HNC 2030 Scorecard: Richmond County

Why Is This Important?

Drug overdose is the leading cause of injury death in North Carolina and affects families and individuals in many ways including but not limited to physical and mental health, impaired attachments, economic hardships, legal problems, and violence (Lander et al., 2013).   

Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: From theory to practice. Social Work in Public Health, 28(3-4), 194–205. https://doi.org/10.1080/19371918.2013.759005

Description

In 2017, the Richmond County Drug Endangered Family Task Force (DEFT) was formed to address the local opioid crisis that contributed to the neighborhood violence, joblessness, higher numbers of child abuse reports, and children living in poverty —spearheaded by the Richmond County Department of Social Services in collaboration with community stakeholders, county government, local health department, and other local partners to provide treatment resources and community education. Funds were obtained from CADCA (Community Advocacy Data Coalition Association), CINC (Community Impact North Carolina), and Sandhills Opioid Response Consortium. This partnership is still thriving today, with additional funds being gained from the NC Opioid Settlement Funds. 

Partners

• Richmond County Department of Social Services DEFT | Richmond County, NC - Official Website (richmondnc.com)
  The Richmond County Drug Endangered Family Taskforce (DEFT) was formed to address the opioid crisis in our local neighborhoods. Community stakeholders, county government, and local agencies have joined forces to provide treatment resources and community education. We are committed to bringing awareness and prevention to Richmond County and its residents by working with local providers to reduce the supply of prescription opioids, increase community awareness and prevention, and supply naloxone to family, friends, and other interested parties who may work, live or know those who may use opioids.  
• Richmond County Health Department Health Department | Richmond County, NC - Official Website (richmondnc.com)
  The mission of the Richmond County Health Department is to help prevent disease, promote health, and protect the environment for all citizens of Richmond County, and to assess and respond to the community's health needs continually.
• Sandhills Opioid Response Consortium Substance Use Disorder | NC | FirstHealth of the Carolinas
  A FirstHealth community coalition committed to reducing opioid-related overdoses in Moore, Montgomery, Lee, Hoke, and Richmond counties. We work with our partners in each county to provide peer support, caregiver support, harm reduction kits, medicine for opioid use disorders, support groups, and syringe exchanges. We also support our partners in building community awareness by providing podcasts, virtual support, and community events like Drop Box locations. 
• Richmond County Partnership for Children Richmond County Partnership for Children | Smart Start (smartstartrichmond.org) 
  Working with parents and caretakers of young children, Richmond County Partnership for Children (RCPC) helps support families. Our Circle of Parents group provides parents with a healthy, non-judgmental outlet to discuss parenting struggles. We share information with our parents about the effects of their choices on children. RCPC continually offers resources and referrals to other community agencies to support our families in all areas needed.
• Richmond County Aging Services Aging Services | Richmond County, NC - Official Website (richmondnc.com)
  Richmond County Aging Services is an organization that provides a focal point for aging resources and opportunities to extend independent living and enrich the quality of life for Richmond County older adults. Older adults have a right to a voice in determining matters that impact them and access to sources of information and assistance for personal and family problems, including opportunities to learn from individuals coping with similar experiences. 
• Hamlet City Police Police Department (hamletnc.us) 
  Our agency, through investigations both self-initiated and community-driven, locates and finds both those using opioids and illegally selling opioids. In addition, we reach out to those who have addictions and try to provide resources to aid in recovery. We believe that both aiding in recovery as well as stopping the illegal supply of opioids is the best way we, as officers, can help the community.
• Rockingham City Police Rockingham Police Department Rockingham NC (gorockinghampd.com)
  The Mission of the Rockingham Police Department is to enforce the laws and ordinances of the State of North Carolina and the City of Rockingham. By providing quality law enforcement, we safeguard lives, enhance community safety, protect property, and reduce the impact and fear of crime. Our officers seek and preserve public confidence by the impartial observance of the law and by offering service and trust to all members of the public.
• Richmond County School System Richmond County Schools 
  The school system teaches drug awareness and avoidance. Richmond County Schools celebrate Red Ribbon Week in the elementary grades each fall, which supports students being drug-free! Each school utilizes counselors and teaching staff to highlight NC curriculum standards and stand-alone activities to promote students being drug-free.
• FirstHealth Emergency Medical Services Emergency Medical Services (EMS) (firsthealth.org)
  FirstHealth EMS is a nonprofit service that provides transports for 911 patients in Chatham, Montgomery, and Richmond counties. With 40 ambulances and 200 employees, the FirstHealth Regional EMS System is one of the largest ambulance systems in North Carolina, covering more than 3,000 square miles. Each county is unique but provides all our patients with a high level of Advanced Life Support (ALS) care. Together with our Medical Transport Team, FirstHealth EMS transports approximately 23,000 patients annually to various state destinations.
• FirstHealth Outreach Department FirstHealth of the Carolinas: Non-Profit Health Care Provider Network
• Sandhills Behavioral Center Sandhills Behavioral Center, Inc. - Outpatient Substance Abuse, Mental Illness Treatment Programs -North Carolina (sandhillsbc.com)
• Sandhills Center Sandhills Center - Mental Health Services
  Sandhills Center, as an organization, manages a network of mental health and substance use providers under Medicaid and state funding, also managing both program funds for an 11-county region. We play a supportive role for community stakeholders in their efforts to address mental health and substance misuse issues in their communities.
• Daymark Recovery Services Daymark Recovery Services - Richmond Center
• Samaritan Colony Addiction Treatments in Rockingham, NC | Samaritan Colony
• Alcohol and Drug Services of Richmond County Alcohol and Drug Services (ADS) | Addiction Treatment Greensboro and Asheboro | Prevention & Intervention Services (adsyes.org)
• Guardian Ad Litem Guardian ad Litem | North Carolina Judicial Branch (nccourts.gov)
  The North Carolina Guardian ad Litem (GAL) program equips community volunteers to serve abused and neglected children by advocating for their best interests in court, including recommendations for substance use treatment for children and parents.  
• Local Faith-Based Organizations
• Richmond County Sherriff's Department Richmond County Sheriff, NC | Official Website
  Our mission is to improve the quality of life in our county by reducing fear, preventing crime, and enforcing the law while protecting each individual’s freedoms guaranteed by the United States Constitution.
• Juvenile Crime Prevention Council NC DPS: Juvenile Crime Prevention Councils 
  The North Carolina Juvenile Justice section of the N.C. Department of Public Safety, Division of Adult Correction, and Juvenile Justice focuses on at-risk youth and juvenile justice issues across the state. Its mission is to reduce and prevent juvenile delinquency by effectively intervening, educating, and treating youth to strengthen families and increase public safety by providing a seamless, comprehensive juvenile justice system that provides the most effective services to youth and their families at the right time, and in the most appropriate setting. 
• Compassionate Counseling (910) 817-9927
• Connections Family Support (877) 211-5995
  Connections Family Support Program hosts a monthly support group at First United Methodist Church in the Bynum Building located at 400 E. Washington St. in Rockingham from 12 Noon to 1:30 PM with lunch provided. Anyone who has children with behavioral, emotional, or learning challenges. Each month, different topics are discussed, and resources are provided.  
• Moore County NC Addiction Recovery | Drug-Free Moore County Moore County NC Addiction Recovery | Drug-Free Moore County 
  Our non-profit organization provides information, education, and resources on prevention, treatment, and recovery to Moore County Citizens.
• Community Impact North Carolina Community Impact North Carolina - Preventing harm of drugs & alcohol (impactcarolina.org)
  To help individuals and communities who find themselves facing the challenge of alcohol and other drug misuse, Community Impact NC is increasing our focus on building safe, healthy, and strong communities. We believe that strong communities are the best way to prevent future harm. We bring expert knowledge and research into the design and implementation of our programs.
• North Carolina Harm Reduction Coalition NC Harm Reduction Coalition - Dedicated to implementing harm reduction interventions, public health strategies, drug policy transformation, and justice reform in North Carolina and throughout the American South. (nchrc.org)
  North Carolina Harm Reduction Coalition (NCHRC) is a statewide grassroots organization dedicated to implementing harm reduction interventions, public health strategies, drug policy transformation, and justice reform in North Carolina and throughout the American South. NCHRC engages in grassroots advocacy, resource and policy development, coalition building, and direct services for people impacted by drug use, incarceration, sex work, overdose, gender, HIV and hepatitis, and first responders.

