HNC 2030 Scorecard: Montgomery County

Executive Summary

Vision
The shared vision of the Montgomery County Department of Health (MCDH) and its Community Partners is to improve the quality of life of Montgomery County citizens by enhancing their capacity to be healthy. MCDH and its Community Partners conducted the Community Health Assessment (CHA) with several end goals in mind:

• Understand the status of health in the County – what are the Leading Causes of Death, what diseases and conditions are prevalent and where do people get their health care.
• Understand the health and wellness obstacles and needs of the citizens. Calculate their perception of current services.
• Assess the effectiveness of communication between individuals and the health and wellness providers.
• Compare the current status to that of the past with an eye toward altering processes and improving communication in order to affect real change.
• Measure the equity of services and processes.
• Evaluate the position and strength of the County, MCDH and the Community Partners to obtain the necessary funding to make the changes and additions that will improve the capacity of its citizens to be healthy.

Leadership and Partnerships
The historic and ongoing affiliation of the Montgomery County Department of Health and its Community Partners, including FirstHealth, creates a core group of leaders that continually work to improve the health and quality of life of Montgomery County citizens. This core group has stepped-up to lead past CHAs and other efforts to evaluate, modify and improve health and wellness in the County. The core group again provided the leadership, and the muscle, to execute the 2020 CHA. The fact that a full CHA with appropriate documentation was accomplished during an unprecedented pandemic that drastically altered the day-to-day functionality and substantially increased the workload of all the partners is a testament to the fact that the core leadership is committed and the partnership is strong. Some of the challenges of the pandemic and resulting staff changes/losses is reflected in the Process included in this report. The CHA Work Group which represents most of the Community Partners is also provided in the following table:

Work Group Member Organization
Craig Jones - Town of Troy Mayor
Bridgette V. Bennett - Better Together Montgomery
Tawanda Bennett - Why Not Me Services
Kimberly Burger - Department of Health, Public Health Educator
Deandra Chambers - Purpose By Design
Annie Dara - FirstHealth School Health Centers
Roxanne Elliott - FirstHealth Community Health
Chrissy Haynes - Cooperative Extension
Pamela Munger - Sandhills Center
Debbi Musika - Montgomery County Partnership for Children
Rhonda Peters - Cooperative Extension
Dottie Robinson - Board of County Commissioner
Amy Santos - FirstHealth Community Health
Karina Sedano - Esther House

Regional/Contracted Services
Montgomery County Department of Health (MCDH) contracted with the consulting firm Leverage & Development, LLC to assist in the analysis of the data and in the development of the CHA report and appendices. The contractor worked under the direction of MCDH. The contractor has worked with several other counties in North and South Carolina on CHAs or CHNAs including: Anson County, NC (2012, 2016, 2020), Rowan County, NC, Union County, NC, Spartanburg County, SC and Cherokee County, SC.

Theoretical Framework/Model
The 2020 CHA was performed in accordance with the guidelines and recommendations from the NC Division of Public Health. The MAPP (Mobilizing for Action through Planning and Partnerships) was used in a modified form. Modifications were done to comply with Covid-19 guidelines from the CDC and the NC Division of Public Health. Modifications primarily impacted the collection of public input because survey solicitation, focus groups and meetings could not be done in person.

Collaborative Process Summary
May 2021: Prepared CHA Report and had it reviewed by CHA Work Group
March - April 2021:
Hired Consultant to do analysis and prepare CHA documents
Gathered Secondary Data
Analyzed Primary & Secondary Data with virtual input from CHA Work Group
August 2020
Modified Plan for Survey Solicitation
Solicited Survey Participation
Received deadline extension from NC Division of Public Health
Summer 2020
Modified CHA Plan because of Covid-19 Pandemic
February/March 2020
Established Work Group & held Initial Meeting
Developed Public Survey & Solicitation Plan
December 2019/January 2020
Determined CHA Work Group Goals
Developed Framework and Methodology

Key Findings

• Diseases of the Heart is the Leading Cause of Death in the County at a Rate that is 108.1 points higher than the #3 Cause of Death. It is 7.9 points higher than Cancer the #2 Leading Cause of Death.
• Several prevalent health conditions & behaviors contribute to Diseases of the Heart including:
  • Hypertension
  • Obesity
  • Diabetes
  • Nutrition
  • Cardiovascular Disease
  • Lack of Physical Activity
• Mental Health / Substance Abuse was seen as a major health problem and unhealthy behavior by the Public Survey participants.
• Rate of Opioid Emergency Department visits has increased by 110.8 points since 2010.
• Life Expectancy of minorities has consistently been lower than whites since 2012.
• Percentage of deaths in several "Leading Causes" is extremely dispproportionate to the percentage of Race/Ethnic population:
  • Kidney Disease
  • Diabetes
  • Cancer
  • Homicides
  • Unintentional Injuries

Health Priorities
Three priorities were selected based on the data collected through the CHA and considering the Healthy North Carolina 2030 Health Indicators/Targets. Care was made to be certain the priorities not only matched the data findings and the priorities of the State, but also position Montgomery County to capitalize on State and local funding and resources.

