The MCH team along with various stakeholders identified two priorities pertaining to adolescents during Delaware’s 2020 MCH Title V Five-Year Needs Assessment process.  NPM 8.2, increase physical activity among adolescents 12-17 years of age and NPM 10, increase adolescents who obtain a preventative well visit annually as priorities.  The Title V team chose to select the Adolescent Well-Visit with the goal of incorporating other priorities for this population within the well-visit measure.  We plan to leverage our School Based Wellness Centers in the state to address Priorities like well visit, physical activity and mental health.

 

Adolescent Well-Visit

 

According to the 2019/2020 National Survey of Children’s Health (NSCH), 28.1% of Delaware adolescents have had no preventive medical visit in the past year.  This trend was decreasing as the 2019 NSCH showed 24.3% of Delaware adolescents had no preventive medical visit in the past year, compared to 29.8% in the 2018 NSCH.

 

Delaware’s School Based Health Centers (SBHCs) provide prevention-oriented, multi-disciplinary health care to adolescents in their public-school setting, and contribute to better outcomes related to selected priorities, NPM 1 Well Woman Care, NPM 8.2 Physical Activity and NPM 10 Adolescent Well Visit.  There continues to be a growing interest for expansion to elementary, middle, and additional high schools, especially given the COVID-19 pandemic.  School Based Health Centers are going through a paradigm shift, and there continues to be a large number of stakeholder interest and commitment to provide evidence based SBHC services based on national and in state innovations in practices and policies, to enhance the growing number of SBHCs in Delaware within the local healthcare, education, and community landscape.

 

Delaware currently defines SBHCs as health centers, located in or near a school, which use a holistic approach to address a broad range of health and health-related needs of students.  Services may also include preventative care, behavioral & mental healthcare, sexual & reproductive healthcare, nutritional health services, screenings & referrals, health promotion & education, and supportive services.  SBHCs are operated by multi-disciplinary health professionals, which includes a nurse practitioner overseen by a primary care physician, licensed behavioral health provider, and licensed nutritionist.  SBHCs are separate from, but interact with, other school health professionals, including school nurses and school psychologists and counselors.  SBHCs also operate alongside and interact with outside health care professionals and systems.

 

The Delaware Division of Public Health (DPH), in collaboration with several key stakeholders, convened this past year and completed the Delaware School-Based Health Center (SBHC) Strategic Plan.  The planning process was utilized to develop a model for expansion of SBHCs that was both financially sustainable and anchored in best practices.  There were 13 goals established to include a comprehensive list of action items to ensure that SBHCs are responsive to the individual needs of Delaware’s children — who, for a variety of reasons, may not otherwise have access to the health care system for critical health and wellness services.

 

The 13 goals of the plan include items, such as creating new SBHC sites where the need is greatest, establishing a new hub-and-spoke model for SBHC setup, fostering partnerships to increase the base menu of services, facilitating referrals to providers, adopting culturally linguistic appropriate services, increasing the capacity for telehealth, developing data collection infrastructure and analysis, establishing payer relationships and funding channels, and more. The plan will be governed by an independent body from public and private sectors, with a completion target date of 2025.  The plan was developed to ensure that SBHCs are responsive to the individual needs of Delaware’s children - who, for a variety of reasons, may not otherwise have access to the health care system for critical health and wellness services.  In June 2021, Delaware released the Implementation Plan for Strategic Plan for School-Based Health Centers.  We will also begin governance and implementation of the Plan as well as setting up a longer-term governance and accountability model to oversee implementation of the Plan and continued success of School Based Health Centers.

 

For the past 30 years, Delaware School Based Health Centers, located in now 38 public high schools, have contributed to the health of the state’s high school adolescents and have been an essential strategy to support individuals overall physical and mental health.  Eventually, these young women and men will be our health consumers, so it is essential to support health and wellness during this critical period and coming of age.  SBHCs provide at-risk assessment, diagnosis and treatment of minor illness and injury, mental health counseling, nutrition and health counseling and diagnosis and treatment of STIs, HIV testing and counseling and reproductive health services (27/32 sites) with school district approval as well as health education.  Given the level of sexual activity among high school students, persistent high rates of sexually transmitted infections (STIs) and the numbers of unintended pregnancies, reproductive health planning services are very important.

