Adolescence is a crucial phase in each person’s life. Adolescence is the period of transition between childhood and adulthood. The many physical, sexual, cognitive, social, and emotional changes that happen during this time can bring anticipation and anxiety for both children and their families. Understanding what to expect at different stages can promote healthy development throughout adolescence and into early adulthood. It is also a time of multiple transitions involving education, training, employment, and unemployment, as well as the development from one state of life to another.
Puberty is a unique life cycle that offers people particular challenges and opportunities. Adolescence is considered a crucial phase in human life that requires extreme parental care, guidance, and empathy. Only with caution, we can ensure that our youth grow into healthy adults who can help improve our society and become their leaders for a bright and prosperous future. Therefore, the goal of effective youth care requires systematic steps to prevent, detect and treat physical and mental disorders in young people.
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
According to the 2020/2021 National Survey for Children’s Health (NSCH), the percent of Delaware adolescents who have had a preventive medical visit in the past year is 71.8%, which is only slightly above the national average of 69.6%. During the 2019/2020 combined results, 71.9% Delaware’s adolescents had a preventive medical visit. We are holding steady with our numbers, but still have much work to be done. During Delaware’s 2020 Needs Assessment, our stakeholders identified the adolescent well visit as the number two priority for this population domain and was ranked 7th important, overall. In general, preventive medical visits declined over 10 percentage points during 2016 through 2021.
Using National Survey of Children’s Health (NSCH) data for 2016-2021, Delaware saw a 5-percentage point decline in two or more ACEs from 21.9% in 2019 to 16.4% in 2020. During the same timeframe, the U.S. saw 1-percentage point decline in two or more ACEs from 18.7% in 2019 to 17.4% in 2020. However, in 2021, the percentage of two or more ACEs among Delaware children 3-17 years was 17.8% (95%CI: 14.1-21.5), a one percentage point increase from 2020. In contrast, in 2021, the percentage of two or more ACEs among the U.S. children 3-17 years was 16.6% (95%CI: 15.8-17.3), a one percentage point decrease from 2020. In summary, two or more ACEs among Delaware children increased while in the U.S. it decreased, and the prevalence of two or more ACEs among Delaware and the U.S. children was not statistically different.
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Professional Curriculum Training |
In person |
September 2022 |
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Curriculum Booster |
In person |
October 2022 |
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Supporting LGBTQ+ Youth |
In person |
May 2023 |
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Sext Ed Webinar |
Virtual |
January 2022 |
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Bilingual Professional and Parent Workshop |
In person |
December 2022 |
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Parent Night at Glasgow HS |
In Person |
November 2022 |
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Teaching Youth About Healthy Relationships |
In person |
4/5/22 |
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Approachable Parent Workshop |
In person |
5/11/22 |
COVID-19 impacted School Based Health Centers across the state of Delaware this past school year. All schools have returned to in person learning with the option of remote learning and/or hybrid learning, increasing the accessing to SBHC’s at the beginning of the year. Many SBHC’s implemented telehealth at the onset of COVID which is still in place to ensure are students have access to treatment when needed. Upon availability of the vaccine to adolescents 12 and older, SBHC’s have coordinated efforts for the vaccine with medical vendors in the latter months of the school year.
COVID 19 efforts to promote education, testing, vaccines, and awareness has been promoted in various ways throughout the state. Using methods such as:
- Social Media
- Radio Stations
- Bulletin Boards
- School Staff
- SBHC Staff
- Flyers/Posters
- Medical Provider Websites
During the 2021/2022 school year, the School Based Health Centers in Delaware schools administered 4,094 depression screenings, 941 STD screenings, 1,753 Emotional (Mental Health) evaluations, and 4,395 risk assessments. In addition to this, SBHC’s in Delaware completed 4,854 physical exams (well child), and 1,283 nutritional counseling sessions. These numbers have increased from the previous school year.
