Adolescent Health Annual Report
Adolescence is an important time for promoting good health and preventing disease. Unfortunately, this important time is one that is sometimes overlooked. Adolescent health includes the physical, social, emotional, cognitive, and intellectual domains. It is important to understand the factors that can affect adolescent health so that organizations and individuals who work with youth can support the health and healthy development of all adolescents.
Adolescent Well-Visit
The National Survey for Children’s Health (NSCH) shows that the percentage of Delaware adolescents who have had a preventive medical visit in the past year declined from 2017 to 2018 but is on the rise again in 2019. In 2017, the percentage was 84.2%, while in 2018 the percentage declined to 70.2%. The 2019, Delaware’s percentage of adolescents who have had a preventive medical visit in the past year increased to 75.7%. During our 2020 Needs Assessment, our stakeholders identified the adolescent well visit as the number two priority for this population domain and was ranked 7th, overall.
During 2016-2018, like the U.S., Delaware saw a decline in the prevalence of ACEs. There was a three-percentage point decline in “two or more ACEs” in Delaware among children. For instance, in 2016 the prevalence of “two or more ACEs” was 22.6% and in 2018 the prevalence was 19.6%. However, in 2019 there was a two-percentage point increase in two or more ACE’s in Delaware, from 19.6% to 21.9% in 2019, while the U.S. had a one-percentage point increase from 17.8% in 2018 to 18.7% in 2019.
In partnership with Planned Parenthood of Delaware, training is offered for staff at School Based Health Centers (SBHCs) each year. Planned Parenthood attendees range from School of the Deaf, Detention and Treatment Centers from within the Department of Services for Children Youth and Their Families (DSCYF), Delaware Adolescent Program Inc. (DAPI), SBHCs, middle schools, high schools as well as community agencies, partners and parents. In addition, mental health and medical providers participate in trainings provided by Planned Parenthood of Delaware throughout the year. The following list represents trainings provided thus far this year. The COVID-19 pandemic has impacted Planned Parenthoods trainings in which all have been virtual. The following courses have taken place thus far:
- Online MPC/BPBR Training - Oct. 1, 2020
- MPC/BPBR Curricula Training - Oct. 14 - 16, 2020
- Let's Talk - CC Camp FRESH-10/29/20 (Parent workshop)
- Teaching about Consent & Healthy Relationships - 12/10/20
- Inclusive Anatomy & Physiology Training - 2/23/21
- Trauma-Informed Sex Education - 4/13/21
- Caring Through Crisis: Trauma Informed Care for Adolescents - 5/26/21
- Supporting an LGBTQ+ Child CAMP Rehoboth - 4/28/21
- Supporting an LGBTQ+ Child CAMP Rehoboth - 4/28/21
COVID-19 impacted School Based Health Centers across the state of Delaware this school year. Given many schools only offering remote learning and/or hybrid there was less access to SBHC’s at the beginning of the year. Many SBHC’s implemented telehealth in which students were able to access care via this method. Upon availability of the vaccine to adolescents 12 and older, SBHC’s have coordinated efforts for the COVID-19 vaccine with medical vendors in the latter months of the school year.
During the 2019/2020 school year, the School Based Health Centers in Delaware schools administered 703 depression screenings, 2,776 STD screenings, 8,304 Emotional (Mental Health) evaluations, 703 depression screenings, and 6,295 risk assessments. In addition to this, SBHC’s in Delaware completed 1,558 physical exams (well child), 3,437 sports physicals, 435 administrative physicals (ex. ROTC, pre-employment), 2,686 immunizations, and 3,502 nutritional counseling sessions.
The SBHC Operational meeting this year was held in conjunction with Title X Family planning on October 28, 2020 and May 26, 2021. It comprised of mental health and medical providers from SBHC’s, providers and administrative representatives from DPH Clinics, Federally Qualified Health Care Centers, Community Health Care Centers, Planned Parenthood as well as DPH/FHS staff. Training and topics focused on mental health and service delivery this year. Topics of discussion comprised of the following:
- Coping with COVID-19 as a HealthCare Professional - 10/28/2020
- Service Delivery During COVID-19 - 10/28/2020
- Caring Through Crisis: Trauma Informed Care for Adolescents - 5/26/21
In addition to the above training, the Adolescent and Reproductive Health Unit completed a virtual Unconscious Bias Training in four sessions (June 3 - June 24) with Pamela Fuller from the Franklin Covey institute.
