Service cuts are hurting Delaware student wellness centers, especially at high needs schools, advocates say

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This story was supported by a statehouse coverage grant from the Corporation for Public Broadcasting.

Pediatrician Priscilla Mpasi was working at the Kuumba Academy Charter School’s wellness center when a fifth grader came to the clinic again to complain of an earache.

The young girl’s ear had started hurting again that day after she heard a loud bang in the cafeteria. Her primary care provider had previously prescribed her antibiotics for the earaches, which had been persisting for months.

During a typical doctor’s office visit, a provider constantly moves from room to room, treating patients. But in the school clinic, the doctor was able to take time with the student and trace back to when her pain first started.

“A couple months prior, she was in her home,” said Mpasi to an audience recently at the ribbon cutting for the new Richardson Park Elementary School school-based health center. Mpasi is also the assistant clinical director for complex primary care community and community medicine at ChristianaCare. “She heard a few loud noises and she was told that those noises were gunshots. She learned the next day that someone had been fatally wounded by gunshots and so whenever she hears a loud noise, she panics thinking that there’s going to be a gunshot.”

Mpasi was able to diagnose the fifth grader’s ear pain as a physical manifestation of trauma caused by gun violence. She walked the student down the hall to the mental health worker and referred her and her family to a community health worker.

Advocates say that’s how school-based health centers are designed to work.

It’s like having an urgent care clinic in a school with medical professionals able to collaborate immediately with mental health specialists, social workers and counselors. But Delaware students may be falling through cracks due to cuts in services by health care providers, a lack of state funding and the growing demand for more health centers in schools to treat rising mental health and behavioral health issues.

The Delaware School Based Health Alliance is calling for lawmakers to add an additional $5.5 million dollars to support existing centers in high schools and to build and operate more in elementary and middle schools. The governor’s proposed budget includes about $5.4 million to maintain existing facilities.

The funding situation for student-based wellness centers is dire, said Marihelen Barrett, executive director of the alliance.

“The high schools have been level-funded for years,” she said. “And so that’s actually eaten into the buying power with inflation. They’re really tight on funding.”

There are more than 50 school-based health centers operated by many of the state’s health systems, according to the alliance. High schools automatically get state-funded wellness centers under current law. Some of those also support the middle schools in their districts.

While two elementary schools, Baltz and Frederick Douglass elementary schools, got $340,000 in the fiscal year 2020 state budget, advocates said more recent elementary school centers have received no legislative financial support or operational dollars.

Along with stagnant state funding of high school clinics, dozens of state lawmakers representing New Castle County say they have heard from school nurses over the past several months that the ChristianaCare Health System cut services at several New Castle County schools without first notifying the Division of Public Health and the school districts.

ChristianaCare operates school-based health clinics in 19 high schools and seven elementary schools in New Castle County and the city of Wilmington. There’s seven school districts in the county. The state Department of Education website shows there’s 31 high-needs schools in Delaware, 28 of them in New Castle County.

A spokesperson for ChristianaCare said some of the high school wellness centers only have medical providers on-site three days a week for the 2023-2024 school year. The nonprofit health system said it made the staffing changes based on previous enrollment and utilization numbers.

In a statement, the spokesperson said medical providers are onsite at the elementary schools every day of the week. While behavioral health therapists are also onsite everyday at each wellness clinic it operates, community health workers and nutritionists have to rotate among schools. It noted medical assistants and school district coordinators are also on its teams.

A June 2023 letter to ChristianaCare’s Erin Booker and signed by more than two dozen lawmakers said that school nurses had expressed concern that the lack of these critical services will have a drastic impact on families and students. The letter obtained by WHYY News was signed by several lawmakers of both political parties and copied to the secretary of the Delaware Department of Education and New Castle County’s seven school districts, including Christina, Red Clay, Colonial and Brandywine.

However a spokesperson for the Division of Public Health disputes that ChristianaCare’s staffing changes have affected services.

“We [the Department of Health and Social Services/Division of Public Health] do not mandate the staffing,” Media Relations Coordinator Laura Matusheski said. “They are required to deliver the services and have been doing so with zero impact on the students.”

Barrett said she continues to hear about the service cuts in high school school-based health centers operated by ChristianaCare. She said these kinds of cuts mean the centers don’t function effectively for students. Her group is asking lawmakers to add $1.5 million, a 20% increase for high school centers.

“One of the most important services that the school-based health centers provide is mental health support and help with trauma and on focus on trauma-informed care,” she said. “The other major focus is on health equity, trying to make sure that underserved kids that are experiencing social determinants of health concerns, such as food insecurity and homelessness, make sure that those needs are met. So it’s more than medical care, it’s more than just coming to get your earache taken care of. And that’s why it’s so important that it be a multidisciplinary service.”

Democratic state Rep. Nnamdi Chukwuocha, one of the lawmakers who signed the letter, said he’s concerned that students in Wilmington are not getting the resources they deserve.

“Having well-run, efficient health service centers inside of our schools is a necessity,” he said. “It’s a necessity because of the needs of our communities and our students. And we just don’t have it. And it’s a travesty, because our students are suffering because of it.”

School districts and community members must rely on creativity and a patchwork of sources to finance health centers in elementary and middle schools. Red Clay and three other school districts joined forces to apply to New Castle County for federal pandemic funding to build new wellness centers over the past few months. Besides Richardson Park in Red Clay, clinics were installed inside Silver Lake Elementary School in the Appoquinimink School District, McCullough Middle School in the Colonial School District and Brookside Elementary School in the Christina School District.

Many of the biggest advocates for the health centers are the school districts themselves, the alliance’s president Jon Cooper said.

“When we look at whole child, whole school, whole community support, we can’t underestimate the value that healthy outcomes provide for a bridge learning environment,” said Red Clay Superintendent Dorrell Green at the grand opening of Richardson Park’s health clinic. “There are a lot of medical acute needs that are now in our schools. The mental health aspect of what we’re dealing with within our community also provides those supports and services through these wellness centers.”

Barrett said much of the push to add wellness centers in elementary schools is happening in Northern Delaware because of the size of the population compared with the rest of the state, and due to Wilmington’s high poverty rate.

Health care systems do get some reimbursement through the student’s insurance or through Medicaid, Cooper said. Parents submit their insurance information when they sign their child up for the wellness center. A medical provider submits a charge to the families’ insurance, however, health centers are forbidden to require parents to pay a copay. Students without insurance are still treated.

Federal funding is available for school-based centers that are managed by federally qualified health centers, also known as community health centers, Barrett said. Her nonprofit is advocating Delaware’s congressional leaders to expand the type of clinic managers eligible for support through the government’s health center program.

Richardson Park, Silver Lake Elementary School, McCullough Middle School and Brookside Elementary School have pandemic funding from New Castle County through the 2024-25 school year. It’s unknown how they’ll raise the money to operate after that.