• Diseases of the Heart
• Mental Health / Substance Abuse
• Minority Health Equity

Diseases of the Heart – Priority
Diseases of the Heart were chosen as a priority not only because it is the Leading Cause of Death in the County, but also because of the following:

• It moved from the second Leading Cause of Death in the 2016 CHA to the first in 2020.
•  It has increased in females.
• It impacts Blacks/African Americans by a greater percentage than whites even though it is the #2 Leading Cause in Blacks/African Americans.
• It is caused or worsened by other health factors and unhealthy behaviors that can be changed/improved/treated.
• It not only has the potential to shorten life, it also diminishes Quality of Life.
• It is related to (affects/causes or is impacted by) several of the Healthy NC 2030 Health Indicators and the Desired Results:
  • Increase physical activity
  •  Improve access to healthy food
  • oReduce overweight and obesity
  • oIncrease life expectancy

Mental Health / Substance Abuse – Priority
Mental Health and Substance Abuse as a combination were chosen as a priority because of the following factors:

• Both of these impact many other health and quality of life issues such as:
  • Employment barrier
  • Maternity complications and Infant health/mortality
  • Traffic accidents and fatalities
  • Violent Crime increase
• Both have consistently been an issue for many years.
• They are often intertwined and must be addressed simultaneously.
• Mental Health was chosen as the 3rd most important Health Problem in the County. (#1 Obesity/Overweight and #2 Diabetes are addressed in the previous priority – Diseases of the Heart)
• Since 2010 there have been significant increases in the Rate of Unintentional Opioid Overdose Deaths and the Rate of Opioid Overdose Emergency Department/Room Visits. The Rate of Emergency Department/Room visits has increased 110.8 points since 2010.
• Participants in the CHA Public Survey said that 3 of the top 4 Unhealthy Behaviors listed in the survey are related to Substance Abuse:
  • #1 Illicit Drug Abuse
  • #3 Prescription Drug Abuse
  • #4 Drunk Driving
• They are related to (affects/causes or is impacted by) several of the Health NC 2030 Health Indicators and the Desired Results:
  • Improve child well-being
  • Decrease drug overdose deaths
  • Decrease excessive drinking
  • Improve birth outcomes
  • Improve access and treatment for mental health needs

Minority Health Equity – Priority
One of the chosen priorities to be addressed during the following three years is Minority Health Equity. This issue was chosen as a priority in part because of the statistical data collected during the CHA process. Another factor in choosing this as a priority was the input and insight from a group of Key Informants that due to their professional positions and involvement with minorities in the County are aware of factors that cause or perpetuate inequities.
Following are the primary factors influencing the choosing of this issue as a priority:

• The high percentage of minority deaths in several Leading Causes of Death compared to the percentage of minority population percentages.
• The high percentage of incident rate for minorities in some diseases and health conditions compared to the percentage of minority population percentages.
• Cultural norms that hamper access to and use of health care, as shared by Key Informants.
• They are related to (affects/causes or is impacted by) several of the Health NC 2030 Health Indicators and the Desired Results:
  • Improve child well-being
  • Reduce overweight and obesity
  • Improve birth outcomes
  • Decrease infant mortality
  • Increase life expectancy

Next Steps

• Share CHA report and appendices with appropriate boards, organizations and agencies.
• Publish CHA online and make printed copies available as directed by State Guidelines.
• Publicize link to online version of complete CHA report and appendices.
• Develop CHIPs that include strategies, tactics and measurements to address the chosen Health Priorities. Engage appropriate community partners. CHIPs to be completed and submitted to the NC Department of Public Health by September 1, 2021.
• Execute CHIPs during 2021 -2023. Use e-CHIPs system to measure progress and rprovide reports to the NC Department of Public Health.

Priorities

Diseases of the Heart

Mental Health/Subtance Abuse

Minority Health Equity

Why Is This Important?

Diseases of the Heart were chosen as a priority not only because it is the Leading Cause of Death in the County, but also because of the following:

• It moved from the second Leading Cause of Death in the 2016 CHA to the first in 2020.
• It has increased in females.
• It impacts Blacks/African Americans by a greater percentage than whites even though it is the #2 Leading Cause in Blacks/African Americans.
• It is caused or worsened by other health factors and unhealthy behaviors that can be changed/improved/treated.  
• It not only has the potential to shorten life, it also diminishes Quality of Life.  It is related to (affects/causes or is impacted by) several of the Healthy NC 2030 Health Indicators and the Desired Results:
  • Increase physical activity
  • Improve access to healthy food
  • Reduce overweight and obesity
  • Increase life expectancy 

Description

• Convene health care and public health champions
• Facilitate impactful collaboration and resource sharing
• Promote implementation of evidence-based strategies to prevent cardiovascular disease
• Address health inequity through specific policies, processes, and practices

Progress in 2022-2023

During 2022 - 2023 FirstHealth of the Carolinas worked through the Montgomery County 2030 team to identify community centers, churches, local businesses, and more to place blood pressure stations. These stations were placed in public and private areas to increase the access to blood pressure monitors for the community. The FirstHealth of the Carolinas team implemented fourteen stations throughout the county for use by community members. 