The SBHC Operational meeting this year was held in conjunction with Title X Family planning on October 20, 2022, and May 3, 2023. 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. The Adolescent and Reproductive Health Department attended an Annual Summit with DHMIC on April 26, 2022. Training and topics focused on mental health and service delivery this year. Topics of discussion comprised of the following:
- Isabella Weber: Education Programs – Planned Parenthood of Delaware 10/20/22
- Frank Hawkins: Education and Awareness -AIDS Delaware 10/20/22
- Darren Jones Ed.D PCC- Unconscious Bias 10/20/22
- Lisa Gruss- Quality Insights 05/03/2023
- Mindy McGrath 340b for Title X – NFPRHA 05/03/2023
- Rose L. Horton, MSN, RN, NEA-BC, FAAN- Count the kicks/ Not on my Watch Consulting Partners 04/18/2023
- Kay A. Johnson – Johnson Policy Consulting, LLC 04/18/2023
- Rebecca Vahle, MA- Family to Family Network
In addition to the above training, the Adolescent and Reproductive Health Unit completed a in person training: Reunite-Reignite-Re-Energize innovating for the Future May 23-23, 2023 in Atlanta, GA with Family & Youth Services Bureau. This conference afforded DPH the opportunity to engage with multiple speakers, interactive workshop sessions and opportunities for networking.
Legislation was submitted and approved; House bill No. 129; awarding $170,000 to two high needs elementary schools per year until all high needs elementary schools are in compliance. There are currently 20 high need elementary schools in the state of Delaware. August 31, 2022, Baltz Elementary and January 24, 2023 Frederick Douglass Elementary became a State Recognized School-Based Health Center Provider. As a SBHC they have applied for and are eligible to provide medical, mental health care treatment and health education to promote a healthy lifestyle. These centers will serve children allowing access to services such as sports physicals, and mental health counseling.
Mental and Behavioral health services continue to be an area of growth and development. In some locations SBHCs continue to struggle to provide services to students due to staffing shortages and frequent turnover rates. While others are able meet and exceed their projected goals to service for mental and behavioral health services. Some SBHCs are still experiencing difficulties servicing students due to the parameters of COVID 19; many have implemented telehealth services to provide an increasing needed service to students.
The Strategic Plan that was developed by the Division of Public Health/ Family Health Systems/Adolescent Health was an intense, virtual, strategic planning process in which 13 goals was established to produce a synchronized organization of SBHC’s across the state of Delaware. The plan is currently being implemented in all stages throughout the state with continued coordinated efforts with stakeholders such as the department of education, medical vendors, Delaware School-based health Alliance, etc. https://dethrives.com/sbhc. As we continue to implement the plan SBHC continues to evolve and develop allowing students to utilize services needed such as mental health, reproductive health and well visits.
Two former SBHC Strategic Steering Committee Members, Dr. Jon Cooper (Co-Chair) and Dr. Aileen Fink (Co-Chair) along with Pediatrician and Chair of the DHMIC, Dr. Priscilla Mpasi, answered SBHC related questions to raise awareness of what SBHCs offer. The questions they answered were organized into short form videos in December 2021. A compiled video was created where all three speakers were featured in the short 2:25 minute long video and was posted online on September 23rd, 2022. This video acted as an introductory video informing the public of what SBHCs are, the benefits of receiving SBHCs services for adolescents, what SBHCs have accomplished thus far in Delaware, and ways on how to get involved by visiting DEThrives.com/SBHCs. The collection of videos can be viewed on the DEThrives’ YouTube channel on its own playlist found here. Currently, there are 34 recognized High School and Middle School SBHC locations and 15 recognized Elementary School SBHC locations in Delaware. Last year, there were 32 High School and Middle School SBHC locations and 7 elementary School SBHCs. These participating schools are shown on this sitemap.
DPH 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. 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.”
As of this reporting period, the program has been implemented in 17 different school districts across the state of Delaware. In addition, 22 Delaware law enforcement agencies are participating in the program. This year’s program began during the 2022/2023 school year (8/28/22 – 6/22/23) and there have been 2,253 incidents generated, which equals to 3,695 notices.
Once this is complete, Take Care Delaware will begin the process again of scheduling meetings with additional New Castle County Vo-Tech and Charter Schools, as well. We recently established 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.
For our selected prior of increasing the number of adolescents receiving a preventive well-visit annually to support their social, emotional and physical well-being, we have focused on access and availability of mental health resources.
We 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 past Needs Assessment, 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.
As with previous years, we have partnered 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 fully partner with our School Based Health Centers and Delaware school districts during the 2022/2023 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. Once SBHC’s are fully staffed, 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.