What We Do

In 2021, it was announced that $56 billion in national settlements with opioid companies from the litigation of the role of companies in creating and fueling the opioid epidemic. The settlement also required significant industry changes to help prevent this type of crisis from ever happening again. A Memorandum of Agreement (MOA), or a legal document that establishes the terms and details of a partnership between two or more parties, was developed between the State and local governments and directs how opioid settlement funds are distributed and used in our state. To maximize funding to local communities on the front lines of the opioid epidemic, the MOA allocates 85 percent of settlement funds to North Carolina’s 100 counties and 17 municipalities with only 15 percent to the State. For more information regarding State spending on opioid settlement funds, please visit https://ncopioidsettlement.org/.

In 2023, DEFT received a significant portion of the NC Opioid Settlement Funds. DEFT is using these funds to assemble a Naloxone bank for emergency medical systems, law enforcement agencies, and other local agencies to replenish their supplies. Another usage of settlement funds is to issue grants to local agencies to help with substance use prevention, treatment, and rehabilitation. The agencies selected this year were the  Samaritan Colony and FirstHealth of the Carolinas. Samaritan Colony will use the grant funds to support fifteen (15) Richmond County people needing treatment and rehabilitation at their comprehensive center, and FirstHealth of the Carolinas will provide a peer support specialist to Richmond County Social Services. We hope that these programs make a measurable difference in our neighborhoods.  

As a collaboration of many local, regional, and state agencies, DEFT promotes Lock Your Meds (LYM) through sponsored events and social and local media advertisements. The focus of DEFT is to reduce the oversupply of prescription opioids, increase community awareness and prevention, increase Naloxone distribution, measure our impact, and revise strategies based on results.

Who We Serve

The service area is the geographical boundary of Richmond County, North Carolina. Richmond County is located in the southwestern corner of the North Carolina Inner Coastal Plains, considered the Sandhills Region. Richmond County's current estimated population is 42,724 (2022) and comprises a White population at 56% and a Black population of 30%. The remaining 14% of the population is American Indian, Pacific Islander, and Two or More Races. Gender averages to be an equal distribution of males to females. 45.6% of Richmond County's population is below the 200% Federal Poverty Level, with the most significant demographic living in poverty being Black females (19%) and White females (16%). Unemployment rates have dropped by 1.1% to near pre-COVID levels. The highest rates of unemployment by population are Native American (29.3%), Two or More Races (16.5%), and Blacks (13). 

How We Impact

DEFT impacts the community by providing resources, education, treatment, and prevention to the people at the highest risk. Using all methods at our disposal, DEFT helps support the systems in place, identify goals, and implement strategies and community plans to provide the best harm reduction possible. 

Overdose kits include Naloxone nasal spray, information on the signs and symptoms of opioid overdose, how to connect with a certified peer support specialist, as well as other resources are distributed by the peer support specialists, Division of Social Services social workers, law enforcement agencies, and Emergency Medical Services to those who may have had an overdose or suspected overdose or to families that may be concerned about a loved one with a substance use disorder.  

Why Is This Important?

