BackgroundLike many others, Cassandra Grantham has taken a non-traditional path into the public health workforce. With a background in project management, health communications, and health education, Cassandra’s skills led her from an educational nonprofit to
MaineHealth. There, she began working in cardiovascular health before moving into child health, where she now serves as the Director of Child Health within the Community Health Improvement Division. Focusing largely on immunizations as one of the system’s population health and
health index priorities, she has led the development and implementation of the Childhood Immunizations Program at
MaineHealth since 2010.
While Cassandra has always believed in the importance of immunizations, she credits the birth of her first child as being the catalyst for becoming “militant about cocooning" and learning about the impact of herd immunity. Cassandra states, “Until becoming involved in this work, I didn’t realize how multi-faceted the issue was and how other people’s vaccination decisions could impact my family and my community. I quickly became really passionate about the value of immunizations for individual and community health.” Today, Cassandra is considered a system and state expert on increasing immunization rates. Employing her various hats as a mother, public health worker, and communications professional, she leverages effective messaging across Maine to improve immunization rates and keep children and families safe from vaccine-preventable diseases.
Partnerships are Key
Cassandra credits partnerships as the key to the success of immunization initiatives in her state; specifically, she cites collaborations among the Maine Center for Disease Control, health systems and professional and quality improvement organizations. Maine’s approach depends on experts working outside their traditional silos and pooling time and resources to move the ball forward, “because Maine lacks a traditional county-level public health infrastructure,” Cassandra says. “We rely on people working across public and private sector organizations, geographical regions, and even with non-traditional groups. Our efforts have been collaborative all the way.”
Since 2011, Cassandra has served on the leadership team that implemented the
First STEPS (Strengthening Together Early Prevention Services) initiative to improve childhood preventive care and immunization rates at pediatric and family practices across Maine. Funded by a grant from the federal Centers for Medicare and Medicaid Services, MaineCare’s Improving Health Outcomes for Children (IHOC) project, based out of the Muskie School of Public Service, contracted with
Maine Quality Counts to implement First STEPS. A preliminary goal of First STEPS was to increase childhood and adolescent immunization rates at participating practices by 4% over 1 year (Sept. 2011-Sept. 2012); however, the increase achieved among children aged 2 to 13 years was actually 5.1% overall. After 26 months, the rate had increased further to 85.3%, for a total increase of 11.1% from the 2011 baseline. At the end of the initiative, First STEPS collaborators developed the
“First STEPS Change Package Toolkit for Improving Immunizations,” which documented the evidence-based tools and resources tested by participating practices. Based on this change package, Cassandra worked across the member organizations that constitute the
MaineHealth system to gain consensus around a framework to continue to improve rates; it included data reporting transparency across the system, personalized action plans for practices and a multitude of process improvement and clinical supports.
She also has led the deployment of a competency-based clinical support staff training program to ensure proper vaccine storage, administration, documentation, and communication with families and providers. So far, over 200 clinical support staff in 37 medical practices have been trained in the program.
Cassandra emphasizes that information technology and social media offer new opportunities to boost childhood vaccination rates. With the anti-vaccine movement maintaining a strong online presence, public health messages based on peer-reviewed evidence should also harness these channels, she says. In collaboration with the
Maine Immunization Coalition, Cassandra and her team created the state’s only integrated website and social media campaign dedicated to increasing awareness of vaccines and creating pro-vaccine parent advocates,
VaxMaineKids. Facebook and Twitter followers number in the thousands, and over 3,500 people have been reached by the website’s messages.
Change Agent
According to Cassandra, it is extremely important to know who may be an advocate, and it is even more important to engage local stakeholders who have a voice in what is being done within specific communities. Increasing awareness for the importance and necessity of vaccinations is a large task, but when done properly, there is ample opportunity for success. Along these lines, Cassandra monitors conversations on mommy blogs to extract information and concerns about immunizations. She translates the information to make it more relevant for her audiences. She has also written testimony in favor of pro-vaccine policies and against anti-vaccine policies proposed to the legislature, organized speakers, and worked behind the scenes to secure the necessary support to maintain the state’s vaccine efforts.
Cassandra says the expression, "An ounce of prevention is worth a pound of cure," defines her mission. She feels that immunizations are the ultimate success in preventing and protecting the public’s health by saving and improving the lives of thousands of children every day.