During the past grant cycle, DPH planned to work with the Department of Education 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 original intention was for all Delaware middle school and high school students to be eligible to enter a creation to the poster contest. DPH was trying to raise awareness and reduce the stigma associated with seeking and accessing treatment for mental health concerns. Our goal was to engage teens to creatively address the topic of mental and emotional wellbeing. Teens and young adults should be encouraged and feel comfortable when asking for help dealing with mental or emotional concerns. MCH strategized on the prizes, as we sought to keep them aligned with “health” in mind. We chose items such as an Apple or Garmin watch, Beats or AirPods, and a one-year subscription to Spotify. We hoped to get the youth excited about an item that could help keep track of health-related topics such as exercising, walking, dancing, etc.
The goal was to launch the poster contest during the 2022/2023 school year. We were hoping to have teachers take on the poster contest as a class project or an extra credit assignment. Unfortunately, the contest rules, criteria and prizes were considerably delayed and have not yet cleared through the Deputy Attorney General’s approval process within DPH. At this point, we are revisiting the poster project altogether and may pivot from the original poster plan. DPH is in the process of working with the U of D Cooperative Extension to engage the health and wellness ambassadors on the creation of electronic mental health messaging.
Whatever the project will look like, we plan to share the winning exhibit or message, along with all entries, on our DEThrives website. We will also advertise the exhibits on our other social media platforms as well. 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 the School Based Health Centers.
In 2020, the Delaware Department of Education (DDOE) developed and launched Project THRIVE, which helps children receive trauma-informed support from their schools, communities and caregivers. Project THRIVE provides free mental health services to eligible Delaware students. Services are available to students, grades pre-k through 12th grade, attending Delaware public schools, private schools, parochial schools and homeschools.
Project THRIVE services help students who are struggling with traumatic situations, such as physical or emotional abuse, community violence, racism, bullying, serious illness or death in the family, and more. Trauma can harm mental and physical health, and limit school success. Project THRIVE offers access to a local network of professional mental health providers, youth centered strategies aimed at recovery and healing, tools for self-regulating emotions and behaviors as well as strategies to improve a student’s engagement in school. Project THRIVE services help students:
- Process and understand traumatic situations
- Attend school regularly
- Better control emotions and behaviors
- Develop coping skills for managing stress at home and school
Children and youth thrive in the presence of thriving caregivers. Project THRIVE is committed to supporting caregiver agency and helping them become good consumers of mental health care on behalf of their children. The mental health provider of choice will be supported in delivering trauma-specific mental health services.
During this past grant cycle, MCH partnered with the Department of Education (DOE) to expand advertisement of Project THRIVE. The need for self-identification of trauma has become a critical component to the success of Project THRIVE. MCH is committed to the success of this program and worked to conduct preliminary research and determined the path forward to deliver targeted advertising to reach youth to increase self-identification and subsequently, utilization of Project THRIVE’s services. The advertisement campaign is focused on building awareness of Project THRIVE to adolescents. The existing video was adjusted to fit each advertisement platform. We selected YouTube, TikTok, Instagram, YouTubeKids, Snapchat and Spotify to advertise with.
The Project THRIVE campaign started on July 21st, 2022, and ran for three months. The purpose of the campaign was to spread awareness of the Project THRIVE name, messaging, and services to children and their parents. Web analytics were analyzed almost every week from the communication vendor to ensure that maximum optimization was done periodically during the campaign. Our communications vendor optimized and proposed adjustments by platform based on performance and outcomes within those three months. They closely monitored the traffic that was coming from each platform and adjusted the ways the ads were being presented (changed the image, changed the posting time, etc.) depending on the analytical metrics collected during the campaign. From doing this, DPH in collaboration with DOE was able to receive optimal results with the help of the changing tactics to maximize the reach with the campaign, then the chances of a user seeing information about this service increases. The call to action was to visit the newly created anchor link, de.gov/projectthrive, which brings you to the section of the DOE webpage that is more consumer friendly rather than reading about background information on the services first that may cater more to professionals. Th other quick call to action would be to dial 2-1-1, or text your zip code to 898-211 to learn more information or enroll in the services which would direct the user to Help Me Grow (HMG) services in Delaware. 
