A quality improvement project that focused on the health outcomes of a local population of unaccompanied asylum-seeking children (UASC) in Cornwall, with a specific emphasis on immunisation.
Aim
To increase immunisation uptake among UASC within four months of their entering local authority care or by the time they turn 18.
Background
Although a successful public health intervention, global immunisation coverage remains a concern. Declining uptake of routine immunisations is associated with increased childhood infections. Poor local UASC vaccination rates reflect the broader immunisation inequalities strategy.
Design
A small test of change was introduced to a clinic for UASC, led by a trainee Advanced Nurse Practitioner. The clinic offered UASC the three-dose vaccination ‘catch-up' schedule within statutory health assessment appointments, extending the already established ‘one-shop’ model.
Methods
The Model for Improvement was applied for this quality improvement project. The vaccines administered were quantified, and post-vaccination surveys were conducted to capture the experiences of clinic users.
Outcomes
UASC vaccination uptake increased significantly during the project, and UASC reported positive experiences at their clinic appointments.
Conclusion
This project demonstrates that offering vaccinations to UASC within a specialist provision improves vaccine uptake, enabling an equitable and inclusive service. The benefits of applying a child-centred and trauma-informed model were evidenced in the positive feedback and improved immunisation outcomes for UASC.
BaggaleyRZennerDBirdPHargreavesSGriffithsCNooriTFriedlandJSNellumsLPareekM (2022) Prevention and treatment of infectious diseases in migrants in Europe in the era of universal health coverage. The Lancet7(10): e876–e884.
3.
BaidwanSK (2022) Initial health assessments for unaccompanied asylum-seeking children: Advice and good practice. Paediatrics and Child Health33(1): 11–16.
BradbyHHumphrisRNewallDPhillimoreJ (2015) Public Health Aspects of Migrant Health: A review of the evidence on health status for refugees and asylum seekers in the European Region.Health Evidence Network Synthesis Report44.Available at: www.diva-portal.org/smash/get/diva2:883004/FULLTEXT01.pdf
6.
ChauhanBWardL (2019) Quality improvement project: Understanding and improving health outcomes for unaccompanied asylum seeking children (UASC) in Harrow. Adoption & Fostering43(2): 225–230.
7.
ChengIHDrillichASchattnerP (2015) Refugee experiences of general practice in countries of resettlement: A literature review. British Journal of General Practice: e171–e176. doi: 10.3399/bjgp15X683977
Department for Education (DfE) and Department of Health and Social Care (DHSC) (2015) Statutory Guidance: Promoting the health and wellbeing of looked-after children. Statutory guidance on the planning, commissioning and delivery of health services for looked-after children (updated 2022). Available at: www.gov.uk/government/publications/promoting-the-health-and-wellbeing-of-looked-after-children–2
11.
HaeuserEet al. (2025) Global, regional, and national trends in routine childhood vaccination coverage from 1980 to 2023 with forecasts to 2030: A systematic analysis for the Global Burden of Disease Study 2023. The Lancet406(10500): 235–260.
12.
HarkenseeCAndrewR (2021) Health needs of accompanied refugee and asylum-seeking children in a UK specialist clinic. Acta Paediatrica110(8): 2396–2404.
13.
HoSJavadiDCausevicSLangloisEVFribergPTomsonG (2019) Intersectoral and integrated approaches in achieving the right to health for refugees on resettlement: A scoping review. British Medical Journal Open1(9): article no. e029407.
14.
HopkinsPHillM (2010) The needs and strengths of unaccompanied asylum-seeking children and young people in Scotland. Child and Family Social Work15: 399–408.
15.
JanesGDelves-YatesC (2023) Foundations chapter. In: JanesGDelves-YatesC (eds) Quality Improvement in Nursing. London: Learning Matters, pp. 7–16.
16.
LauLSRodgersG (2021) Cultural competence in refugee service settings: A scoping review. Health Equity16(5): 124–134.
17.
MaioliSCBhanhaJWickramageKWoodLCNBurgessRDigidikiVErragneLGarciaOOAldridgeRDevakumarD (2021) International migration of unaccompanied minors: Trends, health risks, and legal protection. Lancet Child Adolescent Health5(12): 882–895.
18.
MaldonadoBNArmitageAJWilliamsB (2022) Variation in initial health assessment of unaccompanied asylum-seeking children: A cross-sectional survey across England. BMJ Paediatrics Open6: article no. e001435.
Office for Health Improvement and Disparities (2021) Guidance: Immunisation: Migrant health guide. Advice and guidance on the health needs of migrant patients for healthcare practitioners. Available at: www.gov.uk/guidance/immunisation-migrant-health-guide
PortnoySWardA (2020) Unaccompanied asylum-seeking children and young people – Understanding their journeys towards improved physical and emotional health. Clinical Child Psychology25(3): 636–647.
SpitzerDLTorresSZwiABKhalemaENPalaganasE (2019) Towards inclusive migrant healthcare. British Medical Journal366: article no. l4256.
36.
SuurmondJRuppISeelemanSGoosenSStronksK (2013) The first contacts between healthcare providers and newly-arrived asylum seekers: A qualitative study about which issues need to be addressed. Public Health127: 668–673.
WaltonSBedfordH (2017) Immunisation of looked-after children and young people: A review of the literature. Child: care, health and development43(4): 463–480.
44.
World Health Organization (WHO) (2019) TIP Tailoring Immunization Programmes. Copenhagen: WHO Regional Office for Europe.
