Dare County is pleased to present its 2021-2022 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 2021-2022 CHNA for The Outer Banks Hospital and Dare County Department of Health & Human Services.

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 2018-2019 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 2021-2022 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 now 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 Hospital serve as the local leadership for the CHNA process. This long-term collaboration has been a successful partnership for over a decade.

Healthy Carolinians of the Outer Banks Partnership

Healthy Carolinians of the Outer Banks (HCOB) is a Partnership working towards a healthier Dare County. Coordinated by the Dare County Department of Health & Human Services, and The Outer Banks Hospital, the partnership has input and representation from over 25 local organizations and agencies. The Healthy Carolinians process supports our community in mobilizing people and resources to address community health challenges.

One of the essential functions of the HCOB Partnership is overseeing 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.

Healthy Carolinians of the Outer Banks Structure

Healthy Carolinians of the Outer Banks 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 The Outer Banks Hospital & Dare County Department of Health & Human Services.

Healthy Carolinians of the Outer Banks Executive Committee Members

• Gail Hutchison, HCOB Chair
• Dianne Denny, HCOB Vice Chair
• Sheila Davies, Dare County Health & Human Services Director                    
• Ronnie Sloan, The Outer Banks Hospital President
• Amy Montgomery, The Outer Banks Hospital

Community Health Assessment Coordinators

• Kelly Nettnin, Dare County Health & Human Services
• Laura Willingham, Dare County Health & Human Services
• Jennifer Schwartzenberg, The Outer Banks Hospital
• Lyndsey Hornock, The Outer Banks Hospital

Healthy Carolinians of the Outer Banks Members

Table 1. Types of Partners on HCOB Partnership

Regional & Contracted Services

Health ENC

Health ENC is a collaborative initiative of health departments and hospitals in eastern North Carolina. The collaborative serves 34 counties with 34 participating health departments and 31 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 Member Organizations

Health ENC serves the following counties: Beaufort, Bertie, Bladen, Camden, Carteret, Chowan, Craven, Cumberland, Currituck, Dare, Duplin, Edgecombe, Franklin, Gates, Greene, Halifax, Hertford, Hoke, Hyde, Johnston, Jones, Lenoir, Martin, Nash, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Sampson, Tyrrell, Washington, and Wayne Counties.

On the regional scale, Health ENC coordinates the regional CHNA efforts for the 34 counties of eastern North Carolina. As part of their contracted services, Health ENC provides specific data and interpretation for each of the counties based on surveys and secondary data.

Theoretical Framework

In compiling the 2021-2022 Dare County Community Health Needs Assessment, the HCOB Partnership used a Community Health Business Model to ensure that a collaboration of entities have a presence in the discussions and implementation plans to address the community needs identified in the assessment. Improved outcomes occur when a variety of organizations and services engage together to examine the needs and possible solutions.

Collaborative Process Summary

An essential function of the HCOB Partnership is to oversee the Community Health Needs Assessment process every three years. For the 2021 - 2022 assessment, HCOB began the planning process in December 2020 with trainings and webinars led by Health ENC. The data collection process took place in two sections: March-April 2021 was when the secondary data was received from North Carolina and the primary data was collected through online and paper surveys from the end of April 1, 2021- June 30, 2021. Data analysis took place from July 2021-October 2021 and data was shared with the HCOB key stakeholders at the end of October 2021. HCOB set the health priorities in November 2021.

Evaluation of Progress Since 2019-2020 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 round of the CHNA cycle.

As part of the 2019-2020 Community Health Needs Assessment, substance use, mental health, chronic diseases, and older adults 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 in Appendix A.

Community Feedback on Prior CHNA

The 2019-2020 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, Vidant Health System’s Website, and The Outer Banks Hospital’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

The 2021-2022 CHNA findings are drawn from an analysis of an extensive set of secondary data and in-depth primary data from community leaders, health and non-health professionals who serve the community at large, vulnerable populations, and populations with unmet health needs. Through a synthesis of the primary and secondary data the significant health needs were determined for Dare County and are displayed in Table 2.

Table 2. Significant Health Needs

Selected Health Priority Areas

As explained later in this report, Dare County has selected the following priority areas:

Mental Health

Substance Use

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

Next Steps

Distribution

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

www.HealthENC.org

www.Darenc.com/hcob

www.vidanthealth.com/About-Vidant-Health/Community-Health-Needs-Assessments

www.theouterbankshospital.com/About-Us/Community-Health-Needs-Assessments

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

Community Health Improvement Plans

The prioritization of the identified significant health needs will guide community health improvement efforts of Dare County. Following this process, Dare County will outline how they plan to address the prioritized health needs in their Community Health Improvement Plans. Members of the Dare County community are invited and encouraged to become a part of the journey towards optimal health by joining one of the HCOB taskforces. Community Progress made on these priorities will be available during the years between CHNA by the State of the County Health Report.

Dare County has selected the following priority areas:

Mental Health

Substance Use

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