Parenting at any age can be challenging, but it can be particularly difficult for teen parents. There are costs to having children during adolescence, such as; teen moms are less likely to finish high school, more likely to rely on public assistance, and more likely to be underprivileged as adults (CDC, 2019). In addition, children of teen parents are more likely to be challenged in education, behavior, and health outcomes throughout their lives (CDC, 2019).  

Center for Disease Control and Prevention (CDC). (2019). Teen pregnancy. Retrieved from https://www.cdc.gov/teenpregnancy/

Description

The Teen Pregnancy Initiative Team invited the Richmond County Health Department through the Women's Health Branch at the NC Department of Health and Human Services to apply for the Teen Pregnancy Prevention Grant offered through the Office of Adolescent Health. In July 2015, the Richmond County Health Department received a five-year grant of $1,250,000 to implement the Redefining and Empowering Adolescent and Community Health or REACH program. The goal will be to reduce the number of teen pregnancies in Richmond County by five percent by 2023, as indicated by the Richmond County Health Department 2020-2023 Strategic Plan.  

Partners

Richmond County School System/Richmond County Schools: Eighth and Ninth-grade health teachers and REACH curriculum facilitators collaborate to provide systematic and effective ways for adolescents to learn the essential knowledge and critical skills needed to decrease sexual risk behaviors, promote reproductive health, and connect students to health services in the community. 

What We Do

In December 2015, the CAG (Community Action Group) and the YLC (Youth Leadership Council) groups were formed to actively support the reproductive health education of Richmond County teens. In the spring of 2016, the health department completed a door-to-door survey of the county to access the county resident’s opinions on teen sexual health and behaviors, where they believe teens should receive sexual education and the type of sexual education they should receive. In addition, through the REACH Program, the health department hired three curriculum facilitators to serve as teen health educators. The curriculum facilitators and health education department have been trained in Reducing the Risk (RTR), Making Proud Choices (MPC), Promoting Health Among Teens and Abstinence-Only(PHAT-AO) curriculums, and Parents Matter. 

The Richmond County Health Department, in collaboration with the Richmond County School System, selected two evidence-based teen pregnancy prevention programs to be facilitated through the Healthful Living classes in the eighth and ninth grades. The health department piloted Reducing the Risk at the Ninth Grade Academy and Ashley Chapel Educational Center in 2016. During the 2016-2017 school year Reducing the Risk was taught through all ninth grade Healthful Living classes, and Promoting Health Among Teens-Abstinence Only was piloted at Ellerbe Middle, Rohanen Middle, and Hamlet Middle schools. In the 2017-2018 school year, Reducing the Risk will be entering year two of implementation for all ninth-graders, while Promoting Health Among Teen- Abstinence-Only began year one of implementation for all eighth-graders.

Beginning in December 2016 and before June 2021, the health department hopes that all eighth grade Healthful Living teachers in the Richmond County Middle Schools receive training in Promoting Health Among Teens-Abstinence Only for sustainability after the duration of the grant. As a result, the eighth grade Healthful Living teachers will be able to continue with the facilitation of Promoting Health Among Teens-Abstinence Only while the ninth grade Healthful Living teachers will receive training to facilitate Reducing the Risk for sustainability and then facilitate Reducing the Risk to the ninth-grade students.  

Who We Serve

The REACH program serves all eighth and nineth grade students of Richmond County through the curriculum of Healthful Living taught by the health and physical education teachers.  In year two (FY 2016-2017), REACH was implemented in five locations and had 683 youths completing the curricula.  In FY2018 or year three, 680 youth were targeted with a total of 894 students participating in a least one session.  In year four or FY2019, a total of 949 youths particiapted in at least one session of the target of 1,099 youths.  In the COVID year of FY2020, classes were done virtually with a total of 531 youth participation in at least one session of the the target of 552 youth.  

How We Impact

A total of 3,006 Richmond County youths were educated in high-risk behaviors, including alcohol, drugs, smoking, and sex, were taught positive reproductive health, and informed students of health services in the community. Eighty-eight percent (2,643) of the youth attended more than seventy-five percent of the program sessions. It is the hope of the health department that all eighth and ninth grade Healthful Living teachers will receive training to facilitate their program for sustainability and will be able to facilitate those programs through interpersonal communication and relationships essential standards of their curriculum. After the duration of the REACH grant, it is the hope of the health department that through the education of teens that adolescent birth rates in Richmond County decrease by at least ten percent. Teen education must be maintained in the school system after REACH funding is no longer provided to ensure the decline of adolescent birth rates.

Why Is This Important?

Cigarette smoking remains the leading cause of preventable death and disability in North Carolina and is responsible for 14,200 deaths each year, as well as 30 more people who are sick or live with a disability due to tobacco use (CDC, 2014). Despite a significant decline in the number of people who smoke, 34 million US adults still smoke cigarettes (CDC, 2021). Over 16 million Americans have at least one disease caused by smoking, and 58 million non-smokers are exposed to secondhand smoke (CDC, 2021). About 1,600 young people under 18 years smoke their first cigarette every day, and 235 start smoking daily (CDC,2021). In North Carolina, smoking healthcare costs amount to $3.81 billion, including $931 million in Medicaid and $293 million due to secondhand smoke that could be used for youth prevention and cessation (CDC, 2014). The additional cost of smoking to the NC economy is $4.2 billion in productivity losses each year.

