Abstract for:Exploring deficiencies in the implementation of school immunization policy in Texas

School immunization policies in the U.S. have been very successful at preventing many communicable childhood diseases, but a recent surge in non-medical exemptions for philosophical or religious beliefs has increased the risk for transmission of diseases such as measles for children enrolled in schools. Much of the existing research emphasizes parental ‘hesitancy’ as the reason for rejection of, or delays in, childhood vaccination, but there many different components that might impede the effective implementation of school immunization policy.  This presentation is based on a mixed-methods study (2016-17) that included researchers from different disciplines and school health practitioners.  From our findings, we developed a causal loop diagram showing how various dimensions related to policy implementation – administrative support, records management, parent motivation, exemption procedures – interact in the school environment to affect the demand for childhood immunization.  While we are still refining our model and monitoring procedural and policy changes, we anticipate this systems model will be useful in helping other design effective policies and procedures for improving school immunization.