As required by House Substitute 1 to House Bill 326, below are brief descriptions of programs Nemours has implemented, in addition to those outlined in our CHNA 2023 Progress Report to track and reduce health disparities.
Asthma Home Visiting Program
With support from the Highmark Blue Cross Blue Shield Delaware BluePrints for the Community grants program, Nemours is implementing a community health worker home visiting program across the state focused on improving access to health care, clinical outcomes and stewardship of medical expenses for children with asthma. Any child with asthma being seen by Nemours primary care and enrolled in the Delaware Medicaid program is eligible to receive services. Since the program began in March 2024, it has enrolled 120 patients that have received approximately 250 home visits. Home visits include asthma self-management education, home environmental assessments and access to a variety of supplies such as air purifiers, mattress and pillow encasements, vacuums and cleaning materials. In the coming year, we will expand these efforts through additional funding from the Delaware Division of Public Health’s Advancing Health Equity in Asthma Control through EXHALE Strategies program.
Community Health Education
In 2023, Nemours established a Delaware-based Community Health Education (CHE) that would collaborate with community-based organizations to facilitate health education on a variety of topics important to the health and well-being of young people across the state. Our partners have included schools, libraries, community centers, Boys & Girls Clubs and many others. During 2024, the CHE team took part in more than 150 individual health education events attended by more than 8,000 participants. Event topics included asthma, healthy eating, living and relationships, human papillomavirus (HPV), hygiene, lactation and breastfeeding, mental health, opioid use, oral health, sports safety, substance use, vaping and other topics. These events are open to the public at no cost. We look forward to building on this success during 2025.
Infant Formula Resources
Infant formula is often a critical resource during the first year of a child’s life. It can also be one of the most expensive. To address this challenge, Nemours and numerous other organizations have partnered with the Office of the Lieutenant Governor to provide FDA-approved canisters of infant formula free of charge to any Delaware family with an infant up to 12 months. At this time, we are distributing the formula at our Jessup Street location. This service along with federal government programs including Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) are essential strategies to reduce food insecurity among at-risk families in our state raising young children.
Medical-Legal Partnership
Medical-legal partnership (MLP) is a novel intervention that partners health care providers with legal aid attorneys to recognize and address health-harming legal needs (HHLN). HHLN are social determinants of health (SDOH) such as housing conditions and food insecurity that contribute to disparities in health outcomes. The partnership involves a clinical team provider such as a physician or social worker recognizing a health harming legal need, referring the family to a legal aid attorney, legal intake and history gathering, and provision of a “dose” of legal intervention (includes such services as community referral, legal advice, letter on the family’s behalf or full court representation if needed). It not only helps address the SDOH that impact health disparities, but it also helps ensure equitable access to legal support services. There is a growing body of evidence supporting the positive legal, health and economic outcomes attributable to the improvement of HHLN through legal aid intervention.
Starting in 2022, First Lady Tracey Quillen Carney’s First Chance Delaware and Delaware Community Legal Aid, Inc (CLASI) received $250,000 from Casey Family Programs to establish a one-year pilot of neighborhood-focused civil legal aid services for families at the Nemours Children’s Health, Jessup Street location in partnership with the Stubbs Family Center, together comprising the “Wilmington Community of Hope.” That funding has since transitioned to Nemours investments to maintain a MLP between CLASI and our Jessup Street location, which provides free legal services to families impacted by health disparities and SDOH. Referrals to the MLP can be any family with a child under 21 years of age who receives primary care at Nemours Children’s Health, Jessup Street with income less than 200% of the federal poverty level and at least one HHLN on our screener.
In 2025, we will be expanding legal services through our community health worker home visiting asthma program, our program for children with medical complexity and our primary care location at St. Francis Hospital. Nemours resources are also being invested to evaluate the impact of this program on SDOH and health outcomes. MLP also has important implications for recognizing patterns of social need in families impacted by health disparities and addressing these needs through legislative advocacy.
On-Demand Ear, Nose and Throat Program
The Oto on-demand program is a clinical project that aims to address disparities in access to care for routine pediatric otolaryngology (Ear, Nose & Throat/ENT) issues by leveraging a collaborative effort between general pediatrics and pediatric ENT. The program offers on-demand virtual services for appropriately selected patients and families dealing with recurrent otitis media (middle ear infections) and adenotonsillar disease (tonsillitis), which may require surgical intervention. We see families in conjunction with the referring pediatrician, who facilitates video otoscopic (examination of the ear canal, eardrum and middle ear) or oral cavity exams. This care model ensures timely access for underserved patient populations, eliminating the need for additional days off work or travel. Our goal is to expand this service to our pediatric practices in southern Delaware. This program is one of an increasing number of innovative care delivery initiatives developed by our clinical teams that seek to reduce the impact of health-related social needs, such as accessing reliable transportation.
School-Based Health
Nemours operates 17 school-based health centers (SBHC) in elementary and middle schools across Delaware. With support from Colonial School District, Nemours launched its first SBHC during the 2021–22 school year. We have since expanded to Seaford School District and Christina School District. We provide a variety of services regardless of a family’s ability to pay, including well exams and sports physicals, sick visits, preventative health care including immunizations and health education, behavioral health counseling, nutrition counseling, and assistance applying for insurance programs and other health and social services. SBHCs are a supplementary care setting to primary care and play an important role facilitating services where children spend a large portion of their time, while reducing the need for school absences.
