This SOTCH Scorecard was created and submitted by June 1st, 2021 to meet the requirements for the Transylvania County annual State of the County's Health (SOTCH) Report.
The 2018 Community Health Assessment priority areas are:
Clear Impact Scorecard™ is a strategy and performance management software that is accessible through a web browser and designed to support collaboration both inside and outside organizations. WNC Healthy Impact is using Clear Impact Scorecard™ to support the development of electronic CHIPs, SOTCH Reports and Hospital Implementation Strategy scorecards in communities across the region.
Scorecard helps communities organize their community health improvement efforts:
The following resources were used/reviewed in order to complete the SOTCH:
Mental health and substance use are interconnected to each other and to issues that include suicide deaths, overdose deaths, adverse childhood experiences, depression, anxiety, liver disease, alcohol-related motor vehicle crashes, lung cancer, COPD, and employment. However, residents have limited options for treatment and counseling options, especially for those who have lower incomes, no insurance, or transportation issues. Despite promising community efforts to address substance use and suicide, there is still much work to be done in this area.
Mental Health and Substance Use and the related conditions of well-being are aligned with the following Healthy NC 2020 Focus Areas.
How would we experience lifelong physical, emotional, and social well-being of all residents in Transylvania County?
Community members said that we could experience the following conditions:
What information led to the selection of this health issue and related result?
Transylvania County residents reported more “poor” mental health days; some said they were unable to get the care they need. Suicide rates are higher than the state rates and residents are being treated for mental health symptoms through emergency department visits and hospitalization. Mental health concerns are linked to substance use and ACEs. Key informants named both general mental health and depression/anxiety/stress as top concerns and said that additional treatment resources were needed. Mental health was a priority health issue in 2015.
Substance use is related to overdose deaths, liver disease mortality, and motor vehicle crashes. Smoking rates among pregnant women and breathing someone else’s cigarette smoke at work are concerns. Substance use is connected to mental health and ACEs. Many residents reported their lives being affected by substance use and it was the #2 top community concern named by key informants. It was the top priority health issue in 2015.
In the 2019 Community Health Assessment process, community members identified many connections between mental health and substance use, and determined that they should be addressed as a single priority in Transylvania County.
According to the US Office of Disease Prevention and Health Promotion, "Several factors have been linked to mental health, including race and ethnicity, gender, age, income level, education level, sexual orientation, and geographic location. Other social conditions—such as interpersonal, family, and community dynamics, housing quality, social support, employment opportunities, and work and school conditions—can also influence mental health risk and outcomes, both positively and negatively."1 In addition, "Several biological, social, environmental, psychological, and genetic factors are associated with substance abuse. These factors can include gender, race and ethnicity, age, income level, educational attainment, and sexual orientation. Substance abuse is also strongly influenced by interpersonal, household, and community dynamics. Family, social networks, and peer pressure are key influencers of substance abuse among adolescents."2 Within Transylvania County, individuals with low incomes; those without stable, adequate, and affordable housing; those who may be socially isolated due to geography and lack of transportation; and those with a family history of mental health or substance use issues are at higher risk for poor outcomes in the areas of mental health and substance use. Individuals with high ACE scores are more likely to experience negative health behaviors such as substance use and suicide. In addition, those without access to health insurance are less likely to be able to access care when needed, and resources are limited for mental health and substance use treatment within Transylvania County.
Applied Suicide Intervention Skills Training (ASIST) is a two-day interactive workshop in suicide first-aid. ASIST teaches participants to recognize when someone may be at risk of suicide and work with them to create a plan that will support their immediate safety. Although ASIST is widely used by healthcare providers, participants don't need any formal training to attend the workshop. Results demonstrate that ASIST helps participants become more willing, ready, and able to intervene with someone at risk of suicide. ASIST is also proven to reduce suicidality for those at risk. A 2013 study that monitored over 1,500 suicidal callers to crisis lines found that callers who spoke with ASIST-trained counselors were 74% less likely to be suicidal after the call, compared to callers who spoke with counselors trained in methods other than ASIST. Callers were also less overwhelmed, less depressed, and more hopeful after speaking with ASIST-trained counselors.
Speaker Fe Anam Avis is a nationally known figure in suicide prevention work and has trained thousands of people in suicide awareness and intervention skills. He is the creator of Soul Shop™, an international movement which trains clergy, ministry leaders, and community members to care for those impacted by suicidal desperation as a regular aspect of their life together.
The priority population for this training is any interested community members, and the training aims to make a difference at the interpersonal behavior level. However, this program would also have a profound impact on the priority population of people with existing mental health concerns and those with socioeconomic or other underlying conditions that increase the risk of mental and behavioral health concerns). Implementation of the training itself will take place in a local church, but those trained may work in a variety of community settings.