Center for Disease Control and Prevention. (2021, December 28). Extinguishing the Tobacco Epidemic in North Carolina. Smoking & Tobacco Use. https://www.cdc.gov/tobacco/stateandcommunity/state-fact-sheets/north-carolina/
Center for Disease Control and Prevention, (2014). Best Practices for Comprehensive Tobacco Control Programs. Evidence Based Guides for States. https://www.cdc.gov/tobacco/stateandcommunity/best_practices/pdfs/2014/comprehensive.pdf

Description

Richmond County Health Department provides free tobacco cessation, inclusive of electronic devices, by a certified Duke-UNC Tobacco Treatment Specialist to the community at large. Additionally, in preventing tobacco use in children and young adults, Richmond County Health Department provides a CATCH My Breath certified youth tobacco specialist to work with the schools to implement the CATCH My Breath curriculum in the fight against vaping and tobacco products.  

Partners

• American Cancer Society Stay Away from Tobacco | American Cancer Society

The American Cancer Society is a nationwide voluntary health organization dedicated to eliminating cancer.

• Richmond County School System Richmond County Schools 

The school system teaches tobacco awareness and avoidance. Each school utilizes counselors and teaching staff to highlight N.C. curriculum standards and stand-alone activities to promote tobacco-free students.

• Region 6 Tobacco Collaboration

The collaborative works to improve the health of North Carolina residents by promoting smoke-free environments and tobacco-free lifestyles. Our goal is to build the capacity of diverse organizations and communities to implement and carry out effective, culturally appropriate strategies to reduce deaths and health problems due to tobacco use and secondhand smoke.

• Duke-UNC Tobacco Treatment Specialist Training Program Duke-UNC Tobacco Treatment Specialist Training Program | Durham, NC (dukeunctts.com)

The Duke-UNC Comprehensive TTS Program combines findings from the most current evidence-based research on pharmacotherapy, population-based issues, practical guidance on running a practice, and targeted skills in tobacco dependence counseling. Through a combination of interactive, virtual sessions and online self-paced training, Duke-UNC TTS offers leading-edge, evidence-based continuing education in a fun and engaging online experience. Completion of this course fulfills the training requirement for the National Certificate in Tobacco Treatment Practice (NCTTP), offered by the Association for Addiction Counselors (NAADAC).

• NC DHHS Tobacco Prevention and Control Branch  North Carolina Tobacco Prevention and Control Branch Home Page (ncdhhs.gov)

We provide information about evidence-based ways to reduce the toll of tobacco/vaping use on N.C. communities and to promote tobacco-free living. 

• QuitlineNC QuitlineNC.com

We provide free cessation services to any North Carolina resident who needs help quitting commercial tobacco use, including all tobacco products offered for sale and not tobacco used for sacred and traditional ceremonies by many American Indian tribes and communities. Quit Coaching is available in different forms, which can be used separately or with another program to help any tobacco user give up tobacco.

• CATCH My Breath  CATCH My Breath E-Cigarette & JUUL Prevention

CATCH My Breath is a peer-reviewed, evidence-based youth vaping prevention program developed by The University of Texas Health Science Center at Houston (UTHealth) School of Public Health. The program provides up-to-date information to teachers, parents, and health professionals to equip students with the knowledge and skills they need to make informed decisions about the use of e-cigarettes, including JUUL devices. CATCH My Breath utilizes a peer-led teaching approach and meets National and State Health Education Standards.

• North Carolina Healthy Beginnings Grant 

The Infant Mortality Reduction Program provides funding for education, support, and elimination of exposure to tobacco products to community members in assisting in the quitting of tobacco products (inclusive of electronic nicotine delivery systems) using the 5A’s (Ask, Advise, Assess, Assist, and Arrange). Grants are awarded for three years and are administered by the North Carolina Department of Health and Human Services, Division of Public Health, Women’s and Children’s Health Section, Women’s Health Branch, Perinatal Health Unit.

• Healthy Communities DHHS: DPH: CDI: Healthy Communities (nc.gov)

The North Carolina Division of Public Health (DPH) uses Preventive Health and Health Services (PHHS) Block Grant funding to administer the Healthy Communities Program through the Chronic Disease and Injury (CDI) Section. This program aims to reduce the burden of chronic disease and injury in North Carolina. This funding enables county and district health departments to implement community-based interventions that address poor nutrition, physical inactivity, tobacco use, violence, and unintentional injury.

What We Do

The American Cancer Society Freshstart program uses the 5As over four one-hour sessions to educate participants on the value of quitting smoking and not using electronic nicotine delivery devices. Each session covers strategies to overcome nicotine addiction and withdrawal, tools such as pharmacotherapies (e.g., patches, gum), a quit plan,  and the stay quit maintenance. In addition, each participant receives a Freshstart Participant Guide, six weeks of patches (3-step), incentives (i.e., teeth whitening strips, detergent, body wash), and support. Each participant is also offered NCQuitline referral and services.  

CATCH My Breath Tobacco Use Prevention curriculum is offered to the Richmond County Schools grades 5-12. The program includes workshops, webinars, teacher in-service training, and resources for parents, faculty, and staff to support tobacco and e-cigarette education. In seeking community support, the program also offers concerned citizens, parents, teachers, public health professionals a “Stand with CATCH My Breath” grassroots team for the latest information on tobacco prevention. The CATCH My Breath curriculum has been shown to significantly reduce the likelihood of vaping in the year following program implementation (Kelder et al., 2020).

To reach as broad an audience as possible concerning tobacco prevention and quit services, the Richmond County Health Department implements evidence-based media messaging campaigns approved by the Tobacco Prevention and Control Branch to prevent the use of all tobacco products by young people or help tobacco users quit. Some social media campaigns include Every Try Counts, Tips From Former Smokers, and Truth Initiative.  