Description

Community garden structures aim to increase access to healthy food options for communities in need as identified by the Better Together Montgomery core team. With consideration to rural communities and identified HMP (historically-marginalized population) communities, the gardens were placed in close proximity to ensure the community would have minimal barriers preventing their ability to obtain food from the gardens. 

Progress in 2022-2023

Better Together Montgomery, along with community members worked to plant both spring and fall crops over the 2022 - 2023 time frame. To increase the knowledge of community members of all ages on the benefits of local grown produce, BTM partnered with local resources from the cooperative extension to teach courses on healthy eating and how to incorporate more healthy options into your diet. Plans were developed for educational courses for the Brutonville after-school program to educate students on gardening, maintaining the plants, and how to use the fruits and vegetables they grow themselves to prepare healthy meals. Community members have come together to care for the gardens with the help of Better Together Montgomery to learn, participate, enhance, and continue using the gardens for personal & community benefit.

Why Is This Important?

Mental Health and Substance Abuse as a combination were chosen as a priority because of the following factors: 

• Both of these impact many other health and quality of life issues such as: 
  • Employment barrier
  • Maternity complications and Infant health/mortality
  • Traffic accidents and fatalities
  • Violent Crime increase 
• Both hhave consistently been an issue for many years
• They are often intertwined and must be addressed simultaneously. 
• Mental Health was chosen as the 3rd most important Health Problem in the County.  (#1 Obesity/Overweight and #2 Diabetes are addressed in the previous priority – Diseases of the Heart)
• Since 2010 there have been significant increases in the Rate of Unintentional Opioid Overdose Deaths and the Rate of Opioid Overdose Emergency Department/Room Visits.  The Rate of Emergency Department/Room visits has increased 110.8 points since 2010.
• Participants in the CHA Public Survey said that 3 of the top 4 Unhealthy Behaviors listed in the survey are related to Substance Abuse: 
  • #1 Illicit Drug Abuse
  • #3 Prescription Drug Abuse
  • #4 Drunk Driving  
• They  are related to (affects/causes or is impacted by) several of the Health NC 2030 Health Indicators and the Desired Results: 
  •  Improve child well-being
  • Decrease drug overdose deaths
  • Decrease excessive drinking
  • Improve birth outcomes
  • Improve access and treatment for mental health needs 

What We Do

Naloxone distribution in Montgomery County is a collaborative-based program supported by opioid settlement funds and the Sandhills Opioid response consortium. This program is dedicated to providing life-saving doses of naloxone and opioid overdose reversal medication to individuals seeking access to care. Peer support specialists supported through funding from local government and private entities ensure widespread availability of naloxone through collaboration with community organizations and first responders. Peer support specialists engage in trainings to reduce the stigma surrounding substance misuse. 

Who We Serve

All people in Montgomery County seeking access to naxolone. 

How We Impact

The naloxone distribution program in Montgomery County serves a diverse population reaching underserved and vulnerable people at risk for substance misuse. By attending community outreach events for naloxone distribution, peer support specialists are able to create lasting relationships with individuals seeking assistance around substance misuse and help develop strategies to lead them on a path to recovery. 

Progress in 2022-2023

Funding for a peer support specialist position was secured through the partnership of Montgomery County and FirstHealth of the Carolinas. The position was quickly filled with a trained individual. The goal of the PSS was to increase access to recovery and care resources along with providing harm reduction kits to all people in Montgomery County where this resource was previously limited. Each harm reduction kit includes naloxone, fentanyl test strips, & materials to help connect people to resources available for substance use disorders. Naloxone is given to any requesting organization after completing a mandatory stigma training, or immediately to any individual at their request to equip the community to reduce deaths caused by overdose.

What We Do

Peer support specialists, supported by sandhills opioid response consortium, host stigma reducation trainings for organizations based in Montgomery County. These trainings focus on reducing the stigma revolving about substance misuse and addiction. 

Who We Serve

All people in Montgomery County seeking education on stigma related to substance misuse and addiction for their employees/group. 

How We Impact

Reducing the stigma around substance misuse and addiction opens avenues for education and discussion around services available for individuals in the county seeking care. 

Progress in 2022-2023

Stigma training was implemented for multiple agencies across multiple sectors, including first responders, law enforcement, health care, and faith-based organizations. Peer Support Specialists hired through local and private funding provided these trainings to interested parties. Through each training, participants were provided with resources to utilize in day to day operations within their own organization. 

Description

Montgomery County utilizes both state and local resources to refer community members for tobacco cessation programs. Locally people can access the FirstHealth of the Carolinas "FirstQuit" program that offers sessions led by certified tobacco treatment specialists, follow-up support sessions, quit plans and guides, and more.  

At the state level, people in Montgomery County can receive referrals to QuitlineNC. QuitlineNC provides free cessation services to any North Carolina resident who needs help quitting commercial tobacco use, which includes all tobacco products offered for sale, 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 together, to help any tobacco user give up tobacco.

