A community health needs assessment (CHNA) is the foundation for improving and promoting the health of community members. The role of a (CHNA) is to identify factors that affect the health of a population and determine the availability of resources within the community to address those factors adequately.  

During the two years between each CHNA, local health departments are responsible for providing a State Of The County Health (SOTCH) Report. This document highlights current statistical information in addition to actions and interventions taken to address the top health priorities identified in the 2019 CHNA. This report can assist with community health action planning, influence policy development, and engage community members in public health strategies.

The top three (3) priorities referenced below are:

Wilson County's SOTCH Report looks slightly different this year. To fulfill the North Carolina Local Health Department accreditation requirement, the Wilson County Health Department is now using Clear Impact Scorecard to submit the SOTCH Report and future Community Health Improvement Plans (CHIP). Scorecard is a web-based software for measuring and improving public sector performance and impact. As we transition into the new reporting structure, the Wilson County Health Department will continue providing the traditional SOTCH format for local partners and stakeholders found here.

Priority 1: Obesity

Eat Smart, Move More

 Despite the impacts of COVID-19, the Eat Smart, Move More Program (ESMM), a partnership among the Wilson County Health Department, Wilson County Department of Social Services, and the YMCA of Wilson, continued for another year. With grant funding from the Healthcare Foundation of Wilson, ESMM was implemented to address obesity in the county while assisting individuals who often face life-long struggles with this chronic disease. 

 The ESMM challenges were provided in a virtual format for all participants to comply with social-distancing recommendations. Through these challenges, participants learned about creating healthy meals, implementing physical activity throughout their week, drinking at least 64 ounces of water, how to manage stress, and why sleep is important. ESMM was able to provide three challenges in 2021, with a total of 131 participants and 589 total pounds lost. Participants were also able to record how much sleep they got each week and what techniques they used to manage their stress.

The Eat Smart, Move More Program conducted and supported as much community outreach as possible. In particular, this program partnered with the City of Wilson Farmer's Market and provided tote bags and coupons for produce for those who attended. Wellness items were given to The SPOT, an after-school care program, and those participating in the YMCA of Wilson's walking groups. 

Diabetes Prevention Programs

The Minority Diabetes Prevention Program (MDPP), a statewide collaborative through The NC Office of Minority Health and Health Disparities, is another sustainable chronic disease initiative provided in Wilson County. Much like 2020, this program continued to see the ongoing effects of COVID-19 in 2021. The Wilson County Health Department formed a new partnership with the Wilson County Senior Center offering a yearlong series of classes about healthy eating, physical activity, and behavioral change for people at high risk of developing diabetes. The new MDPP cohort started in October with 10 participants. This class meets at the Wilson County Senior Center and follows all COVID-19 guidelines. 

The YMCA Diabetes Prevention Program (YDPP), a partnership between the Wilson YMCA and the WCHD, still exists, but YDPP classes have been paused since COVID-19.

Priority 2: Fitness & Nutrition

CATCH (Coordinated Approach to Child Health)

In 2021, the Wilson County Health Department continued the partnership with after-school programs to implement the evidence-based curriculum Coordinated Approach to Child Health (CATCH). CATCH is a program that provides health and nutrition lessons, along with a physical education lesson during each session.

This program is broken up between grade levels to help students understand the importance of healthy eating and physical activity. For example, students learn the difference between GO-SLOW-WHOA, which consists of consuming more GO foods than SLOW foods, and more SLOW foods than WHOA foods. Students are also able to taste test different foods. As far as physical activity, students were allowed to try different types of movement each week. They were also taught new ways to ensure they are getting sixty minutes of physical activity every day.

This in-person program is offered through after-school programs and during summer camps. Forty (40) students participated during the school year, and 38 students participated in the summer camp program. This program plans to continue in 2022.                                                                                                                         

City of Wilson - Renovation of Parks and Recreation/Farmers Market

The Wilson Parks and Recreation Department continues to improve the parks and facilities throughout the city limits of Wilson. Each year, new renovations take place for different parks. 