This year Division of Public Health, Family Health Systems, Adolescent Health also completed an intense, virtual, strategic planning process in which 13 goals were established to produce a synchronized organization of SBHC’s across the state of Delaware. The plan is currently in its implementation stage with continued coordinated efforts with stakeholders such as the department of education, medical vendors, Delaware School-based health Alliance, etc. https://dethrives.com/sbhc
DEThrives has developed several organic (non-paid) social tactics to assist Delawareans in understanding the School Based Health Center (SBHC) Strategic Plan. The audience is targeted to stakeholders such as partners, medical providers, parents, schools, community providers, students, other MCH networks (DHMIC, Help Me Grow), other state agencies (such as DSS, Medicaid and managed care organizations, Kids Dept, public libraries, etc.), and with key MCH legislators to increase the awareness of SBHC recommendations.
DPH has signed multi-year MOUs with various school districts in an effort to support and build resilient children and improve the social and emotional wellness of children and adolescents. (https://www.lifeskillstraining.com/botvin-lifeskills-training-middle-school-program/). During the 2019/2020 school year, 12 middle schools representing 5 school districts completed the Botvin LifeSkills program. This represents 1,257 students who completed pre/post surveys.
Unfortunately, COVID-19 restrictions have impacted this program. There were no new schools and/or districts in the 2020/21 school year that delivered the program, and no new MOUs were signed. COVID also impacted the implementation in that all curriculum needed to be online and Botvin did not provide on online resource (i.e. – only paper workbooks) for students. Additionally, pre-post assessments are not available online for teachers to access. Unfortunately, this was a major barrier for teachers. The Brandywine School District and the Capital School District did request additional workbooks for children so their students could pick up from school. However, we have not been given the numbers by either district as to how many students were instructed on the curriculum. It will likely not be evaluated this year on account of the pre and post assessment barrier.
We look forward to our continued working relationships to further the implementation of the Botvin LifeSkills training with the school districts that did not implement the program this past year. In addition, we will continue to provide support to our colleagues in DPH as well as Department of Education (DOE). We will also provide assistance if needed, in the analysis of the pre- and post-surveys completed in the schools that implement the training in the future.
We worked with members of the Delaware State Police (DSP), DOE, and the Department of Services for Youth, Children, and their Families (DSCYF) to explore implementation of a program called Take Care Delaware. This program is modeled closely to the Handle with Care Model that was implemented in West Virginia, Maryland and Tennessee. This program provides a statewide trauma informed response to child maltreatment and children’s exposure to violence. In West Virginia, the model states that “If a law enforcement officer encounters a child during a call, that child’s information is forwarded to the school before the school bell rings the next day. The school implements individual, class and whole school trauma-sensitive curricula so that traumatized children are “Handled With Care". If a child needs more intervention, on-site trauma-focused mental healthcare is available at the school.”
In Delaware, the program’s intention was to be implemented through one pilot school district in August 2019. Data was scheduled to be available in the fall of 2019, once multiple districts participate in the program. The goal was to begin the program in the five New Castle County School Districts in September. These five districts and the nine police departments in the New Castle County began completing trauma training. Unfortunately, because of the COVID-19 pandemic, school districts were overwhelmed and requested that we put the program on hold for the 2020/2021 school year. Districts are currently being trained or retrained again and we will begin the program in New Castle County at the start of the new school year in September 2021.
Once this is complete, Take Care Delaware will begin the process again of scheduling meetings with New Castle County Vo-Tech and Charter Schools, as well. COVID -19 has unfortunately slowed this progress as well. We look forward to establishing a partnership with DSP to support this effort in an attempt to address the social determinant of health impact on children who are exposed to violence in the home.
Although, we selected Adolescent Well Visit as well as Physical Activity in this domain, we will continue to monitor the mental health status of this population. We know that COVID-19 had an impact on the emotional well-being of our MCH population, so it is important that we maintain our efforts in this area until we understand magnitude of this issue.