Progress in 2022-2023

During 2022 and 2023, referrals to our local FirstQuit provided by FirstHealth of the Carolinas continued to see and increase in referrals throughout the year. Local referrals to the NCQuitline are limited due to the access people have in Montgomery County to local resource programs. In 2023, the Department of Health implemented an update to the Tobacco Free Facility policy to remove the 50 foot rule for smoking and further defined prohibited smoking/tobacco products. Policy updates were distributed to community partners in effort to expand the changes municipalities made to their local policies. 

Description

Youth tobacco use has been highlighted as a rising concern for many years in Montgomery County by key community stakeholders. The 2020 Vision group, consisting of many community organizations, has consistenly looked for ways to integrate vaping cessation programs geared toward youth in an effort to prevent the use of tobacco products.  Our partners are 

• Montgomery County School System
• Montgomery County Department of Health
• Region 6 Tobacco Collaborative

All school aged people in Montgomery County. 

Progress in 2022-2023

During 2022-2023, educators from Montgomery County Department of Health along with staff from FirstHealth of the Carolinas trained with regional consultants on how to implement the Catch my Breath training in the local school system. Collaboration through the Montgomery County 2030 group

Educators worked with Communities in Schools to highlight key areas of implementation for education based activities for school aged students. 

Why Is This Important?

One of the chosen priorities to be addressed during the following three years is Minority Health Equity.  This issue was chosen as a priority in part because of the statistical data collected during the CHA process.  Another factor in choosing this as a priority was the input and insight from a group of Key Informants that due to their professional positions and involvement with minorities in the County are aware of factors that cause or perpetuate inequities.  Following are the primary factors influencing the choosing of this issue as a priority:

• The high percentage of minority deaths in several Leading Causes of Death compared to the percentage of minority population percentages.
• The high percentage of incident rate for minorities in some diseases and health conditions compared to the percentage of minority population percentages.
• Cultural norms that hamper access to and use of health care, as shared by Key Informants.
• They are related to (affects/causes or is impacted by) several of the Health NC 2030 Health Indicators and the Desired Results:
  • Improve child well-being
  • Reduce overweight and obesity
  • Improve birth outcomes
  • Decrease infant mortality
  • Increase life expectancy 

Description

The North Carolina Breastfeeding-Friendly Child Care Designation (NC BFCCD) is administered at the NC Division of Public Health (DPH). The NC BFCCD recognizes licensed  child care programs statewide that promote, protect, and support breastfeeding. Child care programs are awarded the NC BFCCD for achieving each of the five standards for breastfeeding-friendly child care. The five standards of the NC BFCCD include: 1) written policy; 2) community connections; 3) professional development; 4) environment; and 5) curriculum. The NC BFCCD integrates the Ten Steps to Breastfeeding-Friendly Child Care from the Carolina Global Breastfeeding Institute (CGBI) at UNC-Chapel Hill into the five standards. 

Progress in 2022-2023

In 2022, Montgomery County Department of Health began working with Healthy Communities and the regional ICO4MCH to develop partners for breastfeeding friendly spaces throughout the county. With the help of the breastfeeding program manager with ICO4MCH staff were able to partner with the Montgomery County School System to implement breastfeeding friendly spaces in each of the eleven schools as well as the central office. Once spaces were implemented, staff worked closely with school administration to achieve designation status. 

In 2023, staff and regional partners implemented spaces and applied for designation status as the local Walmart store, pregnancy resource center, county courthouse, and daycare facilities. In addition to the development of these spaces, staff have worked to further partnerships in the community in hopes to increase the number of locations throughout the county that receive a breastfeeding friendly designation. 

Description

Better Together Montgomery is a collaborative group operating on a community-centered health model to address inequities in Montgomery County. Currently the group is composed of members from the Brutonville Community, Montgomery County Department of Health, FirstHealth of the Carolinas, and the Montgomery County School System.  Better Together Montgomery is a community based group operating on a community-centered health model to address inequities in Montgomery County. The program serves all people seeking assistance with food.  Healthy food options, and often sustainable food sources, are not available in parts of our rural community. Boxes of love operates on a have a little, give a litte, need a little, take a little model to supply food to the communities they are placed in. Similar to a food pantry, community members will supply extra food items to the box and those that need them may take what they need free of charge. 

Progress in 2022-2023

During 2023, Better Together Montgomery (BTM) worked within their core team to plan and develop the Boxes of Love program to provide easy access to food and non-food items. The team worked through the design of each box and the items that would need to be included. The next steps of the program were to procure boxes for team to place throughout the county and a sustainability plan for each location. 

Description

Safe Sleep NC is a program of the UNC Center for Maternal and Infant Health. The goal is to strengthen the adoption of infant safe sleep practices that reduce the risk of Sudden Infant Death Syndrome (SIDS) and that prevent infant sleep-related deaths such as accidental infant asphyxiation and suffocation across the state.