In 2021, a kid-friendly upgrade took place at J. Burt Gillette Athletic Complex. The BB&T Noah’s Arc All Children’s Playground at Gillette received a generous donation from a local family that went towards the renovations of the playground. As a result, the following amenities were added: new shade structures, artificial turf, picnic tables, umbrellas, and a slider capable of riding a person who uses a wheelchair, along with their family, all at once. J. Burt Gillette Athletic Complex also was a non-college host site for the NCAA Division I Women’s and Men’s Soccer Tournament. There were six (6) women’s teams and four (4) men’s teams that played at the athletic complex. 

Wilson Parks and Recreation and the City of Wilson also hosted their first Pickleball tournament at the Greater Wilson Rotary Park and Recreation Park Center. There were 61 participants in the three-day tournament from eastern and central North Carolina who participated. Renovations will continue throughout 2022 for the local parks and recreation centers.  

The City of Wilson continued its efforts with the Wilson Farmers and Artisan Market. Each Saturday, this event was held from 8am-12pm at the Vollis Simpson Whirligig Park starting May 1, 2021, through August 28, 2021. Each week there was a range of 22 to 32 vendors selling local produce, meats, arts and crafts, candles, and other homemade items, along with different food trucks for breakfast or lunch options. Local organizations and non-profit groups also had tables with information or giveaways for those who attended. Those exhibits featured free exercise demonstrations, blood drives, scavenger hunts, and other fun activities for everyone to enjoy. The Wilson County Health Department participated in the Farmers Market in 2021 and will continue to in 2022.                                     Photo Credit:  Drew C. - Wilson Times:  Children playing on a new piece of equipment at the BB&T Noah’s Arc playground.

Priority 3: - Mental Health - including Alcohol and Substance Misuse

Know Your Risk: Addiction Wasn’t in the Prescription (Opioid Messaging Video Campaign)

Wilson County continued its opioid messaging campaign, Know Your Risk: Addiction Wasn’t in the Prescription for 2021. This video kiosk campaign originated in October 2019 through state-based funding provided to local health departments through the Healthy Communities program. Stakeholders worked closely with NC DHHS: Division of Services for the Deaf and the Hard of Hearing to provide American Sign Language (ASL) throughout the video. Throughout this campaign, community members are educated on the dangers of prescription opioids when misused. The campaign also acknowledges various community resources related to substance misuse, including where to access Narcan. Some community partners featured in the video are Wilson County Emergency Medical Services, Opportunities Industrialization Center (OIC) of Wilson, Wilson County Sheriff’s Office, Community Impact North Carolina, and the Wilson County Substance Prevention Coalition. Furthermore, four iPad kiosks are located at the Wilson County Health Department, WilsonValue Drug Store, Wilson County Library, and Carolina Family Health Center. Unfortunately, access to the video and survey has been limited due to COVID-19 barriers and restrictions.

Syringe Services Program 

During COVID-19 response and recovery efforts, the Wilson County Syringe Services Program continued to increase services as much as possible. Previous funding from the Healthcare Foundation of Wilson allowed program participants to receive takeaway kits. These kits include sterile syringes, alcohol swabs, band aids, triple antibiotic ointment, sterile water, condoms, sterile cotton, a small sharps container, sterile cookers, and educational materials. In addition, hygiene kits were also available for those in need, including shampoo, conditioner, body wash, toothbrush, toothpaste, deodorant, a comb, and Chapstick. The syringe services initiative also provides access to Narcan for those in active use and the family and support systems of those actively using.

Like most counties across the state and the nation, Wilson County saw a rise in substance use and overdoses. As a result, the demand for our mobile outreach services saw a significant increase in 2020. In 2021, it grew to become our leading distributor of supplies and services. In 2021, 715 takeaway kits, 174 hygiene kits, and 76 Naloxone kits were distributed among 75 participants enrolled in the program.

