HNC 2030 Scorecard: Cabarrus Health Alliance

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.

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)

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.
 

Overview

State of the County Health Report 2022
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 Health Needs Assessment. The 2022 Cabarrus County SOTCH was submitted to North Carolina Department of Human Services (NCDHHS) on March 6, 2023.

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; emerging issues; new, paused and discontinued 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 and/or the shared link of the 2022 State of the County Health Report will be disseminated to the Healthy Cabarrus Advisory Board. The Advisory Board will also be asked to identified ways that they can assist with public and partner awareness of the report and its findings. Hard copies will be distributed to target community locations, which 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 has experienced a 2% or higher annual population growth since at least 2010. The population of Cabarrus County, North Carolina in 2021 (ACS 1 Year Estimate) was 231,278, an increase of 29.5% from the 178,564 residents who lived in the county in 2010. For comparison, the US population grew 7.3% and North Carolina's population grew 10.2% during that same time period. 

Rapid population growth will not only impact how agencies and organizations serve residents, due to capacity and staff challenges, but communities can also experience lack of housing and schools, increased pollution, insufficient water availability and waste-disposal problems.

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: 231,278

Sources:
U.S. Census, American Community Survey 1-Year 2021 Estimate
US Bureau of Labor Statistics - December 2022

Progress on Community Health Improvement Plans

For data updates and progress specific to additional strategies outlined in the Community Health Improvement Plan for the Mental and Behavioral Health (Short Term) and Housing (Long Term) priorities, please visit each respective Scorecard here.

Housing and Homelessness

Cooperative Christian Ministry 

Rebuilders College and Brown Mill Commons – The Rebuilders College at Brown Mill Commons will initially provide 48 transitional, stable housing units, as well as nutritional support, resources for adult and child education, healthy habits and activities, connection to vital resources, access to public and other transportation, job training, career coaching and employment opportunities.  Participants who complete the program will have achieved: debt elimination, credit improvement, financial budgeting and savings, increased income and financial stability, established child care supports, reliable transportation strategy, academic achievement, successful parenting practices, healthy lifestyles, and household stability.  

Grace Place – Grace Place is an asset-based program, designed to provide the basic needs of food, housing and community for extremely low-income senior individuals in an environment that allows them to establish stability and connect with vital resources while promoting personal responsibility and community engagement. Serving extremely low income, seniors, Veterans, or those on disability (12-14 units), the campus will have multiple units strategically positioned around a community center which provides access to prepared meals, laundry facilities, transportation services, counseling, activities, educational opportunities, and life skills training.

HelpwithHousing.net – This site provides a selective referral for the homeless or those in housing crisis in Cabarrus County to a local entity that best serves their specific needs or condition.  The site also aggregates data to provide community leaders with insight into the real housing need in our community.  This site is a readily available digital platform for the homeless population or those serving others in housing crisis in our community to be CONNECTED to the appropriate resource that bests fit his/her needs. www.helpwithhousing.net 

Unsheltered Impact Report – The Unsheltered Impact Report is the product of a multi-agency focus group chartered by local Law Enforcement and Emergency Services to compile the working knowledge of the agencies working hand on with the unsheltered homeless in Cabarrus County.  The resulting report gives insight to quantifying the population, understanding the circumstances of the unsheltered and identifying potential corrective actions or solutions to improve the plight of the homeless in our cities.  The report has been presented to numerous local initiatives who address populations which are integrated with the unsheltered, in order to ensure appropriate considerations in all future corrective measures.

WeBuild Concord

WeBuild Concord expanded its mission in 2022 to provide housing opportunities through public and private partnerships for residents, including the building and development of homes, a community land trust, and advocacy for equitable housing and community development.

On November 30, WeBuild hosted a ground breaking for the Lincoln Street Townhome Project, a 26-unit townhome development designed to increase affordable housing and homeownership in the Logan Community. The Lincoln Street Project is a collaboration with the City of Concord, Cabarrus County Government and other community partners. The project will begin the most significant homeownership effort in the historic Logan Community. Currently, less than 35% of residents in the Logan Community own their homes, which is extremely low. The City of Concord and Cabarrus County support the effort with funding from the American Rescue Plan Act (ARPA) and the City’s affordable housing revolving fund. The Lincoln Street Townhome Project is the first of a more than $12 million investment in affordable and equitable housing projects by WeBuild Concord over the next several years.