Montgomery County Department of Health utilizes the educational curriculum provided by Safe Sleep NC to teach expecting parents & parents/caregivers of young babies about the risks associated with unsafe sleep practices to equip parents to minimize risks in of sleep-related infant death. Participants are taught about current guidelines & recommended practices to provide safe sleep spaces for infants & how to keep those sleep spaces safe. At class completion, participants are encouraged to utilize resources available to them to help them feel confident in their ability to provide their baby with a safe sleep space. 

Progress in 2022-2023

Montgomery County education staff worked diligently throughout 2022 to continue the efforts of the safe sleep education program for all people in Montgomery County. Staff implemented monthly group education classes for all individuals referred to the safe sleep program. Individual classes were held on an as needed basis for any referral. Staff utilized online communication platforms (i.e. Zoom) to reduce barriers in participation for participants. 

In 2023, education staff continued the efforts of the safe sleep education program for all people in Montgomery County. Group classes are hosted twice a month, with individual classes being held on an as needed basis for participants. 

Description

Positive parenting is simply an approach to parenting that gives parents and carers tools and strategies to raise their child in an environment that is safe, loving and predictable. Triple P’s positive parenting program allows each person doing the program to decide what is important to them. So it’s not telling you how to raise children, but giving you the confidence and skills to build good relationships, set boundaries and rules calmly and in ways that kids understand, and follow up with consequences that are not harmful.

To sum it up, Triple P helps you:

• Raise happy, confident, capable kids
• Build and maintain a close, loving relationship with your child
• Understand more about child development to make parenting more enjoyable and easier
• Encourage positive behavior
• Prevent and manage misbehavior effectively, in a way that supports children’s emotional wellbeing
• Have rules and routines everyone respects and follows
• Feel less stressed and calmer
• Feel more able to handle various parenting situations, knowing you’re doing the best for your kids.

Progress in 2022-2023

Providers with the Montgomery County Department of Health, as well as community partners within the school system and Partnership for Children, completed Positive Parenting Program (Triple P) provider training to help make the program more accessible to people in Montgomery County. Along with in person sessions at each of these facilities, online Triple P services were advertised through social media and posters in clinic settings to communicate the benefits of the Triple P program and online availability. Through these efforts, parents were able to receive more information on the benefits of the program and contact information for training providers. 

Progress on CHIPs

During 2021, the Montgomery County Department of Health faced many challenges related to the COVID-19 pandemic when implementing the Community Health Improvement Plan (CHIP). Despite the challenges we have faced, the department has been able to effectively: 

• Adopt the Results-Based Accountability concept to develop our county level health reports
• Transfer our current programs, initiatives, and performance measures into the online Clear Impact Scorecard platform
• Shift to a web based system for our Community Health Assessment, CHIP, and State of the County Health Report
• Link to the HNC 2030 Scorecard to create greater awareness of population accountability

Morbidity and Mortality Changes Since Last CHA

Leading Cause of Death 

In 2019, the three leading causes of death in Montgomery County were Heart Disease, Cancer, and Chronic Lower Respiratory Disease. This accounted for nearly 50% of all deaths in Montgomery County. 

Source: North Carolina State Center for Health Statistics (2019 is the most recent published data) 

COVID-19 Confirmed Cases and Deaths 

The data presented by the North Carolina State Center for Health Statistics regarding the leading cause of death in 2019 does not depict the impact that Coronavirus (COVID-19) had on our community in 2020-2021. Since March 2020, Montgomery County has noted 5,020 total cases of COVID-19 (Figure 1) in our community. Montgomery County has recorded 111 total deaths (Figure 2) attributed to COVID -19 from March 14, 2020 to January 1, 2022. Each confirmed case of COVID-19 is reported with data on race, ethnicity, and age (Figure 3, 4, 5) identified. Testing efforts in Montgomery County are a continued effort through the Montgomery County Department of Health, third party testing locations, and our community partners. The most current data on COVID-19 in Montgomery County can be found online in the Montgomery County COVID Dashboard. Additional information can be located on the State COVID Dashboard at https://covid19.ncdhhs.gov. 

Montgomery County COVID-19 Vaccinations

Montgomery County vaccination data can be found on the North Carolina Department of Health and Human Services Data Dashboard. As of January 4, 2022, 42% (n = 11,516) of Montgomery County’s population was fully vaccinated with 45% (n = 12,233) being partially vaccinated. Current vaccination efforts in the county continue to reach the target goal set forth by NCDHHS.

Emerging Issues Since Last CHA

COVID-19 Pandemic

COVID-19 has continued to be a concern in Montgomery County that has had a lasting impact on every person and their overall health during 2021. Since the beginning of the pandemic in March of 2020, Montgomery County has reported 5,020 cases (as of January 2022) of COVID-19 and over 100 deaths attributed to COVID-19. To diminish the impact of COVID-19 on our community, we focused on creating new partnerships and maintain current programs when feasible to support the community during such a difficult time. Throughout the pandemic, many of our community members suffered from food insecurity. This was partially impacted by the decrease in volunteers for many food pantries due to such a large portion of the volunteer base being a vulnerable population. Due to a lack of food delivery options in the area, many individuals relied on food pantries or family members to ensure their food needs were met. 

