HNC 2030 Scorecard: Cabarrus Health Alliance

The 2020 Community Health Needs Assessment (CHNA) conducted in Cabarrus County identified the following priority areas:

  1. Housing (CHNA pg. 23, 63)
  2. Mental and Behavioral Health (CHNA pg. 23, 73)
  3. Early Childhood Education and Development (CHNA pg 23, 52)

The CHNA process is intended to inform community stakeholders, as well as community members on how collectively and individually they all play a role in creating a healthier community for the residents of Cabarrus County. By September 2021, key stakeholders and community members were convened to assist with the development of Community Health improvement plans for each identified priority need. As instructed by the Community Planing Council and Healthy Cabarrus Executive Committee, Healthy Cabarrus staff will urge partners and community members to apply an equity lens to all proposed and recommended strategies, ensuring a positive impact among marginalized populations. When necessary or if not already established, community coalitions/taskforces will be created to carry out action plans.

The following Community Health Improvement Plans (CHIP) were created and submitted to the North Carolina Department of Health and Human Services (NCDHHS) on Tuesday, September 7, 2021. This document includes CHIPs associated with the top two priorities housing (Long-Term) and mental and behavioral health (Short-Term). Both plans meet the requirements outlined in the NC Local Health Department Accreditation and NC Department of Health and Human Services - Department of Public Health Consolidated Agreement.

 This Scorecard is a living document and is not intended to be a complete list of all programs or partners working on these issues in Cabarrus County. While Healthy Cabarrus and Cabarrus Health Alliance hope to continue to grow the programs and performance measures included, the intial Scorecards highlight targeted strategies that are focused on moving the needle on the identifed indicator. Use the icons to expand items and learn more:

  • R = Results we hope to see as our health improves
  • I = Indicators are data that concern us and the story behind the data that helps us understand why things are getting better or worse
  • O = Organizations that are responsible for overseeing the implementation of specifc programs, projects or strategies to address identified community needs.
  • P = Programs and partners working together to make things better
  • PM = Performance Measures are ways we are measuring success and describe how we are making a difference

COMMUNITY HEALTH ASSESSMENTS
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Executive Summary

Introduction and Vision

Healthy Cabarrus, housed within the Cabarrus Health Alliance, the public health authority of Cabarrus County, was created in 1997 as a multi-sector initiative designed to work collaboratively with community partners to improve the health of those who live, work, learn, play, pray and utilize services in Cabarrus County. Part of the collaborative responsibilities includes overseeing the Community Health Needs Assessment (CHNA) process every four years. While its mission includes the mobilization of community partners, its vision for conducting the county’s Community Health Needs Assessment (CHNA) is to not only identify the top needs, and develop community health improvement plans with strategies that can effectively address those issues faced by residents.

Healthy Cabarrus Missions: United through partnerships, we commit our time, talents and financial resources to create a health community and hopeful future for all.

With an understanding of social determinants of health, Healthy Cabarrus recognizes that an individual’s health is determined by more than just their physical well-being. According to the Centers for Disease Control and Prevention (CDC), a person’s health is impacted by access to social and economic opportunities; the resources and supports available within their homes, neighborhoods, and communities; the quality of schools; the safety of their workplaces; the cleanliness of their water, food, and air; and the nature of their social interactions and relationships.

Social determinants of health are issues far too complex for one group or agency to solve alone. While Healthy Cabarrus does not provide direct services to the community, they provide ongoing support to community partners by guiding community strategy development, identifying resources, and helping to create evaluation measures.

Leadership, Partnerships and Collaborative Process

Cabarrus Health Alliance, along with Healthy Cabarrus’ five-member Executive Committee, made up of external community stakeholders, oversees the CHNA process and ongoing community collaborative efforts. The 2020 CHNA launched with the development of the Community Planning Council (CPC) on September 19, 2019. The Cabarrus County Community Planning Council is made up of a diverse, multi-sectoral group of representatives including more than 40 individuals. The primary role of CPC members is to support primary and secondary data collection; assist with analyzing data and information collected; and interpret county data and community feedback to identify the top priority issues facing residents of Cabarrus County.

Healthy Cabarrus Executive Committee Members
Atrium Health Cabarrus Tri Tang, Chair
BCI Investgations and Consulting Merl Hamilton, Vice Chair
Cabarrus County Government Mike Downs
Concord Housing Department Angela Graham
Rowan Cabarrus YMCA Brent Rockett

 

Community Planning Council Number of Partners
Pubilc Health Agency  2
Hospital/Health Care System 2
Healthcare PRovider - other than behavioral Health 4
Behavioral Health Provider 1
EMS, Law Enforcement, Court System 4
Local Government 7
Non-profit Organizations 6
Business - employers, not organizations 4
Education - early childhood, K-12 and high education 4
Media/Communication Outlets 1
Public Community Members 3
City and County Service Systems 4

Contracted Services
Cabarrus Health Alliance established a Memorandum of Understanding (MOU) with North Carolina Central University to receive epidemiological support throughout the CHNA process. This support included review of survey tools, focus group discussion questions, and the collection and analysis of data.
The Healthy Cabarrus Executive Director supervised a University of North Carolina – Gilling’s School of Public Health master’s practicum student who contributed to the CHNA process by analyzing the community member survey responses by race/ethnicity, income and zip code. The practicum student also reviewed data for correlating factors and trends in subpopulation responses.