 

In most recent years there have been seven SBHC established in elementary schools with epilogue language from FY2020 expanding SBHCs in elementary schools at two per year in high needs elementary schools throughout the state.  As of this writing, two additional elementary schools are currently going through the process of certification.  Along with establishing SBHC’s in elementary schools many of the SBHC’s are exploring the opportunity of expanding services to more students by opening “spoke” sites.  Having these additional sites will provide critical services to students in our state.

 

Mental and Behavioral health services continue to be an area of growth and development.  SBHCs continue to struggle to provide services to students due to staffing shortages and frequent turnover rates.  It is imperative to promote and increase awareness and education regarding resources for Mental and Behavioral health.  Some areas in Delaware experience limited access to healthcare.  It is our goal to increase education, awareness, and resources to young women of reproductive age in the Sussex County area, focusing on the following:

 

Goals	Increase awareness- Educate young women of reproductive age
Target Audience	Young women of reproductive age and pregnant women in Western Sussex Latinx Women in Western Sussex
Key Messaging	Importance of being healthy before, during pregnancies; Importance of early prenatal care and where to locate, family planning; Importance of postpartum

 

In addition, Delaware’s SBHCs provide important access to mental health services and help eliminate barriers to accessing mental health care among adolescents (i.e. women).  Over the last couple of years, school district school boards voted and approved to add Nexplanon as a birth control method offered at 14 of the school-based health center sites.  This is a major accomplishment being that each school district’s elected school board members vote on and approve what services can be offered at each SBHC site.  Offering the most effective birth control methods as an option, gives more young women informed choices so that they can decide when and if to get pregnant and ultimately reduce unplanned pregnancies.

 

During the last reporting period, we launched SBHC related information on social media.  As explained in our Adolescent Health Annual Report, we launched phase one of this plan.  Phase two consists of informing the public where someone can find a SBHC and to promote enrollment in SBHCs (addressing the how and why with enrollment).  The target audience includes parents of elementary-aged children in Delaware.  As of now, in July 2022, we are in between the phases of one and two.  Future SBHC work includes our vendor creating a new video in the Spring/Summer 2022, that will act as an introductory video informing the public what SBHCs are, what they have accomplished so far in Delaware, and the future goals.  This video includes footage of three speakers answering SBHC related questions.  No tentative date has been set as to when this video will be allowed to be shared online.  Additionally, there is a tentative SBHC conference held in Summer 2023.  A press release will more than likely be launched around this time to help increase awareness of this event.

 

Overall education, awareness, and continued support for adolescents in Delaware is an initiative where Delaware continuously explores avenues to engage the adolescent population.  The goal is to increase avenues to distribute information to adolescents, using methods such as:

 

Social Media	Provider Websites
Bulletin Boards	School Staff
Radio Stations	SBHC Staff
Summits	Community Events
Flyers/Poster	School Events
Student Lead Events

 

To be successful with the adolescent population information needs to be presented in a manner where it is received, accepted, and retrained by adolescents.

 

The Adolescent Health Program team recently attended a Teen Health Summit hosted by Planned Parenthood at Delaware Technical Community College in Wilmington, Delaware on June 16, 2022, where remarks were given by Michelle Mathew, Bureau Chief, of Adolescent & Reproductive Health.  Ms. Mathew gave insight and information on SBHC services.  Resource tables were hosted by multiple organizations and agencies to promote services and products available to increase adolescent and reproductive health throughout the community.  The Adolescent and Reproductive health program will continue to support our medical sponsors, agencies and stakeholders in delivering education and resources to adolescents for behavioral and mental health, reproductive and health services.

 

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.  COVID-19 continues to impact Planned Parenthoods trainings, while some trainings remain virtual other trainings have been offered in person.  Planned Parenthood of Delaware trains teachers to deliver curriculum to parents and students.  PPHD also has community outreach activities to whose target populations are LGBTQ2S+, pregnant/parenting and juvenile delinquency youth.

