The "Story Behind the Curve" helps us better understand data associated with a specific result we want to achieve. When we look closely at data and engage partners that can provide context to positive or negative factors that influence the data's trajectory, we can better identify strategies and interventions that can turn the (data) curve in the direction that improves the well-being for those in our community. 

Cabarrus County has one hospital system, Atrium Health, with three Emergency Department locations: Concord, Kannapolis, and Harrisburg. As we work collaboratively to improve the mental and behavioral health of those that live, work, play and pray in Cabarrus County, we need to monitor and assess access to care. Often times an individual cannot access appropriate mental health services in a timely manner, leaving them or their loved ones with nowhere else to turn for help but the emergency department. 

What's helping? These are the positive factors or influences hat are working in our community.

• Community engagement in Mental Health First Aid and Question, Persuade, Refer training
• COVID-19 American Recovery Plan/Cabarrus Recovery Grants
• Support of Cabarrus County Government, convening of Mental Health Advisory Board
• Peer Support Specialists
• Law Enforcements investment in officer education and training
• Collaboration with local mental health providers to accept direct student referrals

What's hurting? These are the negative factors or influences that are working in our community. 

• Lack of available in-patient treatment
• Stigma
• COVID-19 - patient fear of seeking services at the emergency department due to high community spread
• Lack of supportive recovery community
• Geriatric Psychiatric unit for the Atrium Health region is located at Atrium Health Cabarrus

What is to come? Any anticipated community or environmental influences that could impact work in our community.

As of September 1, 2021, Cabarrus County will complete its Local Management Entity (LME)/Managed Care Organization (MCO) transition from Cardinal Innovations Healthcare to Partners Behavioral Health. NC Department of Health and Human Services contracts with LMEs/MCOs to manage behavioral health care services paid with federal, state and local taxes, including Medicaid, as well as state and local grant funds. While there are clearly defined roles and responsibilities for MCO's, they do have the option to operate as an 'open' or 'closed' network provider. In an “open” network, care is authorized to be provided by any provider who is willing and able to provide the care.  In a closed network, only those providers who have contracted with a Managed Care Organization will be authorized and paid by that organization to provide care. Cardinal Innovations has operated in Cabarrus County as a "closed" network provider, which has limited the number of providers available to the public. Partners Behavioral Health is an "open" network provider, we hope to see an increase in provider access (1.7 behavioral health providers per 10,000 population), leading to a decrease in ED psychiatric admissions.

Source: NC DHHS, NC Injury and Violence Prevention Branch - NC Violent Death Reporting System

The list of governmental and community based organizations below are actively engaged in the development and implementation of the Community Health Improvement Plan addressing emergency department admissions for behavioral health patients, as well as providing wrap around supports for those who were previously incarcerated or have experienced trauma.

• Amazing Grace Advocacy
• Atrium Health Cabarrus - Emergency Department
• AYA House
• Cabarrus County
  • County Commissioners - Mental Health Advisory Board
  • Emergency Medical Services
  • Department of Human Services
• Cabarrus County Partnership for Children
• Cabarrus County Schools
• Cabarrus County Sheriff's Department
• Cabarrus Health Alliance
• Cabarrus County's Juvenile Crime Prevention Council
• Concord Police Department
• Daymark Recovery Services
• Department of Juvenile Justice
• District Attorney's Office
• Genesis: A New Beginning
• Kannapolis Police Department
• Partners Behavioral Health
• Probation and Parole (NC DPS)
• Opportunity House
• RHA Behavioral Health
• S&H Youth and Adult Services

Alternative Destination Transport program provides pathways of care other than transport to the emergency department for 9-1-1 patients. This strategy would include transport of patients with low acuity medical conditions to urgent care centers and clinics for treatment, the transport of medically stable intoxicated patients directly to the detoxification center, and the transport of medically stable psychiatric patients directly to mental health facility for medical clearance and admission.

Co-responder Models for Individuals in Behavioral Health Crisis enhance law enforcement’s capacity to develop an immediate and targeted response to acute and non-acute situations. At its core, the co-responder framework typically features a specially trained team that includes at least one law enforcement officer and one mental health or substance abuse professional responding jointly to situations in which a behavioral health crisis is likely to be involved, often in the same vehicle, or arriving on scene at generally the same time.

Crisis Intervention Team Training and programs create connections between law enforcement, mental health providers, hospital emergency services and individuals with mental illness and their families. Through collaborative community partnerships and intensive training, CIT improves communication, identifies mental health resources for those in crisis and ensures officer and community safety.

Mental Health First Aid (MHFA) is a training course to help laypeople know how to assist individuals with mental health problems or at risk for problems such as depression, anxiety, and substance use disorders. Courses last 8 to 12 hours and include information about signs and symptoms of mental health problems and appropriate responses, as well as interactive activities using MHFA’s five-step action plan: assess risk of self-harm, listen non-judgmentally, reassure and share information, encourage self-help, and encourage professional help. 