Community Centered Health 

Community Centered Health 
Community centered health involves shifting the focus from individuals to the community and works to prevent health issues before they require treatment. Better Together Montgomery, which consists of representatives from local community organizations, is using grant funds from the Blue Cross Blue Shield Foundation of North Carolina to use community centered health to improve food access and economic stability to the Peabody and Brutonville communities of Montgomery County. CCH has three main areas of focus: 

1.    Community members as leaders and partners
2.    Community level changes in policies, systems, and environments 
3.    Clinical shifts prioritize creating health 

The group paused many current projects in 2020 due to the rapid rate of COVID transmission in the community and focused on supplying the current needs of community members through local organizations. New and current group initiatives can be found in the New Initiatives Since Last CHA portion of the document. 
 

New/Paused/Discontinued Initiatives Since Last CHA

COVID-19 Pandemic Impacts

Due to the impacts COVID-19 had on our community, many staff within the work place devoted more time to COVID-19 related activities. These activities included, but are not limited to, COVID-19 testing and mass vaccination clinics. Though these initiatives had taken a forefront during the course of 2021, our clinic remained opened on a modified schedule to continue to provide services to those in Montgomery County. 

Conquering Motherhood 
Throughout 2021, our health education staff were able to resume select outreach initiatives regarding infant mortality and maternal health through an online platform (Zoom). With the use of technology, educators were able to provide information on safe sleep practices and postpartum depression to new or current parents. These online classes were a part of the current Conquering Motherhood outreach initiative hosted by the Department of Health in partnership with Improving Community Outcomes for Maternal and Child Health (ICO4MCH). The Conquering Motherhood program targeted new or current parents seeking valuable information on topics such as infant feeding, car seat safety, postpartum depression, and general infant care. Meetings for the ICO4MCH initiatives resumed utilizing an online meeting platform and advertisement was conducted through a variety of social media platforms. 

Car Seat Safety 
Car seat safety classes were paused briefly due to a rise in COVID-19 cases in Montgomery County. Once the COVID-19 rate returned to a low rating for our community, we were able to restart our car seat safety class for parents in our area. Through this program, we were able to continue our partnership with Safe Kids North Carolina and provide valuable information and resources to parents in our community regarding the safety of their child while in or around the vehicle. 

Community Centered Health 

Better Together Montgomery uses a community centered health approach to focus on the individuals in the Peabody and Brutonville communities. Due to the rapid rate of COVID transmission in our county, many predefined initiatives were placed on a hold until it was safe to conduct in-person outreach. During this time, core team meetings transitioned to an online meeting platform as the group reassessed the current needs of each community. Members from the core team were able to work together to implement a community garden in the Brutonville community to assist with the food needs of those in the surrounding area. This effort was a combination of community participation, core team assistance, and community partners. As this work continues throughout 2022, the group will continue to connect with the community to gain insight and feedback as they work towards improved food access and economic stability. 

Progress on CHIPs

The State of the County Health Report 2022 provides community partners, stakeholders, and the general public with an update on the priority health issues identified in the 2020 Community Health Assessment and the strategies implemented to address these issues. The Montgomery County Department of Health, FirstHealth of the Carolinas, and members of the Montgomery County 2020 Task Force collaborated to complete the 2020 assessment. The top three community health priority issues identified were: 

1. Diseases of the Heart 

2. Substance Abuse and Mental Health 

3. Health Equity 

To view the 2020 Community Health Assessment, please visit the Montgomery County Department of Health’s website at www.montgomerycountync.com/departments/health-department. 

The following report includes progress made on each of the three priority health issues as well as demographic, morbidity, and mortality data for Montgomery County and the state of North Carolina. The last section in the report discusses emerging issues in the field of public health that are being addressed in Montgomery County: Mpox and Food Insecurity. 

Progress on CHIPs

The clear impact scorecard outlines the efforts being made by the Montgomery County Department of Health and community partners to address the health priorities identified in the 2020 Community Health Assessment. Use the following links to see up to date information regarding each program and initiative taking place to improve the health outcomes in Montgomery County.

For the priority area Diseases of the Heart, see progress tabs for each program below.

​ All people in Montgomery County live in communities that support healthy lifestyles.

Million Hearts Initiative 

Community garden structures.

For the priority area Substance Abuse and Mental Health, see progress tabs for each program below. 

SU All people in Montgomery County have equitable access to mental health and substance use disorder services.

Youth Vaping Cessation 

Tobacco Cessation 

Stigma Reduction Training 

Naloxone Distribution

For the priority area Health Equity, see progress tabs for each program below. 

All people in Montgomery County live in healthy, equitable communities that offer complete social, physical and mental well-being to all its residents at all stages of life.

