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Delaware’s School Health Network can expand to strengthen families


On the list of things that have gained notoriety and appreciation during the pandemic, Delaware’s public school system ranks high. Parents who support distance education have seen firsthand the tremendous time, work and dedication educators invest every day to provide quality education. Today, they better understand the details involved in protecting children from COVID-19 as they learn in the classroom.

Additionally, the community gained a better understanding of the other critical supports our schools provide – including everything from social skills development, structure, peer interaction, access to mental health programs and physical and wellness, all of which can help give parents the flexibility and time they need to work, juggle daily demands, and provide for loved ones.

This increased value placed on public schools—as an integral part of the fabric that allows Delaware’s youth and communities to exist, grow, and thrive—provides a powerful backdrop for the Division of Education’s new strategic plan. Delaware Public Health for School Health Centers, focused on a thoughtful approach to expanding them statewide. Working with more than 20 stakeholders, DPH recently unveiled a five-year plan to align efforts, identify best practices, and improve the entire SBHC system to ensure consistency, sustainability, and accessibility that can drive to a continuum of care and better health and wellness outcomes for young people in Delaware.

Since its first SBHC was established in the 1980s, Delaware now has one in 32 public high schools without a charter, as well as seven elementary schools. However, given the significant changes that have taken place over the past decade – the widening health disparity gap; how health care is approached, accessed and delivered; rates of childhood obesity and other chronic diseases and conditions; and social and emotional health challenges to name a few – it is clear that our approach to improving the health and well-being of our young people needs a commitment to bold change. We must be aggressive in meeting our children’s most critical needs on a journey of a lifetime. Our five-year SBHC plan is the engine that will drive this vision.

SBHCs do not replace a student’s primary care provider. Instead, the health center network integrates behavioral and physical health, and they coordinate and refer to community providers and school nurses. SBHCs function as a hub to launch and sustain young people on the path to physical and emotional health and well-being. They allow needs to be identified and addressed before problems escalate, and they connect children and families to quality resources that exist in our community. Therefore, SBHCs play a key role in our statewide efforts to improve population health and reduce long-term health care costs.

Additionally, based on extensive literature research on SBHCs in K-12 schools nationwide, we are confident that our five-year strategic plan will have an impact beyond “keeping a child in good health” and that it will solve disparities in health care. SBHCs also support academic achievement and have been shown to reduce high school suspension and failure rates, and increase overall student average and class promotion. Behavioral health benefits, such as reduced violent behavior and absenteeism, as well as improved social skills and attention levels, also flow from SBHCs. SHBCs are associated with fewer teen pregnancies, fewer reports of substance use, and fewer non-asthma-related hospitalizations – the examples are plentiful.

Delaware’s initiative to expand the SBHC network was prompted by a fiscal year 2020 budget allocation of $340,000 by the Delaware General Assembly to the DPH to support the creation of elementary SBHCs in need. A multi-disciplinary steering committee was created using a rigorous year-long planning process, providing critical information on needs, resources, limitations and challenges, as well as potential solutions. This was achieved through a literature review, focus groups, key informant interviews, focus groups, parent/guardian/student surveys, development of an inventory matrix of services and a high needs scorecard, and holding public meetings. All information is on file and available by visiting the public website, Dethrives.com/sbhc.

As we move forward, the implementation phase will be guided by an independent body with diverse representation from public health, education, health care providers, behavioral health, legislative and others, as well as school boards and parents and/or guardians. in the three counties of Delaware. This body will work together to make recommendations and decisions, make assessments and guide any necessary adjustments.

DPH and the Co-Chairs of the Steering Committee would like to thank everyone who provided input and subject matter expertise, served on working groups, completed surveys, participated in focus groups and/or attended town hall meetings. Their contributions will influence improving the access and quality of health care our children receive at our Delaware school health centers. This is an exciting time for our children and our families, for our present and our future.

Dr. Karyl Rattay is the director of the Delaware Division of Public Health.

Karyl Thomas Rattay MD, MS, is director of the Delaware Division of Public Health.