The Lutheran Church of the Good Shepherd's Reimaging Health Collaborative has been a partner with public health and other community organizations to promote and host outreach and education around important mental health and substance use topics. In October 2019, they hosted a Community Suicide Awareness Training with speaker Fe Anam Avis to provide attendees with basic conversational skills to help someone considering suicide.
In November 2019, the Collaborative and the church's worship and music teams hosted a community Service of Hope and Assurance that focused on providing quiet, uplifting accompaniment for those who may have difficulty facing the impending holiday season.
In December 2019, the Collaborative reached out to community groups to begin planning efforts to host a two-day ASIST training in Transylvania County. Transylvania Public Health's Healthy Communities coordinator offered support for the training, including funding through the Healthy Communities program. Planning meetings were set for January 2020, and the training for up to 30 people was scheduled for April 2020. Due to COVID-19 restrictions, the training was delayed and will be rescheduled for later in 2021.
The partners for this training include:
Agency |
Person |
Role |
Lutheran Church of the Good Shepherd | Kimberly Dunbar | Lead |
Transylvania Public Health | Beth Hyatt | Support |
Transylvania County’s top two causes of death and many of our morbidity statistics of concern including obesity, type 2 diabetes, high blood pressure, heart disease, certain cancers, and stroke are directly affected by nutrition and physical activity. Residents report having trouble accessing healthy food and getting the recommended amount of physical activity.
Healthy Lifestyle and the related conditions of well-being are aligned with the following Healthy NC 2020 Focus Areas.
How would we experience lifelong physical, emotional, and social well-being of all residents in Transylvania County?
Community members said that we could experience the following conditions:
What information led to the selection of this health issue and related result?
Many county residents are overweight or obese, which is connected to multiple poor health outcomes including diabetes. Residents are not meeting recommendations for nutrition and physical activity, and many residents experience regular stress and other barriers, all of which contribute to obesity. It was the #1 top concern among key informants and was selected as a health priority in 2015.
Diabetes is related to obesity, physical activity, and nutrition, and rates are increasing. It was named as a top community concern by key informants. Key informants also identified heart disease/stroke as a top community concern, and it, too, is closely related to body weight and physical activity. A large proportion of Transylvania County’s population is affected by high blood pressure and stroke, and cardiovascular disease is a leading cause of death and hospitalization. Cancer was the leading cause of death in Transylvania County. Incidence can be related to ACEs, behaviors like alcohol and tobacco use, and environmental causes like radon, but cancer is also linked to overweight and obesity.
According to the US Office of Disease Prevention and Health Promotion, "Good nutrition, physical activity, and a healthy body weight are essential parts of a person’s overall health and well-being. Together, these can help decrease a person’s risk of developing serious health conditions, such as high blood pressure, high cholesterol, diabetes, heart disease, stroke, and cancer. A healthful diet, regular physical activity, and achieving and maintaining a healthy weight also are paramount to managing health conditions so they do not worsen over time."1 Within Transylvania County, individuals with low incomes or who work long hours; those without stable, adequate, and affordable housing with adequate kitchen facilities; those who may be far from grocery stores and infrastructure for physical activity due to geography and lack of transportation; and those who must travel long distances to and from work are less likely to have the time, desire, and opportunity to prepare and cook nutritious meals and spend leisure time being physically active. In addition, people who are overweight or obese, those who do not eat the recommended amount of fruits and vegetables, and those who do not participate in the recommended amount of physical activity are at-risk for poor health outcomes including diabetes, stroke, high blood pressure, and high blood cholesterol.
Diabetes Prevention Programs are CDC-recognized lifestyle change programs that offer participants with a full year of support and tools to learn how to eat healthy, add physical activity to daily routines, manage stress, stay motivated, and solve problems that can get in the way of goals. This program is proven to prevent or delay type 2 diabetes. Participants who lost 5-7% of their body weight and added 150 minutes of exercise per week cut their risk of developing type 2 diabetes by up to 58% (71% for people over 60 years old).
DPP is an ongoing program in our community, but has never been offered at Brevard Housing Authority. The priority population for this program are residents of Brevard Housing apartments, who typically have low household incomes and are more likely to be African American. DPP aims to make a difference in individual and interpersonal behaviors. Implementation will take place in the neighborhood where most participants live.
TPH staff supported implementation of a Diabetes Prevention Program at Brevard Housing Authority. The initial classes concluded in 2019 and monthly follow-up classes were ongoing into 2020. A virtual DPP option was offered in 2020 and follow-up classes will continue into 2021.
TPH also received funding from NC State to implement an additional DPP at a worksite, but the original worksite preferred an online DPP option and no other interested worksites have been identified to date.
The partners for this program include:
Agency |
Person |
Role |
Transylvania Public Health | Julie Cunningham | Lead |
Brevard Housing Authority | Nicola Karesh | Lead |
NEW AND EMERGING ISSUES
These are the new or emerging issues in Transylvania County in 2020 that were not identified as priorities in our 2018 Community Health Assessment.
The following were new initiatives or changes in our community in 2020: