Johnston County CHIP 2022-2024

Why Is This Important?

Johnston County is home to the halfway point between a major drug trafficking route between New York and Florida on I-95. The overdose death rate in Johnston County has more than doubled between 2015 and 2021 (16 out of 100,000 in 2015 vs. 35 out of 100,000 people in 2021) (SCHS, 2021). This concerning trend demonstrates one of the most severe impacts of the opioid epidemic on Johnston County. At the same time, fentanyl continues to infiltrate drug supplies throughout the county. Datasource: NC State Center for Health Statistics (SCHS) Vital Statistics Death Certificates. Available at: https://schs.dph.ncdhhs.gov/

What We Do

In 2017, Johnston County established an Opioid Task Force (OTF).

The Johnston County Opioid Task Force (OTF) is a collaborative group led by the Johnston County Public Health Department.  The group has over 200 partners who are dedicated to creating solutions for families and community members impacted by substance use.  This group holds quarterly meetings to discuss updates, success stories and upcoming plans.  In 2019, the health department with support from the OTF, wrote and recieved a grant to train peer support specialists, to train community and professionals on NARCAN administration, and distribute Narcan.  

The Narcan distribution program was housed at the Johnston County Health Department. It was advertised to the public as a walk-in service for free Narcan. Since receiving opioid settelment funds in 2022, our Narcan distribution program has grown in capacity. We offer a larger numbers of doses to community organizations as well as first responders in our county. In 2022, we distributed 600 doses of Narcan to the 40 fire and EMS stations in Johnston County and over 300 doses to the general community. In 2023, we distibuted a total of 3,125 doses of Narcan to a combination of community members and first responders.

Who We Serve

OTF serves Johnston County residents.

How We Impact

More Narcan in the community increases the opportunity to reverse more overdoses and thus prevent more deaths from opiates.

The OTF has had many successes to include:

• Training Certified Peer Support Specialists

• Training pharmacists on the importance of providing Narcan to those with opioid prescriptions.

• Distributing Narcan

• Hosting Narcan Trainings to educate the public on how to recognize signs of an opioid overdose, as well as administer Narcan correctly.

• Coordinating a Mental Health Fair

  

   

   

What We Do

In 2018, with grant funding distributed by the State of North Carolina (from SAMHSA and the CDC), the Johnston County Health Department funded 16 individuals in recovery to attend a peer support specialist training. Following this training, we did not have the capacity to employ any of these individuals.  The peer support specialists continued to support Johnston County in their respective communities after completing the training.
In 2023, with Opioid settlement funds from the State of NC, Johnston County Health Department funded 8 individuals in recovery to attend a peer support specialist training. We hope to employ 2 peer support specialists to work with Johnston County Residents at Johnston County Behavioral Health and through an EMS program in the future.

In 2024, We will train additional Peer Support Specialists. These participants must complete 60 hours of hands-on training from an accredited program. We will offer an application based scholarship for 8-10 individuals.
Peer support specialists' primary role is to mentor a person in recovery by linking them to treatment resources, building self-efficacy, sharing experiences, and assisting with securing other basic needs like housing and food.

Who We Serve

Residents with at least one year in recovery from opioids or other substances, who are interested in completing a certification program to become a Peer Support Specialist and help others on their recovery journey.

How We Impact

According to the NC Peer Support Specialist Website, Johnston County has 52 certified Peer Support Specialists. Being a county of over 200,000 people this is less than .026% of our population. Each peer support specialist would need to serve almost 4,000 people. Training more peer support specialists in Johnston County would impact our residents access to Peer Support services.

What We Do

Johnston County Public Health Department Staff and Region 7 Tobacco Control Manager will collaborate to offer education to the Johnston County Medical Community regarding the Quitline NC.

Who We Serve

We will serve the Johnston County Medical Community.