 

Our CDC assignee has been training and building capacity with our Management Analyst in the Bureau of Adolescent & Reproductive Health section to develop performance metrics, data quality audits, and reporting for School-Based Health Centers data submitted by medical sponsors.  Our CDC assignee has also been reviewing YRBS and Delaware School Survey Data to inform surveillance strategies for socio-emotional health of adolescents.  Our SBHC evaluation paper is now under publication.  These data support the use of School Based Wellness Centers as a strategy to increase preventative well-visits, increase physical activity as well as support emotional well-being.  A new SBHC data brief for state fiscal year (SFY) 2019-2020 was developed by linking SBHC enrollment data and Department of Education (DOE) school enrollment data. An updated evaluation plan linking SBHC enrollment data, DOE school enrollment data, Medicaid claims data, HDD data, is being currently underway. Delaware successfully applied and received CDC/Harvard evaluation practicum. Two students and staff from DPH (Bureau Chief of Adolescent Health, and Management Analyst, Dr. Hussaini) and DOE participated in the practicum during 2022. Dr. Hussaini worked with Bureau Chief of Adolescent Health to mentor the two Harvard students to develop a SBHC elementary evaluation plan.

 

The program identified efforts to build strong relationships among SBHCs, school personnel, and the community, and ensure that trauma-informed and culturally & linguistically responsive care exist in SBHCs. The evaluation measures enrollment, utilization, and patient; along with intermediate outcome such as referrals to social services, referrals to PCPs, and connections to specialist services.

 

The evaluation consists of two key questions:

1. How do SBHCs in high-need elementary schools operate?

2. How does SBHC-facilitated health care and social services utilization impact the physical and psychosocial needs of students in high-need elementary schools?

 

Interviews and meetings were held with stakeholders to, and the following areas of measurements are also included in the evaluation:

1. Examining whether differing implementation practices between medical sponsors have impacts on quality of care, physical and psychosocial outcomes, and health equity.

2. Assessing current data reporting practices/measures and level of standardization across medical sponsors.

3. Gauging how SBHC systems could anticipate certain health or social needs within these high-need schools.

4. Developing relevant key indicators of health equity in this population.

5. Evaluating successes and barriers to the current implementation of SBHCs, e.g., stakeholder buy-in, communication efforts between SBHCs and other stakeholders, measurement, and data-related issues.

6. Establishing recommendations for each stage of the program which could increase efficiency, quality of care, and healthy outcomes for this population.

 

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 will continue to monitor the mental health status of the adolescent 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 will continue to partner with our School Based Health Centers to increase the number adolescents who receive an annual preventive medical visit.  Our School Based Health Centers offer mental health support and counseling to support the emotional well-being of adolescents.  School Based Health Centers have also expanded into elementary schools in Delaware as well.

 

We plan to continue our 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. 

 

We will continue our work with the  Department of Education to sponsor a poster contest that promoted teens to seek emotional and mental health treatment, when needed.  The original goal was to launch the poster contest in February 2022 during an annual DOE Teacher’s Exp but unfortunately it was not completed and approved in time.  We are hopeful, we can launch this project early in the Fall of this year.  We were able to partner and develop a marketing campaign that included several tactics.  The campaign launched in July 2022, and we are excited to see the data analytics for the campaign later this year, early next year.

 

We will continue to partner with the Department of Education to advertise Project THRIVE throughout each middle and high school within the State of Delaware.  In the future, we plan to expand advertisement outreach.  Such ideas include school tv monitors for adolescents to watch and monthly/weekly updates from principals and administrators to parents and caregivers.  We would also like to pursue advertisement on tv monitors in the Department of Motor Vehicle, Division of Social Services and Division of Child Support Enforcement.  Lastly, we will also pursue advertisement via the School Based Health Centers in each middle and high school.   

 

Physical Activity (ages 12-17)

 

Only 14.9% of Delaware adolescents, ages 12-17, are physically active at least 60 minutes each day, when comparing to the national average of 15.2%.  Delaware’s adolescents who are physically active at least 60 minutes each day, 4-6 days per week, rests at 21.4%, while the national average is 25.8%.  Although, NPM 8.2 is a newly selected priority during this grant cycle, MCH has a long history of partnering with the Physical Activity, Nutrition and Obesity prevention (PANO) program In the Health Promotion Disease Prevention Section of DPH.  MCH will continue to leverage this partnership to increase physical activity among adolescents.