Theoretical Framework and Model
Healthy Cabarrus uses the North Carolina Division of Public Health’s eight-phase community health assessment process.
1. Establish CHNA Leadership Team: The Healthy Cabarrus Community Planning Council represents a diverse group of community sectors, such as the business sector, social services, community members, faith leaders or representatives, as well as transportation and housing experts.
2. Collect primary data: Community Member Survey, Key Informant Survey, and Focus Groups
3. Collect secondary data: Gather data from local, state and national-level sources, along with data surrounding social determinants of health. CPC members are also responsible for compiling and sharing data that their organizations capture.
4. Analyze and interpret county-level data: Host monthly data review sessions with Community Planning Council and other subject-matter experts.
5. Determine health priorities: Review data and conduct priority ranking with Community Planning Council members and stakeholders from key groups. Include priority ranking questions within Focus Group sessions and Community Member Survey.
6. Create CHNA document.
7. Disseminate CHNA document: Distribute throughout the community by reaching out to media outlets, conduct and participate in community meetings, and share findings with key stakeholders.
8. Develop Community Health Improvement Plans: Plan to address health priorities identified in the CHNA and how progress will be measured in the short- and long-term.

To find previously submitted action plans and progress to date on the 2016 priority needs, please visit
www.healthycabarrus.org and review Cabarrus’ annual State of the County Health Report (SOTCH).

Next Steps
The Healthy Cabarrus Community Planning Council presents this report as a call to action. The CHNA process is intended to inform community stakeholders, as well as community members on how collectively and individually they all play a role in creating a healthier community for the residents of Cabarrus County. The results of this report will be distributed in the community through multiple communication platforms and channels.

By September 2021, key stakeholders and community members will be identified and convened to assist with the development of community health improvement plans for each identified priority need. As instructed by the CPC and Healthy Cabarrus Executive Committee, Healthy Cabarrus staff will urge partners and community members to apply an equity lens to all proposed and recommended strategies, ensuring a positive impact among marginalized populations. When necessary, community coalitions/taskforces will be established to carry out action plans.

Priorities
  1. Housing (CHNA pg. 23, 63)
  2. Mental and Behavioral Health (CHNA pg. 23, 73)
  3. Early Childhood Education and Development (CHNA pg 23, 52)
Mental and Behavioral Health - Short Term CHIP
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Why Is This Important?

Mental and behavioral health continues to be a top identified need among Cabarrus County residents and community stakeholders. Mental health includes an individuals emotional, psychological, and social well-being. Good mental wellness is important at every stage of life, but limited access to services and providers, as well as the stigma associated with mental illness have left many individuals feel isolated and alone. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), people with co-occuring disorders are at risk for developing one or more primary conditions or chronic diseases (HIV, Hep C). The coexistence of both a mental illness and a substance use disorder, are known as co-occuring disorders. Evidence has also shown that individuals diagnosed with chronic health conditions or disease like cancer, diabietes, chronic pain and heart disease are at higher risk of suffering from a mental illness as well. 

Just like physical health, mental health needs to be taken care of and maintained, with available, affordable, and timely access to care. Access to mental and behavioral healthcare has been identified as a priority need in Cabarrus County since 2012. This result statement and local community health improvement plan (CHIP)align with Healthy NC 2030 indicator:

  • Health Indicator 19: Suicide Rate or Self Harm
FHLI-NC
HNC2030
I
2019
12.6
2
-3%
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Description

In 2016, Cabarrus County committed to becoming a partner of the national Stepping Up initiative. The initiative focuses on reducing the number of people with mental illness in jails. The concept of mental health overhaul is tremendous; however, acknowledging and responding to a problem that affects one of our own programs was a starting place.

According to the Stepping Up Initiative, two million people with serious mental illness are admitted to jails across the nation each year. Almost three-quarters of these adults also have drug and alcohol use problems. Once incarcerated, individuals with mental illness tend to stay longer in jail and upon release are at a higher risk of returning to incarceration than those without these illnesses.

Cabarrus County Department of Human Services employees a team (3 staff) that works with individuals both while incarcerated and post release. Staff work with justice involved persons from the point of when they are arrested and taken into custody, at which time detention officers perform medical screenings that Stepping Up staff review. Certain questions within the screening tool are designed to determine if an individual has a mental health or substance use disorder. When reviewing the screenings, staff determine which individuals might need additional follow-up and then takes them  through a more detailed questionnaire. Staff analyze where that individual is currently in their mental health needs, and together they, staff and the justice involved person, design a treatment and transition plan.

As part of that plan, Stepping Up staff assist individuals with setting up appointments with treatment providers when they are released and follows up with them even after they’ve left the detention center to be sure they kept those meetings.

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Description

S&H Youth and Adult Services (SHYAS) has partnered with Atrium Health Cabarrus - Behavioral Health Unit to provide Peer Support services for individuals admitted to the emergency department for mental health or substance use disorders. Peer Bridger Serivces are provided by SHYAS's peer support counselors who have two or more years of recovery and use their strength hope and experience to help others overcome their life challenges. The Peer Bridger Program is an evidence-based intervention aimed at improving outpatient service engagement, quality of life and reduce re-hospitalization rates after discharge from psychiatric hospitals. 

SHYAS provides One on One and Group Adult Peer Support Services that includes assistance with

  • Obtaining Meals
  • Engaging in Social Activities and Developing Natural Supports; 
  • Identifying, Obtaining & Maintaining Educational Resources & Employment; 
  • Identifying, Securing, and Maintaining Housing; 
  • Pre-Crisis and Post Crisis Support; 
  • Demonstrating Self Advocacy; 
  • Addressing Health Concerns and Facilitating Total Wellness; 
  • Promoting Self Help
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What We Do
Who We Serve
How We Impact
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PM
Q4 2021
161
3
64%
P
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Description

The lack of mental health crisis services across the U.S. has resulted in law enforcement officers serving as first responders to most crises. A Crisis Intervention Team (CIT) program is an innovative, community-based approach to improve the outcomes of these encounters. CIT programs create connections between law enforcement, mental health providers, hospital emergency services and individuals with mental illness and their families. Through collaborative community partnerships and intensive training, CIT improves communication, identifies mental health resources for those in crisis and ensures officer and community safety.

