State of the County Health Report 2022
Conducting a Community Health Needs Assessment is an ongoing process that engages diverse agencies, providers, and individuals in identifying community assets and strengths, as well as unmet needs. Leadership for this collaborative process is provided by Healthy Carolinians of the Outer Banks. The following State of the County Health (SOTCH) Report, serves as an update and documented progress following the findings of the 2021-2022 Community Health Needs Assessment. The 2022 Dare County SOTCH was submitted to North Carolina Department of Human Services (NCDHHS) on March 6, 2023.

Information provided within this report is specific to the identified priority health issues: mental health and substance use. The report also provides updated data and information specific to Dare County mortality and morbidity rates; COVID-19 response, emerging issues and new initiatives. 

Communication with stakeholders and community members regarding the identified community health priorities and progress to-date is vital to community health improvement. Following review by the Dare County Board of Health & Human Services and Healthy Carolinians of the Outer Banks Executive Committee, access of the 2022 State of the County Health Report will be shared with Healthy Carolinians of the Outer Banks, other community partners, and the community. Hard copies will be available in our department lobbies.

About Dare County
Dare County is located in Northeastern North Carolina and stretches along approximately 110 miles of shoreline known as the Outer Banks. Manteo is the County seat and is around 200 miles east of Raleigh. The Virginia Beach area is nearby and offers residents a quick trip to popular restaurants, shopping and an airport in Norfolk. 

Dare County is home to the Outer Banks. The area is a popular resort and vacation attraction and during the summer season over 300,000 weekly tourists visit for vacation.  Dare County is home to the Cape Hatteras National Seashore, the Wright Brothers National Monument, the Fort Raleigh National Historic Site, the Alligator River National Wildlife Refuge, the Pea Island  National Wildlife Refuge, Jockey's Ridge State Park, the Elizabeth II State Historic Site, the Roanoke Island Festival Park, the North Carolina Aquarium and the Nags Head Woods Nature Preserve.

Six municipalities are located within the county: Duck, Kill Devil Hills, Kitty Hawk, Manteo, Nags Head and Southern Shores. The county has a Commissioner / Manager form of Government. The seven members of the Board of Commissioners serve staggered four-year terms.

The Census Bureau, 2021 American Community Survey estimates Dare County's population to be 36,718, with male and female breakdown very close to 50/50.

Source: American Community Survey, 2021, https://data.census.gov/table?q=Dare+County&tid=ACSDP5Y2021.DP05

Dare County residents are older when compared to North Carolina, Dare County's median age is 47.8 years while North Carolina's median age is 39.4 years. Almost 20% (18.7%) of residents are under 18 years of age and another 21.9% of residents are 65 years of age or older. 

The CHIP Scorecard was created and submitted on  September 5th, 2022 in order to meet the requirements for the Dare County Long and/ or Short Term Community Health Improvement Plans. This scorecard has metrics which are updated yearly for the State of the County Health Report that reflect prograss on Dare County CHIPs.

This section will contain updates on ongoing initiatives or programs of interest that are not able to be captured by metrics or the initaitive only occured during this calendar year.

Cross Cutting

Suicide Awareness: Event & Documentary
The Breaking Through Task Force, Saving Lives Task Force, Be Resilient OBX, and Dare County Department of Health & Human Services partnered to host a town hall event on September 27, 2022 at First Flight High School.With approximately 90 individuals in attendance, the main feature of the event was the recently filmed documentary Shattering the Silence: A Documentary about Suicide in Dare County. The thirty-minute documentary included stories of six Dare County residents who have been impacted by the suicide of a loved one or suicidal ideations.

Attendees had the opportunity to enjoy refreshments and explore resources in Dare County related to mental health prior to the documentary viewing. After the documentary, a panel was held and members of the audience were able to ask questions of these local professionals. The panel included: Benny Baldwin,Documentary Videographer; Christie McEwan, Outer Banks Counseling Services; Susan Lee, Documentary Counselor; Kristen Krischoff, Mobile Crisis; Tracey Webster, Trillium; Dr. Ashley Clower, Surf Medicine & Dare County Department of Health & Human Services Board Member. Watch the documentary here.