We are planning to partner with our School Based Health Centers to address increasing the number adolescents who receive an annual preventive medical visit. Our School Based Health Centers offer mental health support and counseling so even though Bullying was not selected during this cycle, we still plan to support the emotional well-being of adolescents. MCH also understands that bullying behavior can be triggered at much earlier ages. With this in mind, our Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program and our Early Childhood Comprehensive System (ECCS) programs have a focus on social and emotional wellness and provide materials and education to the families and communities they serve. School Based Health Centers have also expanded into elementary schools in Delaware as well.
This past year we began a partnership with the Cooperative Extension, University of Delaware, Health & Wellness Ambassadors. U of D Health Ambassadors are a team of Teen Leaders and Adult Mentors who advocate for a holistic healthy lifestyle across the state. Health and Wellness Ambassadors are role models and official representatives and promotors who help plan and implement the Delaware 4-H Healthy Living Program aimed at improving the health of themselves, their peers, and their community.
4-H Healthy Living Program topics include nutrition, fitness, mindfulness, substance prevention and life skills. Their goals are to promote healthy lifestyle choices, create media about healthy living, participate in community outreach and education, asset building, education, and promotion, and to create and facilitate community change.
The Health Ambassadors are trained in various holistic health topics and often help to teach programs in the community. They also help to plan and work at local healthy living events across the state. Adult Leaders are often college-aged health science major or graduates. Teen Leaders receive mentorship and support from Adult Leaders as part of the program.
Poor mental health in adolescence is more than feeling blue. It can impact many areas of a teen’s life. Youth with poor mental health may struggle with school, grades, decision making, and their health. Unfortunately, because of the Covid-19 pandemic, we were unable to partner with our School Based Health Centers and Delaware school districts during the 2020/2021 school year. Our hope was to work with the School Based Health Centers and the school districts to promote teens who need emotional and mental health treatment. Our goal is to begin the partnership once again with the Department of Education and the school districts to promote a health messaging campaign to address mental health treatment.
Instead, we worked with the University of Delaware 4-H Department to sponsor a poster contest that promoted teens to seek emotional and mental health treatment, when needed. Unfortunately, there is oftentimes a stigma associated with mental illness, emotional disturbances and seeking treatment. The purpose was for youth and adolescents to know they can request assistance when dealing with mental illness – and not feel ashamed about it. Mental illness can affect a person’s thinking, feeling, mood, or behaviors. Young adults should feel comfortable when asking for help when dealing with mental or emotional concerns and should never feel embarrassed. The University of Delaware promoted and advertised our emotional and mental health treatment poster contest via various avenues. In addition, it was also promoted through the U of D Health Ambassador monthly meetings.
All youth and adolescents ages 11 to 19, were encouraged to submit an original design that helped reduce the stigma associated with seeking treatment for mental illness. Posters were evaluated based on the following rules: provide a clear and understandable message in a concise format; easy to read; letters and words should be clear and legible; language used should be appropriate for age group; and the artwork must be the artist’s original creation. The winning poster was determined by a panel of three judges, each of whom is a Program Health Treatment Coordinator within DPH’s Maternal and Child Health Bureau (Home Visiting Program Administrator, CYSHCN Program Director and the Title V Coordinator/SSDI Project Director). The posters were each judged by clarity and visual appearance, the overall message, content and balance as well as the overall impact to make a contribution to the field. Our winning exhibit was a 13 year old girl from Seaford, Delaware.
One cash prize will be awarded by DPH to the first-place winner. We plan to share the winning exhibit, along with all entries, on our DEThrives website. We also have plans to advertise the exhibits on our other social media platforms as well. DPH would also like to pursue working with the winner’s middle school to advertise the poster directly with the school. We feel this could also reach more adolescents who are struggling with seeking help for emotional or mental health concerns. MCH plans to work with our Adolescent Health Program Manager to expand the poster contest in the future by working with schools and School Based Health Centers. The prizes envisioned for this project will be all health related, such as a Fitbit or gym membership.
Physical Activity (ages 12-17)
The prevalence of obesity among Delaware adults doubled from 13 percent in 1992 to about 28 percent in 2007. Fortunately, the prevalence has been relatively level since 2007, staying close to 29 percent from 2007 through 2015. To address this major public health challenge, DPH promotes policies and systems changes, and implements programs and strategies in the following areas: Physical Activity, Health Eating and Obesity Prevention.
