The Delaware Maternal and Child Health/Title V Program is housed within the Department of Health and Social Services, Division of Public Health (DPH), Family Health Systems (FHS).  Housed within FHS is our Bureau of Adolescent and Reproduce Health, Bureau of Maternal and Child Health and the Center for Family Health Research & Epidemiology.  Delaware’s Title V MCH Director also serves as the FHS Section Chief.  Therefore, all programs within FHS are under the direction of the MCH Title V Director.  This allows for greater collaborative relationships between the three Bureaus under FHS.

Delaware’s Title V priorities and plans for the coming year are presented below by population domain, as defined by the MCHB.  In some of the health areas, we are building on years of previous work and partnerships and have very detailed action plans forward.   

Population Domain: Women’s and Maternal Health

Defining the Need: In 2020, 81.9% of Delaware women, ages 18-44, had received a routine check-up within the last year (BRFSS).  Access to preventive health care is critical to identify health issues early, prevent the onset of disease, and prepare women for healthy pregnancies.   Delaware struggles with the dilemmas of recognizing different health care providers are delivering varying components of well women care; coordination and communication of well women care among health care providers and other social supports is incongruent often existing in silos.   

Accomplishments to Date:  Through a partnership with the Delaware Healthy Mothers and Infants Consortium, there has been much work to educate our population about preconception health, in which preventive health visits play a key role.  This work includes social media outreach around the theme that “Health Begins Where You Live, Learn, Work & Play.”  Over the last year, Delaware DPH, DHMIC has continued to implement our 3 year strategic action plan, which includes a well women care initiative as a priority.  All priorities and interventions will be carried out through the lens of improving health equity, the use of the life course approach, enhancing data collection and use of quality improvement to achieve stated goals.  The DHMIC has also sustained the Healthy Women Healthy Babies 2.0 program model to focus on a) performance/value based care b) address the social determinants of health and c) coordinate and provide referral linkages with community health workers. 

Plans for the Coming Year:  Preventive health visits are an integral part of preconception care.  In the coming year, we will work on our social media education and marketing campaign and quarterly webinars to encourage teens and women to develop reproductive life plans.  We will also continue to educate and counsel women of reproductive age (ages 14-44) about all contraceptive methods that are safe and appropriate for them, including long-acting reversible contraceptives (LARCs).  A law was passed this year, that allows pharmacists in DE, along with 11 other states, to administer or dispense contraceptives under a standing order from the Division of Public Health and regulations will be published to support implementation.   A Delaware Momnibus bill package was passed and signed by the Governor this Delaware General Assembly session, including Doulas in Department of Corrections, cultural competency and implicit bias training development for maternal and child health providers, plan for Doula reimbursement by Medicaid, expansion of Medicaid to cover women 1 year postpartum, are among the few key policy areas. 

Population Domain: Perinatal/Infant Health

Defining the Need:  According to PRAMS 2020 data, the overall estimate of mothers who delivered a live infant within the past year and ever breastfed was 82.8% and currently breastfeeding/at the time of survey was 48.2%.  Delaware infants who are ever breastfed in 2019 was at 87.3%.  This is compared to 86.6% in 2018 and 87.1% in 2017.  When you view the percent of Delaware infants who are breastfed exclusively through six months, the number are significantly lower.  The data clearly shows the need for improvements in overall breastfeeding initiation but also the need to address disparities that exist in Delaware.  Based on PRAMS data, the 2020 prevalence of ever breastfed among Black non-Hispanics was 82.0% as compared to 82.6% among white non-Hispanics, and 82.4% among Hispanics. Similarly, the 2020 prevalence of currently breastfeeding (or at the time of survey) among black non-Hispanics was 41.5% as compared with 50.8% among white non-Hispanics and 45.1% among Hispanics. 