 

The Physical Activity, Nutrition, & Obesity Prevention (PANO) activities for the August 2022 through July 2023 Application Year will be focused on key healthy lifestyle and chronic disease intervention areas impacting youth and the families and communities they live in.

 

Through the Physical Activity, Nutrition, and Obesity Prevention (PANO) Program’s Advancing Healthy Lifestyles (AHL): Chronic Disease, Health Equity & COVID-19 initiative, PANO will continue to support youth health through the AHL foundational pillar: Coordinated School Health and Wellness.  Through AHL, PANO is facilitating the connection between youth-serving organizations (YSOs) and schools to support the health and well-being of youth and to strengthen community partnerships.  Under the AHL initiative, these partnerships focus on the link between a community-based, youth-serving organization and the health and social-emotional well-being of participating youth.  In September 2021, through AHL, PANO partnered with the Boys and Girls Clubs of Delaware (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.  Triple Play is primarily facilitated by BGC youth mentors (called Wowzers) and college interns, managed by BGC staff.  The 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.  BGC will implement Triple Play at 3 locations across the state, one in each County for 10 weeks, from mid-June to the end of August 2022.  The New Castle and Kent County locations will be hosted at school sites, while the Sussex County location will be hosted at a Boys and Girls Club site due to transportation challenges in this rural area.  Participants will receive Triple Play programming 4 days a week throughout the summer which is significantly more than the weekly programming they were receiving during the school year.  Triple Play programming will continue in September 2022 through June 2023, again in BGC school-based locations.

 

Through the AHL foundational pillar: Community Capacity Building, DPH will continue to facilitate technical assistance (TA) to four community partner teams on the implementation of community-based interventions, all of which impact children and families.  In 2021, PANO began working 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; a physical activity and nutrition education intervention for children with disabilities and their families that teaches 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 underserved communities.  By June 2022, all four community partner teams had developed project and evaluation plans, including data collection methods, so that projects could be implemented starting July 2022.

 

MCH will continue to support PANO by providing support to the Physical Activity, Nutrition, & Obesity Prevention, Division of Public Health 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.

 

The team at the DSU Allied Health Center as a community summer program for youth, ages 6 to 12, in the Capitol Park community, a low-income, high-need neighborhood of downtown Dover.  Participating youth will have access to physical activity opportunities and nutrition education, July 2022 to August 2022.  This program will be implemented in partnership with various colleges and programs of DSU, as well as other community stakeholders, such as Delaware State Police, Delaware Department of Education (DOE), First State Community Action Agency, and other YSOs.  One of the goals of this project is to expand to serving youth during the school year.  Plans are in place to offer this as an after-school program starting September 2022 to June 2023.  The DSU Pediatric Motor Development Clinic, Kinesiology, and Occupational Therapy programs have partnered with DOE and the Charlton School to provide movement-based and physical activities to youth with disabilities, ages 7 to up to 21 years old.  Youth will also participate in nutrition education, which will be shared with families at home.  In addition, Charlton “parent forums” will host the DSU program’s Dine and Discover series which offers families practical physical activity options for the whole family and accessing affordable healthy food.  This program will run August 2022 to June 2023 and plans to serve about 115 Charlton students.

 

DPH will partner with other state agencies and community organizations to sustain Community Capacity Building.  We will engage community partners who are primarily serving disparate or targeted communities, to develop strategies that address PANO related activities.  These efforts will 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.  DPH will promote policy, systems, and environmental (PSE) change strategies and interventions through community-based initiatives such as the Lt. Governor’s Challenge and Community Mini-Grants.  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 PANO 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.

 

The 2022 Lt. Governor’s Challenge launched in March 2022 and had received 24 nominations at the close of the nomination period, May 31, 2022.  The Lt. Governor’s Challenge Review Committee will review nominee applications July through August 2022 and announce the 2022 winners the 1st week of September.  PANO will host a virtual awards ceremony with the Lt. Governor in October 2022.  The goal is to continue 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.