According to the 2018/2019 National Survey of Children’s Health (NSCH), Delaware is among the lowest of its surrounding states when comparing the percentage of adolescents, ages 12-17, who are physically active at least 60 minutes per day. Additionally, 17.9% of Delaware’s adolescents are physically active zero days per week. Although Delaware is the lowest of its surrounding states when it comes to adolescents being physically active every day, resting at 13.0%, this percentage has increased from 11.6% to 13.0% from the 2017/2018 to the 2018/2019 results. During our 2020 Needs Assessment, our stakeholders selected increasing physical activity among this population as the number one priority for this population domain and was ranked 5th overall.
The Physical Activity, Nutrition, and Obesity prevention (PANO) program in the Health Promotion Disease Section of the Division of Public Health (DPH) facilitates collaborative work efforts and interventions that address increased physical for Delaware families including children and adolescent. MCH has partnered with the PANO office to increase physical activity for adolescents, ages 12-17. In our Adolescent Health application report, we describe current and future work opportunities to leverage a parentship with PANO to impact the physical activity of our adolescents.
Since April 2020, PANO has provided support to the Delaware Cancer Consortium, Cancer Risk Reduction Committee, Healthy Lifestyles Subcommittee (HLSC). In January 2020 the HLSC presented health and wellness policy recommendations to the Office of the Governor. These 14 recommendations included policy recommendations for children and youth, and some policies identified impact the health and wellness of adolescents:
- Expand DELACARE regulations (Regulations for Early Care and Education and School-Age Centers) to family childcare homes and strengthen physical activity requirements across settings.
- Prohibit sugar sweetened beverages (SSBs) in Early Childhood Care and Education Centers.
- Preserve robust school nutrition standards, as defined in the 2010 U.S. Department of Agriculture (USDA) nutrition guidelines for school lunches and maintain flexible, healthy standards relative to consumption of sodium, whole grain, and milk.
- Strengthen the implementation of annual health related fitness assessment, reporting and compliance standards set forth in Delaware Department of Education Regulation 503 Instructional Program Requirements Section 5.0: Physical Education.
- Develop and implement out-of-school nutrition policies (before-school, after-school, sports).
- Propose and implement time requirement standards for elementary, middle and high school physical education and physical activity.
In August 2020, PANO released a Request for Proposals (RFP) for Advancing Healthy Lifestyles: Chronic Disease, Health Equity & COVID-19 (AHL). One objective of the AHL initiative is to support the next phase of implementation and planning for these policy recommendations.
AHL has four components: A) Project Facilitation; B) Coordinated School Health and Wellness; C) Community Capacity Building; and D) Workplace and Employee Wellness. Each component provides opportunities to implement evidence-based practices and programs that reach broad populations across the lifespan, however with a cross cutting approach that overlaps and interrelates with one another. Each component is designed to engage and support specific objectives of the initiative which will help develop a HLSC Action Plan and a AHL Strategic Plan for PANO (Component A), while connecting to partners in schools (Component B), the community (Component C), and the workplace (Component D).
In Component B of AHL, PANO facilitated a review of best practices for a mini-grant program in Delaware school settings. PANO convened school health stakeholders to discuss the possibilities of implementing a mini-grant program in the 2020-2021 school year. PANO facilitated these discussions to assess the then-current environment for facilitating school health and wellness policies, systems, and environmental (PSE) activities, in the context of the limitations and restrictions in place for the COVID-19 pandemic. Due to those challenges, it was determined not to pursue implementing a mini-grant program in Delaware schools for the 2020-2021 school year. However, plans were developed for ways to engage Delaware schools in PSE strategies to address health promotion and disease prevention initiatives in schools in the 2021-2022 school year.