Accomplishments in the Past Year: 

The following activities have been accomplished this past year with the use of Title V funding and through partnerships with entities such as the DHMIC, WIC and the Breastfeeding Coalition of Delaware (BCD).  According to the Ripples Group findings in the Final Quarter Report of 2022, WIC WOW Data System:

• Breastfeeding initiation rates in the WIC population has remained stable at 57%
• Duration at 3 months has remained steady in all clinics at 42% since 12/21
• Duration in all counties increased at 6 months from 27% to 34% since 8/21
• Exclusivity rates at 12 months increased from 19% in 12/21 to 28% in 3/22

The virtual breastfeeding classes remain successful.  Additionally, a third breastfeeding class was added to the schedule.  A breastfeeding group will be added for an additional tier of support to the WIC Program participants.  The Breastfeeding Coordinators also taught Levels One and Two of the NEW USDA Breastfeeding Support Curriculum, Learn Together, Grow Together in April and June of 2022. The Delaware WIC Program will also Virtually host the Annual Breastfeeding Event on August 4, 2022.

Plans for the Coming Year:  The Breastfeeding Coalition of Delaware was selected as one of the HWHB mini-grant awardees.  Their goal is to improve breastfeeding rates for women of color to the HWHB high-risk zones of Wilmington, Claymont, and Seaford by providing access to community resources, education, and peer support.  The project, Delaware Breastfeeding Village is offering accessible support, engaging groups, text check-ins, access to variable levels of lactation support, and incentives for participation. In addition, the Breastfeeding Coalition of Delaware hired three diverse breastfeeding peer counselors (BPC) and one lactation consultant to provide breastfeeding support to women.  WIC and Medicaid eligible mothers can participate in a 6-month program where they receive support from a breastfeeding peer counselor and a lactation consultant if needed.  

Population Domain: Child Health

Defining the Need:  The priority is for children to receive developmentally appropriate services in a well-coordinated early childhood system.  Only 36.9.1% of Delaware children, ages 9-35 months, received a developmental screening in 2019 and 2020.  Delaware is also below the national average of 36.9% of children having a completed developmental screening.  In addition, Delaware aims to increase access to comprehensive oral health care for children most at risk for oral disease.  According to the 2019/2020 National Survey of Children’s Health (NSCH), 22.6% of Delaware children, ages 0 through17, have not had a preventive dental visit in the past year. 

Accomplishments in the Past Year:  There was a total of 13,842 PEDS Online screens completed on children 0-59 months between 1/21 and 12/21, which corresponds to an estimated 9,090 unique or unduplicated children.  MCH continued the tracking of the Ages and Stages Questionnaire (ASQ) and PEDS screens through a MOU between the Office of Early Learning (OEL) and MCH.  We also had success in organizing Books, Balls and Blocks (BBB) Online using zoom.  About 15 BBB online events were held from 6/20 to 7/21.  MCH supported The Bureau of Oral Health and Dental Service (BOHDS) efforts to complete the Basic Screening Survey.  The students in 3rd grade were screened in addition to students in kindergarten.  Through the Delaware Smile Check Program, 2,363 students received individualized oral health education and resources to address their specific needs and 873 fluoride varnish applications were applied to students screened.  In addition, through case management 204 students were connected to a dentist and completed care for restorative work that was not completed.

Plans for the Coming Year:  Delaware’s developmental program plans to partner with the Office of Early Learning to bring the universal developmental screening legislation into practice.  We also plan to support efforts to increase the number people/providers/ parent leaders trained to use the ASQ and PEDS.  Additionally, we will continue collaboration with early intervention programs to improve referrals following high risk developmental screens to ensure families are connected to treatment services.  MCH will continue to support BOHDS efforts in reporting the results from the Statewide Oral Health Survey ASTDD.  The information will be used to produce a report to be released to stakeholders that identifies the gaps in oral health access to care, insurance, and other barriers to care which were identified through the survey.  BOHDS will develop access to care plans, preventive dental programs, and methods to reduce barriers to care to resolve inequities associated with care during the 2023 fiscal year.

Population Domain: Adolescent Health

Defining the Need:  The priority need is to increase the number of adolescents receiving a preventative well-visit annually to support their social, emotional and physical well-being.  The 2019/2020 NSCH shows that the percentage of Delaware adolescents who have had a preventive medical visit in the past year rests at 71.9%, compared to 75.6% nationally.  In addition, Delaware strives to increase the number of adolescents who are physically active.  According to the 2019/2020 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.     