Campaign videos were created (short form videos ranged from 10 to 15 seconds and long form videos went up to 40-second-long videos) to target students and their families. Screenshots of the video are found below. Due to optimization strategies that were presented during the second month of the campaign, it was decided for the vendor to draft social media posts on a collaborative platform called Airtable. It is a platform where DPH, DOE, or other partners could easily utilize well after the campaign concludes to continue the Project THRIVE messaging online. These drafted Project THRIVE social media posts included the topic, the post’s description, the graphic and/or video for the post (can be viewed or downloaded), and any additional DPH/DOE notes. It also houses the hardcopy materials that were made for the campaign. No edits can be done to the Project THRIVE Airtable link so it safe to share the link to partners so they can easily access and share its contents.
The communication vendor looked at three key performance indicators during the campaign. Looking at the impressions was the best engagement tool since that meant that we were increasing awareness of this service which was the primary goal of the campaign. Secondly, looking at the click through rate (CTR) shows the percentage of impressions (number of times a post has been displayed) that turn into views. You can get an idea of the rate at which people are clicking on the ads. Lastly, analyzing the view rates shows the percentage of completed views divided by the impressions which shows you a percentage of people who have watched the entirety of the ad. Looking at the combined performance indicators, it would show us how many people are viewing the content and at what percentage are views turning into clicks and at what percentage are users actually viewing the entire ad. The communication vendor separated its analytical data by impressions, CTR, and view rates, but they also looked at each key performance indicator’s numbers as a whole, by social media platform, and by creative to look for any additional patterns. The biggest limitation for the communication vendor during this campaign was not being able to have direct Google Analytic access to the DOE’s Project THRIVE landing page and in return, they were unable to place tracking pixels on the page to collect certain analytics since the DOE did not grant the vendor access to the page. They were also limited in terms of optimizations such as the CTR since it would have been useful to collect the user’s demographic info who visited the DOE landing page.
During the first month of the campaign alone, we were able to reach a third of Delaware, which is 300,000 unique users. The campaign earned over 6 million impressions where TikTok, Snapchat, Instagram and video ads made up the majority of the impressions. During the second month of the campaign, we gained a higher impression rate than the first month earning over 8 million impressions, where video ads continued to make up the majority of the impressions primarily by TikTok, followed by Instagram, and then Snapchat. During the third and final month of the campaign, we were again able to earn over 6 million impressions, where video ads made up the majority of the impressions for the third time in a row, primarily made by TikTok, Instagram, and Snapchat.
Overall, the campaign was able to reach a consistent 6-8 million impressions each month which was the primary goal for the media ads since large impression rates equal increased awareness of the Project THRIVE messaging. TikTok, Instagram, and Snapchat consistently ranked as the top three platforms that were frequented on average per month and that brought in the most impressions out of all the other media channels that were utilized. Video ads remained king during the campaign since that medium earned the most impressions and CTR every month – so, utilize videos when doing ads for this population. Limitations in collecting an accurate CTR occurred since the communication vendor did not have permission to analyze the Project THRIVE landing page to see the number of clicks earned and the landing page views. Therefore, our vendor could not provide any recommendations on how to improve the CTR since they did not have access to DOE’s Project THRIVE’s landing page. The view rate either barely met or exceeded the average YouTube ad view rate of 31.9% since the view rate ranged from 31%, 77%, and 41%. Lastly, by consistently looking at the analytics and optimizing accordingly even by making the tiniest tweaks such as reducing an ad run time by 1.5 seconds, the campaign saw great results.
Printed materials were also created by the communication vendors so the Project THRIVE name and messaging could be physically placed throughout Delaware schools. There were banners, 11”x17” sized posters, and stickers with QR codes linking back to DOE’s page that were handed out in schools. The Title V Coordinator reached out to the DOE’s school counselors, nurses, psychologists, deans, superintendent offices, principals, Public Information Officers (PIO), and other district leaders in an attempt for them to directly share the Project THRIVE messaging at their local schools, looping the videos in district and school 
offices, placing the Project THRIVE content in each of the Superintendent and Principals’ weekly/monthly email blasts to families, etc. These were all ideas of MCH to spread the messaging during and even after the campaign. In contacting multiple schools throughout Delaware, only a handful replied sharing that they would be willing to share the messaging (along with SBHC content). These school districts include: the Caesar Rodney School District, Capitol School District, Colonial School District, and the Appoquinimink School District. Currently, DPH’s Social Marketing Coordinator contacts each school district on a monthly basis and shares SBHCs related content or Project THRIVE related content directly asking them to post these topics on their social media channels. Unfortunately, there have not been many shares from the multiple school districts, perhaps 1-2 shares maximum within the last three months. Project THRIVE and SBHC social media posts are also shared and asked for the DDOE’s PIOs to post on social media which fortunately gets reposted consistently.
