Dare County is pleased to present its 2024-2025 Community Health Needs Assessment (CHNA). This report provides an overview of the methods and processes used to identify and prioritize significant health needs in Dare County.  This document serves as the 2024-2025 CHNA for Outer Banks Health and Dare County Department of Health & Human Services.

A Community Health Needs Assessment (CHNA) helps health leaders evaluate the health and wellness of the community they serve and identify gaps and challenges that should be addressed through new programs, services and policy changes. This report was developed as part of the Health ENC coalition’s collaborative, regional 2024 CHNA process. Health ENC – a group of stakeholders who help find ways to collaborate and share resources to improve the health of the population in eastern North Carolina – served an integral role in making this comprehensive assessment possible. The report adheres to North Carolina Local Health Department Accreditation standards, as well as Internal Revenue Service requirements for not-for-profit hospitals.

Mission Statement
The Dare County CHNA serves as a document and process to describe the current health status of Dare County with the following overarching goals:

• Evaluate the impact of Community Health Improvement Plans from the 2021-2022 CHNA
• Collect and analyze primary and secondary data to identify areas of need within the county
• Report findings to the residents of Dare County and key stakeholders
• Engage the community to determine priorities that need to be addressed
• Develop a Community Health Improvement Plan to address identified health priorities

Vision Statement
The 2024-2025 CHNA provides a structured process for Dare County to prioritize health needs, and to plan and act upon unmet community needs. The process provides a strong foundation that will support and promote optimal health and wellbeing for all individuals who live in Dare County.

Leadership
Local public health agencies in North Carolina (NC) are required to conduct a CHNA at least once every four years. The CHNA is required of public health departments in the consolidated agreement between the NC Division of Public Health (NCDPH) and the local public health agency. Furthermore, a CHA is required for local public health department accreditation through the NC Local Health Department Accreditation Board (G.S. § 130A-34.1).

As part of the US Affordable Care Act of 2011, non-profit hospitals are also required to conduct a community health (needs) assessment at least every three years. Recognizing that duplicate assessment efforts are a poor use of community resources, LHDs and non-profit hospitals across the state have models for collaboratively conducting the community health assessment process.

Since 2013, Dare County Department of Health & Human Services and The Outer Banks Health serve as the local leadership for the CHNA process. This long-term collaboration has been a successful partnership for more than 12 years.

Acknowledgements
This Community Health Needs Assessment (CHNA) represents the culmination of work completed by multiple individuals and groups.  Dare County Department of Health & Human Services, Outer Banks Health, and Healthy Carolinians of the Outer Banks would like to extend its gratitude to all the focus groups participants, health leaders, and community members who provided information used in the development of this assessment. In addition, the Health ENC Steering Committee and Dare County CHNA Leadership would like to thank Kathryn Dail, Director of Community Health Assessment at the NCDHHS Division of Public Health, for her valuable guidance throughout the development of this assessment, as well as Ascendient Healthcare Advisors for directing the CHNA process and producing this report.

Collaborative Process Summary
This assessment is a product of a local and regional collaborative process. On the local level, Healthy Carolinians of the Outer Banks, Outer Banks Health, and Dare County Department of Health & Human Services took a leadership role to facilitate the CHNA process. Health ENC, the regional assessment collaborative, selected and hired the vendor. Ascendient, the chosen vendor, collaborated with a Health ENC Steering Committee to create and implement the CHNA timeline. The process began in January of 2024. Ascendient gathered secondary data, provided technical support through the local primary data collection for each county, analyzed data collected, and provided a draft report for each participating county.

Healthy Carolinians of the Outer Banks (HCOB) had a variety of community partners contributing to the CHNA process on the local level. The table below illustrates the types and numbers of partners involved in the local collaboration process.

The pages that follow outline the members of Healthy Carolinians of the Outer Banks and Health ENC. Details on the roles and responsibilities of these partners and assessment vendor are also provided.

