially (every other year or every two years)  
  3. Other, specify:  
 
     
     
 
 
23. Does your validation report reflect preschool assessment results before or after “follow-up” of noncompliant children? Follow-up refers to any activities or interventions implemented in order to ensure that noncompliant students become compliant.  
 
Before follow-up  After follow-up:  
     
 
24. Would you be willing to send us a copy of the materials you use in your “census" and "validation” assessment? This could include procedure manuals, data collection forms, standard vaccination record forms, facility report forms, examples of your reports and other relevant materials.  
 
Yes  No:
 
Please send materials via mail or email by July 18, 2003 to:
 
 
Angela Myrick
zqt8@cdc.gov
1600 Clifton Road, NE
MS-E 52
Atlanta, GA 30333
Fax: 404-639-8614
     
 
25. This is the end of the interview. Thank you for participating. Do you have any additional comments that you would like to share with us?
 
     
 
Please click the button to save your data. 
 
 
CDC is working hard to evaluate state assessments so that we may help the states to conduct assessments through educational materials and support. You may be contacted by telephone in the near future and asked to elaborate on some of your experiences pertaining to immunization assessments, immunization exemptions, and the enforcement of immunization laws. We appreciate your help and assistance in these efforts.

If you have any questions or comments, please do not hesitate to contact Carol Stanwyck (CStanwyck@cdc.gov; 404-639-8308) or Angela Myrick (zqt8@cdc.gov ; 404-639-8950). Thank you.
 
Date last modified: Tuesday, November 25, 2008 11:13:16 AM