In Component C of AHL, PANO worked with the contracted vendors to facilitate technical assistance (TA) to three community partners on the planning and implementation of their community-based interventions, all of which impact children and families. PANO worked with the American Lung Association (ALA), University of Delaware (UD), and Delaware State University (DSU) to provide TA on PANO-related interventions which include: an asthma self-management program to be offered to children in schools and/or in youth-serving organizations (YSOs); improving access to healthy, locally produced food in targeted communities; and, a three-pronged intervention for children with autism and their families that teaches water competency to prevent drowning, teaches parents skills to increase the healthfulness of family meals, and increases physical activity for this population.
DPH also partners with state agencies and community organizations to sustain community capacity building. These efforts enable community-based organizations to achieve long-term and sustainable outcomes around health and wellness initiatives that support young Delawareans and the communities that care for them. PANO promotes PSE strategies and interventions through community-based initiatives such as the Lt. Governor’s Challenge and the Community Mini-Grant program. The Lt. Governor’s Challenge recognizes an Individual, Workplace, Community, Town/City/Neighborhood, or School for advancing the goals of a healthier Delaware in one of four focus areas: Emotional Well-Being; Healthy Living; Chronic Disease Management and Prevention; and Mother and Child Health. The Community Mini-Grant program awards grants to communities and organizations that exhibit a strong commitment to tobacco prevention and control programs and are enhancing or expanding access to physical activity and healthy eating opportunities for children, families, and communities.
MCH collaborated with PANO this past year during their Healthy Lifestyles World Café. MCH joined in their interest for exploring actions for Healthy Lifestyles. Along with other partners and stakeholders, MCH was willing to participate in important discussions during the World Café. The group engaged in a stimulating and productive series of discussions on the Policy Recommendations that emerged from the Healthy Lifestyles Subcommittee (HLSC) of the Delaware Cancer Consortium’s Cancer Risk Reduction Committee (CRRC).
During the World Café, participants joined a modified version of a round-robin discussion. Rather than attendees moving from group to group, the moderators came to us. Each moderator brought a set of Policy Recommendations to consider, and the group commented on. During each discussion input on the priorities from each perspective was provided, as well as what each participant believed would lead to effective change. In addition, participants provided various resources and agencies needed to take action for impact.
The 2020 Lt. Governor’s Challenge had over 40 nominations, with 7 final winners. The Lt. Governor’s Challenge Virtual Reception was held on October 13, 2020 and recognized all 7 finalists, including 3 winners associated with Delaware youth. The Academia Antonia Alonso Charter School created a Compassionate Schools team consisting of faculty and staff to utilize best practices and initiatives to build a safe environment that nurtures inclusion, respect, and acceptance of diversity. POLYTECH School District developed an initiative that provided nicotine addiction education, resources, and cessation options rather than disciplinary consequences in classrooms where the most vaping incidents were occurring, to decrease the number of vaping students. Mr. Khayree Bey, Health teacher at McCullough Middle School, Colonial School District, implemented a program that teaches students yoga, mindfulness, conflict resolution, calming strategies, and self-awareness. These strategies were also provided to teachers, parents, and community members. PANO continues to partner with the Office of the Lt. Governor to support the 2021 Lt. Governor’s Challenge. Dr. Karyl Rattay, director of the Delaware Division of Public Health was invited to participate in the first Lt. Governor Challenge Podcast in early April 2021. The Podcast topic was “COVID-19 & Healthy Lifestyles” and alignment with the overall Lt. Governor Challenge, HLSC recommendations, COVID-19 and the importance of healthy living. The 2021 Lt. Governor’s Challenge officially launched mid-March 2021 with a special focus on COVID-19. Nominations opened April 1, 2021 and closed June 11, 2021. Although nominations are closed, PANO continues to encourage those who are using PSE strategies to make Delaware healthier to visit www.ltgovernorschallenge.org to learn more about the Lt. Governor’s Challenge.
Another way MCH has found to provide support to the Physical Activity, Nutrition, & Obesity Prevention, Division of Public Health was through collaborative efforts to inform maternal and child health stakeholders, other community partners and home visitors about the Advanced Healthy Lifestyle Initiative Webinars on Coordinated School Health & Wellness, Community Capacity Building and Workplace/Employee Wellness.