Kelder, S. H., Mantey, D. S., Van Dusen, D., Case, K., Haas, A., & Springer, A. E. (2020). A Middle School Program to Prevent E-Cigarette Use: A Pilot Study of “CATCH My Breath.” Public Health Reports, 135(2), 220–229  https://doi.org/10.1177/0033354919900887

Who We Serve

We serve every one of all ages, races, religions, and ethnicities who live within Richmond County boundaries. According to County Health Rankings and Roadmaps (2021), Richmond County has twenty-six percent of adult smokers (age-adjusted) as determined by data from 2018. The percentage of the adult population who smoke in a county reports that they currently smoke every day or some days and have smoked at least 100 cigarettes in their lifetime. The current estimated population in Richmond County is 42,946 and comprises an estimated White population at sixty-one percent and an estimated Black population of thirty-two percent. The remaining estimated seven percent population is American Indian, Pacific Islander, and Two or More Races. The median age averages around forty-one years. Gender averages to be an equal distribution of males to females. The estimated population of persons under the age of eighteen is twenty-three percent and reflects the racial composition of the adult population.

How We Impact

The Richmond County Health Department, Smoking Cessation Program, impacts the community by promoting strategies to prevent smoking initiation, including electronic nicotine devices and eliminating exposure to secondhand smoke. In addition, Richmond County Health Department realizes a need to identify and eliminate tobacco-related disparities in our county. The disparities include high-risk populations such as those with mental illness, substance use disorders, and those who identify as lesbian, gay, bisexual, and transgender. Other disproportion populations include low-income, less-educated, males, young adults, children, Black and Native Americans.  

Richmond County Health Department and its partners collaborate on advocating and promoting tobacco-free environments and lifestyles. Together, we advocate for policies to end the sale of flavored tobacco products ( i.e., candy-flavored, menthol), increase state tobacco sales tax, create local tobacco-free policies (i.e., local government indoor and outdoor), restrict access of tobacco stores to minors, and increase restrictions on tobacco advertising.  

Progress on CHIP

 In 2020, it has been difficult to implement the community health improvement plan (CHIP) due to the COVID-19 pandemic. The program has been able to successfully:

• Adopting Results-Based Accountability

• Transitioning CHIPS from paper-based to web-based documents

• Setting up results, indicators, programs, and performance measures in Clear Impact Scorecard

• Linking to the HNC 2030 Scorecard to create greater awareness of population accountability

• Covid-19's impact on the CHA-CHIP-SOTCH process and the ability to work with partners and implement planned programs

Morbidity and Mortality Changes Since Last CHA

COVID-19  Related Deaths 
The Coronavirus has had an impact on the morbidity and mortality rates in Richmond County since April 2020, when the first case was recorded.  As of May 18, 2021, Richmond County has had 96 COVID-19 related deaths.  69 of the deceased have died in the local hospital system, 23 have died in another healthcare facility and 4 have died outside a hospital or healthcare facility setting.  Each death is recorded by gender, race/ethnicity, and age.  All data is collected locally and reported to the community as well as the to the NC Electronic Disease Surveillance System (NCEDSS). 

Figure 1
COVID Related Deaths by Race

Note: Data obtained from the NCEDSS 
 

COVID Related Deaths by Age
Figure 2

Note: Data obtained from the NCEDSS

COVID-19 Testing Data
All Richmond County residents who are tested for COVID-19, either locally or elsewhere, are reported to the Richmond County Health Department which checks for accuracy. Free drive-thru testing continues behind the Richmond County Health and Human Services building by an outside company.   Tests are divided into the total number of tests for the county and the total number of positive tests. Cases of COVID-19 are divided into the total number of recovered, age, gender, and race/ethnicity. All data is collected locally and reported to the community as well as the to the NCEDSS. 

Figure 3
COVID Negative, Positive, and Recovered Numbers 

Note: All data obtained from the NCEDSS

Figure 4
COVID Positive Tests by Age 

Note: All data obtained from the NCEDSS

Figure 5
COVID Cases by Gender 

Note:  All data obtained from the NCEDSS

Figure 6
COVID Cases by Race 

 Note:  All data obtained from the NCEDSS

COVID-19 Vaccination Data
All Richmond County vaccination data is supplied by the NC Department of Health and Human Services.  Vaccination in Richmond County is a coordinated effort between the Richmond County Health Department and the local hospital system, FirstHealth of the Carolinas.  Richmond County has aligned its vaccination target goal of 66% with that of the NC Department of Health and Human Services target goal.  As of May 18, 2021, 30% of Richmond County's population has been fully vaccinated and 33% has had at least one dose. 

Figure 7
Fully Vaccinated by Race 

Note:  Data obtained from NC COVID 19 Vaccination Management System (NCCVMS)

Figure 8
Partially vaccinated by Race 

Note: Data obtained from NCCVMS

Figure 9
Fully Vaccinated by Age

Note:  Data obtained from NCCVMS

Figure 10
Partially Vaccinated by Age 

Note: Data obtained from NCCVMS

Figure 11
Fully Vaccinated by Gender

Note: Data obtained from NCCVMS

Figure 12
Partially Vaccinated by Gender 

Note: Data obtained from NCCVMS

Emerging Issues Since Last CHA

The Coronavirus-19 had a profound and lasting effect on Richmond County.  Richmond County Schools were shut down early in the pandemic only to open the new year with virtual classes and staggered schedules for students, faculty, and staff.  This closure limited student's access to meals, which, combined with other community shut-downs, escalation of unemployment rates may have caused a worsening of food insecurity.  Efforts were made to combat this issue by local food pantries, local farms, faith-based organizations, and the school system to get food to many local children and families in need.  Richmond County Schools cafeteria staff dedicated long hours to provide meals to students and families in need that were delivered by school buses. Ever-present food deserts, having already been identified by the Richmond 2020 Coalition, may have been exacerbated because of the reduction in food availability due to ruptures in chain supply challenges. 