Question, Persuade and Refer (QPR) is intended to reduce suicidal behaviors and save lives by providing innovative, practical and proven suicide prevention training for general community members. The skills and techniques taught during this 1-hour training empowers all people, regardless of their background, to make a positive difference in the life of someone they know.

Peer Supports placed within the Emergency Department, assist individuals with the develop of crisis plans, support patients during their hospital stay if admitted to inpatient service, educate them on harm reduction, and link them with community-based resources after discharge. 

RECONNECT for Resilience trainings are trauma-informed and resiliency-focused, and offer practical strategies that individuals, organizations, and whole communities can use to promote balance and wellbeing. Attendees are taught about trauma, the brain, and the human nervous system in a way that participants of all ages, educations, or backgrounds can understand. Our simple, teachable format is designed for anyone to learn. The 14-hour Reconnect training is a strengths-based, somatic program. Through demonstrations and group practice, participants are given the “owner’s manual” to the body’s safety and threat management system and learn to use their own natural ability to find balance.

School-based social and emotional instruction (SEL) focuses on five core competency areas: self-awareness, self-management, social awareness, relationship skills, and responsible decision making¹. Such instruction typically includes efforts to develop skills such as recognizing and managing emotions, setting and reaching goals, appreciating others’ perspectives, establishing and maintaining relationships, and handling interpersonal situations constructively. Skills may be modeled, practiced, and then applied throughout the school day.

Telemental health services are mental health care services provided over a distance via telephone or videoconference. Services can include psychotherapy, counseling, supplemental support services accompanying face to face therapy, and self-directed services such as online cognitive behavioral therapy. Patients can receive care via their home computer through services such as Skype or be hosted at clinics or hospitals where telemedicine equipment is housed.

Trauma Informed Communities (TIC) includes the use a comprehensive, multi-stakeholder, and multilevel approach to support and strengthen traumatized and distressed residents and communities and address the effects of unresolved community trauma such as historical community disinvestment, poverty, inadequate and insufficient housing, violence, social isolation, and structural racism.

A Mental Health Action Planning retreat was held by Healthy Cabarrus virtually, due to COVID-19 restrictions, on January 28, 2021. During the retreat, a multi-sectoral group of community partners and individuals with lived experience were convened to review the Community Needs Assessment findings and identify strategies, partnerships or new initiatives that could address factors that are driving up psychiatric ED admissions and limiting individual's access to mental and behavioral health services. The discussion led to three main themes for the Mental Health Advisory Board and the associated task forces to focus on:

• Coordination of Services for Justice Involved Persons
• Data and Assessments
• Trauma Informed Communities

The table below outlines strategies identified to improve the mental and behavioral health of individuals in Cabarrus County. Lead agencies and recommended performance measures are also included. It should be noted that as interventions are implemented and data is shared across agencies, modifications may be necessary to best capture appropriate performance measures to highlight impact of efforts.

Additional Community Interventions and Strategies

• New In-Patient Mental Health Facility in Cabarrus County
• Amazing Grace Advocacy: Respond to the desperate need of support and case management for children in Cabarrus County with complex disabilities of the brain, involving mental health, childhood trauma, autism, intellectual disabilities, and neurological brain disorders.
• Atrium Health Cabarrus: Create an expanded behavioral health holding unit outside of the Emergency Department at Atrium Health Cabarrus. The new behavioral health holding unit will be a 3,623 square-foot locked space encompassing between 12 to 14 beds, a dedicated shower, a telepsych unit, and other behavioral health care needs.
• Cabarrus County and Kannapolis City Schools: RECONNECT for Resilience trainings are trauma-informed and resiliency-focused, and offer practical strategies that individuals, organizations, and whole communities can use to promote balance and wellbeing. 
• Cano Family Services: Provide culturally competent, specialized, behavioral health and parent education services to individuals and families in Cabarrus County.
• Camino Health Center: Support to launch a bilingual behavioral health services program and expand primary care services at Concord locations
• Genesis A New Beginning: Provide on-site therapy in Cabarrus County and Kannapolis City Schools.
• Kannapolis Head Start: Mental health provider to determine mental health needs within the Head Start program.
• Mental Health America: Emotional Toolbox for Building Resilient Communities is a comprehensive, county-wide initiative that serves to provide the community with access to the resources, awareness, education, and online screening tools needed to address mental health concerns for themselves, their families, friends, coworkers, and neighbors.
• Silver Linings for Seniors: Employ Community Health Workers (CHWs) to promote mental health services and provide mental health first aid training in communities. Provide direct services, mental health counseling to Cabarrus County residents (via teletherapy and in-person counseling).
• Vida Wellness Center: Mental health counseling services through individual sessions, family sessions, and group counseling services.