The goals of a local CIT program are:

  1. To improve safety during law enforcement encounters with people experiencing a mental health crisis, for everyone involved.
  2. To increase connections to effective and timely mental health services for people in mental health crisis.
  3. To use law enforcement strategically during crisis situations—such as when there is an imminent threat to safety or a criminal concern—and increase the role of mental health professionals, peer support specialists, and other community supports.
  4. To reduce the trauma that people experience during a mental health crisis and thus contribute to their long-term recovery.

Cabarrus County Sheriff's Office, Concord Police Department and Kannapolis Police Department are all working towards the goal of having 100% of law enforcement CIT trained. In partnership with the Mental Health Task Force, all three local law enforcement agencies are working to captured improved data on utilization skills and knowledge gained in CIT training in the field.

Housing and Homelessness - Long Term CHIP
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Why Is This Important?

According to the Robert Wood Johnson Foundation, healthy homes promote good physical and mental health. Good health depends on having homes that are safe and free from physical hazards. In contrast, poor quality and inadequate housing contributes to health problems such as chronic diseases and injuries, and can have harmful effects on childhood development. Poor indoor air quality, lead paint, and other hazards often coexist in homes, placing children and families at great risk for multiple health problems. 

A shortage of affordable housing limits a family or individuals choice about where they live, causing lower-income families to be left with limited options, that primarly include substandard housing in unsafe, overcrowded neighborhoods with higher rates of poverty and fewer resources for health promotion (e.g., parks, bike paths, recreation centers and activities). The lack of affordable housing affects a families’ ability to meet other expense needs, placing many under tremendous financial strain. High housing-related costs place an economic burden on low-income families, forcing them to make decisions between paying for food, heating and/or other basic needs. 

The Cabarrus County Homelessness Task Force and the Cabarrus Housing Collaborative jointly identified eight populations of homeless individuals living in Cabarrus County. The populations listed below were identified because of their unique needs and specific types of housing supports necessary.

  • Families with Children (one or two parent)
  • Single Adults with Disabilites (male and female)
  • Young Adults Aging out of Foster Care (predominantly female)
  • Youth Runaways
  • Senior Adults (single and married)
  • Previously Incarcerated
  • Adults Needing Substance Use or Mental Health in-patient treatment and housing supports
  • Chronically Homeless

This results supports efforts to address with the following Healthy NC 2030 indicators:

  • Health Indicator 9: Severe Housing Problems
I
2019
$72,333.00
2
0%
RM
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County Health Ranking Map

Severe housing problems

Percentage of households with at least 1 of 4 housing problems: overcrowding, high housing costs, lack of kitchen facilities, or lack of plumbing facilities.

The 2020 County Health Rankings used data from 2012-2016 for this measure.

 

CHR Link to County Level Data

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Action Plan

Huddle Housing (HH) will be carriage housing units positioned (huddled) around a community building with shared facilities on a site in Kannapolis to provide housing for extremely low-income individuals earning
$9,500 to $15,000/year. Often times this target population are people on disability, working minimum wage, and veterans. They can afford housing costs of about $250 - $375 per month (rent, utilities combine), and currently there is no housing solution in Cabarrus County for these individuals. 

Homeless to Housing (H2H) will be a multifamily campus that can serve 48 to 50 households of families, senior adults, and adults with disabilities who are currently homeless or in a housing crisis. Once at full capacity, the facility will serve about half of the current level of need for these populations. CCM is actively working on securing a location for this facility.

Description

Cooperative Christian Ministry serves Cabarrus and Southern Rowan counties through programs that move people from crisis to restoration.

  • Relieving hunger and food insecurity
  • Keeping families together in their home
  • Addressing homelessness and housing crisis

Teaching perseverance and restoring hope among struggling families in our community.

CCM’s network of food pantries, crisis financial assistance and continuum of housing programs are built on the support of individuals, businesses, foundations and churches throughout the region. CCM’s collaborative services deliver resources and education that help individuals and families create a path to stability by networking with partner organizations and local businesses.

  • Over 30,000 volunteer hours each year
  • More than 40,000 people assisted with food, financial assistance or housing

CCM continues to impact our community and transform lives through the ministry of Jesus Christ and a demonstration of God’s love in action.

Cooperative Christian Ministry’s long time mission has been ‘to provide immediate assistance to members or our community who are experiencing crisis in the areas of food, housing, or finances while engaging them in a series of actions that will empower them to move beyond crisis.’ The organization recently released its 2025 New Horizon Strategic Plan which includes a rapid expansion of transitional and crisis housing solutions. 

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What We Do

The City of Concord launched the Concord Family Enrichment Association, now WeBuild Concord in May of 2021. WeBuild Concord is a as a nonprofit established to develop equitable strategies for affordable housing and merge private, public and social resources for wealth creation and economic mobility for residents. Beginning with the 2020-2021 fiscal budget, the city gave 1 cent of the tax rate to affordable housing. This investment is set to recur each year, equaling $2.8 million for affordable housing: $1.4 million from the recurring tax rate and $1.4 million from the city’s return on investment the previous year.