The aging population of Richmond County, many of who rely on strategically located community centers for daily supplemental food or meals, were particularly hit hard by the COVID pandemic.  Many of Richmond County volunteers who work or provide care for this vulnerable population are aging and susceptible to the virus, as well.  Whereas, family, friends, and volunteers may have bought/brought groceries and essentials for those who are socially and economically challenged were no longer able to assist being they were at high risk themselves.  Many people began using technology-driven food delivery services, such as Door Dash or Insta-cart which were not an option for older adults with limited technology literacy and in some cases limited internet access.  The Meals on Wheels program was running at high volume and needing volunteers before the pandemic became overwhelmed with applications. 

Housing became a serious issue.  However, state and local policies were established to prevent evictions and utility cut-offs for non-payment.  This provided a small but significant relief to those who were unemployed due to COVID restrictions.  Many of the churches provided homeless shelters, food, and aid to those in need, many of who were not of their congregation.  

Internet availability and accessibility became an issue quickly with schools trying to keep students current with the curriculum.  Older students had school-supplied devices for homework, projects, and research; however, the lack of internet in the home was a barrier to attending the virtual classes.  Barriers to having internet in the home were identified as affordability (devices and service), living in areas without internet service, and not enough broadband to support multiple streaming devices in the home.  Some barriers were overcome by Richmond County Schools supplying internet devices and hotspots to those in need, as well as delivering worksheet packets to the elementary school students.  Telemedicine emerged as a critical resource for many who were homebound or unable to access medical care which created other issues for many who could not attend doctor's appointments and could not access the internet as well as not having the technology literacy to use the applications (apps) for telemedicine.   

New/Paused/Discontinued Initiatives Since Last CHA

In response to COVID restrictions, office personnel began to work from home or work staggered schedules, and volunteers who donated time and energy to the many initiatives began to stay home.  This caused many of the Richmond County initiatives to be either paused or changed to other mediums.  Initially, most initiative meetings that were not paused began using telephone or conference calls because many thought the pandemic would end soon; however, since the pandemic proved to be longer lasting than expected many initiatives meetings moved to virtual settings.  Which increased the need for internet service and user-friendly virtual platforms.  The initiatives that were not paused or were resumed changed to a more educational outreach using social media and billboards.

Health People Health Carolinas, First-in-Health Richmond County 2020 Taskforce, Montgomery, and Richmond Coalition, Healthy Communities, and the Minority Diabetes Prevention Program all paused their initiatives because most of the members were also public health educators, hospital administration, medical providers, and school administration who were needed to work elsewhere to battle the COVID epidemic.  

Improving Community Outcomes for Maternal and Child Health (ICO4MCH), Tobacco 6 Tobacco Prevention and Control Branch, and Richmond County Drug Endangered Family Taskforce (DEFT) initiatives were paused with meetings going virtual.  Some initiatives were resumed to an educational component with outreach through social media.  Some outreach was through paid advertisements using social media as well as using strategically placed billboards in the county.  

Redefining and Empowering Adolescent and Community Health (REACH) and Juvenile Crime Prevention Council (JCPC) initiatives were paused then resumed with limitations using virtual platforms. 

Progress on CHIP

In 2021, due to ongoing COVID-19 efforts, it had been challenging to work on the community health improvement plans (CHIP).  The Richmond County Health Department was able to:

• Open clinics to the public, with COVID-19 restrictions 

• Run programs virtually or with COVID-19 social distancing restrictions 

• Develop detailed results, indicators, programs, and performance measures in Clear Impact Scorecard

• Link Clear Impact Scorecard to the HNC 2030 Scorecard to create greater awareness of population accountability

• Establish a health equity workgroup to assess and improve internal equity practices

Morbidity and Mortality Changes Since Last CHA

COVID-19 Efforts

In 2021, Richmond County Health Department continued the battle against COVID-19 with masking, social distancing, and limited clinic capacity, with a primary focus on vaccination. Mass vaccinations were carried out with the collaboration of the FirstHealth of the Carolinas hospital system on the First Health Moore Richmond Memorial Hospital campus. As mandated by the NC DHHS, vaccinations were carried out in a specific order; the first groups were first responders, healthcare professionals working with covid patients, and those who worked with vulnerable populations such as nursing home staff. County populations were then divided by birth year and vaccinated in chronological order, starting with the earliest years. Richmond County Vaccination Rate goal is 66%; by December 2021, the rate was 46%, 53% for those 12 years and older. The following graphs show the disaggregated data (November 2021) for those vaccinated. The most vaccinated racial group is the Asian or Pacific Islander at 43%, followed by the White at 34%, Black or African American at 28%, and the lowest being Native American or Alaskan Native at 12%.   The racial vaccination rates follow the general racial makeup of the county. While Asian or Pacific Islanders may have the highest rates of vaccination could be due to all of that 1% of the population becoming vaccinated. In addition, 4.3% of the local Spanish population were vaccinated.

Vaccination by age groups slightly decreases within the upper age groups and dramatically reduces as age does. By far, more women, 37%, are vaccinated than men, 31%, at any age. Low vaccination rates among underserved populations may be due to a lack of transportation to vaccination sites, social media misinformation regarding vaccines, or a lack of trust in local and state governments. To overcome this, the Richmond County Health Department did several vaccination sites, including Hoffman, Dobbin Heights, Ellerbe, Cordova, and the central Richmond County Senior High, to promote awareness and distribute vaccines to underserved populations. In addition, due to ongoing infections, drive-thru COVID testing sites were increased to a second site in the parking lot of the Robert L. and Elizabeth S. Cole Auditorium in Hamlet, which offered Rapid and PCR testing. Daily updates were issued using countywide social media and websites to increase transparency to the public regarding COVID infections, deaths, and vaccinations. A county zip code map was also distributed that displayed the number of cases in each area of the county. Examples are given below. 