Additional opioid-related funding was granted to the Wilson County Substance Prevention Coalition and local subcontracting partners through the Health Resources and Services Administration (HRSA). This three-year funding will sustain program expansion for syringe services and testing for HIV, Hepatitis C, and Syphilis for program participants.

Leading Causes of Death

According to the North Carolina State Center for Health Statistics in 2019, the top leading causes of death in Wilson County were heart disease, cancer, and cerebrovascular diseases. In addition, poor nutrition, tobacco use, and physical inactivity are lifestyle factors that can significantly increase these less favorable outcomes.

Communicable Disease and Sexually Transmitted Infections

The 2017-2019 average rate of newly diagnosed AIDS (10.2) ranks Wilson County number 15 out of 100 counties. The average rate of newly diagnosed HIV rates from 2017 – 2019 (among adults and adolescents) was 20.5 and ranked Wilson County 10th highest in the state. The syphilis diagnosis rate (24.5) from 2017-2019 ranked Wilson County 7th for newly diagnosed cases. 

COVID-19 Response 

As we look back, 2021 felt more like a roller coaster ride than 2020. Overall, the county achieved major gains but endured more deaths, more variants, and more uncertainty.  Wilson County started 2021 in a COVID surge with a rapid rise in cases and hospitalization rates.  Similar trends are projected in the new year.

                   

                                                                       

Various emergency teams throughout the county devoted countless hours providing ongoing COVID-19 relief efforts. A major focus was the administration of the COVID-19 vaccine to the community. In January, Wilson County started administering vaccines to the public. The first vaccine event was held at Fike High School. Several partners worked in tandem to create a conducive model and execute a smooth implementation plan. The health department collaborated with Wilson County Emergency Management, Wilson County Schools, Wilson Medical Center, Carolina Family Health Center, Wilson County EMS, Wilson City Police Department, Wilson County Sheriff's Office, Wilson Fire and Rescue, and On Target Preparedness. Over 2,000 COVID-19 vaccines were distributed to the community alone during this one of many vaccine events.

Through the vaccine rollout phase, the Wilson County Health Department developed strike teams that ventured into the community to administer the vaccine to those who could not get to the health department. Our strike teams visited 37 manufacturing companies and 23 daycares. They participated in 19 community outreach events and assisted three (3) churches with their events. Vaccine administration was provided to those who were homebound, and special clinics were held for Wilson County Schools teachers, students, and staff. In addition to outreach efforts, the county's leading vaccine clinic was in full operation at the health department throughout the week. The Wilson County Health Department administered 37,012 COVID-19 vaccines in 2021.

A fully operational call center was another vital component of the county's COVID-19 response. Staff in the call center helped schedule patients for their COVID-19 vaccine appointments, answered questions related to the vaccine, and assisted with data entry into the COVID-19 Vaccine Management System (CVMS). In 2021, our call center staff answered 24,610 calls. The Wilson County Health Department will continue with COVID-19 response and relief efforts in 2022.

Escalation of the Opioid Crisis 

As the COVID-19 pandemic raged, the county faced another major public health crisis — the opioid epidemic. Between COVID-19 lockdowns and economic devastation, substance use, especially opioid misuse, continues to change and become worse. Over time, illicit fentanyl, fentanyl analogs, methamphetamine, and cocaine, often in combination or in mixed forms, became more of a common theme within this epidemic.  As shown in Figure 1 below, the total of all emergency department (ED) medication/drug overdose visits for Wilson County residents increased from 169 in 2018 to 268 in 2021. The same trend occurred with ED opioid-specific overdose visits. The number of opioid-related visits increased from 29 in 2018 to 95 in 2021.  The monthly trend of opioid-related emergency department visits in 2021 for county residents compared to the state is illustrated in Figure 2.

