State of the County Health Report 2023
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 2023 Dare County SOTCH was submitted to North Carolina Department of Human Services (NCDHHS) on March 4, 2024.

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, 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 2023 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.

(Data Source: https://data.census.gov/table/ACSDP5Y2022.DP05?q=Dare%20County)

(Data source: 2022 ACS https://data.census.gov/table/ACSST5Y2022.S0101?q=Dare%20County)

Dare County residents are older when compared to North Carolina, Dare County's median age is 47.3 years while North Carolina's median age is 39.2 years. Almost 20% (18.4%) of residents are under 18 years of age and another 23.0% 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.

Substance Use

Opioid Settlement Funds
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. 

Funds have been allocated for the following initiatives:

• Overdose Response Coordinator

• Recovery Court Case Manager

• Naloxone & Xylazine Testing Strips

• Linkage to Care

• Social Determinants of Health

Because Dare County is a “can do” community, a portion of the funds was allocated toward community initiatives/mini grants. The following progress was made in fiscal year 2022-2023 with use of the community initiatives/mini grant funds:

• Dare County Recovery Court received a grant to assist those in the justice- involved population and recovery with reentry services and post-treatment support. At the end of the fiscal year, a total of 47 individuals were enrolled in the program. There were six program graduates. Six participants graduated to the lowest level of monitoring. Eleven of our participants are enrolled in residential treatment. Twenty-four enrolled in outpatient treatment. Funds eliminated cost as a barrier for individuals served and allowed for individuals to participate in several substance-free events. It has received really positive feedback from the participants.

• Interfaith Community Outreach was able to provide monetary assistance to residents with addiction who have completed a treatment program. This grant allowed ICO to provide rental assistance to nine residents as they continue their sober living.

• Outer Banks Yoga offered a 75-minute weekly yoga/meditation class, designed specifically for individuals in recovery from drug addiction. They hosted 16 free yoga classes in our community over a four-month period from January to May 2023. Services were provided to 15 participants with eight attending on a regular basis, 100% reported improvements in their well-being after yoga class 

• Cross Roads OBX received funds to increase organizational capacity to help those with substance use disorders in Dare County. Cross Roads OBX was able to hire a second part-time peer support specialist in July 2023. More than 50% of individuals served by Cross Roads OBX between October 2022 and June 2023 are now in a more stable housing and employment situation. Over 95% of program participants were impacted by opioid abuse. Cross Roads also serves as a linkage to care for its program participants with 80% being referred to care at a detox facility, longer term rehabilitation facility, and/or sober living house. 

• Changing Tides was able to help cover costs associated with services and treatment for qualified Dare County residents.  These residents were able to obtain quality treatment, and most likely would not have been able to afford any treatment at all without the grant funding.  All clients who were assisted completed their semesters in compliance without alcohol or drug use.  These individuals were discharged with stable housing, improved family relationships and employment.

• Outer Banks Dare Challenge received funds to better set up Dare County residents with the tools necessary for long-term success in recovery. In 2023, 37 men were enrolled in our program.  Six  men have graduated from the program and have made the commitment to stay on as interns and staff. Two graduates were recently married and are employed. 

Fentanyl Kills Campaign

28 Businesses were delivered the following:

222 Boxes of Naloxone (total of 444 doses)

138 Fentanyl Test Strip Displays (of which 58 are display shelves and combined with Naloxone)

552 Fentanyl Test Kits which includes:

• 1,104 Test Strips for Fentanyl

• 552 Test Strips for Xylazine

• 1,500 pens

• 50 bags

• 750 stickers

• 450 posters

Digital Ads were delivered to the following Target Audiences:

• VUSIC Concert Attendees:  22-Jun, 14-Jul, 15-Jul, 22-Jul, 27-Jul, 29-Jul, 2-Aug, 4-Aug, 6-Aug, 10-Aug, 18-Aug

• Party Scenes: Top performing locations: 7-11 Manteo, Blue Crab Tavern Colington, 7-11 KDH, 7-11 Kitty Hawk, Outer Banks Brewing Station KDH, Avalon Pier KDH, Poor Richard’s

• Commercial Fishermen: Top performing locations: Shallowbag Bay Manteo, Pirates Cove Manteo, Wanchese Marina, Hatteras Harbor Marina 