Substance Use
Dare County is part of North Carolina’s historic $26 billion agreement that will help bring desperately needed relief to communities impacted by opioids. In Dare County, these funds will be used to support treatment, recovery, harm reduction, and other life-saving programs and services. Because Dare County is a “can do” community, a portion of the funds was allocated towards mini grants.

The mini grant application period was open from August 16, 2022 until September 6, 2022. Applications were reviewed and approved by the Saving Lives Task Force Board. The following projects were funded:

• Dare County Recovery Court: Assist those in the justice- involved population and recovery with reentry services and post-treatment support.

• Just in Case: Provide Narcan and Fentanyl test strips in a free, convenient, and discreet manner in the form of a vending machine.

• Community Care Clinic of Dare: Implement medically-assisted treatment (MAT) for opioid use disorder (OUD).

• OBX Room in the Inn: Fund qualified and dedicated Dare County residents to become certified Mental Health First Aid Trainers.

• Cross Roads OBX: Increase organizational capacity to help those with substance use disorders in Dare County.

• Interfaith Community Outreach: Provide monetary assistance to residents with addiction who have completed a treatment program.

• Outer Banks Yoga: Provide a 75-minute weekly yoga/meditation class, designed specifically for individuals recovery from drug addiction.’

• Changing Tides: Cover costs associated with services and treatment for qualified Dare County residents.

• Outer Banks Dare Challenge: To provide a more intense focus on setting up Dare County residents with the tools necessary for long term success in recovery.

• Contracted Community Peer Support Specialist: Attend Recovery Court Sessions monthly and assist participants and professionals. Work with Dare County Detention Center to set up needed programs.

Progress on these initiatives will be shared in the next SOTCH.

Substance Use Summit Held
The Faith-Based Subcommittee of the Dare County Saving Lives Task Force hosted a Substance Use Summit and workshop for Faith leaders. The event was held on Thursday, March 31st at St. Andrews by the Sea, Nags Head, from 10:00am - 1:30pm.

Eric Landry, with the Faith-Based Community Initiatives from Tennessee, shared the successes of their faith community in addressing substance disorder issues in their congregations and local communities.

The event’s goal was to provide participants and their congregations with a better understanding of Substance Use Disorders and how we can use faith in prevention, treatment, and recovery efforts. Participants were also introduced to the “Saving Lives, Faith-Based Committee Substance Use and Mental Health Resource Guide” which includes organizations and local resources available to help.

Mental Health
The Breaking Throught Task Force ordered three children's mental health workbooks: How to Handle Bullying, We are all Special, and How to Handle Stress and Conflict. The workbooks were made available at the following locations:

• Kill Devil Hills Library
• Manteo Library
• Hatteras Island Library
• Surf Pediatrics & Medicine
• New Horizons
• Manteo Elementary School
• Cape Hatteras Elementary School
• Nags Head Elementary School
• First Flight Elementary School
• Kitty Hawk Elementary School

Workbooks were also placed at the following Dare County Department of Health & Human Services locations:

• Manteo Lobby
• Nags Head Lobby
• Frisco Lobby
• Child Health Pod
• Family Services Pod
• Childrens Services Pod
• WIC Program Office

In 2022, a total of 2,500 workbooks were issued to these locations. 

Mental Health Counselors Roundtable
At the request of the HCOB Executive Committee, The Breaking Through Task Force partnered with Dare County Department of Health & Human Services to hold a mental health counselors roundtable event. The purpose of the event was to collect information from counselors regarding themes they are observing in their practice and collaborate on opportunities to better assist them in their work. 

All known counselors currently practicing in Dare County were invited to participate in the forum. The event was held on May 3, 2022 at DCDHHS campus in Manteo. A total of 12 counselors participated. Key staff from BTTF and DCDHHS were in attendance.

The forum was a simple process and participants were asked questions about:

• Themes and observations in their practice

• Concerns among their patients and the community at large

• Broad resolution ideas

The following are observations shared by the attending counselors.

General Observations

• Depression and anxiety seem to be the most common concerns.

• Seeing/hearing about more overdoses since COVID-19.

• Substance use seems to be the top issue among justice-involved persons.