In lieu of continuing with paid media, MCH has pursued sharing the Project THRIVE content organically (free) with the help of DPH and the DOE. Through our paid communications vendor, DPH contracted to create various posts and stories. DPH is now organically posting and tagging the DOE on social media (Facebook, Twitter, and Instagram) so the content can be reshared by the DOE and other partners to help broaden the message. The call to action is to visit the newly created anchor link “de.gov/projectthrive” (brings you to the part of the DOE webpage that is more consumer friendly rather than reading about background info on the services first that may cater more to professionals) to learn 
more info and to dial 2-1-1, or text your zip code to 898-211 to learn more info or enroll in the services.
Thanks to the communication efforts between DPH and school districts, a PIO from the Colonial School District contacted the DPH’s Title V Coordinator, sharing that there was a media opportunity to help share news of the Project THRIVE messaging. So, a live interview was scheduled at the DeTv news station in Wilmington, Delaware on October 24th, 2022, with Dr. Teri Lawler. Teri Lawler, is a psychologist under the Delaware Department of Education (DDOE), is the Program Lead for Project THRIVE, and also worked alongside DPH during the Project THRIVE campaign, and shared information about Project THRIVE. Teri had an 11-minute live interview that discussed key points of Project THRIVE services such as describing what Project THRIVE is and why it’s needed, defined what “trauma” is, and shared the available resources such as DOE’s trauma toolkit, the Project THRIVE campaign materials, and DOE’s website de.gov/projectthrive to find for more information. The interview can be viewed on DeTv’s Facebook page here between the 17:43 - 29:07 minute timeframe.
Physical Activity (ages 12-17)
The percentage of overweight children and adolescents (85th to 94th percentile) in Delaware has remained steady since 2019, where the NSCH shows 17.4% were overweight. According to the 2021 NSCH, 17.9% of adolescents in the same category are considered overweight currently. In addition, obese children and adolescents (95th percentile or above) in Delaware have reduced by over four percentage points from 18.4% in 2019 to 14.0% in 2021.
The prevalence of obesity among Delaware adults has continued to increase over the last few years. In 2012, the obesity prevalence in adults was 26.9%, and in 2021 that number increased to 33.9% of adult Delawareans. Conversely, the prevalence of overweight adults in Delaware has declined over the years from 39.1% in 2012 to 34.9% in 2021. To address these major public health challenges, 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 2020/2021 National Survey of Children’s Health (NSCH), Delaware is average among its surrounding states when comparing the percentage of adolescents, ages 12-17, who are physically active at least 60 minutes per day, one to three days per week. Additionally, 21.5% of Delaware’s adolescents are physically active zero days per week. Although Delaware is again average with its surrounding states when it comes to adolescents being physically active every day, resting at 16.0%, this percentage has trended upwards from 11.6% in the 2017/2018 NSCH and 13.0% from the 2018/2019 results. During our 2020 Needs Assessment, our stakeholders selected increasing physical activity among the adolescent 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.
The Physical Activity, Nutrition, and Obesity Prevention (PANO) is a bureau within the Division of Public Health. PANO’s long-term goal is to reduce the prevalence of adult and childhood obesity and other chronic diseases by promoting healthy lifestyles and improving health outcomes for Delawareans. PANO’s objectives encompass the development and implementation of evidence-based policy, system, and environmental (PSE) strategies that will help Delawareans engage in regular physical activity, better nutrition, and make intentional lifestyle changes, lowering the risk of developing heart disease, cancer, chronic lower respiratory disease, diabetes, and other chronic diseases.