• Parents: Top performing locations: Front Porch Manteo, USPS Manteo, Avenue Grill Manteo, USPS Kitty Hawk, Dare County Rec Dept KDH, Fessenden Center, Front Porch Nags Head

• General Targets: Top performing locations: Buxton, Avon, Frisco

• Young People: Top performing locations: Front Porch Manteo, TW’s Kitty Hawk, First Street Beach Access KDH, Abalone Street Beach Access KDH, Secret Spot Surf Shop Nags Head, Waveriders Nags Head, Front Porch Nags Head, Ashley’s Espresso Parlour KDH, Byrd Street Beach Access Kitty Hawk, Avalon Pier, Jennette's Pier, WRV Kitty Hawk

Radio PSAs

• 2 radio PSAs were distributed by East Carolina Radio

Bulletin Board

• Billboard in Manteo was updated with Fentanyl Kills message

Recovery & Overdose Support Services

Recovery & Overdose Services (ROSS) are designed to assist those struggling with substance use and misuse. This is achieved by helping individuals with mental health and trauma challenges, supporting family and friends of those who struggle, and/or providing harm reduction education and resources. The following are accomplishments achieved in 2023: 

• Staff became EMS affiliates, which allows for a more efficient overdose response program within Dare County.

• Naloxone & Fentanyl test strip distribution locations have increased. 

  • EMS has a more robust leave-behind program, where staff provide Naloxone prior to leaving overdose scenes. 

  • Kitty Hawk lifeguards now have a supply of Naloxone on hand for employees to use if necessary. 

  • First Flight Rotary now partners with Dare County Department of Health & Human Services to implement its Naloxone distribution grant. 

  • College of the Albemarle- Dare Campus now has a supply of Naloxone on hand in the event an individual overdoses on school property. 

  • Outer Banks Health also keeps a supply of Naloxone on hand to provide to patients who visit the emergency department.

  • Room in the Inn also has a supply of Naloxone and fentanyl test strips on hand for any participants who may need them.

• Staff partnered with Fishing Partnership Support Services to hold Harm Reduction Education in March of 2023.

Keeping Current

Keeping Current is an interactive program designed to empower and equip adults with the tools necessary to prevent teen substance abuse. The program features education on technology and apps; how to communicate with teens; and a mock teenage bedroom with items that could indicate a substance abuse concern. We recommend the program for any adult who is around youth - parents, teachers, youth pastors, caring adults, and community members.

In 2023, Dare County Department of Health & Human Services received an anonymous grant award to purchase items to update the mock teenage bedroom and other equipment used to implement the program.

Mental Health
Dare County becomes a NAMI Affiliate

NAMI Affiliates are created by groups of individuals who embrace the mission of NAMI and its commitment to building a community of hope for all of those in need. Volunteer leaders come to NAMI with a passion to dedicate their time and resources to facilitate support groups, teach NAMI signature programs, advocate for mental health systems change, and foster peer relationships that empower and strengthen new leadership.

Out of the Shadows Walk

The first annual Out of the Shadows Suicide Awareness Walk was scheduled for October 14, 2023 from 10 a.m. to 1 p.m. at the First Flight High School track in Kill Devil Hills. The goal was to offer an important opportunity for the community to come together and work toward breaking the stigma and silence that often surrounds suicide and mental illness. 

A collaboration between the Breaking Through Task Force, Dare County Department of Health & Human Services (DHHS), Saving Lives Task Force, SMART Recovery and other dedicated community members, the event was to include a keynote speaker, vendors, mental health professionals, suicide education and awareness materials, live music and food. 

Due to the possibility of inclement weather on October 14, 2023, the walk was canceled and rescheduled for May of 2024.

Children’s Mental Health Workbooks

The Breaking Through Task Force continues to provide three children's mental health workbooks: How to Handle Bullying, We are all Special, and How to Handle Stress and Conflict. The workbooks continue to be 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

• Dare County Department of Health & Human Services

• Manteo Lobby

• Nags Head Lobby

• Frisco Lobby

• Child Health Pod

• Family Services Pod

• Children's Services Pod

• WIC Program Office

Mental Health Counselors Roundtable
In 2022, 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 meeting was so beneficial, the group elected to reconvene on a quarterly basis and identify goals and objectives the group can work toward to improve mental health services for our community members. 

