Adolescent Health Application Year
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 National Survey of Children’s Health (NSCH), 24.3% of Delaware adolescents have had no preventive medical visit in the past year. This trend is decreasing as the 2018 NSCH shows 29.8% of Delaware adolescents had no preventive medical visit in the past year.
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 healthcare, sexual and reproductive healthcare, nutritional health services, screenings and referrals, health promotion and 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 to develop a 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. Next steps of the Strategic Planning process include publishing the Strategic Plan and Implementation and Evaluation Plan. 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 32 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 SBHC’s in elementary schools at two per year in high needs elementary schools throughout the state. There are currently two additional elementary schools going through the process of certification.
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.
Information about the SBHCs Strategic Plan will be posted on DEThrives social media channels. A handful of social media tactics have been developed which includes: a few Steering Committee Members answered questions and their recorded answers will be showcased as videos on the DEThrives social channels, the list of SBHC sites have been updated on the DHSS site and is also linked on the “dethrives.com/sbhc” webpage, press release and op-ed documents were created for public relation purposes, a strategy infographic was created for centers to post in their buildings, and a parent handout was created to help parents understand the services that are being offered. The goal is to launch these organic social tactics within the next month or so.
Our CDC assignee has been training and building capacity with our Management Analysist 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.
There is a Sexually Transmitted Infection (STI) campaign that is in the developmental process right now with Delaware Contraceptive Access Now (DE CAN) led by DPH’s Family Health Systems’, Reproductive Health Program Director and in collaboration with the STI Program Director. The goal of this campaign is to reveal the rising STI rates in Delaware, particularly the Chlamydia rates. The age range for this campaign is meant to target young adults aged 15-29 years old.
Unfortunately, because of the Covid-19 pandemic, we were unable to partner with our School Based Health Centers and Delaware school districts during the 2020/2021 school year. Our hope was to work with the School Based Health Centers and the school districts to promote teens who need emotional and mental health treatment. Our goal is to begin the partnership once again with the Department of Education and the school districts to promote a health messaging campaign to address well visits and mental health treatment.
We will continue our partnership with the Cooperative Extension, University of Delaware (UD), Health & Wellness Ambassadors for the upcoming grant cycle. 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.
Our goal is to again work with the UD 4-H Department to sponsor another poster contest that promotes 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 will be 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.
MCH plans to work with our Adolescent Health Program Manager to expand the poster contest in the future by working with schools and School Based Health Centers. The prizes envisioned for this project will be all health related, such as a Fitbit or gym membership.
Physical Activity (ages 12-17)
13.0% of Delaware adolescents, ages 12-17, are not physically active at least 60 minutes each day, when comparing to the national average of 16.5%. Delaware’s adolescents who are physically active at least 60 minutes each day, 4-6 days per week, rests at 24.0%, while the national average is 27.3%. Although, NPM 8.2 is a newer priority, 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 2021 through July 2022 Application Year will be prioritized and streamlined, focusing efforts on key healthy lifestyle and chronic disease intervention areas impacting youth and the communities they live in.
Through the PANO Program’s Advancing Healthy Lifestyles (AHL): Chronic Disease, Health Equity & COVID-19 initiative, PANO will continue to support youth health through AHL Component B: Coordinated School Health and Wellness activities. Incorporating input from educational stakeholders and partners, PANO has developed a workplan that outlines a school health and wellness strategy for FY 2022 (July 1, 2021 - June 30, 2022). PANO will identify and engage Healthy School Action Team (HSAT) members to involve them in AHL youth health and wellness efforts. HSAT membership will include school wellness champions, youth serving organizations (YSOs), like those that have before-and after-school programs (e.g. YMCA, Boys & Girls Clubs); organizations that address nutrition and heathy eating (e.g. Food Bank of Delaware); and community organizations that support healthy activities for youth (e.g. First State Community Action Agency). Throughout the 2021-2022 school year, PANO will conduct regular (bi-monthly) meetings with HSATs at the county level. PANO will also be able to provide technical assistance (TA) and consultation to HSAT champions to develop projects for their schools or youth programs and determine outcomes. PANO will facilitate the first annual statewide HSAT meeting which will include, schools, YSOs, community partners, and state leadership. The purpose of the event will be to highlight the work of the AHL Component area to promote and educate participants on the importance of this initiative. The content of the meeting will include state and national data that supports the efforts, as well as subject matter expert panel discussions. PANO will also conduct a systematic review of evidence-based strategies and best practices that schools in Delaware and nationally, are doing to address childhood obesity, nutrition, and physical activity for students and school employees. Based on this review PANO will develop a white paper on coordinated school health and wellness to educate and inform state, school, and community partners on school health and wellness. PANO plans to compile this content into a resource (booklet or on-line tool) that will offer a menu of evidence-based school health policies, systems, and environmental (PSE) strategies; interventions that highlight the PSE changes; and resources required to implement strategies related to partners, costs, and materials.