Healthy Carolinians of the Outer Banks Partnership
Healthy Carolinians of the Outer Banks (HCOB) is a Partnership working towards a healthier Dare County. The Partnership has been established in Dare County since the first Community Health Needs Assessment was conducted in Dare County in the early 2000’s. Coordinated by the Dare County Department of Health & Human Services and Outer Banks Health, the partnership has input and representation from more than 25 local organizations and agencies. The Healthy Carolinians process supports our community in mobilizing people and resources to evaluate the current state of the community’s health and address identified health challenges.

One of the essential functions of the HCOB Partnership is to oversee the Community Health Needs Assessment process every three years. The partnership participates in the gathering and analysis of primary and secondary data. Once the data is reviewed, HCOB prioritizes the identified health opportunities and forms task forces to address concerns as needed.

HCOB includes a partnership board and executive committee. The executive committee includes the HCOB Coordinator, Chair, Vice-Chair, previous Chair (if available), and Community Health Needs Assessment Coordinators and leadership from both Outer Banks Health and Dare County Department of Health & Human Services.

The tables below provide names, titles and organizational information for all HCOB members that participated in the 2024 CHNA process.

HCOB Executive Committee Members

Community Health Assessment Coordinators

HCOB Members

Regional & Contracted Services

Health ENC

Health ENC is a collaborative project created in 2018 to establish a regional health assessment process for health departments and hospitals in Eastern North Carolina. The collaborative serves 34 counties with 24 participating health departments and 20 participating hospitals. The collaborative uses a shared approach for primary and secondary data collection to produce a comprehensive Regional Community Health Needs Assessment every three years that can be used to partially satisfy requirements for North Carolina Local Health Department Accreditation and the Internal Revenue Service requirement under the Patient Protection and Affordable Care Act for charitable hospitals.

Health ENC, a group of stakeholders who seek ways to collaborate and share resources to improve the health of the population in Eastern North Carolina, served an integral role in making this comprehensive assessment possible. To provide focused guidance throughout the assessment process, Health ENC convened a smaller decision-making group, which will be referred to as the Steering Committee throughout this CHNA.  

The Health ENC CHNA Steering Committee

Ascendient

Ascendient is a top-50 healthcare strategy, planning, and feasibility consulting firm. They provide future-focused research and analysis to help facilities positively transform the way they deliver care. Their specialized team combines academic insights with decades of experience to help healthcare organizations adapt and thrive.

Ascendient collected secondary data for this CHNA and provided procedural support for primary data collection through administering the community survey as well as providing resources to complete focus groups and key informant interviews. They compiled the data, provided analysis, and a draft of the CHNA report.

HCOB would like to thank Ascendient Healthcare Advisors for directing the Regional Health ENC CHNA process and developing the content of this report.

Theoretical Framework

This assessment was developed in alignment with the RWJF population health framework, originally developed by the University of Wisconsin’s Population Health Institute.  Using the population health framework as a guide for the CHNA process helps categorize many individual pieces of data in a way that connects the dots between health status and social drivers of health so that local leaders can better understand and address the health and well-being of the communities they serve. Throughout the process, Healthy People 2030’s “Social Determinants of Health and Health Equity” was also considered.

Secondary (existing) data is an important piece of the CHNA process. Key sources for secondary data included information provided by the Health ENC CHNA Steering Committee and a variety of public data sources related to demographics, social and economic determinants of health, environmental health, health status and disease trends, mental/behavioral health trends, and individual health behaviors.  Each data measure was also compared to state or national benchmarks to identify areas of specific concern for Dare County. Top community needs identified through secondary data analysis included employment and income, environmental quality, healthcare access and quality, and transportation and transit. 

