Immunizations are one of the most cost-effective child health prevention activities; yet in Maine, immunization rates decreased from 83.3% in 2005 to 76.2% in 2008 according to America’s Health Rankings. The proposed project aims to improve access to immunizations for rural and/or low-income, medically underserved children in Cumberland County, Maine’s most populated and ethnically-diverse community. This work is important in light of the problem of increasing vaccination delays documented in Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases," published in 2009 in the New England Journal of Medicine. The project will engage a wide range of partners to develop an actionable strategic plan to improve access to childhood immunizations and basic health screenings. The plan will identify alternative settings (child care centers/schools etc.) in which to provide immunizations, as well as alternative providers (school nurses/home health nurses). The planning process will use focus groups and interviews to gain input from parents and health care providers, as well as a community asset mapping project to identify existing resources and gaps. This project will not supplant the need for a medical home, but rather will provide all parents with convenient options to ensure their children are immunized in a timely manner. The plan will also identify methods for alternative immunization settings to: 1) assess child medical home and insurance status and make appropriate referrals in the event a child lacks those resources; and 2) use Maine’s immunization information system, ImmPact2, to share information between alternate immunization settings and medical homes. "