Four meetings were held in 2023: March 21, June 20, September 19, December 5. In 2023, the group established a charter, supported a grant application to increase access to mental health care, and began planning quarterly continuing education initiatives to be added onto 2024’s quarterly meetings.

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.

Diabetes & Obesity Prevelance (2014, 2015, 2016, 2017, 2019, 2020)

(Chart source: County Health Rankings, Dare County Profiles (2023, 2022, 2021, 2020, 2019, 2018)

Percentage of adults 20 years of age and older with diabetes and obesity both have declined in Dare County.
 

Cancer Incidence Rates (2010- 2014, 2013-2017, 2015-2019, 2016-2020)

(Chart Source: https://www.statecancerprofiles.cancer.gov/incidencerates/)

All cancer incidence rates are on the decline in Dare County, with the exception of breast and bladder.

Mortality

Mortality Data (2012-2016, 2013-2017, 2014-2018, 2015-2019, 2016-2020)

(Chart 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/)

Total mortality rates have increased since last period. Death rates due to heart disease, cancer, chronic lower respiratory disease, suicide, liver disease & cirrhosis, septicemia, diabetes, and pneumonia & influenza have all decreased. Death rates due to cerebrovascular disease, Alzheimer's disease, unintentional non-motor vehicle injuries, and nephritis have all increased.

Access to Healthcare

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

(Chart Source: https://nchealthworkforce.unc.edu/interactive/supply/)

Healthcare Providers in Dare County overtime have increased. However, in 2022 the ratio of primary care physician assistants, primary care physicians, generalist physicians, and dentists have decreased when compared to the previous year. When compared to North Carolina, Dare has less physician assistants (all specialties) physicians (all specialties) and dentists.

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.

To address the ongoing issues and opposition to housing developments—and to create an atmosphere of collaboration among local governments—Dare County formed a task force in October 2023 that is dedicated to finding solutions to the housing issues that exist throughout the county.

The Dare County Housing Task Force will consist of approximately 25 stakeholders, including various Dare County officials and representatives from each of Dare County six municipalities, among other members. The first meeting of the Housing Task Force will take place at 9 a.m. on Thursday, January 18, 2024 in Room 168 of the Dare County Administration Building, which is located at 954 Marshall C. Collins Drive in Manteo.

Human Trafficking Task Force Begins

Outer Banks Hotline and the Dare County Sheriff’s Office have partnered to combat human trafficking. The two agencies recently received a large grant through the U.S. Office for Victims of Crimes for the planning and implementation of a joint human trafficking task force (the North Carolina Eastern Region Human Trafficking Task Force) to cover Dare, Camden, Currituck and Pasquotank counties. The task force will help expose local trafficking offenses, those who commit them and victims previously hidden from view.

Several factors contribute to the trafficking problem in Dare County including, but not limited to, activities related to the agricultural, hunting and fishing industries; a large hospitality and tourism industry; and location just below the Virginia border. Dare County also has a large number of transient occupants and visitors which contribute to the problem.

Health & Human Services staff has been assigned to work with the task force. 

Community Care Clinic of Dare- Medically Assisted Treatment

Community Care Clinic of Dare implemented a medically-assisted treatment (MAT) for opioid use disorder (OUD). Six staff members at the Community Care Clinic of Dare have been thoroughly trained in the purchasing, dispensing, preparation and injection of Extended-Release Naltrexone (Vivitrol). Six Vivitrol doses were ordered and are stored at the clinic. For the counseling piece of Vivitrol treatment, local options have been identified for patients to choose: individual counseling sessions with the health department's LCSW, one-on-one sessions with the peer support specialists, local AA meetings, local SMART Recovery sessions (one is held weekly at the clinic), and referral to PORT Health Services if appropriate. Processes are in place to ensure Vivitrol clients are given their first injection prior to dismissal from jail or treatment. The individuals are transported to the Community Care Clinic of Dare for the first injection and will meet with the clinic's nurse case manager for assessment of social determinants of health. The goal is to identify needs they will have once dismissed and have referrals made in advance of dismissal. Furthermore, awareness and education initiatives have improved within the healthcare provider community, with a 28% increase in provider screening for high-risk opioid use. There has also been a 15% increase in providers referring to MAT.