PANO provides support to the Delaware Cancer Consortium, Cancer Risk Reduction Committee, Healthy Lifestyles Subcommittee (HLSC). The HLSC developed health and wellness policy recommendations to the Office of the Governor, many of which impact the health and wellness of adolescents. To help implement some of these policy recommendations, PANO launched the Advancing Healthy Lifestyles: Chronic Disease, Health Equity & COVID-19 (AHL) initiative.
AHL foundational pillars include Coordinated School Health and Wellness, Community Capacity Building, and Workplace and Employee Wellness. Each component provides opportunities to implement evidence-based practices and programs that reach broad populations across the lifespan, with a cross cutting approach that overlaps and interrelates with one another. Each component is designed to engage and support specific objectives of the AHL initiative which will help develop a HLSC Action Plan, while connecting to partners in schools, the community, and the workplace.
PANO planned to engage Delaware schools through implementing a mini-grant program and supporting school health action teams to implement policy, systems, and environmental (PSE) strategies that promote healthy lifestyles for Delaware youth. However, the impact of COVID-19 presented various challenges. The realities of engaging and securing commitment with schools led to considering other ways to reach and support youth as they transitioned back to school in the fall of 2021. Community based, youth serving organizations (YSO) have a unique role in communities and often have additional flexibility that schools may not. The Boys and Girls Clubs of Delaware (BGC) reaches a large population of youth statewide with their extensive network, variety of programming, and relationship with schools. The Centers for Disease Control and Prevention highlighted partnerships between school and community organizations, including providers of out-of-school-time programs such as before-school, after-school, and summer programs, as a strategy to address health and educational inequities that widened during the COVID-19 pandemic. In September 2021, through AHL, PANO partnered with BGC to introduce a new program called Triple Play at 3 locations in Delaware; Milford, Laurel, and Western Sussex. This healthy lifestyle program focuses on the three components of a heathy self, Mind, Body, and Soul. The goal of the program is to improve knowledge of healthy habits, good nutrition, and physical fitness; increase the numbers of hours per day youth participate in physical activities; and strengthen their ability to interact positively with others and engage in healthy relationships. BGC delivers Triple Play once a week to youth in school-based sites, serving as a bridge between the extensive constellation of programs and resources of the BGC and the schools where youth are enrolled. Triple Play is primarily facilitated by 12-18 year-old high school student youth mentors (called Wowzers) and college interns, managed by BGC staff. The school-YSO partnership with BGC emphasizes systems change approach to adapt or replicate a proven health promotion model in multiple environments where youth work and play. In the Spring 2022, 148 Delaware youth participated in the Triple Play program at the 3 school-based locations. During summer 2022, 253 youth participated in Triple Play programming at 2 school-based locations, and at a BGC Center location in Sussex County. In Fall 2022, 106 youth participated in the Triple Play program at 3 school-based locations. On November 17, 2022, PANO hosted a webinar, through the Advancing Healthy Lifestyles Learning Series, to provide an opportunity for program facilitators and a teen Wowzer to share a summary on implementing Triple Play programming in Delaware, and highlight school and community partnerships to support after-school programming. A summary report and one-page infographic were also developed to share information on the program process and accomplishments. In Spring 2023, Triple Play programming was expanded to 6 school-based locations throughout Delaware, with 2 participating schools in each county.