Figure 1: ED Overdoses/Source: NC Detect                                                                                                             Figure 2: Percentage of Total ED Visits by County/Source: NC Detect

The Wilson County Substance Prevention Coalition, which is composed of several local agencies, is a group of community-minded people creating community-level change.  Despite the challenges of the COVID-19 pandemic, the coalition continued to address the spikes associated with substance misuse as best as possible.  A significant portion of the coalition’s values aligned with North Carolina’s Opioid Action Plan and its focus areas:

• Create a coordinated infrastructure
• Reduce oversupply of prescription opioids
• Reduce diversion and flow of illicit drugs
• Increase community awareness and prevention
• Make naloxone widely available; link overdose survivors to care
• Expand treatment and recovery-oriented systems of care
• Measure our impact and revise strategies based on results

In addition to coalition staff and community representatives, many of the local initiatives were carried out by the following partners: Area L AHEC, Carolina Family Health, CINC, Eastpointe, OIC of Wilson, Wilson County (DSS, EMS, Health Department, Sheriff Office), Wilson Police Department, and Wilson Professional Services. 

                                                                                                      Expansion of WASH Centers 

Wilson Area School Health (WASH) Centers are school-based health clinics currently operating within three public schools and on a local college campus. These centers   are instrumental in helping families overcome barriers that may prevent students from receiving needed health care services. The WASH centers also help decrease absenteeism for both students and staff. Services are provided within

• Forest Hills Middle School (opened 2017)

• Beddingfield High School (opened early 2019)

• Barton College (opened in August 2020) 

• Hunt High School (opened March 2021)

Each facility is equipped with a reception desk, a waiting area, and exam rooms. With the assistance of East Carolina University, telemedicine services are available as an additional asset at each site. 

As far as COVID-19 response and recovery, our WASH centers were on the front lines, providing on-site testing, vaccine administration, and assistance with changing COVID-19 guidelines. In 2021, there were 2,353 patients seen through Wilson County Schools at Forest Hills Middle School, Beddingfield High School, and Hunt High School. These WASH Centers also administered 9,041 COVID-19 tests to students and teachers. Barton College saw 1,597 patients and administered 9,590 COVID-19 tests. There are plans to open another WASH Center at Fike High School next school year.   

WASH Dental 

Wilson Area Student Health Dental Program (WASHD) originated in the fall of 2020. This WASH derivative also consists of a partnership between the Wilson County Health Department and Wilson County Schools. WASHD provides preventive dental and clinical services to school-aged children with Medicaid or uninsured. This program consists of a full-time dentist, dental assistant, and office manager. At the beginning of 2021, lingering COVID regulations delayed the dental program from getting into the schools. Once restrictions eased, the dental staff visited six different elementary schools and served 159 clients. In emergency situations, children can be seen at the Wilson County health department.

Medicaid Transformation/Managed Care 

The Maternity Care Coordination and Child Service Coordination programs have been a part of child health and maternity public health programs since 1988. They have evolved over the years,  with the most significant changes in 2021. In 2019, name changes were incorporated, which began the transition steps in the Managed Care process. Obstetric Care Management (OBCM) was modified to Care Management to High-Risk Pregnancy (CMHRP). The Care Coordination for Children (CC4C) program was converted to Care Management for At-Risk Children (CMARC). Per the North Carolina Department of Health and Human Services (NCDHHS), the newest name changes were to distinguish the prior fee-for-service programs from the managed care programs. In July 2021, CMHRP and CMARC programs began operational and programmatic changes that came with Managed Care. Reimbursement to local health departments for care management has changed from the Department of Public Health (DPH) to six individual Prepaid Health Plan (PHPs) sources. Program guidance is still provided by the Department of Public Health (DPH); however, ultimate oversight is provided by the PHP. The six PHPs are Healthy Blue, UnitedHealthcare, WellCare, AmeriHealth Caritas, Carolina Complete Health, and Medicaid Direct. Since July 2021, referrals to CMARC and CMHRP have more than tripled per month. Without the addition of staff, this has significantly impacted care management caseloads.   