DPH also collaborates with the Tobacco Prevention and Control Program (TPCP) and the American Lung Association to facilitate a Community Mini-Grant program. The Community Mini-Grants award funding to schools, community-based, and youth serving organizations that conduct tobacco prevention programs, physical activity, nutrition promotion and obesity prevention programs, or implement PSE changes related to tobacco and PANO. Grants are awarded to schools or organizations that exhibit a strong commitment to tobacco prevention and control programs in Delaware and enhancing or expanding access to physical activity and healthy eating opportunities for children, families and communities. Community Mini-Grant activities for the Fiscal Year 2021 (FY 21) were conducted October 2020 to May 2021. Likely due to the uncertainties and challenges of COVID-19, PANO observed that Delaware schools did not apply to participate in the FY 21 Community Mini-Grants program, for the first time in the history of the grant program. However, 29 Community Mini-Grants were awarded, with the majority of the grantees serving youth and families specifically. During FY 21, 43% of events and campaigns worked to prevent the initiation and use of tobacco, and 51% worked to reduce obesity through increased knowledge, skills, and behaviors of healthy eating and physical activity. In FY 21, grantees conducted 49 community groups (573 sessions), reaching over 5,000 individuals. These community groups included youth health promotion, health education, and tobacco prevention groups, with the most common type of community group reported as youth health promotion. Community groups reached a wide range of ages, with 39% reaching middle and high school students. Due to various restrictions and challenges of COVID-19 during this FY 21 grant year, organizations primarily conducted activities in a virtual setting.
DPH collaborates with the Delaware Department of Education (DOE) on coordinated school health and wellness initiatives. To support DOE physical education regulations on annual physical fitness assessment, reporting and compliance standards, we support the utilization and implementation of FitnessGram®, the physical fitness education and assessment tool, developed by the Cooper Institute. PANO continues to collaborate with the Cooper Institute to be able to provide physical education and physical activity resources to Delawareans in addition to providing technical assistance for FitnessGram® implementation, professional development, and training opportunities for Delaware educators, and provides online resources. PANO developed an online Tool Kit for FitnessGram® and physical education resources, available at www.deschoolpe.org, www.deschoolpe.com, and on the HealthyDelaware.org website (https://fitnessgram.healthydelaware.org and https://www.healthydelaware.org/fitnessgram). In partnership with the Cooper Institute, DPH hosted a FitnessGram® workshop session at the 2020 SHAPE Delaware Conference, held on October 9th: https://fitnessgramsoftwarehelp.files.wordpress.com/2020/09/de_onlineresources.mp4.
SHAPE is the professional Society of Health and Physical Educators. The Delaware SHAPE annual convention is designed to provide SHAPE members and health education professionals the opportunity to share instructional ideas with each other and learn from local and national subject matter experts. We are pleased to participate in the annual learning opportunity to support Delaware educators. PANO also hosted 2 professional development opportunities for Delaware educators, with OPEN, a public service entity of US Games and BSN SPORTS, a Cooper Institute Partner. These trainings: FitnessGram in a COVID World and COVID 19: The Response and Future Resources, were offered in May 2021. These web-based learning opportunities offered Delaware educators support in administering and assessing FitnessGram® in both hybrid and remote settings, with practical examples and resources, and a live Q&A.
PANO also continues to explore additional opportunities to support increased physical activity and healthy living. In Spring 2021, PANO provided DOE with the Coordinated Approach To Child Health (CATCH) Social-Emotional Learning (SEL) training system, which connects SEL to the physical education curriculum. This SEL CATCH curriculum is designed for students 4 years old to 14 years old, so all Delaware schools serving that population received this CATCH curriculum, including 62 middle schools.
DPH is also working with DOE to facilitate improved responses from schools for school health data surveys, including the School Health Profile (SHP), the Youth Tobacco Survey (YTS) and the Youth Risk Behavior Survey (YRBS). The YRBS is a biennial (odd years) and anonymous student survey for students in grades 6-12 that provide data on student physical, emotional, and psychological health. Its statistics, charts, and other data report not only on student trends in physical activity, but also on texting and driving, drinking, vaping and drug use, bullying, social media use, and other behaviors. PANO continues to work with DOE to encourage participation in this survey in particular, as 2019 received a very low participation rate for the YRBS.
PANO will continue to facilitate collaborative work efforts and interventions across the state that address health and wellness for Delaware families, children, and youth.
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