Future housing projects scheduled for the beginning of 2022, will be developed with resources from WeBuild Concord, the City of Concord, and Cabarrus County. The Lincoln Street Townhomes Project, a 26-unit townhome development, will provide residents earning less than 80 percent of the area median income (AMI) an opportunity to own their homes. The Lincoln Street Project will be in the historic Logan Community. WeBuild Concord also announced a partnership with the City of Concord to provide several single-family homes during the same period.

In September 2021, WeBuild Concord lead community partners, stakeholders, non-traditional community leaders and community members through the proess of developing a Cabarrus County Community Land Trust (CLT) model. CFEA contracted Grounded Solutions to facilitate 5, 1-hour sessions to provide a general overview of CLTs, as well as assist with the identification of next steps and understand the road ahead to developing a local CLT.

Who We Serve

Concord and Cabarrus County residents who are low- and moderate-income renters and homebuyers.

How We Impact

Community land trusts (CLTs) are private, non-profit organizations that purchase land to lease to residents with low and middle incomes for housing use. CLTs separate ownership of the home and the land it occupies, which reduces the size of a mortgage and lowers monthly mortgage payments. The land the home is on is leased to homeowners as part of a long-term ground lease, typically for 99 years. CLT agreements require homes be owner occupied and stipulate that the home may not be rented out or “flipped” by renovating it for quick resale. As part of their shared-equity agreement, homeowners on CLT-owned land are required to sell the home back to the CLT or to another resident with low income at an affordable price when they decide to move. CLTs may also purchase and hold land to support community development, open space efforts, community gardens, and similar initiatives. CLTs often include stewardship activities such as teaching expectant and new homeowners about finances, alerting them to high risk loans, and assisting potentially delinquent homeowners. (Source: Robert Wood Johnson Foundation - What Works for Health)

Community Land Trusts can:

Can help create partnerships by bringing together various members of the community, including developers, affordable housing advocates, government officials, and low- and moderate-income households.

  • CLT staff can provide expertise on financial resources for affordable housing to city planners and private developers.
  • Provides for long-term affordable housing needs, as the CLT owns the land and keeps the housing affordable long-term, often in perpetuity.
  • Can counter neighborhood disinvestment by introducing resident control over land.
  • CLTs often work in conjunction with other local strategies, such as a housing trust fund,
  • demolition taxes, or inclusionary zoning ordinances, creating a synergistic and multifaceted approach to affordable strategies.
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Description

The Salvation Army - Cabarrus County is in the final phases of fundraiser for their new emergency shelter, which includes expansion from 28 beds to 62 beds, and from 1 family room to 7 family rooms. The facility will offer congregate prepared meals and living space, monitored activities & programs Private sleeping space; shared shower and laundry. Will include community meal/soup kitchen; work opportunities for residents, staff and clinical space for offices, counseling, meetings, medical treatment and assessments; and access to transportation services and parking.

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What We Do
Who We Serve
How We Impact
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Description

Critical Home Repair (CHR) programs address major safety concerns in homes by making necessary repairs at a subsidized rate, allowing homeowners to remain in their homes and preserving Cabarrus County’s dwindling affordable housing stock. Cabarrus County, the City of Concord, City of Kannapolis and Habitat for Humanity Cabarrus, all provide different levels and types of critical repair programs. More than a year ago, the four agencies began meeitng monthly to review critical repair applications that each of their agencies received. By meeting and reviewing jointly it has allowed them to assess if the application was more appropriate for another entity to accept and complete. This collaborative effort has ensured that more individual's home critical repair needs are met, as some individuals may have applied to the wrong jurisdiction or agency, previously making them ineligible for services.

P
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Description

Coordinated Entry and Assessments would operate as a portal of entry process that aims to connect individuals and families who are homeless, or those at imminent risk of becoming homeless, to an existing available shelter/housing resource in the Cabarrus Community. The Cabarrus County Homelessness Task Force and the Cabarrus Housing Collaborative, both stressed the need for a central entry point to eliminate barriers for those in housing crisis.

Some Coordinated Entry Programs use the following definition of homeless. A homeless person is someone:

  • Living in in a place not meant for human habitation, or
  • Living in emergency shelter (including domestic violence shelter), or
  • Living in transitional housing for homeless persons, with an imminent exit date, or
  • Exiting an institution where they temporarily resided for up to 90 days (and were in a shelter or a place not meant for human habitation immediately prior to entering that institution)

In a Coordinated Entry system, households experiencing homelessness :

  • Know exactly where to go to get help;
  • Are assessed in a standard and consistent way;
  • Are matched with the housing/services that best meet their needs, as available. 

By assessing everyone the same way, the community can be strategic about its limited resources and where resources may need to be redirected or added. Coordinated Entry, however, is not a  housing program or a guarantee of shelter or housing.

 According to the National Alliance to End Homelessness, this approach is more efficient because it:

  • Helps people move through the system faster by reducing the amount of time spent moving from program to program before finding the right match
  • Reduces new entries into homelessness by consistently offering prevention and diversion resources
  • Improves data collection and quality and provides accurate information on what kind of assistance people need
Early Childhood Education and Development
R
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% Change
Why Is This Important?

Evidence indicates that children learn more during their first six years of life than they do at any other point in their lives. Addressing the disparities in access to early childhood development and educational opportunities can significantly boost and have long lasting impacts on a child’s future health outcomes. Seventy-one-percent of children, 6 years old and younger, live in a household where their parents or single parent reports to work. Although there has not be a dramatic increase in the five and younger population, resources for early childhood education and care are becoming increasingly more challenging to access, as staffing shortages and cost limit availability. The early years are extremely critical and many studies have shown that early childhood interventions can produce long lasting impacts on a child’s cognitive, physical, social, emotional and behavioral development.