• Any coping skills present in patients seem to have been reduced or removed after COVID-19 pandemic.

• Cost of living in Dare County and other environmental stressors have skyrocketed since COVID-19.

• Breaking Through Task Force has done a good job at addressing and breaking mental health stigma for individuals seeking individual counseling.

• Toxic stress in workplaces is a common theme observed among counselors.

Access Concerns

• Not enough mental health providers to meet the needs of our community. Current provided have limited capacity, waitlist, or are not taking new patients.

• Many individuals relocating to the area are having a hard time finding a counselor with availability.

• Primary care providers are not taking new patients, which impacts patients who may be in need of medication.

• Individuals who require Medication Assisted Treatment face many challenges and barriers to getting medications in Dare County (from provider availability/willingness to limited scheduling and availability) 

• Not a lot of Medicare providers in the area.

• Blue Cross & Blue Shield of North Carolina have changed their policies regarding telehealth, all of their providers must provide services through Teladoc, which is blocking access to services for patients.

School System & Youth

• A group of students have not rebounded from COVID-19 setbacks.

• There are some students who are developmentally delayed due to COVID-19.

• Anxiety is common amongst elementary aged students.

• School counselors have observed a shift in focus from the individual to the family needs.

• Generational issues seem to be more common on Hatteras Island.

• Working on establishing mental health and substance use modules for teachers to promote consistency on all school levels.

• Teenagers are in need- counselors who work with this population have had to stop accepting new patients.

• Students are struggling with returning to school in person and handling academic stress again.

• More young people with addictions such as substance use and pornography.

• Lack of social skills and coping skills have been observed with these young people.

• Parents coping skills are lacking and impacting their children.

Items to Investigate Further

• A group of students have not rebounded from COVID-19 setbacks.

• There are some students who are developmentally delayed due to COVID-19.

• Anxiety is common amongst elementary aged students.

• School counselors have observed a shift in focus from the individual to the family needs.

• Generational issues seem to be more common on Hatteras Island.

• Working on establishing mental health and substance use modules for teachers to promote consistency in response on all school levels.

• Teenagers are in need and counselors who work with this population have had to stop accepting new patients.

• Students are struggling with returning to school in person and handling academic stress again.

• More young people with addictions such as substance use and pornography.

• Lack of social skills and coping skills have been observed with these young people.

• Parents coping skills are lacking and impacting their children.

Next Steps

This group plans to reconvene quarterly and identify goals and objectives the group can work towards to improve mental health services for our community members. Due to staffing, the quarterly meetings will begin in March of 2023.

Morbidity Data
Morbidity is another term for illness or medical condition. and often times refers to having a disease or a symptom of disease, or the assessment of the amount of disease within a population.  Some examples of common morbidities are heart disease, diabetes, and obesity, but morbidities can range from Alzheimer's disease to cancer to traumatic brain injury. When a person has more than one morbidity at a time, it is referred to as co-morbidity. Morbidities are NOT deaths. Prevalence is also used as a measure to determine the level of morbidity in a population.

Dare County Cancer Incidence Rates (2010-2014; 2013-2017; 2015-2019)

* indiciates 3 or fewer cases

Source: https://www.statecancerprofiles.cancer.gov/incidencerates/

Morbidity data indicates an increase in liver & bile duct and breast cancer. From 2015-2019 Dare County saw a decrease in incidence rates of: oral, lung,bladder, prostate, colorectal and all cancers.

Diabetes & Obesity Prevelance (2014, 2015, 2016, 2017, 2019)

Source: County Health Rankings, Dare County Profiles (2022, 2021, 2020, 2019, 2018)

The percent of adults with diabetes decreased, while the percent of obese adults increased.

COVID-19 Cases

More than 75% of COVID cases were residents. The gender breakdown was somewhat close to an acurate representation of the population with 45.6% of cases being in males and 54.4% of cases being in females. The most common age group to test positive were individuals 25-49 years of age (34.6%) followed by 50-64 years of age (23%), and 65 plus years of age (18.2%). 