 

In September 2022, PANO will be facilitating a new Community Mini-Grant program.  The Community Mini-Grants will award funding to schools, community-based, and youth serving organizations that provide physical activity, nutrition promotion and obesity prevention (PANO) programs, or implement PSE changes aligned with PANO’s goals of improving health and reducing chronic conditions.  In July 2022 PANO will invite community partners to apply for mini-grants in the range of $5,000-$15,000.  PANO will offer a learning session in July for more information and details on the Community Mini-Grant program.  Awarded activities must address the AHL outcomes of improving opportunities for physical activity, healthy food, and maintaining a healthy weight by applying a PSE approach.  Proposals will be due in August 2022.  PANO will notify awardees and establish contracts in September of 2022, with anticipated start dates for awarded projects and intervention in October 2022.  The Community Mini-Grant program will end May 31, 2023.  PANO will offer at least two capacity-building learning sessions that will be required for awardees to attend, throughout the program year.

 

DPH will continue to collaborate with the Delaware Department of Education (DOE) on Coordinated School Health and Wellness initiatives.  Currently, DOE has state regulations on Physical Education which includes a requirement for annual physical fitness assessment, reporting and compliance standards.  DOE has used FitnessGram®, the physical fitness education and assessment tool developed by the Cooper Institute for several years.  However, DOE has decided that for the 2022-2023 school year, they will use a different vendor for their physical fitness and assessment tool.  PANO will be providing financial support for the new Focused Fitness contract with DOE, which will provide software licenses for WELNET Delaware, the new software that will provide physical fitness assessment and rubric modules.  PANO will continue to offer resources for technical assistance for WELNET implementation, professional development, and training opportunities for Delaware educators, and keep the PANO-developed online resources and Tool Kit up to date and reflective of best practices from the Cooper Institute, which will remain as an additional resource available online.

 

PANO will also provide technical assistance and resources to Delaware’s professional Society of Health and Physical Educators (SHAPE DE).  SHAPE DE will host its annual convention in October 2022.  The SHAPE DE 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.  Starting July 2022, PANO will provide event planning, communications, and technical support to SHAPE DE to help build the internal capacity of this non-profit organization that serves as a resource for Delaware health and physical education teachers.  PANO will update SHAPE DE’s webpage and manage the updates and communications for the annual SHAPE DE convention.  In October 2022, PANO will improve the SHAPE DE website so that it will align more with the SHAPE America website, and offer members and educators with additional resources, professional development, training, and funding opportunities, and serve as a networking tool for health and physical education teachers in Delaware.  PANO is hoping to help SHAPE DE grow its membership to better serve these important educators in Delaware.

 

DPH will continue to partner 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 the YRBS in particular, since the 2019 received a very low participation rate and Delaware was unable to provide a 2019 YRBS final report.  The 2021 Youth Risk Behavior Survey (YRBS) concluded on December 31, 2021.  The survey was conducted by the University of Delaware Center for Drug and Health Studies and 31 of 36 schools that were randomly selected by the CDC participated, which is about 86%.  Motivation to participate in the YRBS process in 2021 was encouraged by a one-time participation incentive.  DPH is consistently working to improve response rates from the schools, and efforts to find ways to improve school participation will resume.  DPH is having conversations with DOE to possibly consider legislative activities, funding, or both.  If needed, PANO is prepared to assist with additional funds to improve YRBS participation starting January 2023.

 

PANO will continue to facilitate collaborative work efforts and interventions that address increased physical activity, improved nutrition, and healthier lifestyles for Delaware youth.

 

DPH will continue to facilitate collaborative work efforts and interventions that address increased physical activity, mental health awareness, improved nutrition, healthier lifestyles, and information and resources for Delaware children and adolescents.  MCH will continue to utilize DEThrives to engage and inform our adolescent population with up to date information pertaining to various needs and topics via social media posts, Facebook Instagram and Twitter.  Subjects pertaining to Adolescents, such as My Life My Plan Teen, Addiction, Mindfulness, Covid-19, School Based Health Centers, Anxiety and Depression, Mental Illness, Exercise, and more have been posted.  In working with our partners, MCH will continue to use social media to promote adolescent health comprehensively.  Social media messages will be developed around the importance of preventative well visits, healthy lifestyles and emotional wellbeing.  We are currently in phase V (Site Development and Production) out of VII for the status of the website rehaul project.  We will ensure these messages are present on the website as well.  Our website will also include resources and link to available community programs.