In Component C of AHL: Community Capacity Building, PANO plans to continue working with contracted vendors to facilitate technical assistance (TA) to three community partners 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; and, a three-pronged intervention for children with autism and their families that teaches water competency to prevent drowning, teaches parents skills to increase the healthfulness of family meals, and increases physical activity for this population. In the fall 2021, PANO will work with these community partners to implement their project activities. The plan is to also engage at least one new community partner agency to provide TA for a PANO-related youth-serving project plan.
PANO will partner with other state agencies and community organizations to sustain Community Capacity Building. PANO 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. PANO 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 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 2021 Lt. Governor’s Challenge has received about 50 nominations, an increase from the 2020 Challenge, though several are duplicate nominations this year. The Lt. Governor’s Challenge Review Committee will review nominee applications through August 2021 and announce the 2021 winners the 1st week of September. PANO will host a virtual awards ceremony with the Lt. Governor on September 10, 2021. PANO continues to encourage those who are using PSE strategies to make Delaware healthier to visit www.ltgovernorschallenge.org to learn more about the Lt. Governor’s Challenge.
Additionally, in September 2021, PANO will collaborate with the Tobacco Prevention and Control Program (TPCP) and the American Lung Association (ALA) to facilitate a Community Mini-Grant program. The Community Mini-Grants award funding to schools, community-based, and youth serving organizations that conduct tobacco prevention programs, physical activity, nutrition promotion and obesity prevention (PANO) programs, or implement PSE changes related to tobacco and PANO. Community Mini-Grant applications will be received in September 2021 and activities will be conducted October 2021 to May 2022. ALA will produce a report in July 2022 that will provide a summary of activities conducted over the course of the grant program.
PANO 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. PANO will continue supporting the utilization and implementation of FitnessGram®, the physical fitness education and assessment tool developed by the Cooper Institute. PANO will also continue to provide technical assistance for FitnessGram® 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. As in FY 21, PANO will host at least one professional development training for Delaware educators to better inform and support FitnessGram®, implementation with OPEN, a public service entity of US Games and BSN SPORTS, a Cooper Institute Partner. PANO will also host a workshop or training session at the 2021 Delaware SHAPE Conference which is scheduled for October 8, 2021. SHAPE is the professional Society of Health and Physical Educators. The Delaware SHAPE annual convention is designed to provide SHAPE members and health education professionals the opportunity to share instructional ideas with each other and learn from local and national subject matter experts. PANO is pleased to participate in this annual learning opportunity to support Delaware educators.
For the 2021 - 2022 school year, PANO will collaborate with DOE to explore efforts to ensure students with special needs are included in the physical fitness assessment resources, and that adaptive resources are available for Delaware students. This may require additional tools that can supplement FitnessGram®, or it could mean a new process or system will be supported. PANO will work with DOE to make sure all Delaware students have access to physical education resources as needed.
PANO 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, as 2019 received a very low participation rate for the YRBS. The YRBS will be conducted in September 2021, so special efforts will be made in August 2021 to promote and educate DOE on the YRBS to increase participation this year.
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 working on revamping our DeThrives website and we will ensure these messages are present on the website as well. Our website will also include resources and links to available community programs.
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