Mortality Data

Source: NC State Center for Health Statistics, County Health Data Book (2018, 2019, 2020, 2021, 2022) Mprtality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; https://schs.dph.ncdhhs.gov/data/databook/

Since the previous Community Health Needs Assessment period, there have been increases in the rates of deaths due to cerebrovascular disease, Alzheimer's, unintentional non-motor vehicle injuries, nephritis, nephrotic syndrome & nephrosis. 

Access to Healthcare

In July of 2022, Manteo Board of Commissioners established an Access to Healthcare Task Force to work on re-establishing primary care options in the town of Manteo. Meetings began in August of 2022 and members of the task force include local government, public health, hospital staff/board members, residents, and business owners. Prior to the end of the year, Outer Banks Health was able to reopen a clinic and re-establish care for residents who had lost their primary care due to the initial clinic closing. 

Access to Healthcare data has been collected to begin to determine the need of further work in this area.

Rate of Healthcare Providers (per 10,000) over time in Dare County

Source: https://nchealthworkforce.unc.edu/interactive/supply/

Physical Healthcare Providers in Dare County overtime have increased. However, when compared to North Carolina, Dare falls behind the standard.

Affordable Housing

For several years, Dare County officials have worked diligently to find a solution to the challenges that many seasonal and year-round workers face when it comes to securing safe and affordable housing on the Outer Banks.

Since the beginning of 2022, Dare County has made significant strides in its ongoing efforts to determine suitable locations for essential and workforce housing developments — as well as to attract and retain private developers who possess the skills and experience necessary to construct such housing projects on these sites. 

Thanks to the public-private partnerships that Dare County has formed with two private developers since the start of the year—Coastal Affordable Housing and Woda Cooper Companies—the county’s efforts are paying off and making clear progress. Plans are currently underway for multiple projects that aim to provide high-quality and affordable housing options for members of the community's essential workforce.

Opioid Settlement Funding
A meeting which was called by North Carolina Attorney General Josh Stein on October 20, 200, featured comments from several key stakeholders and local officials, including Dare County Board of Commissioners Vice Chairman and Saving Lives Task Force Co-chair Wally Overman, Dare County Commissioner Ervin Bateman, Dare County Department of Health & Human Services Director Dr. Sheila Davies, Dare County Sheriff Doug Doughtie, Dare County Department of Health & Human Services Director of Health Education & Outreach Services and Saving Lives Task Force Co-chair Roxana Ballinger, and Dare County Recovery Court Coordinator Emily Urch.

During the meeting, local officials detailed Dare County’s plans to address the ongoing opioid crisis utilizing the national opioid settlement funds that were secured following a settlement with four pharmaceutical manufacturers and distributors. Of the $26 billion settlement, $750 million was allocated to North Carolina, of which 15 percent will go to the state, with the remaining 85 percent of funds to be utilized by local governments, including Dare County, which is slated to receive a total of $3.4 million over the next 18 years. 

Approximately $420,000 that has been designated for Fiscal Year 2023 will be used to fund a local overdose response coordinator position; an additional probation officer for Recovery Court; community distribution of Naloxone and Fentanyl testing strips; a “Fentanyl Kills” mass public awareness campaign; various community initiatives, such as contract services and mini grants; and linkage to care/social determinants of public health, which can include funding an individual’s admission into a treatment facility, providing transportation or assisting with housing. 

Dare County Health & Human Services Cuts Ribbon on Expanded & Renovated Facility
A ribbon-cutting ceremony to celebrate the completion of the newly renovated Dare County Department of Health & Human Services facility was scheduled to be held at 4 p.m. on Tuesday, May 24, 2022. The ribbon-cutting ceremony featured several speakers who will discuss the importance of the wide array of programs and services that are provided by the Dare County Department of Health & Human Services, as well as the significant and positive impact that renovating the facility has had on the community.  

The construction project consisted of renovating the two existing and outdated buildings on the Dare County Department of Health & Human Services campus, which is located at 109 Exeter Street in Manteo. In addition to undergoing extensive renovations to modernize the facility, the two separate buildings were also connected with the construction of a 6,500-square-foot addition between them that now sMerves as the building’s lobby and main entrance. erging the Public Health Division and the Social Services Division into a singular facility provides patients and clients with one convenient check-in location, which allows the department to more efficiently and effectively provide its many services to the residents of Dare County.