Accomplishments in the Past 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.  School Based Health Centers in Delaware schools administered depression screenings, STD screenings, Emotional evaluations, and risk assessments.  In addition to this, SBHC’s in Delaware completed physical exams (well child), sports physicals, administrative physicals (ex. ROTC, pre-employment), immunizations, and nutritional counseling sessions.  MCH recently partnered with DOE to promote Project THRIVE, which helps Delaware students, grades pre-k through 12th grade, who are struggling with traumatic situations, such as physical or emotional abuse, community violence, racism, bullying, and more.  DPH’s Physical Activity, Nutrition & Obesity Prevention partnered with BGC to introduce a new program called Triple Play at 3 Delaware locations.  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.  

Plans for the Coming Year:  There is a STI campaign that is in the developmental process right now with Delaware Contraceptive Access Now (DE CAN).  In addition, Delaware’s SBHCs provide important access to mental health services and help eliminate barriers to accessing mental health care among adolescents.  PANO will continue to support youth health through Coordinated School Health and Wellness activities, incorporating input from educational stakeholders and partners.  PANO will identify and engage Healthy School Action Team members to involve them in youth health and wellness efforts.  MCH is also assisting with DOE’s Project THRIVE by generating brand awareness to increase program participation through a paid print materials advertising campaign.  MCH will also assist DOE to post content directly to counselors, nurses, psychologists, deans, superintendent offices, etc., in addition to working with Public Information Officers (PIO) and district leaders need to loop the video in the district offices and school offices.  We will also assist with posting videos or content in other places outside of school locations such as Division of Social Services, Child Support, Division of Motor Vehicle, etc.  We will also work with someone from the Delaware State Education Association (DSEA) to promote Project THRIVE. 

Population Domain: CYSHCN

Defining the Need:  The priority is to increase the percent of children with and without special health care needs who are adequately insured.  Delaware estimates a population size of Children and Youth with Special Health Care Needs (CYSHCN) of 28,493.  According to the 2019-2020 National Survey of Children’s Health (NSCH), 67.2% of Delaware children are adequately insured in comparison to the national average of 66.7%.  This includes CYSHCN between the ages of 0 through 17.

Accomplishments in Past Year:  A competitive Request for Proposal (RFP) process was executed to revitalize the Family SHADE (Support and Healthcare Alliance Delaware) program.  The approach was to select a vendor which demonstrated cultural and linguistic competencies through clearly defined values, behaviors, attitudes, policies, structures, and practices.  Parent Information Center (PIC) was the awarded vendor to implement the newly approach to Family SHADE.  PIC, with guidance from DPH, began to work together to align the state identified NPMs with a request for proposal mini-grantee competitive process.  PIC was tasked with developing a mini-grantee process to fund local communities/organizations to implement interventions that address the Title V state and NPM.  Through the competitive request for proposal minigrantee selection process, 2 community-based agencies were awarded.  Jay’s House and Tomaro’s Change.

• Jay’s House serves families of children with Autism in New Castle County, with resources in the community to assist with providing a better quality of life for all family members.  Their mission is to provide support to children and families affected by Autism. 
• Tomaro’s CHANGE has a history of providing therapy services to youth and families.  Also, the organization has provided charity services to teens and adolescents who had low or no income.  Services such as, parent/child relationship building, supplying basic needs such as hygiene products, clothes/shoes, cribs, and car seats.  Tomaro’s CHANGE provides holistic care to youth and families, particularly those who are uninsured or underinsured.    

Plans for the Coming Year:  PIC will implement Learning Communities to families and organizations that serve parents of CYSHCN through the Family SHADE.  In an effort to enhance capacity and sustain programs that serve CYSHCN, Family SHADE will provide technical assistance and quality assurance to two agencies that were awarded in April of 2022.  The Family SHADE project will provide learning collaboratives where the organizations can learn from each other, network, learn best practices, and learn to leverage existing programs on resiliency and self-sufficiency, and do continuous quality improvement based on the collected data.  The PIC Team in partnership with their external evaluator will work with the two selected organizations to create evaluations including a data collection plan to monitor baseline data, benchmarks, and quarterly data. 

Through ongoing programmatic meetings with the CYSHCN Director and the PIC Team, Family SHADE will work toward educating families of CYSHCN on the available medical insurance coverage that is available in Delaware through innovative approaches such as Zoom meetings, emails, mail distribution and through the distribution contact list of partnering agencies that serve CYSHCN.