Primary (new) data were collected through focus groups, key informant interviews, and a web-based survey for community members that included feedback from 1,211 people who live, work or receive healthcare in Dare County. A total of three in-person focus groups were conducted, with a variety of community members from different backgrounds, age groups and life experiences.  Additionally, fifteen key informant interviews were conducted with individuals and organizations in Dare County to gain perspective on the health and well-being of residents.  Primary data identified behavioral health (including mental health and substance use), employment and income, healthcare access and quality, and housing and homelessness as top needs that impact the health and well-being of people living in Dare County.

Evaluation of Progress Since 2021-2022 CHNA

The community health improvement process should be viewed as an iterative cycle. An important piece of that cycle is revisiting the progress made on priority health topics set forth in the preceding community health needs assessment. By reviewing the actions taken to address priority health issues and evaluating the impact those actions have made in the community, it is possible to better target resources and efforts during the next CHNA cycle.

As part of the 2021-2022 Community Health Needs Assessment, substance use, mental health, and access to care were selected as prioritized health needs. A detailed table describing the strategies/action steps and indicators of improvement for each priority area can be found on Dare County’s Clear Impact Scorecard.

Community Feedback on Prior CHNA

The 2021-2022 Dare County Community Health Needs Assessment was made available to the public via hard copy access at all three Dare County library locations. Electronic copies are available on HCOB’s website, ECU Health System’s website, and Outer Banks Health’s website. Community members were invited to submit feedback via various community events and/or presentations and by email to the CHNA coordinators. No comments had been received on the preceding CHNA at the time this report was written.

Key Findings

Representatives from Dare County worked together to identify the priorities the county should focus on over the following three-year period. Leaders evaluated the primary and secondary data collected throughout the process to identify needs based on the size and scope, severity, the ability for hospitals or health departments to make an impact, associated health disparities, and importance to the community.

Dare County also compiled a Health Resources Inventory, which describes a variety of resources available to help Dare County residents meet their health and social needs.

Selected Health Priority Areas

Although it was not possible for every single area of potential need to be identified as a priority, Dare County selected three top priority health needs, which are shown here in alphabetical order:

• Access to Healthcare

• Mental Health

• Substance Use

CHNA leadership will work to develop Community Health Improvement Plans around these three public health concerns.

Next Steps
Following completion of this report, health leaders throughout Dare County will use its findings to collaborate with community organizations and local residents to develop effective health strategies, new implementation plans and interventions, and action plans to improve the communities they serve.

Distribution
An electronic copy of this report is available on the following websites:

www.DareNC.gov/HCOB  

https://www.ecuhealth.org/about-us/community/health-needs-assessment/

https://www.outerbankshealth.org/about-us/community-health-needs-assessments/

Paper copies of this report are available in all three Dare County libraries.

A high level summary booklet of this report is available for download at: www.DareNC.gov/HCOB

HCOB Partnership members are available present this CHNA Report to businesses, government entities, and/or community groups. Please contact HCOB Coordinator: Laura Willingham at Laura.Willingham@DareNC.gov or 252.475.5079 to schedule a presentation today.

Community Health Improvement Plans & Implementation Strategy Plans
The prioritization of the identified significant health needs will guide the community health improvement and implementation strategy efforts of Dare County. Following this process, Dare County Department of Health & Human Services will outline how it plans to address the prioritized health needs in its Community Health Improvement Plans. Outer Banks Health will provide details on how it plans to address priorities through its Implementation Strategy Plan.

When available, finalized plans can be found at:

Dare County Department of Health & Human Services – Community Health Improvement Plans

https://scorecard.clearimpact.com/Scorecard/Embed/91409

Outer Banks Health – Implementation Strategy

https://www.outerbankshealth.org/about-us/community-health-needs-assessments/

Members of the Dare County community are invited and encouraged to become a part of the journey toward optimal health by joining one of the HCOB task forces. Community progress on these priorities will be documented in the State of the County Health Report during the years between the CHNA.

Dare County has selected the following priority areas:

• Mental Health
• Access to Care
• Substance Use

CHNA leadership will work to develop Community Health Improvement Plans around these three public health concerns.