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Title V Technical Assistance Meeting

 Delaware Emphasizes Adolescent Physical and Mental Health though School Based Health Centers

By Midge Barrett, Kathy Cannatelli and Valerie Woodruff
Delaware School Based Health Alliance

In 1984, a delegation of Delaware leaders including the supervisor of School Health Services from the Department of Education and the director of the Health Department attended a session of the Southern Governor's Association where they engaged in an intriguing discussion about School Based Health Centers. They brought this idea back to Delaware and sparked change. In 1985, Delaware opened its first "demonstration" school based health center in Middletown High School, funded by the Title V MCH Services Block Grant and led by a visionary principal who later became a champion for the centers as the secretary of the Department of Education. Soon the center caught the attention of Gov. Mike Castle who included state general funds in the budget to open three more centers. Then Gov. Elect Tom Carper made school based health centers a centerpiece of his administration and included funds in his budget for a center in every high school in Delaware. The centers have been operating as a vital part of the adolescent health care system in Delaware for 30 years and the legislature has maintained is commitment to state funding each year. The centers are operated by hospital based health systems with administrative oversight by the State Division of Public Health. The Department of Education is an important partner to ensure effective coordination with the education system. Each school district and its community leaders and parents participated in the original planning of the centers and continue to offer support and leadership. 

The Delaware centers also are referred to as "Wellness Centers," which conveys one of the central tenets of the Delaware model – helping students reach and maintain a state of physical and mental health. The principles at the core of the Delaware model since the beginning include:

  • Services are available to all students – not just uninsured or low-income students. Leaders recognized that all youth need a system that addresses their need for access to services that is different from the adult health care system.
  • Services are multidisciplinary – including medical and nursing care, nutrition and mental health services.
  • Services emphasize health promotion and health literacy to help students prepare for healthy adult living.
  • Centers are part of the school and work collaboratively with the school nurse and other school staff to create a total school health environment.
  • Centers provide reproductive health services if approved by the school administration and school board.

While the centers have enjoyed wide support from parents, students, health care providers and policymakers, more needs to be done. The lessons learned in high schools need to be transferred into middle schools, most centers need more mental health and nutrition services to meet need and demand, administrative costs of collecting third party insurance payments have created some access barriers for students, and level funding has caused some erosion in services.  The newly formed Delaware School Based Health Alliance is working with many constituents to address these concerns and to expand and improve school based health centers.