PANO has facilitated technical assistance (TA) with 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) Cooperative Extension, and two teams at 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; a program for children with disabilities that will teach parents skills to increase the healthfulness of family meals, and increases physical activity for this population; and revitalizing a community space for health education and physical activity for children in an underserved community. Since July 2021, PANO has been working with these community partners to develop project and evaluation plans so that all projects can be implemented in 2022. The community partner evaluation and data collection plans are directly aligned with AHL outcomes, and each directly impact children and adolescent health. In Fall 2022, ALA conducted outreach to schools and YSOs throughout Delaware to provide asthma education and training to school nurses and support staff to offer ALA’s Open Airways for Schools program which teaches elementary school children ages 8 -11 asthma self- management, and Kickin’ Asthma, a program that empowers youth ages 11-16 to better manage their own asthma. Through AHL, PANO is collaborating with 8 Delaware schools to implement these ALA programs. In Fall 2022, UD Cooperative Extension launched pilot programming in 3 community stores in Dover, Harrington and Farmington which connected the community to fresh produce from a local farm. In Spring 2023, UD hosted nutrition education sessions in stores with Supplemental Nutrition Assistance Program Education (SNAP-Ed), supporting children and families in these targeted communities. In Fall 2022, DSU facilitated a semester of programming for Occupational Therapy college students to work with students with disabilities at the Charlton School, to help increase gross motor skills and physical activity. Seventeen DSU students and 27 Charlton students participated in the Fall and 19 DSU students and 20 Charlton students participated in Spring 2023. In Spring 2023, DSU also hosted a Dine and Discover series for the Charlton families and students, which was a collaboration with the DSU Occupational Therapy program and DSU Cooperative Extension SNAP-Ed program, addressing healthy eating and nutrition with a high-need population. In Summer 2022, DSU Allied Health Center hosted a half-day summer camp in a Dover community, reaching over capacity of serving 23 children ages 6- 12 years old. The camp offered structured play for increased physical activity, a vegetable garden, nutrition education and healthy snacks.
Through AHL, in Summer 2022, PANO also launched a mini-grant program which offered funding and technical assistance to 7 community based organizations implementing policy, system, and environmental changes to support healthy eating and physical activity in communities throughout Delaware. 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. See table below for program summaries for August 2022 to March 2023:
- 4-H held 13 events with youth and adults, including walking and “plogging” challenges as well as trainings and presentations.
- BGC guided youth participants through harvesting plants and seeds and maintaining soil beds on the BGC mini-farm.
- The City of Newark began construction on its new community garden, including installing the waterline and sidewalks and beginning fence installation.
- Delaware Breast Cancer Coalition hosted 16 “Yes2Health” classes and events, including programming on nutrition, healthy eating, and physical activity.
- Inner City Cultural League provided lessons, activities, and information on nutrition and physical activity during 15 youth-centered, family, and community events at locations throughout Dover.
- Worship Christian Center held weekly online discussions on healthy eating and nutrition and convened weekly walking club meetings at the Dover Mall.
YMCA facilitated 33 health and wellness outreach events with various partners and community participants.
PANO partners with the Office of the Lt. Governor to facilitate the annual Lt. Governor’s Challenge. The focus of the annual Lt. Governor’s Challenge is on emotional wellbeing; healthy living; chronic disease management and prevention; and mother/child health, within the workplace, school, community/neighborhood, or an individual. There were 24 nominations received in 2022. The planning team put a lot of effort in to promoting and educating on the nomination process and describing what a good nomination application looks like, defining and sharing examples of policy, system, and environmental (PSE) interventions. The awardees that have shown the highest degree and most comprehensive PSE changes earned the Delaware Wellness Hero Award, and winners of the Delaware Health Leader Award were commended for taking significant steps to improve the overall health of their community. Some of the winners that were selected include organizations that specifically impact the health and wellness of children and their families like the ECO Team at Welch Elementary School (Caesar Rodney School District), and the Community Education Building in Wilmington. Nominations opened March 2021 and closed on May 31, 2022. The Lt. Governor’s Challenge awards were presented to 7 honorees in November 2022 at the Wilmington Public Library. PANO met with the review committee and selected awardees in August 2022. Visit www.ltgovernorschallenge.org to learn more about the Lt. Governor’s Challenge and read more about the 2022 winners. Planning for the 2023 Lt. Governor’s Challenge began in March 2023 with nominations closing in May 2023.
PANO 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, PANO supports the utilization and implementation of WELNET ® a physical fitness education and assessment tool, from Focused Fitness. PANO collaborates with DOE and Focused Fitness to provide physical education and physical activity resources to Delawareans. PANO provides technical assistance for WELNET ® implementation, professional development, and training opportunities for Delaware educators, and provides online resources. A WELNET® training was provided for Delaware educators on August 1, 2022. The training was recorded and added to DOE’s professional development management system for teachers to view at any time. There were 44 teachers in live attendance, primarily teacher leads for school districts and charters, and 125 teachers who viewed on-line. There were also 4 webinar videos for teachers to view during in-service days. A representative from WELNET® also presented at the SHAPE Delaware conference in October 2022, to provide further training for a roster of 300 Delaware health and physical education (HPE) teachers in attendance. By January 2023, 58% of HPE teachers signed in to Focused Fitness and entered WELNET data for over 20,000 students and 74% of schools had student physical fitness assessment data entered into WELNET ®. DOE has been contracted with Focused Fitness since July 2022. PANO will continue to provide support and partnership for WELNET® and Focused Fitness resources.