This results supports efforts to address with the following Healthy NC 2030 indicators:

  • Health Indicator 5: Adverse Childhood Experiences
  • Health Indicator 6: Third Grade Reading Level

 

Similar to housing, the government has set the recommendation of how much families/people should spend on childcare. For housing, individuals should not spend more than 30% of their income on rent/mortgage + utilities, for child-care a two-child household should only spend 7% of their income on childcare or they are considered ‘cost burden’. In Cabarrus County two-child households are spending 24% of their income.

Child Care Cost Burden is the percent of median household income a two-child household spends on annual childcare costs.

Why is affordable childcare important?
When child care is affordable and accessible, it can increase opportunities for parents or guardians to pursue further education or participate in paid work to earn income, and in some cases, gain healthcare and retirement benefits to support their families. When much of a paycheck goes toward child care expenses, households face difficult trade-offs in meeting other basic needs such as paying rent or mortgage, affording doctor visits, healthy foods, utility bills, and reliable transportation to work or school. 

 

FHLI-NC
HNC2030
I
2019
56.8%
1
-6%
I
2019
15.3%
2
-35%
State of the County Health Reports (SOTCHs)
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Time
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Overview

State of the County Health Report 2021
Conducting a community health assessment is an ongoing process that engages diverse agencies, providers, and individuals in identifying community assets and strengths, as well as unmet needs. Leadership for this collaborative process is provided by the Cabarrus Health Alliance (CHA) through Healthy Cabarrus. The following State of the County Health (SOTCH) Report, serves as an update and documented progress following the findings of the 2020 Community Needs Assessment. The 2021 Cabarrus County SOTCH was submitted to North Carolina Department of Human Services (NCDHHS) on March 7, 2022.

Information provided within this report is specific to the identified priority health issues: housing, behavioral health, and early childhood education and development. The report also provides  updated data and information specific to Cabarrus County mortality and morbidity rates; COVID-19 response, resiliency, and recovery; emerging issues and new initiatives. 

Communication with stakeholders and community members regarding the identified community health priorities and progress to-date is vital to community health improvement. Following review by the Cabarrus County Public Health Authority Board of Commissioners and Healthy Cabarrus Executive Committee, copies of the 2021 State of the County Health Report will be disseminated to the Healthy Cabarrus Advisory Board, as well as hard copies to target community locations. Targeted locations include local libraries, community centers, park and recreation departments, federally qualified health centers, in addition to other sites with high community member presence.

Cabarrus County Profile
Cabarrus County’s population has seen consistent growth since 2000. Between 2010 and 2020, Cabarrus County’s population increased by 26.8% percent or nearly 50,000 people. In comparison, during that same time period, North Carolina’s population only increased by only 9.5%. As documented in previous reports, extreme, rapid growth impacts how agencies and organizations provide services to residents, and often times vulnerable populations such as persons with disabilities, limited English proficiency, children under 5 and persons over 65 are disproportionately affected.

Total Cabarrus County Population: 225,804

Sources
Persons in Poverty, Median Household Income - U.S. Census 2015-2019
Educational Attainment - U.S. Census, American Community Survey 1 Year - 2019
Unemployment Rate - US Bureau of Labor Statistics - December 2021

Progress on Community Health Improvement Plans

Following the 2020 Cabarrus County Community Health Assessment, major strides and strategic decisions were made to impact and improve the wellbeing of Cabarrus County residents.  With the support from the Cabarrus County Commissioners, Cabarrus County distributed $33.5 million in American Rescue Plan Recovery Funds to more than 50 agencies, with a priority placed on supporting sustainable initiatives that would address the county’s greatest needs.

  • Housing Programs: $14,072,673
  • Behavioral and Mental Health Programs: $11,450,785
  • Childcare and Afterschool/Summer Programs: $1,781,002

For the full summary of the Cabarrus Recovery Grants allocation, click here. 

Housing and Homelessness

Healthy Cabarrus worked with local housing leaders to convene the Cabarrus Housing Collaborative. The newly formed collaborative, includes representation from across the public, private, and non-profit housing sectors, with the goal to create a cross-sector, multi-faceted plan to address housing challenges in Cabarrus County. The group plans to develop its mission, vision, and core values in early 2022, as a foundation for its future work to address needs faced by those experiencing housing crisis; seeking affordable housing; or actively seeking support for necessary critical repairs. 

Cooperative Christian Ministry
Cooperative Christian Ministry’s long time mission has been ‘to provide immediate assistance to members or our community who are experiencing crisis in the areas of food, housing, or finances while engaging them in a series of actions that will empower them to move beyond crisis.’ The organization recently released its 2025 New Horizon Strategic Plan which includes a rapid expansion of transitional and crisis housing solutions. 

  • Huddle Housing (HH) will be carriage housing units positioned (huddled) around a community building with shared facilities on a site in Kannapolis to provide housing for extremely low-income individuals earning
    $9,500 to $15,000/year. Often times this target population are people on disability, working minimum wage, and veterans. They can afford housing costs of about $250 - $375 per month (rent, utilities combine), and currently there is no housing solution in Cabarrus County for these individuals. 
  • Homeless to Housing (H2H) will be a multifamily campus that can serve 48 to 50 households of families, senior adults, and adults with disabilities who are currently homeless or in a housing crisis. Once at full capacity, the facility will serve about half of the current level of need for these populations. CCM is actively working on securing a location for this facility.