In addition, Nemours developed the Data Access for Student Health (D.A.S.H.) program in collaboration with Colonial School District, Delaware Health Information Network and The Data Service Center. With parental consent, D.A.S.H. facilitates the sharing of school attendance data with primary care providers across the state. For children who are part of our primary care network, Nemours receives alerts when students accrue a threshold of absences. Our care teams then contact the child’s parent and school to develop a holistic care plan that seeks to address root causes of absenteeism. Nemours plans to expand D.A.S.H. to additional school districts in 2025.
Social Needs Screening and Referral
Nemours has refined its strategies to make a positive impact on the social determinants of health (SDOH) and health-related social needs (HRSN) of its patients via a screening tool administered to Delaware primary care patients since 2020.
While screening for social needs is a critical first step, the provisioning of resources and support to families is ever more important. Nemours has a multi-tiered approach providing support for needs from including providing printed resource lists and contact information during a visit to escalating the family for support from care coordination and social work. Most recently, Nemours developed a partnership with Delaware Helpline, Inc. (Delaware 211) in 2023 to expand the resources we have available. Families can receive a referral to resources available in their specific communities. For example, we may provide a referral to a food bank in their neighborhood if they express concern with the availability of food. In addition, Delaware 211 can notify Nemours if the family actually received the referred service and provide additional supports based on their interaction with each family. This work demonstrates how Nemours pairs its high-quality medical services with social support resources to holistically serve the needs of patient families.
Teen Pregnancy Collaboration
Timely prenatal care is essential for the health of both the mother and the baby. It supports early detection and management of potential health issues, reduces the risk of complications and ensures better health outcomes. Several years ago, Nemours found that a significant number of its adolescent patients attending primary care sick visits were pregnant. We also determined that many of these patients did not have an established relationship with an obstetrics provider. As a result, Nemours now offers these patients a warm handoff to Christiana Care’s Healthy Beginning maternal health care program. We hope facilitating this connection promotes more coordinated care and healthier pregnancies while decreasing preventable emergency department use and infant mortality.
Nemours Children’s Reading BrightStart!
In January 2023, Reading BrightStart! re-energized our partnership with the United Way of Delaware and the Get Delaware Reading Campaign. More than 15 teachers from pre-K providers within New Castle County Head Start and Children and Families First were trained to implement the Level One curriculum in their classrooms in the spring of 2023. A staff member at Stubbs Early Learning Center also became a trainer to support usage of the Level Two curriculum in multiple classrooms at their school. Towards the end of 2023, yet another teacher training was conducted in Dover at Children and Families First to support classrooms utilizing the curriculum in spring 2024.
In addition to the work with the United Way of Delaware, the Nemours Children’s BrightStart! became members of the DE Early Literacy Workgroup of the Delaware Readiness Team. This is a statewide initiative of volunteer-based teams that strengthens communities at a local level and helps children from birth through age eight get ready for school and life. We meet with the team monthly to stay abreast of work related to literacy in Delaware.
Healthy Kids, Healthy Future Technical Assistance Program
Through the Healthy Kids, Healthy Future Technical Assistance Program (HKHF TAP) funded by a Cooperative Agreement with the Centers for Disease Control and Prevention, Nemours Children’s partnered with Rodel and the Delaware Readiness Teams to promote and align child health and wellness initiatives in Delaware from 2022–2024. Under this program, Rodel was awarded a total of $165,813 to lead these efforts. Rodel implemented a state action plan to promote healthy habits in Early Care and Education (ECE) settings and centered their efforts on the Delaware Readiness Teams’ focus areas of Healthy Children and Developmental Screening and Family Empowerment. Through HKHF TAP, Rodel completed the following activities:
- Rodel established a working group of around 60 state and local partners focused on healthy eating and physical activity and assessed healthy eating and physical activity resources in the state through a landscape assessment.
- Rodel hosted family and community events where they highlighted local resources to support health and wellness. Through these efforts, they organized two community health fairs, as well as several kindergarten readiness events and an early childhood literacy event in collaboration with the Nemours Children’s Reading BrightStart! team.
- In 2021, Delaware passed new early childhood legislation that focuses on healthy development and systems change, including requirements for developmental and lead screenings. Through HKHF TAP, Rodel supported implementation of the new statewide developmental screening initiative that went into effect on July 1, 2023, and integrated healthy eating and physical activity messaging into ECE trainer, provider and family resources and other materials. Rodel assembled and distributed approximately 350 developmental screening bags to provide families with a variety of materials needed to complete the screening questionnaire to assess their child’s growth and development.
- In 2023, Delaware built state-wide capacity for physical activity training for ECE providers through Nemours Children’s Physical Activity Learning Sessions (PALS), a training package for ECE and health training and technical assistance staff on best practices for physical activity. Seventeen (17) Individuals from the professional development organization in Delaware (DIEEC) and other organizations became trainers, and PALS is now integrated into Delaware’s professional development system. On June 1, 2024, Rodel hosted an in-person PALS training for ECE Providers. Attendees received training on the PALS curriculum and resources to support active play in their programs. Rodel planned to follow up with the ECE programs by asking them to complete a survey to see how the training and materials have supported increasing physical activity in their programs.
- Through HKHF TAP, Nemours Children’s offers an annual opportunity for states to participate in a curated, time-bound set of Springboard Opportunities. Over the last two years, Rodel has submitted a request on behalf of Delaware to participate in several Springboards, which include:
- Early Childhood Outdoor Learning Environments Certificate Course provided by North Carolina State University; and
- Gardening with Young Children Certificate Course provided by North Carolina State University; and
- Health Equity Training and Technical Assistance provided by the Institute for Public Health Innovation.