How We Impact

Although the majority of tobacco users want to quit smoking, less than half report being advised by their primary care providers to quit and only about a quarter of those patients receive evidence-based counseling and/or medications (Duke-UNC TTS, 2023). Quitlines alone may not be as effective as other evidence-based interventions, however, they have a greater population-based impact and can play an important role in supporting someone’s quit journey (QuitlineNC, 2023). Referring patients directly to the QuitlineNC also reduces barriers of patients reaching out for self-help resources on their own.

By providing education to the Medical Community, we hoped to increase the number of Quitline NC Referrals from Johnston County NC.  An increase in referrals would indicate that those who are seeking help quitting are being referred to a reliable resource. Johnston County Public Health Department staff and partners, such as the Region 7 Tobacco Control Manager; collaborate to offer education to the Johnston County medical community regarding the Quitline NC through webinars for clinicians and education about eReferrals.

QuitlineNC provides free cessation services to any North Carolina resident who needs help quitting commercial tobacco use. Quit Coaching is available in different forms, which can be used separately or together, to help any tobacco user give up tobacco.  

Resource: https://quitlinenc.dph.ncdhhs.gov/ (05/17/2022)

What We Do

A trained facilitator will offer the American Lung Association smoking cessation program, Freedom from Smoking.

Who We Serve

Adults 18 and over who use tobacco products in Johnston County.

How We Impact

Increase the number of adult smokers who complete the Freedom from Smoking program.

Why Is This Important?

Transportation has been an issue for Johnston County for the last few CHNA cycles. We lack a true public transportation system. Johnston County has population of over 200,000 people and is considered a rural county. JCATS (Johnston County Area Transit System) exists for mostly medical transport and some general transport. JCATS strives to also provide Rural General Public (RGP) transportation to school, work, appointments, etc., at a reduced cost to riders. However, RGP funding support for this service is very restricted and because of the limited number of vehicles in our fleet, seating availability is secondary to riders served by contracting agencies.  JCATS strives to offer RGP service 6am-5pm, Monday - Friday. 

In March of 2023, JCATS launched a new ride-share program called Quick Ride. The quick ride program allows for rides Monday-Friday 7am-6pm in and around Smithfield and into Selma. This is a fee for service transportation option much like Uber. Transportation has consistently been a barrier for Johnston County residents. By providing mobile services in the form of outreach and WIC, we can improve the lack of access to healthcare and nutrition education.

What We Do

Johnston County Area Transit System (JCATS) provides Human Services Transportation and some Public Transportation.

A variety of transportation services are provided, including medical trips in county and to destinations out of county, workplace and job training, senior centers, child care centers, social services, public hearings, dental care.

JCATS strives to also provide Rural General Public (RGP) transportation to school, work, appointments, etc., at a reduced cost to riders. However, RGP funding support for this service is very restricted and because of the limited number of vehicles in the fleet, seating availability is secondary to riders served by contracting agencies. RGP services are offered 6am-5pm, Monday - Friday.

 In March of 2023, JCATS launched a new ride-share program called Quick Ride. The Quick Ride program allows for rides Monday-Saturday 6am-8pm in and around Smithfield and into Selma. This is a fee for service, low cost transportation option much like Uber. The cost is $6.00 each way.

Who We Serve

Johnston County residents can be picked up anywhere in Johnston County and transported within Johnston County as well as surrounding areas. The surrounding areas include: Chapel Hill, Dunn, Durham, Fuquay-Varina, Goldsboro, Greenville, Kinston, Newton Grove, Wilson, and Raleigh.

How We Impact

With a population of over 200,000 and a designation of Rural, JCATS is the only transportation option. In 2021, total rides provided by JCATS were 70,792. Of that, 39,955 were to a medical appointment. In 2022, total rides provided by JCATS were 86,092. Of that, 51, 218 were to a medical appointment. The numbers represent a 21% percent increase in the number of medical transports made in one year. Also, general transport ridership increased by 13% from 2021 to 2022.

Progress on CHIPs

Progress on the priorities for Johnston County Communty Health Improvement Plan can be found by clicking on the links to the following programs:

Narcan Distribution

JCATS 

Peer Support Specialist Training

Mobile Telehealth Program

Based on the performace measures listed above from our 2021 CHNA, the following progress has been made.