Breastfeeding Friendly Designations

Positive Parenting Program 

Baby Safe Sleep Education

Montgomery County Department of Health was able to expand their outreach and communications with community groups and partners during 2022. This was in part due to the relief of some COVID-19 restrictions within the community. During this time, staff worked to promote healthy choices related to the health priorities identified in the 2020 Community Health Assessment. This includes: 

- Training educators in the CATCH my Breath and other tobacco cessation educational course to encourage students to stop the use of vaping and using tobacco products 

- Partnering with the Better Together Montgomery group as well as FirstHealth of the Carolinas to increase community access to walking trails and safe areas for outdoor play to increase communities that support healthy lifestyles 

- Partnering with the Sandhills Opioid Consortium to promote the Peer Support Specialist for her work in recovery and harm reduction education 

- Continuing the work of the safe sleep program to provide safe sleep materials to community members to help support healthy, equitable communities that offer complete social, physical and mental well-being to all its residents at all stages of life

Morbidity and Mortality Changes Since Last CHA

Mortality 

The leading causes of death for Montgomery County was collected from the State Center for Health Statistics, with the most recent data being from 2019. The data shows that the leading causes of death have had little change from that represented in our 2020 Community Health Assessment. Compared to the leading causes of death in North Carolina (Cancer, Diseases of the Heart, and Chronic lower respiratory diseases), Montgomery County ranks slightly lower for the top three causes of death than that state level. 

Morbidity 

COVID-19 cases have shown a significant decline since the beginning of 2022. With a total of 3,847 reported cases, Montgomery County ranks lower than the state average for cases per each reporting week. (Moving forward, COVID-19 case data will be reported in a different manner).

Emerging Issues Since Last CHA

MonkeyPox (Mpox) 

MonkeyPox was first identified in Montgomery County in August 2022. With the prevalence of the infection, our staff were able to educate community members on the proper infection control techniques and isolation protocols. 

Food Insecurity 

Identified in a current food assessment as well as the FirstHealth of the Carolinas CHNA, food insecurity has become a topic of discussion in Montgomery County within the past year. During the beginning of COVID, we saw many changes in food distribution sites and the allotment of food for each family. We are working within our community groups to ensure that the food distribution is still meeting the needs of our community as well as assessing the healthiness of the food being distributed. 

New/Paused/Discontinued Initiatives Since Last CHA

New

Utilization of Opioid Settlement Funds 

Montgomery County was allotted funds to increase the support of substance abuse resources. The current Board of Commissioners is responsible for allocating funds throughout the community and ensuring the funded partners are assisting the community to the best of their ability. Our current partner, Sandhills Opioid Consortium, has been allotted funding from the board to support the efforts of a designated Peer Support Specialist. This peer support specialist is housed within the department of health building and provides community members increased access to care revolving around recovery and harm reduction.  

T2 Diabetes Education 

Our education staff partnered with FirstHealth of the Carolinas to train in the T2 Diabetes prevention program. This program will allow our staff to implement a yearlong class for community members to focus on the importance of a healthy lifestyle when presented with pre-diabetes markers. 

Discontinued 

COVID-19 Vaccination Clinics 

During 2022, our clinic continued hosting vaccination days for community members to receive their most up to date vaccine or booster for COVID-19. Due to the expansion of the availability of the most current COVID-19 vaccine, we limited vaccinations to appointments only. Through the availability of self-administered COVID-19 test kits from state partners our clinic was also able to provide community members with free testing kits.  

Advancing Equity

The state level funding for the advancing equity program ended during the current fiscal year. Although the funding has been removed, MCDH is dedicated to continuing the work of the program to help improve our services and the care the community receives. Our staff continue to partner with our external equity committee and work to improve our services through policy development and change.

Progress on CHIPs

Morbidity and Mortality Changes Since Last CHA

Leading Cause of Death

In Montgomery County, heart disease ranks as the predominant cause of mortality. Its evasive nature, often missed in early stages and usually not presenting with immediate life-threatening symptoms, underscores its profound impact on the well-being of people living in Montgomery County. Heart disease exacts a notable toll on the quality of a person’s life, often with debilitating symptoms that impede daily life. The preventability of many heart conditions elevates the importance of addressing this serious health concern. Compounding the challenge, Montgomery County is a rural community, characterized by limited access to quality healthcare and screening services. This barrier exacerbates disparities in health outcomes and highlights the necessity for bolstered heart health initiatives. Prioritizing interventions at prevention, early detection, and comprehensive delivery of healthcare is paramount in mitigating the burden of heart disease within the community. By addressing these multifaceted challenges, a healthier, more resilient population is fostered to promote the collective well-being of Montgomery County.  

Emerging Issues Since Last CHA

Emerging issues identified in Montgomery County include the end of the COVID-19 pandemic health emergency by state officials. As the community continues navigating this new post-pandemic era, attention remains fixed on combatting food insecurity. These emerging & evolving issues, representative of the county’s resilience in the face of adversity, draw due attention to the need for action and innovative solutions.