Discontinued Behavioral Health Program 

The Behavioral Health Program (BHP) at Wilson County Health Department had thirteen established patients at the start of 2021. Unfortunately, the ongoing COVID-19 pandemic led to a lack of patients following up with BHP appointments. During the first two months of 2021, several patients were lost to follow-up after numerous attempts to reschedule appointments. In February 2021, the Licensed Clinical Social Worker (LCSW) leading the program resigned. The remaining patients enrolled were notified and offered assistance for referrals to other mental health resources and providers in Wilson County. Due to the decrease in established patients and difficulty with recruiting an LCSW, after much consideration, the Wilson County Health Department's Behavioral Health Program (BHP) ended March 31, 2021.  

RIDE 

In September of 2020, the RIDE program began in Wilson. RIDE is a low-cost transportation system that replaced the local city bus system. This program allows for more transportation coverage within the city limits providing corner-to-corner transportation. Riders are picked up and dropped off at a nearby corner closest to their desired location. For individuals with disabilities, pick-up and drop-off locations can be door to door. Riders can request pick-ups and drop-offs to and from any locations within the service area. RIDE operates 7am-6pm Monday through Saturday. For those who do not drive or have a vehicle, the affordability, convenience, and dependability has made this type of transportation a community favorite. 

The program is a partnership with TransitTech, a leader in the microtransit arena. Those needing assistance can book rides through the website, the app, or by telephone. Trips are $1.50 each, and bulk discounted pricing is available. Passengers can bring an additional person along for $1, and children under eight (8) travel free. Wilson Transit Senior Citizens and Disabled ID cardholders are eligible for discounted pricing.

From February - March of 2021, RIDE offered free transportation for individuals going to a medical facility for a COVID-19 vaccination appointment. This service was made possible through CARES Act funding in partnership with the North Carolina Department of Transportation. 

RIDE is hopeful it will expand in the future. However, steady increases in fuel prices and an 18 % increase in wages since its launch in 2020 have hindered recent expansion efforts. 

Trauma-Informed Schools (Darden Middle & Sallie B. Howard School for the Arts)

One out of every four children attending school has been exposed to a traumatic event that can affect learning and/or behavior.     —NCTSN Child Trauma Toolkit for Educators

In a trauma-informed school, administrators, teachers, and staff are prepared to recognize and respond to those impacted by traumatic stress. In addition, students are provided with clear expectations and communication strategies to guide them through stressful situations. Maslow's Hierarchy of Needs Theory infers, when a student's basic needs are met, such as feeling safe, cared for, and respected, they are positioned to realize and reach their full potential. The goal is to provide tools to cope with extreme situations and create an underlying culture of respect and support. Traumatic stress can arise from various sources: bullying at school, loss of a loved one, witnessing harm being done to someone else, and events such as divorce or homelessness.

Research shows that having the tools to manage traumatic stress can improve academic achievement, attendance, school climate, retention of new teachers, and reduced dropout rate. These practices will also help students build the capacity to address trauma and support their ability to self-regulate, which are skills they need to succeed in life. 

During the 2020-2021 school year, the Rural Opportunity Institute (ROI), in partnership with Area L AHEC and the Wilson County Department of Social Services (DSS), provided capacity-building support to the staff of Darden Middle School. Darden Middle was selected to be the first cohort of trauma-informed schools within the Wilson County Schools.

The Wilson County Substance Prevention Coalition, through its collaborative partnerships, works to implement the Miss Kendra Program with students in grades K-5 at the Sallie B. Howard School Charter School for the Arts. The Miss Kendra Program actively addresses the impact of trauma and toxic stress on student engagement. The Miss Kendra Program is a trauma-informed social-emotional learning (SEL) program with year-long curriculums for kindergarten through high school children. The program helps schools create an environment that supports open conversations about stress and transforms the relationship between teachers and students, which is needed now more than ever.                     SOURCE: The Treatment and Services Adaptation Center