Johnston County's Mobile Telehealth Program through UNC Health Johnston has offered 

Narcan distribution that began in 2018 is continuing to be an integral part of the opioid settlement funds activities. Since reciving Opioid Settlement Funds in 2022, Johnston County has distributed over 3,000 doses of Narcan into the hands of the community, EMS, fire departments, and local organizations/churches.

The number of doses of Narcan administered in Johnston County from January 2023-March 2023 by community and EMS was 95.

Transportation has been an issue for Johnston County for the last few CHNA cycles. We lack a true public transportation system. JCATS (Johnston County Area Transit System) exists for medical transport only. In March of 2023, JCATS launched a new ride-share program called Quick Ride. The quick ride program allows for rides Monday-Friday 7am-6pm in and around Smithfield and into Selma. This is a fee for service transportation option much like Uber.

Mobile WIC services have alleviated the need for Transportation to WIC appointments. Prior to Covid in 2020, WIC was offered at 3 sattelite locations (Clayton, Benson & Princeton).

Morbidity and Mortality Changes Since Last CHA

No significant changes in Mortality have occurred in Johnston County within the last year since completing our CHNA in 2021. 
During our last CHNA Covid was impacting our mortality and morbidity numbers significantly. The number of deaths related to Covid-19 has decreased in 2022, compared to 2021.

Emerging Issues Since Last CHA

Diabetes⁵

Type 2 Diabetes can lead to heart disease, stroke, kidney failure, blindness, and lower-limb amputation.  Recent research has also shown a connection between diabetes and dementia, hearing loss, and some forms of cancer.  Diabetes increases the risk of early death, and diabetes-related complications can lower quality of life. About 422 million people worldwide have diabetes and 1.5 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. In Johnston County, 11% of adults age 20 and older are diagnosed with Diabetes⁸. This is roughly 25,000 people. Johnston County Public Health offers a Diabetes Prevention Program to provide information and education on lifestyle changes for healthy living to delay or prevent type 2 diabetes.

Many times a diabetes diagnosis can be prevented. Since January of 2023, Johnston county public health department has offered 2 year long evidence based diabetes prevention programs to the Johnston County Community.

Covid-19 & Increased Substance Use

Covid-19 continues to present many challenges in education, identification, treatment andrecovery, both short and long term. There have been several new strains/mutants of the virus creating a necessity for additional types of vaccines for prevention and treatments for recovery and wellness. Since 2020, Covid has had periods of low incidence and periods of high incidence. Covid incidence in Johnston County has been on an overall downward trend since mid 2022, likely due to covid-19 vaccinations⁹. Johnston County Public Health continues to offer Covid-19 information, education, testing, vaccinations. At-home Covid-19 tests are also available daily.

Tobacco and alcohol use increased during the Covid-19 pandemic. In 2020, In Johnston County, 18% of adults were current cigarette smokers¹⁰. In 2021 that number increased to 20%. Over the last two decades alcohol deaths increased around 2.2% per year, however, between 2019-2020 deaths involving alcohol jumped to 25.5%, totaling 99,107 deaths in North Carolina. Tobacco use increased Pandemic-related anxiety, boredom, and irregular routines were cited as major drivers of increased nicotine and tobacco use during the initial COVID-19 shutdown, according to research just released by Columbia University Mailman School of Public Health researchers⁷. Johnston County has a youth empowerment group, a group of high schoolers who provide peer education on the dangers of substance use. Quarterly evidence based smoking cessation classes are offered by the health department.

Mental Health-Social Isolation⁶

Loneliness and social isolation in older adults are serious public health risks affecting a significant number of people in the United States and putting them at risk for dementia and other serious medical conditions. A report from the National Academies of Sciences, Engineering, and Medicine (NASEM) points out that more than one-third of adults aged 45 and older feel lonely, and nearly one-fourth of adults aged 65 and older are considered to be socially isolated. Older adults are at increased risk for loneliness and social isolation because they are more likely to face factors such as living alone, the loss of family or friends, chronic illnesses and hearing loss.  In 2021, 14% of the population in Johnston County was 65 or older¹¹. This number continues to grow as Johnston County is the fastest growing county in the state.