WeBuild Concord
The City of Concord launched the Concord Family Enrichment Association, now WeBuild Concord in May of 2021. WeBuild Concord is a as a nonprofit established to develop equitable strategies for affordable housing and merge private, public and social resources for wealth creation and economic mobility for residents. Beginning with the 2020-2021 fiscal budget, the city gave 1 cent of the tax rate to affordable housing. This investment is set to recur each year, equaling $2.8 million for affordable housing: $1.4 million from the recurring tax rate and $1.4 million from the city’s return on investment the previous year.

Future housing projects scheduled for the beginning of 2022, will be developed with resources from WeBuild Concord, the City of Concord, and Cabarrus County. The Lincoln Street Townhomes Project, a 26-unit townhome development, will provide residents earning less than 80 percent of the area median income (AMI) an opportunity to own their homes. The Lincoln Street Project will be in the historic Logan Community. WeBuild Concord also announced a partnership with the City of Concord to provide several single-family homes during the same period.

Salvation Army
In August 2021, the Salvation Army broke ground on a new 16,000 square foot ‘Center of Hope Emergency Shelter’. The new facility will help to address the community’s emergency housing needs for homeless residents and increase local capacity to serve families with nowhere else to turn. The new facility will increase the crisis beds available from 28-bed to 64-bed, including the addition of six living units for families with additional beds for women and men. Families are some of the fastest growing homeless populations in Cabarrus and neighboring counties. 

  • The new Center of Hope will offer six 2-bedroom family living units that include a family room and private bathroom. 
  • Seclusion of the family unit allows two-parent families to stay intact and allows teenage young men to stay with their families rather than being separated into the men's dorm. 
  • Privacy and security is increased for families, including a private playground for children, separate dining from individual men and women, and secure access to the family floor. 
  • Programs and partnerships that help meet the immediate and long-term needs of shelter residents to help them identify and overcome barriers to stable housing.

Additional services and programs that Salvation Army residents will have access to:

  • Medical and mental health care;
  • Finance and budgeting classes;
  • GED and vocational classes;
  • Life skills classes;
  • Intensive case management.      

Behavioral Health

Cabarrus County is a designated Health Professional Shortage Area in mental healthcare. For the last nine years, access to mental healthcare has been identified as a priority need in the Cabarrus County Community Health Assessment. In 2017, the Cabarrus County Commissioners established the Cabarrus County Mental Health Advisory Board, a formal county board, to oversee efforts and advocate for improved access to mental health services. 

After years of work and advocacy to improve the mental healthcare system for residents, commissioners made the decision to vote to disengage from Cardinal Innovations Healthcare, the County’s Managed Care Organization (MCO). The disengagement process required approval from the North Carolina Department of Health and Human Services (NC DHHS), and in September 2021, Cabarrus and Union counties were notified that, NC DHHS Secretary Mandy Cohen approved both requests for realignment with Partners Health Management . The realignment was effective September 1, 2021.

To reevaluate efforts due to continued changes within the behavioral health system, Healthy Cabarrus hosted a virtual action planning meeting in January 2021, nearly 4 years after the first retreat in April 2017.  The meeting focused on assessing previous efforts of the Mental Health Task Force; identifying current gaps and new challenges; as well as educating partners on Results Based Accountability. The action planning retreat, helped to realign task forces to respond to emerging needs and narrow focus to priority populations.

New focus areas for the Mental Health Task Forces: Trauma Informed Communities, Persons who are Justice Involved, Data and Assessments

Cabarrus County Behavioral Health Facility Expansion
The 2021 North Carolina State Budget allocated $30-million to Cabarrus County for the development and building of a regional behavioral health crisis service center. Leaders from Cabarrus County, Atrium Health, Cabarrus Health Alliance and Partners Behavioral Health have started working to identify best practices to maximize service delivery, and are scheduled to visit Guilford County’s new mental health facilities in early 2022. Tentatively the behavioral health crisis center will include separate adult and child/youth facilities, as well as a behavioral health urgent care (BHUC). 

CHA Expand Behavioral Health Services
Prior to 2021, CHA employed two Licensed Clinical Social Workers (LCSWs) for our pediatric and maternal health patients. Grant funds through the Cabarrus Recovery Grants, increased the number of LCSWs to a total of 5 to provide evidence-based treatment and support services. Through this services expansion, individuals eligible to receive services through these grant funds will be limited to Cabarrus County residents who are uninsured, underinsured, or low-to-moderate income. Short-term expected outcomes include: 

  1. Expanded capacity in Cabarrus County to provide mental health treatment services and support for vulnerable residents;
  2. Decreased impact of COVID-19 on the mental wellness of vulnerable Cabarrus County residents; and, 
  3. Decreased health disparities for Spanish-speaking Cabarrus County residents. 

The long-term vision for CHA’s new Behavioral Health Department includes engagement in policy practice at the state and local level, as well as efforts to continue to develop and expand community based behavioral health education.

Early Childhood Education

Cabarrus County Government hired Early Childhood Education Coordinator, Carla Brown, to lead and coordinate efforts to improve the County’s early childhood systems. Ms. Brown works closely with the 15-member Early Childhood Task Force Advisory Board (ECTFAB), which was established to advise the Board of County Commissioners on matters related to the primary development of children in Cabarrus County. 

The ECTFAB, expanded to include four primary work groups: Healthy; Basic Needs; Social, Emotional and Nurturing Relationships; Learning and Ready to Succeed. The Task Force and Work Group members are responsible for developing action plans and identifying necessary strategies to impact the NC Early Childhood Action Plan benchmarks, ensuring shared community partner responsibility to improve the lives of the County’s youngest residents. 