COVID State of Emergency 

The effects of the COVID-19 emergency, despite its ending, will have lasting effects due to reshaping various aspects of social, economic, and healthcare avenues. With the easing of restrictions and the restoration of normalcy, there remains a shortage of healthcare providers in Montgomery County to be addressed. While the reduced strain on resources and healthcare staff is promising, improving access to healthcare for people living in Montgomery County is paramount. The need for preventative care is once again able to be highlighted through the promotion of vaccination campaigns, heart health screenings, and community outreach and education.

Food Insecurity

Amidst the ongoing challenges posed by food insecurity in Montgomery County, light has been shed on the urgency of addressing the issue. Over the past year, our community experienced shifts in food distribution needs and resource allocation to meet the evolving needs of families in our communities. While the work remains unfinished, community partner collaboration has kept the issue as a top priority, with the hopes of ensuring food security for all people living in Montgomery County. Partners remain committed to distributing quality essential foods that are high in nutritional value, keeping the health of our community at the forefront of their mission. 

New/Paused/Discontinued Initiatives Since Last CHA

Montgomery County Department of Health and its community partners made great strides in the calendar year 2023 to start new initiatives related to priority health issues identified in the 2020 Community Health Assessment. Through the partnership with Montgomery County Board of Commissioners and Sandhills Opioid Response Consortium, opioid settlement funds were leveraged to assist with the distribution of Naloxone in the form of harm reduction kits. The designated peer support specialist through the consortium has worked to develop lasting relationships with community leaders, first responders, and people in Montgomery County to ensure that harm reduction kits are widely available throughout the county. Through the scorecard, we are able to showcase how many kits are given out to community members through her work. In addition to providing life-saving doses of naloxone and opioid overdose reversal medication to individuals seeking access to care, the harm reduction kits contain information on recovery resources available as well as necessary test strips for individuals in search of them.

Staff at Montgomery County Department of Health have been able to address key concerns with parents and guardians through the implementation of the Positive Parenting Program (Triple P). Clinical and non-clinical staff have been trained at MCDH to administer the program to parents and guardians that bring up specific concerns related to their child’s behavior. MCDH staff can assist parents with any child under the age of twelve, but have developed relationships with community organizations that can administer assistance for children outside of the age range.

In addition to providing the triple p program, health education and maternal health staff have worked diligently with the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) collaborative to educate maternal health patients on post-partum depression. Through the use of the mothers and babies curriculum, educators can address common mental health related outcomes for mothers prior to delivery. This program addresses the signs and symptoms of post-partum depression to educate the mother prenatally on what she may experience. Due to the lack of maternal mental health services within the county, any program addressing mental health for our patients has been a priority.

Diseases of the Heart can have many root causes, but one key factor our local Better Together group addressed was the need for physical activity to help boost heart health of the community. After analyzing the need for outdoor physical activity spaces, group members along with community leaders developed a plan to increase the walkability of the community center by developing a walking trail. In early spring of 2023, Better Together was able to build a walking trail in the Brutonville Community for anyone in the county to utilize. This trial has helped with the facilitation of exercise groups and walking sessions with the community center.

Vaping cessation has been a topic of concern for many in the community, especially among the youth in our school system. Montgomery County Department of Health staff along with FirstHealth of the Carolinas educators were able to train in the CATCH My Breath program to help facilitate youth vaping cessation utilizing a nationwide evidence-based program. Facilitation and further training within the school system is a project that is ongoing to bring this information into our local schools.

Throughout this past year the T2 Diabetes program has been paused for Montgomery County. This program addresses healthy lifestyle choices for those that present with pre-diabetes markers. With continued efforts by Montgomery County Department of Health and FirstHealth of the Carolinas, it is our hope to facilitate the year-long class with community members in the future.

Description

The State of the County Health Report 2023 provides community partners, stakeholders, and the general public with an update on the priority health issues identified in the 2020 Community Health Assessment and the strategies implemented to address these issues. The Montgomery County Department of Health and members of the Montgomery County 2020 Task Force collaborated to complete the 2020 assessment. The top three community health priority issues identified were: 

1. Diseases of the Heart 
2. Substance Abuse and Mental Health 
3. Health Equity 

To view the 2020 Community Health Assessment, please visit the Montgomery County Department of Health’s website at www.montgomerycountync.com/departments/health-department. 

The following report includes progress made on each of the three priority health issues as well as demographic, morbidity, and mortality data for Montgomery County and the state of North Carolina. The last section in the report discusses emerging issues for our community in the field of public health that are being addressed.

Montgomery County Department of Health and community partners has worked continuously throughout the calendar year of 2023 to address the health priorities listed in our most recent CHA. Chronic diseases of the heart is still a top health concern for people in Montgomery County, and through community partnerships several health improvement initiatives have been implemented to address them. Heart health has been at the forefront of these initiatives throughout 2023 with new programs being designed to address health risk screenings and blood pressure management.

Staff and community partners have also focused on health improvement initiatives to address the rising use of harmful substances among adults and youth aged individuals.

Community partners and local health department staff continue to address equitable access to care through collaborative group efforts. Health department staff have been able to grow their involvement with a local group operating on a community centered care approach to change. Through this group, initiatives have been put in place to address access to food, heart health, and more.