The effects of social isolation on mental health are a challenge during the best of times, but social isolation has taken on a new meaning during the coronavirus pandemic. As bars, restaurants, schools, and shopping centers closed, and we were all instructed to social distance with our immediate families at home, the opportunity for social interaction was greatly reduced.

Social isolation can exacerbate existing mental illnesses and it can make feelings of loneliness intensify, creating some serious negative effects on the health and well being of us all. These include Increased risk of Anxiety and Depression, faster cognitive decline and progression of Alzheimer’s disease, increased stress, increased drug and alcohol use, and increased risk of heart disease. Johnston County Public Health and Johnston County Behavioral Health in collaboration with its partners continue to offer assessments, evaluations, education, interventions and treatments (outpatient, individual and group counseling). In addition, Johnston County Public Health partners with Community and Senior Services to offer programs for seniors to encourage socialization.

Opioid use and misuse

In 2021, 3,961 people died of a suspected opioid overdose in North Carolina, a 21% increase from 2020. More than 760,000 people in the United States have died of opioid use since 1999, and in North Carolina that number is 13,000 people¹². Between July 2021 and July 2022 alone, more than 100,000 people have died of a drug overdose. In Johnston County, that number increased by 40% in 2021. Accidental drug overdose is the number one cause of accidental deaths in North Carolina and nationwide. In March of 2022, North Carolina Reported a 40% Increase in Overdose Deaths in 2020 Compared to 2019. 

Opioids, sometimes called narcotics, are substances that act on opioid receptors to produce morphine-like effects. Medically, they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use disorder, reversing opioid overdose, and suppressing cough. Opioids, sometimes called narcotics, are medications prescribed by doctors to treat persistent or severe pain.  Opioids include drugs such as heroin and prescription pain medications such as morphine, codeine, methadone, oxycodone (Oxycontin, Percodan, Percocet),  hydrocodone (Vicodin, Lortab, Norco), fentanyl (Duragesic, Fentora), hydromorphone (Dilaudid, Exalgo), and buprenorphine (Suboxone). The U.S. Department of Health and Human Services declared the opioid crisis a public health emergency in 2017. Local and state public health agencies have been rolling out treatment and prevention programs that include medication assisted treatment such as methadone and suboxone clinics.

In July 2022, Johnston County received funds from the state of North Carolina from the Opioid Settlement to address the opioid epidemic. Johnston County will receive $8.1 Million to be spent over 18 years, to implement mitigation and prevention activities listed below. A preliminary plan will be updated as needed over the grant period based on community needs.

        Category                                                                                   Strategy

References:

5. Centers for Disease Control and Prevention.  What is Diabetes?.  CDC.gov/diabetes/basics/diabetes.html. Retrieved 2/1/2023

6. National Academies Press. nap.nationalacademies,org/catalogs/25665.  Social Isolation and Loneliness in adults. Retrieved 2/1/2023

7. Columbia University Mailman School of Public Health researchers. https://www.publichealth.columbia.edu/public-health-now/news/covid-19-lockdown-linked-uptick-tobacco-use.  Retrieved 2/1/2023

8. Diabetes Prevalence. County Health Rankings. (n.d.). Retrieved February 28, 2023, from https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-model/health-outcomes/quality-of-life/diabetes-prevalence?year=2022&county=37101 

9. NCDHHS Covid Cases and Deaths Dashboard. (2022). Retrieved February 28, 2023, from https://covid19.ncdhhs.gov/dashboard/cases-and-deaths 

10. Adult Smoking. County Health Rankings. (n.d.). Retrieved February 28, 2023, from https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-model/health-factors/health-behaviors/tobacco-use/adult-smoking?keywords=275&f%5B0%5D=type%3Astates&f%5B1%5D=type%3Acounties&year=2020&county=37101