Lockhart Child Development Center

The Lockhart Child Development Center opened in early 2021, after extensive collaboration and planning. The Cabarrus County Early Childhood Task Force Advisory Board initially recommended this collaborative approach to Cabarrus County Commissioners as a way to meet State education benchmarks and support the educational needs of area families. Local partners supported the initiative with resources that took the idea from concept to reality.
Partners in the project include:

  • All Saints’ Episcopal Church provides the f acility and administration of the education center
  • Rowan-Cabarrus Community College uses the site to train Rowan-Cabarrus Community College students who wish to pursue a career in early childhood development
  • Cabarrus County Government assisted with the initial startup costs and provides tuition assistance to County employees who enroll their children in one of 40 spots dedicated to children of County employees
  • The County plans to use the site to inform businesses about the importance and value of helping employees with childcare expenses.

Click to play video above.

Community Health Improvement Plans for housing and behavioral health are available here. Indicator and performance measure data is updated quarterly and annual based on the source.

Mortality and Morbidity Changes

Mortality

Rates of morbidity, mortality, and emergency hospitalizations can be reduced if community members have adequate access to services such as health screenings, routine testing, and vaccinations.  Prevention indicators can call attention to a lack of access or knowledge regarding one or more health issues and should inform program interventions.

The data within this section comes from the State Center for Health Statistics 2021 County Health Data Book and the Robert Wood Johnson Foundation – County Health Rankings. The data within the 2021 County Health Data Book spans 5 years, either 2014-2018 or 2015-2019 and is considered current for community health assessments and state of the county health reports due in March 2022. 

 The red arrow indicates the data is worse than the previous reporting period. The green arrow indicates health improvements since the previous reporting period.

Disparity ratios are calculated by dividing the rate for a population by the best rate for a selected health indicator to determine how much more likely a particular event is to occur in a population compared to another population. In the table to the left, infant mortality disparity for both the state and Cabarrus County compares the death rates of white and African American babies. In Cabarrus County, African American babies are 1.66 times more likely to die before 1 year of age when compared to white babies.

 

The data available for leading cause of death shows that diseases of the heart has surpassed cancer – all sites, as the number one leading causes of death among Cabarrus County residents. Although state and county data are not yet available for leading causes of death for 2020 and 2021, the Centers for Disease Control and Prevention reports COVID-19 as the third leading causes of death in 2020, proceeding heart disease and cancer. Diabetes dropped from the 8th leading cause of death to the 9th. 

2015-2019 NC Resident Race/Ethnicity and Sex-Specific Age-Adjusted Death Rate Disparities 

  • African Americans, both males and females, have higher rates of death associated with Disease of the Heart and two-times higher rate for nephritis/nephrosis (kidney disease) 
  • African American females consistently have the highest rates of death caused for Breast Cancer and three-times higher rate for Diabetes
  • Females, both African American and White, have a much higher rate of Alzheimer’s disease than their male counterparts
  • Suicide is highest among white males. All other races, sexes are too small a number to calculate a county-wide rate

 

 

 

 

 

 

 

 

 

 

 

It is important to point out that like the leading cause of death data, the life expectancy data available is prior to the COVID-19 pandemic. According to the Proceedings of the National Academy of Sciences (PNAS) COVID-19 has generated a huge mortality toll in the United States, with a disproportionate number of deaths occurring among the Black and Latino populations. Experts anticipate that COVID-19 will reduce US life expectancy by 1.13 years, with estimated reductions for the Black and Latino populations being 3 to 4 times that for Whites. Disparities in life expectancy between race and ethnicities existed prior to the pandemic. In 2019, data showed a two year life expectancy difference between white and African American Cabarrus residents, 78.9 and 76.9 respectively. 

 

Morbidity

Morbidity is another term for illness or medical condition. and often times refers to having a disease or a symptom of disease, or the assessment of the amount of disease within a population.  Some examples of common morbidities are heart disease, diabetes, and obesity, but morbidities can range from Alzheimer's disease to cancer to traumatic brain injury. When a person has more than one morbidity at a time, it is referred to as co-morbidity. Morbidities are NOT deaths. Prevalence is also used as a measure to determine the level of morbidity in a population.

2021 Robert Wood Johnson County Health Rankings: Quality of Life, Health Behaviors and Clinic Care Measures

 

 

*Items shaded in yellow indicate that Cabarrus County is doing better than or the same as the state of North Carolina, but not has good as Benchmark Counties or Top Performers in the U.S.
*Items shaded in red indicated that Cabarrus County is doing worse than the state of North Carolina and Top Performers

 

 

 

 

To learn more about the County Health Rankings or to see how other counties across North Carolina are performing, click here.

Sources
NC State Center for Health Statistics

Robert Wood Johnson Foundation - County Health Rankings

 

 

Emerging Issues

COVID-19

The COVID-19 pandemic remains an emerging and on-going issue as variants cause rapid increases in case counts and deaths.Cabarrus County experienced the first COVID-19 related death in North Carolina in early March 2020, placing the county in a state of emergency. The Public Health Authority of Cabarrus County d.b.a Cabarrus Health Alliance (CHA) has been responsible for supporting the multi-sector and cross jurisdictional response to COVID-19. As the local health department, CHA, is responsible for overseeing contact tracing, contact investigation, and public education on mitigation strategies. 

On January 6, 2021, CHA began administering the COVID-19 Pfizer vaccine at the Cabarrus Arena and Events Center. More than 1,000 people were vaccinated the first day and tens of thousands more were vaccinated through similar large scale drive-thru clinics operated by the health alliance. Understanding capacity issues and the challenges of rapid mobilization, CHA partnered with school systems, nonprofits and private sector companies to meet testing and vaccine demands as public requests increased. CHA continues to monitor and make local and state COVID-19 data easily accessible to the public. County health officials are preparing to move from response to recovery and plan to engage individuals from across the county, including traditional and non-traditional leaders, in hopes of creating a Recovery Coalition, which will make recommendations for how to move forward from pandemic to endemic.

