2020 Transylvania County SOTCH Scorecard

Why It Matters?

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.

Alignment

Mental Health and Substance Use and the related conditions of well-being are aligned with the following Healthy NC 2020 Focus Areas. 

• Mental Health: "Mental health, an integral component of individual health, is important throughout the lifespan. Individuals with poor mental health may have difficulties with interpersonal relationships, productivity in school or the workplace, and their overall sense of well-being. Depression is linked to lower productivity in the workplace, is a leading cause of suicide, and has been associated with increased use of health care services." (North Carolina Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: North Carolina Institute of Medicine; 2011.)
  • Objective 1. Reduce the suicide rate (per 100,000 population)
  • Objective 2. Decrease the average number of poor mental health days among adults in the past 30 days
  • Objective 3. Reduce the rate of mental health-related visits to emergency departments (per 10,000 population)
• Substance Use: "Substance use and abuse are major contributors to death and disability in North Carolina. Addiction to drugs or alcohol is a chronic health problem, and people who suffer from abuse or dependence are at risk for premature death, comorbid health conditions, injuries, and disability. Therefore, prevention of misuse and abuse of substances is critical. Furthermore, substance abuse has adverse consequences for families, communities, and society, contributing to family upheaval, the state’s crime rate, and motor vehicle fatalities." (North Carolina Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: North Carolina Institute of Medicine; 2011.)
  • Objective 1. Reduce the percentage of high school students who had alcohol on one or more of the past 30 days
  • Objective 2. Reduce the percentage of traffic crashes that are alcohol-related 5.7%
  • Objective 3. Reduce the percentage of individuals aged 12 years and older reporting any illicit drug use in the past 30 days

Experience & Importance

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.

What Is It?

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.

Updates

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.

Partners

The partners for this training include:

Why It Matters?

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.

Alignment

Healthy Lifestyle and the related conditions of well-being are aligned with the following Healthy NC 2020 Focus Areas. 

• Physical Activity and Nutrition: "Overweight and obesity pose significant health concerns for both children and adults. Excess weight increases an individual’s risk of developing type 2 diabetes, high blood pressure, heart disease, certain cancers, and stroke.39 For the first time in two centuries, the life expectancy of children in the United States is predicted to be lower than that of their parents. The root cause of this phenomenon is the increase in obesity.40 Increased physical activity and improved nutrition are among the many factors that can help individuals reach and maintain a healthy weight." (North Carolina Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: North Carolina Institute of Medicine; 2011.)
  • Objective 1. Increase the percentage of high school students who are neither overweight nor obese.
  • Objective 2. Increase the percentage of adults getting the recommended amount of physical activity.
  • Objective 3. Increase the percentage of adults who consume five or more servings of fruits and vegetables per day.

Experience & Importance

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:

• Access to natural world
• Less chronic disease
• Less substance use
• Access to affordable healthy food
• Active lifestyles
• Systems that support physical activity e.g. infrastructure, sidewalks, paths
• Sense of community engagement
• Less social isolation
• Healthy social experiences
• Education and ability to make good choices
• Fewer unintentional deaths
• Supports to age in place e.g. fall prevention
• Transportation / better public transit
• Participation in youth sports
• Protected natural resources
• Employer support for healthy lifestyle
• Promoted resiliency
• Importance of vaccines understood
• Education in schools
• Experiential education and opportunities across the lifespan
• Year-round options for physical activity
• Affordable options / sliding scales
• More pools
• Life skills training
• People know how to access information
• Living wage jobs
• Access to basic healthcare
• Alternative treatments
• Prevention options
• Celebration of diversity in race, ethnicity, religion, etc.
• Intentional and collaborative efforts

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.

What Is It?

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.

Updates

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.

