What's Helping? 

• “A great school system supports this population.  We also have a numbner of agencies who know about and believe in the ACEs.  There have been trainings on ACEs and right before COVID hit, we were planning another conference that would include ACEs.”
• Telehealth Options
• Community Collaboration
• Social Workers
• Drug court
• Support groups
• School Counselors
• Broadband internet
• Transportation to specialists
• Churches
• Mental Health Training/Schools

What's Hurting? 

• “Lack of dedicated resources to building community capacity to understand the issues and understand how to take knowledge learned to build resiliency.  Reduce and treat trauma and develop policies and practices to intervene.”
• Shame, stigma, resistance, lack of empathy
• Needing Medicaid to acquire services
• Need more certified counselors in schools
• COVID-19 issues and no sense of normalcy
• Transportation problems
• Lack of job opportunities 
• Geographically isolated areas
• Poverty
• Access/lack of providers
• Barriers to obtaining care and treatment
• Lack of funding for un or under-insured (treatment/medications)
• Response time to crisis calls
• Wait time to see providers
• Difficulty treating clients with complex mental health/substance use disorder needs
• Need more student support within the schools
• Lack of support within the community
• Lack of community education
• Lack of sober living homes
• Lack of detox or inpatient treatment programs
• Lack of counseling and support
• COVID-19 Pandemic

What do people most affected by this issue say?

• Court issues
• Financial pressures/barriers
• Lack of Medicaid
• No transportation to access community resources
• Isolation
• Stigma
• Trauma history
• Emotional neglect
• Growing up in dysfunctional family/generational cycle
• Low self-esteem; feeling of acceptance when using
• Lack of or loss of recreational activities

“Local leaders, especially foundation directors and elected officials, looking closely at data to address the underlying root causes of trauma in Avery.  To name a few, poverty, housing, transportation, access to health food, access to primary care, behavioral health, dental health, and substances abuse disorder treatment.  County-wide training around trauma/resiliency-informed science, practices, and policies and the impact on youth and families in crucial…especially with all groups/agencies in the county who serve youth/families…law enforcement, schools, non-profits, health dept, social services, courts, juvenile justice, etc.”

Partners in our Community Health Improvement Process:

• Avery Cares, Drug Crisis Roundtable
• Healthy Carolinians of Avery County
• Avery Youth Initiative
• Avery County Health Department
• Cannon Memorial Hospital
• Daymark Recovery Services
• Avery County Social Services
• Western Youth Network
• Avery County Schools
• Feeding Avery Families
• Avery County Drug Court

Partners with a Role in Helping Our Community Do Better on This Issue: 

• EMS
• Law Enforcement
• Local Health Providers
• Pharmacies
• Churches
• Parents/Grandparents
• Youth
• WNC Healthy Impact
• Triple P/Blue Ridge Partnership for Children
• Community Leaders
• Mayland Community College

Process for Selecting Priority Program/ Strategies:

A community wide 75-questionnaire was conducted in the spring and summer of 2021 to give residents an opportunity to express concerns and opinions about the quality of life in Avery County. This included questions about the quality of life, economy, education, health, housing, physical activity, social issues, transportation, and COVID. Surveys were conducted by telephone by a trained interviewer and efforts were made to reach a representative sample of the population.   Self-administered surveys were also available online. A total of 225 Avery County surveys were analyzed: 200 via telephone interview and 25 via the publicly available weblink.  

Some of the major findings that the Healthy Carolinians of Avery County discussed in the prioritization process included the large proportion of respondents whose life has been negatively influenced by substance abuse.  Approximately 27% of respondents were classified as excessive drinkers and 12% reported using opioids in the past year, with or without a prescription.  Twenty percent of respondents reported more than seven days of poor mental health in the past month and almost 20% did not get needed mental health care or counseling in the past year. Sixty-five percent of Avery County respondents had calculated BMIs in the overweight or obese range and less than a quarter of respondents got the recommended amount of physical and strengthening activity in an average week.  Twenty percent of respondents reported current smoking, 12% used smokeless tobacco and 7% used vape products.

In additional to secondary data and survey collection, eleven (11) community stakeholders participated in an online key informant survey.  Individuals were asked to consider specific health issues, provide comments about social determinants of health, and evaluate the strengths and opportunities of the Avery County community. The graphic below displays a summary of their ranking of health topics in the community.

During monthly meetings, standards for the Community Health Assessment Process and Accreditation were discussed and reviewed for publication in the 2021 Community Health Assessment. Each member reviewed and approved of the Community Health Assessment Survey and Community Resource Directory included in the assessment. After the analysis was completed, qualitative and quantitative data findings were presented to the CHA team. The team reviewed the data and developed the top ten major health issues based upon statistical data and community survey results.  Based on findings from the community survey combined with secondary health data, in November 2021, Healthy Carolinians of Avery County members identified chief health concerns for the county.

1. Substance Abuse
2. Obesity Issues
3. Mental Health
4. Childhood Trauma
5. Food Insecurity
6. Poverty Issues
7. Housing Expenses
8. Language Barriers
9. Stigma
10. Effects of COVID-19

In November 2021, Healthy Carolinians of Avery County along with the CHA Team members participated in a prioritization activity to determine the three leading health concerns to be addressed during this cycle. The worksheet asked that each of the ten concerns be ranked, to find the top three concerns for future action. The results from the prioritization process were reviewed and discussed at the meeting. Results of these worksheets were calculated to come up with the top three priorities, which are as follows:

1. Mental Health
2. Substance Abuse
3. Food and Nutrition

The following actions have been identified by community members as ideas for what can work for our community to make a difference on Mental Health.

Actions and Approaches Identified by Our Partners

• Treat/help people from being repeat criminals, and encouraging re-entry into society
• Prevent/Influence and impact others to make the right choices creating awareness around the consequences
• Expand education in middle school and high school settings
• Support Groups
• Awareness and education on mental health issues

What is Currently Working in Our Community 

• Access/Public Mental Health facility

• Medication Assisted Treatment program at High Country Community Health
• Community collaboration
• Youth Education (schools) and Empowerment (MP3)
• Madison Substance Awareness Coalition (collaboration)
• Youth assessment/survey collection
• Community survey collection
• Drug Court
• Substance Use support groups
• Triple P
• Stigma education
• Telehealth in schools and jail
• Resilience Training, suicide prevention training and mindfullness/mental health classes in schools and community
• Drug free community grant
• Expansion of internet/public hot spots
• Child Fatality and Protection Team efforts

Evidence-Based Strategies