Racism declared a Public Health Crisis

In late 2020, the Cabarrus County Public Health Authority Board of Commissioners, the governing body of the Cabarrus Health Alliance, joined a growing number of U.S. cities, counties and public health departments in declaring racism a Public Health Crisis. Throughout 2021, CHA staff, departments and leadership worked diligently to implement efforts and advocate for systems and policy changes, to accomplish the 13 items outlined within the proclamation. Racism has created a health divide negatively impacting black and brown residents. Minorities in Cabarrus County have lower life expectancies when compared to their white counterparts, meaning they are more likely to die before age 75. Data also shows that black residents are more likely to die from heart disease and diabetes, than white residents.  To view the entire proclamation, as well as the internal and external strategies outlined, click here

Smoking and Tobacco use

The NC Tobacco Prevention and Control Branch (NC TPCB) reports that tobacco use is the leading cause of preventable disease and death in North Carolina and the United States. In Cabarrus County, the highest rate of death due to cancer, is caused by cancer of the trachea, bronchus and lung. Studies have shown that smoke-free laws can not only protect people from secondhand smoke, butcan motivate and help tobacco users quick and even prevent or reduce initiation of use among youth.  Cabarrus County has adopted four of the six recommended North Carolina Countywide 100% Tobacco Free Policies outlined by the NC TPCB. An opportunity remains to advocate and educate on the positive health impacts for residents and employees with the adoption of tobacco free government grounds ad public places.

Every day, about 1,600 young people under 18 try their first cigarette, and nearly 200 become daily cigarette smokers (CDC). For many years in Cabarrus County smoking and tobacco use data showed decreases in reported use by youth. In recent years, smokeless tobacco products and electronic vaping have been the primary products of tobacco use for middle and high school students. According to the 2021 Cabarrus Youth Substance Use Survey, only 2% of middle and high school students reported current cigarette use, while 6% reporting current vape use (10.6% High School, 2.1% Middle School). Cabarrus County students also reported highest perceived risk associated with cigarette use, even when compared to prescription drugs, alcohol and marijuana use. 

The Rescue Agency, shined a light on some shifts in tobacco trends associated with teen vaping behavior data due to the COVID-19 pandemic. Data showed decreased vaping use by experimenting teens due fewer peer interactions and less access, while regular users reported increasing their vape use due to boredom and coping with stress from being home. The Healthy Cabarrus Substance Use Coalition and community partners are working to identify strategies to change youth perception and decrease the number of youth who report first time tobacco use, either through use of cigarettes or electronic vaping devices. 
 

New, Paused or Discontinued Initiatives

Office of Rural Health - Dental Grant Service Expansion 
With funding from the Office of Rural Health, Cabarrus Health Alliance (CHA) will increase access to evidence-based dental care that prevents and reduces the incidence of oral disease through targeted recruitment, patient education, and comprehensive treatment; reaching at least 1,000 low-income, underinsured, or uninsured residents patients annually. Care will be provided at CHA’s two dental offices, and by leveraging existing infrastructure, staff, and community relationships to institute a systems-change that brings pop-up dental services to vulnerable residents at trusted locations that already serve them.  

Through these funds, the dental program will provide each patient will be afforded up to $500 of free dental services. If completing their treatment plan extends beyond that value, the patient will be automatically enrolled in a 60% discount using our sliding fee scale. Partner pop-up locations:

  • Cooperative Christian Ministry
  • El Puente Hispano
  • Local churches – through Atrium Health’s Faith Community Health Ministry

Community Health Workers
The American Public Health Association defines a Community Health Worker (CHW) as “a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationships enables the worker to serve as a liaison and link between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.”In 2021, both Cabarrus Health Alliance and Atrium Health launched CHW programs with the goal of supporting community members in reducing health-related risk behaviors. CHW’s also work to identify social determinants of health (SDOH) gaps for priority populations, so recommendations can be made based on knowledge and experience for systems level change to improve opportunities for a healthy life for community members.

Cabarrus Health Alliance Community Health Worker
CHA has hired and began training six (6) racially and linguistically diverse CHWs who come from the culture and community they intend to serve. CHW’s will be deployed to the following agencies/locations:

  • El Puente Hispano
  • Cooperative Christian Ministry
  • Cabarrus County Department of Health and Human Services
  • Community Free Clinic
  • Cabarrus Health Alliance – Communicable Disease Department
  • Cabarrus Health Alliance – Women’s Health Clinic

Public Private Partnership

Public–private partnerships (PPPs) have been placed at the forefront of many conversations, as they have become a popular way to get major infrastructure projects built and develop a shared responsibility for improving resident/employee well-being. Compared with traditional solutions, which can strain government and non-profit resources, these public-private arrangements are intended to boost efficiency and effectiveness.

The involvement of large employers during workforce housing discussions has been a focus of the Cabarrus Housing Collaborative. When companies like Amazon launch a $2 billion Housing Equity Fund to preserve and create over 20,000 affordable homes across the country, it is imperative that they have a seat at the local table to strategize future housing growth and development.

The public and non-profit sectors are encouraged and challenged to engage the private sector with education and advocacy of how for-profit companies are a vital part of the community. From large corporations to small businesses, these entities should have the opportunity to contribute far beyond just jobs, salaries, and wages. They are members of the community and should have a space to share their concerns and be active in supporting solutions.
 

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