11. Census Quick Facts. Census.gov. (2021). Retrieved February 28, 2023, from https://www.census.gov/quickfacts/fact/table/johnstoncountynorthcarolina/PST045221

12. The Impact of Opioids. MorepowerfulNC.org. (2017). Retrieved February 28, 2023, from https://www.morepowerfulnc.org/get-the-facts/the-impact/#:~:text=More%20people%20die%20from%20opioid,lives%20to%20unintentional%20opioid%20overdoses.

New/Paused/Discontinued Initiatives Since Last CHA

Priorities discontinued from 2018 CHNA:

• Heart Disease & Stroke: Johnston Health's goal was to obtain The Joint Commission Stroke Certification, and it was achieved in 2021.
• Respiratory Diseases: Although patients will continue to be referred to a smoking cessation program, respiratory diseases was not selected as a priority, instead tobacco cessation will fall under Substance Use.

Progress on CHIPs

Johnston County's progress on CHIP priorities in 2023, can be found at the links below.

Programs and initiatives related to Access to Care:

Mobile Telehealth This outreach program improved access to comprehensive and quality health care. Uninsured patients with chronic conditions are referred to Project Access for charity care.

Programs and initiatives related to Substance Use:

Narcan Distribution The number of doses of Narcan administered in Johnston County from January 2023-December 2023 by community and EMS was 3,125. This was more than triple the amount from 2022.

Quitline QuitlineNC referrals and calls by Johnston County residents continues to be adversely impacted by the COVID-19 pandemic.

Peer Support Specialist Training Training opportunities for Certified Peer Support Specialist increased recovery support resources in Johnston County. In 2023, 8 people completed PSS training with opioid settlement funding.

Programs and initiatives related to Transportation:

JCATS In March of 2023, JCATS launched a new ride-share program called Quick Ride. The Quick Ride program allows for rides Monday-Saturday 6am-8pm in and around Smithfield and into Selma. This is a fee for service, low cost transportation option much like Uber. The cost is $6.00 each way.

Morbidity and Mortality Changes Since Last CHA

Johnston County, according to the Robert Wood Johnson County Health Rankings, is ranked #18 out of the 100 counties in North Carolina. Johnston County is ranked among the healthiest counties in North Carolina (Highest 75%-100%) in health outcomes and the higher middle range (higher 50%-75%) in health factors.

Johnston North Carolina | County Health Rankings & Roadmaps

Mortalities due to COVID-19 have continued to decrease in 2023.

Emerging Issues Since Last CHA

These are the new or emerging issues in our community in 2023:

• North Carolina Medicaid Expansion started December 1, 2023 as did the need for increased access to care.
• Monkeypox
• Xylazine education
• Need for re-entry programs to connect people coming out of incarceration to housing and other resources
• Need for Detox resources
• Lack of adult daycare services
• Fall and balance prevention to support healthy aging, due to the increase in the 65 and older population in Johnston County
• Post COVID-19 recovery/continued school absenteeism rates
• Increase in seasonal respiratory illness (Covid-19, RSV, Flu)
• Post-Overdose Response Team
• Need for increased Mental Health First Aid training
• Suicide prevention and firearm safety

New/Paused/Discontinued Initiatives Since Last CHA

Discontinued/Paused initiatives in 2023:

• Satellite WIC clinics as part of transportation were paused in 2023 due to increased caseloads and changes to the WIC requirements.
• Freedom from Smoking was paused due to low participation.

New initiatives in 2023:

• CATCH my Breath, an evidence-based youth vaping prevention program began in Johnston County Public Schools, specifically in 6th grade classrooms.
• Community Narcan Trainings began in 2023. These trainings focus on recognizing and responding to opioid overdoses. We have partnered with a Selma Police Officer that also has a background in EMS. We aim to offer these trainings once a quarter in various locations around Johnston County.