Figure 1                                                                              Figure 2
Vaccination by Race                                                           Vaccination by Age
          
Note: COVID-19 Vaccine Management System (CVMS), November 2021              Note: COVID-19 Vaccine Management System (CVMS), November 2021

Figure 3                                                                                 
Vaccination by Gender                                                          
              

Note: COVID-19 Vaccine Management System (CVMS), November 2021      

Figure 4
Vaccination by Ethnicity

Note: COVID-19 Vaccine Management System (CVMS), November 2021   

Figure 5                                                                          
Example of Richmond County COVID Updates 
     
Note: Distributed daily through county social media, news media, and webpages

Community Health Improvement Plan: Substance Use Disorder

COVID-19 pandemic challenges affected those who suffered from substance use disorders, their families, and those in recovery. It is well known that many mental health disorders such as depression, bipolar disorder, anxiety disorder, schizophrenia, borderline personality disorder, and post-traumatic stress disorder contribute to substance misuse (NIDA, 2021). COVID pandemic restrictions included social isolation, closed mental health facilities, and closed outpatient treatment centers; which, combined with other stressors such as ongoing life disruption, changes to daily routines, job loss, and financial problems, aggravated already fragile individuals who suffer from ongoing mental health issues and substance misuse. This is undoubtedly true in Richmond County. Data has shown a sharp increase in annual overdose death rates from 2019 at 15.6% to 2020 at 53.5% and seems to be holding steady at that upper rate which is 20 points higher than the state rate at 32%. Fatal overdose events were 90% unintentional. The increase may have been due to the increased availability of illicitly manufactured fentanyl, fentanyl analogs, and the lack of a preferred substance. The rate of opioid overdose emergency department visits also escalated during the pandemic. Richmond County had a rate of 339% in 2020 to 420% in 2021. The Richmond County Emergency Medical Systems, operated by FirstHealth of the Carolinas, collects and reports data regarding naloxone distribution. These numbers should be interpreted with caution and may not be compared to numbers from 2020 because law enforcement also reported their naloxone reversals while 2021 data is only from emergency services. Richmond County Department of Social Services tracks infants born positive for substances and reflects on a case-by-case basis. Not all mothers and babies are tested. Reports have indicated that the major contributor was marijuana by 51% and usually one other substance such as methadone or an opioid. This also correlates with the increase of children in foster care from 34.1% in 2020 to 43.7% in 2021.

 Drug Endangered Family Taskforce (DEFT) worked remotely behind the lines of the pandemic by developing a webpage (https://www.richmondnc.com/489/DEFT) with public access to our local data and a listing of area resources and contact information of area recovery groups. The page also contains information from the National Institute on Drug Abuse regarding addiction science. Addiction awareness information comes in different formats for teens, parents, and teachers. The DEFT Peer Counselors set up FaceBook Live for private groups for daily counseling sessions since the weekly Addiction Recovery Support Group every Wednesday at the health department was paused due to COVID. DEFT also distributed medication lock boxes and naloxone kits to the community's individuals who may have a loved one in crisis. The cost of substance misuse has no limits and affects family, friends, relationships, and the community. Addiction can cause emotional pain for loved ones, particularly children, affecting their future lives and relationships. Due to the ongoing stigma around addiction, it may be challenging to bring up the subject or help. When loved ones are struggling with an addiction, one of the more essential things that can be done is learning more about the problem. 

Figure 7                                                                                                                                          
Annual Overdose Deaths                                                                                                         
 
Note: Data from North Carolina Opioid Action Plan Dashboard     

Figure 8
Opioid Overdose Emergency Department Visits

 Note: Data from North Carolina Disease Event Tracking and Epidemiologic Collection Tool 

Figure 9                                                                                              Figure 10                                                                                                                            
Naloxone Distribution                                                                        Infants Affected by Substance Use
              
Note: Data from the Richmond County Emergency Medical Systems                                                                        Note: Data from the Richmond County Child Protective Services                           

 Figure 11
Children in Foster Care Due to Parental Substance Use 

Note: Data from the Opioid and Substance Use Action Plan Data Dashboard

National Institute on Drug Abuse. (2021, December 15). Mental Health. Drug Facts. https://teens.drugabuse.gov/drug-facts/mental-health#topic-5

Community Health Improvement Plan: Teen Pregnancy 

Although the CDC (2021) reports that the national teen pregnancy rate has declined, evidence points to more teens abstaining from sexual activity, while other teens who are sexually active use birth control than in previous years. Richmond County teen pregnancy rates are still higher than the NC rates, historically accurate for the 15-19 age group. Through valiant efforts of the REACH program, teen pregnancy in the 15-17 age group has seen a decrease overall. The middle and high school students were educated on positive reproductive health practices and informed of local health services. The number drop from 2019 to 2021 indicates that COVID-19, when the health department health professionals were engaged in COVID testing and vaccinations and the clinic services, were temporarily discontinued. The age group, 18-19, has remained consistently high, which may be because this age group is going to college, getting married, and joining the workforce. Other contributing factors, low education, and low-income levels are two social determinants of health that may contribute to high teen births (CDC, 2021).

Table 1
Teen Pregnancy Rates 

Note: Data obtained from NC Division of Statistics Rates based on small numbers (<20 pregnancies) are unstable and not provided.