PANO provides support to the Division of Public Health (DPH) Health Education Administrator who facilitates the various youth surveys statewide, such as the Youth Risk Behavior Survey (YRBS) and the School Health Profile (SHP). Select schools are currently scheduling participation in the 2023 Youth Risk Behavior Survey (YRBS). Data collection will occur during the 2023-2024 school year. The YRBS is a biennial (odd years), 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. The survey is conducted by the University of Delaware Center for Drug and Health Studies and 29 of 36 schools that were randomly selected by the CDC are scheduling participation. DPH is consistently working to improve response rates from the schools, and efforts to find ways to improve school participation will resume. The School Health Profile (SHP) is a biennial CDC survey that assesses school health policies and practices. These surveys are also conducted every other year by education and health agencies among middle and high school principals and lead health educators, and was last completed in 2022. The information obtained from the YRBS, and the SHP surveys are used to help develop state programs and initiatives and help to guide prevention efforts, which will improve the health and health outcomes for Delaware communities and youth.
PANO will continue to facilitate collaborative work efforts and interventions across the state that address health and wellness for Delaware families, children, and youth.
Nutrition Counseling
New Castle County Community Health Services has reinstated its Nutrition Program and is looking to expand services in the upcoming year, initiated in March of 2023 with the onboarding of a Registered Dietitian Nutritionist (RDN) after the position was vacant the previous year. In navigating the Nutrition Program in the direction to accept more participants, there has been a reestablishment of the nutrition referral system for Division of Public Health. Programs such as Family Planning, Child Health, Sexual Reproductive Health, and our Tuberculosis Clinic are able to refer to a RDN for nutrition counseling. Other state programs such as Child Development Watch, which focuses on children with developmental delays and/or disabilities has reestablished a referral process for nutrition consults. This expansion provides opportunity for the Nutrition Program to reach more community members including children and adolescents. Nutrition consultations have been resumed, with appointments being conducted either over the telephone or in person based on patient/parent preference and accommodations. Consults focus on the identified nutritional concern(s) and distributing knowledge and resources to help minimize obstacles along the path towards resolution or management of concerns.
Merging the RDN’s prior pediatric experience as a WIC Nutritionist and referrals received thus far as the Community Health Nutritionist, common nutrition concerns include obtaining and maintaining healthy weight, encouraging the introduction of new foods, increasing the consumption of a broader variety of healthy foods, and the ability for participants to make more informed food choices to live a healthy lifestyle. Along with these common concerns, recognition and navigation of food preferences, allergies, intolerances, and sensitivities as well as digestive disorders, developmental disabilities, and chronic health conditions is critical. As the Nutrition Program grows, the increasing clientele will present health conditions such as diabetes, heart disease, obesity, high blood pressure as well as Celiacs Disease and Autism Spectrum Disorder, among others. With many influencing factors, individualized food plans are key to accomplishing nutrition and health goals.
With the goal to inspire healthy lifestyles, healthy eating guidelines, recommended daily intakes, and portion sizes of foods are discussed with the client and are personalized based on the needs and preferences of the individual. Integrating client involvement and making them a partner in their health journey helps inspire positive choices and attainable goals on the way to managing and minimizing detrimental health outcomes. Combining client input and their health concern(s), food plans and recipes guided by USDA’s MyPlate and the Dietary Guidelines for Americans 2020-2025 are provided and are tailored to the certain preferences and dietary needs of each client.
In addition to nutrition consulting, continuing education is a critical part of the career of an RDN to maintain registration and licensure, in addition to exploring research and staying up to date on current health and nutrition news and topics. Our RDN has recently completed trainings since beginning the role, which include Nutrition in Adolescent Growth and Development; Food Allergies, Intolerances and Sensitivities in Pediatric Practice: The Role of the Registered Dietitian Nutritionist; Reconsidering Feeding Difficulties in Clinical Practice; and Nutrition Intervention for Healthy Childhood Growth.
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