Partners

The partners for this program include:

Updates

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 COVID-19 pandemic caused disruptions to most aspects of life in Transylvania County. Primary areas of concern include restrictions on visits to nursing home residents, school and childcare closures (which affected parents' ability to work and access to meals for children), avoidance of healthcare provider and emergency department visits, and limitations on in-person services for a variety of social services. To address these new needs, long-term care facilities offered "window" visits and drive-by "parades for residents, Transylvania County Schools offered bus delivery and pick-up options for meals, Transylvania County's Parks and Recreation began a weekday childcare camp for children of county employees, many healthcare providers began offering or enhanced access to telehealth visits, and other providers offered remote or parking lot options to receive services. Large proportions of public health staff time were diverted from CHA strategies and other chronic health activities into COVID-19 response activities. 
• Transylvania County's United Way closed in January 2020, due to "a changing climate of philanthropy, reduced donations, and a myriad of new options for people to donate to charitable organizations." About 15 local non-profits that were receiving funding from United Way have had to seek funding from other sources or make changes to programming. The direct service programs associated with TRAIN (Transylvania Resource Access Information Network) have been tranferred to other agencies: Transylvania County Library is now managing the monthly roundtable and newsletter for non-profit and governmental service agencies. 

Updates

The following were new initiatives or changes in our community in 2020:

• Pisgah Health Foundation and Dogwood Health Trust continued to offer grants to Western North Carolina counties. Pisgah Health Foundation is focused on improving health and wellness by addressing healthy opportunities in targeted social determinants of health areas including health, food insecurity, housing, social cohesion, and education. Dogwood Health Trust funding will address substance use, as well as immediate needs and a "leverage fund" designed to help organizations bring in grants from other funders.
• The Blue Zones Project conducted community feedback sessions in January and February 2020 on the topics of built environment, food policy, and tobacco policy, which directly affect the community's selected health priorities. The official kick-off was planned for May 2020, but was delayed until September due to COVID-19 limitations. Committees have been meeting remotely to develop plans and policies. The food policy committee is focused on improvements to school food service, restaurants, hospitals, and grocery stores. The tobacco policy committee began work to review and draft options for tobacco-free city buildings and public events.
• The C.A.R.E. Coalition of Transylvania County was awarded an additional grant to address substance use among county residents, with grantwriting assistance from the Dogwood Health leverage fund. All meetings shifted to remote format (Zoom) in April 2020, but participation and engagement remained high. The coalition is preparing to conduct its second mental health survey of middle and high school students in cooperation with Transylvania County Schools in spring 2021.
• Transylvania County Commissioners officially signed the ordinance to adopt tobacco-free county buildings, grounds, and parks in February 2020. New signage was installed on county campuses by fall 2020.
• Healthy Communities funding from NCDPH included strategies to address nicotine use and vaping in schools. An employee of Blue Ridge Community College who works in both county high schools was identified to take the Certified Tobacco Cessation Specialist training, which was completed in June 2020. Promotional materials were distributed to both Brevard and Rosman high schools about the services for students. Public health staff are also working on options for policies or pledges for coaches of youth and school sports to not use tobacco products while coaching and to encourage athletes not to use tobacco products.
• Healthy Communities strategies also allowed for continued efforts around healthy food access. Public health staff worked with the Transylvania County Hunger Coalition to support food pantries throughout the county. Food distribution continued, although some changes were needed to comply with COVID-19 limitations. A new food pantry was opened at Christ Church of the Nazarene, and hours of operations were extended at Silvermont and Quebec Senior Meal Sites. Public health staff also served on a county-wide feeding committee with representatives from Transylvania County Schools, non-profits, and food pantries. This group worked to distribute information about the school system's efforts to increase food access for students and helped coordinated food assistance for individual families affected by COVID-19.
• TPH partnered with MountainWise to continue worksite support with funding from Appalachian Regional Commission. Gaia Herbs received its full Breastfeeding-Friendly Workplaces Award designation in January 2020 by meeting all 3 required standards. Public health and Mountainwise staff also worked with Jarrett Brothers IGA Grocery in Rosman to begin offering "Double Up Food Bucks" that provide EBT recipients with $5 coupons to be used for future fruit and vegetable purchases for every $5 spent on produce. This program is also now being offered at the Transylvania Farmer's Market.
• TPH continued its work with HealthSpace to develop custom environmental health software to house all food, lodging and institutions records as well as well and septic permits.