Figure 12                                                                                                       Figure 13
Long-Acting Reversible Contraceptive                                                           Family Planning Clinic 
                          
Note: Data from Richmond County Health Department Patagonia Electronic Health Records                      Note: Data from Richmond County Health Department Patagonia Electronic Health Records

Center for Disease Control and Prevention. (2021, December 12). About Teen Pregnancy. Reproductive Health. https://www.cdc.gov/teenpregnancy/about/index.htm
 

Community Health Improvement Plan: Smoking and Vaping

Richmond County Health Department Public Health Education Department has escalated its community smoking cessation efforts with an adaption of the American Cancer Society FreshStart program. The smoking cessation program consists of four sessions, one hour each using the 5 A's, practical counseling, motivational interviewing, and stages of change counseling. Counseling sessions were provided one-on-one or small socially distanced group sessions (3-4 individuals). Funding was provided by the Healthy Beginnings Infant Mortality Grant (IMR), which provided training from the Duke-UNC Tobacco Treatment Specialist Training program as well as provided incentives and nicotine replacement therapy for participants. Program promotion and advertisements were done with social media as well as encouraged through participant word of mouth. Referrals were unnecessary since anyone seeking help combating nicotine addiction can access the program; however, local primary care providers, health department clinic providers, and WIC participants were encouraged to ask patients who use tobacco to seek our program. Unfortunately, due to COVID restrictions, we could not promote the program by attending any community events this past year.

Richmond County Health Department, Smoking Cessation program, collaborated with the NC North Carolina Tobacco Prevention and Control Branch-Region 6, including Cumberland, Hoke, Harnett, Lee, Moore, Montgomery, Randolph, Richmond, Anson, and Scotland Counties. Region 6 Tobacco Control's goals are to build the communities capacity to implement and carry out effective, culturally appropriate strategies to reduce chronic tobacco-related health issues, tobacco-related death and prevent the initiation of tobacco use. In addition, funding provided by the Region 6 Tobacco Control enabled training for the Tobacco Treatment Specialist in the CATCH My Breath youth vaping prevention program as a community trainer. The free CATCH My Breath Curriculum is offered to the Richmond County School district and includes community and teacher workshops, webinars, and resources to support tobacco and e-cigarette education.   

Emerging Issues Since Last CHA

COVID -19, although not an emerging issue for 2021, brought about other health conditions which the National Institutes of Health refer to as long-term COVID-19 symptoms as PASC, which stands for post-acute sequelae of SARS-CoV-2 (Troxel et al., 2021). Common names include post-COVID syndrome, long COVID, or long-term COVID, and those with this condition are sometimes called “long haulers” (CDC, 2021). Symptoms can last weeks or months after the initial infection or appear weeks afterward. Long COVID could happen to anyone who has had COVID, even if their illness was mild or no symptoms. Most reported symptoms were:

• Difficulty breathing or shortness of breath

• Tiredness or fatigue

• Symptoms that get worse after physical or mental activities (post-exertional malaise)

• Difficulty thinking or concentrating (“brain fog”)

• Cough

• Chest or stomach pain

• Headache

• Fast-beating or pounding heart (heart palpitations or tachycardia)

• Joint or muscle pain (Arthralgia or Myalgia)

• Pins-and-needles feeling (Paresthesia)

• Diarrhea

• Sleep problems

• Fever

• Dizziness on standing (lightheadedness)

• Rash (hives or urticaria)

• Mood changes

• Change in smell or taste (Anosmia or Dysgeusia)

• Changes in menstrual cycles

The CDC (2021) emphasizes that understanding post-COVID conditions remains incomplete, and guidance for healthcare professionals will likely change over time as the evidence evolves. Long COVID can be challenging as well as caring for a loved one with the condition, especially when there are few to no answers or solutions. However, there are ways to help relieve the burden of experiencing or caring for a loved one with such conditions as joining support groups.   

Hamlet Senior Center offers a local COVID Support Group that meets on the last Wednesday of each month.

Other support groups include

Body Politic (https://www.wearebodypolitic.com/campaign),

 Survivor Corps (https://www.survivorcorps.com/), 

Long COVID Kids (https://www.longcovidkids.org/).

Centers for Disease Control and Prevention. (2021 Dec 15). COVID-19. Post-COVID Conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/

Troxel, A. B., Frontera, J. A., & Mendoza-Puccini, C. (2021). The National Institutes of Health COVID-19 NeuroDatabank and NeuroBiobank: A National Resource for Learning, Discovery, and Progress. Frontiers in neurology, 11, 615061. https://doi.org/10.3389/fneur.2020.615061

New/Paused/Discontinued Initiatives Since Last CHA

The COVID pandemic drew attention to pre-existing conditions this past year. Stress was placed on families, children, and vulnerable populations due to insufficient traditional school support, social isolation, racial injustice, economic distress, and lack of technological resources. These issues impacted the low-income, racial, and ethnic communities and highlighted disparities. 

To help overcome these and other disparities, the NC Division of Public Health received federal funding, known as the Advancing Equity Grant. This new funding initiative will be used to address local COVID-related health disparities and advance health equity by improving the Richmond County Health Department’s capacity to serve those at higher risk or underserved, which includes those of historically marginalized populations. HMPs or Historically Marginalized Populations as defined by the NC DHHS (2021) are those individuals, groups, and communities that have been denied access to services, resources, and power relationships across economic, political, and cultural dimensions due to systemic, durable, and persistent racism, discrimination, and other forms of oppression. HMPs are usually identified by their race, ethnicity, socioeconomic status, geography, religion, language, sexual identity, and disability status. In addition, the Advancing Equity grant has enabled the health department to establish a permanent internal workgroup, Advancing Health Equity Workgroup (AHEW), to assess and improve the internal equity practices and track equity efforts. These practices will include an examination and modification, if needed, of the organizational mission, vision, culture, policies, as well as the recruiting and hiring practices. Another facet of the grant is establishing or joining a local equity council in Richmond County. In this instance, the Richmond County Health Department has partnered with the Richmond County Partnership for Children to create a coalition to address Adverse Childhood Experiences (ACEs) and build community resilience. This coalition is still in the planning stages.

North Carolina Department of Health and Human Services. (2021, December 15). Healthier Together - Health Equity Action Network. https://covid19.ncdhhs.gov/HealthierTogether

Executive Summary

Priorities