Behavioral Health

Atrium Health Cabarrus - Behavioral Health Holding Unit (BHHU) 
The Cabarrus Healthcare Foundation received a $3.5 million grant from Cabarrus County Government – American Rescue Plan Act funding to build and upfit a Behavioral Health Holding Unit (BHHU) at Atrium Health Cabarrus. The 3,623 square-foot locked space will be located just outside the hospital’s existing emergency department (ED) and include eight beds which will be designated for behavioral health patients seeking crisis care through the ED.  The addition of the BHHU will allow for traditional ED beds, that were repurposed for behavioral health patients, to again be used for those needing emergency medical services.

The BHHU will provide a safe space that maintains the dignity and respect for mental health patients who are seeking care during crisis. The hospital will maintain five beds within the traditional ED, ensuring a total of 13 beds for patients in behavioral health crisis. The renovated space will have a dedicated tele-psych room, shower and activity space. 

Cabarrus County Government - Regional Mental Health Facilities 
In spring 2022, Cabarrus County released an initial Request for Proposals (RFP) from for-profit and not-for-profit providers, to operate a newly constructed regional behavioral health facility in Kannapolis. The facility is expected to begin operations in early 2025. The County is seeking to enhance existing crisis response service systems in the community and to divert individuals from hospitalization and emergency departments when appropriate. 

Although design concepts will be finalized in 2023, the County does anticipate one building with a single floor. The combination of Behavioral Health Urgent Care (BHUC) and traditional treatment beds, for adults, children and adolescents, is intended to provide a “no wrong door” center to receive walk-in and drop-off patients experiencing a behavioral health crisis. The goal of the facility is to provide initial treatment and stabilization leading to diversion of appropriate patients to less restrictive levels of care with only those who require 24-hour treatment being referred to the Facility Based Crisis (FBC), Substance Use Disorder (SUD), Psychiatric Residential Treatment Facility (PRTF), or other beds in the region. The treatment spaces (FBC, SUD, PRTF) within the facility will be designed to comply with the Facility Guidelines Institute (FGI) guidelines for inpatient treatment spaces to allow for flexibility in adjusting licensure and program types as the needs of the local population shift during the lifespan of the facility. 

Cabarrus County - NC Department of Health and Human Services, Mental Health Town Hall 
North Carolina Department of Health and Human Services Secretary (NCDHHS) Kody H. Kinsley — alongside N.C. State Senators Jim Burgin and Paul Newton and State House Representatives Kristin Baker, and Wayne Sasser — hosted a town hall in Kannapolis on November 29, to discuss mental health in North Carolina.  NCDHHS leadership and Cabarrus County Commissioners are committed to advancing behavioral health and resilience, as more than three million people in the state have mental health or substance use disorders.  Members of the public from Cabarrus and surrounding counties were able to attend, ask questions and contribute to the conversation. State officials offered comments on key policy issues, such as Medicaid Expansion, access challenges related to behavioral health and state legislation that restricts staff and billable services.

Click here to watch the full Mental Health Town Hall hosted in Cabarrus County. 

Cabarrus Health Alliance (CHA) School Nurse Program - Mental Health and Social Emotional Learning Supports 
CHA's School Health Department, which manages all school nurses in Cabarrus County and Kannapolis City Schools, was able to use state funds to provide school based mental health and social emotional learning interventions. The funds were approved to be used for hiring mental health providers to provide population-based mental health support, wrap around, non-clinical mental and behavioral health services for students, teachers, and staff as well as training and education in addition to the COVID testing services provided in 2021.
Through a collaborative approach with CCS and KCS, the School Health team identified and have been able to support the following activities:

• Train school health support staff in Question, Persuade, Refer (QPR) and Reconnect for Resilience
• Train all school nurses in QPR and Reconnect for Resilience
• Support Reconnect for Resilience Training for KCS and CCS staff
• Provide QPR Trainer Training and Reconnect Trainer Training to some KCS & CCS staff members, as well as the School Health Admin Team – This approach now allows these trainings to be incorporated into new school nurse orientation, creating sustainability for continued education and interventions.
• Hire nearly 10 additional Behavioral and Mental Health Support positions for KCS
• Make and distribute grade-level appropriate “Coping Skills Toolboxes” that can be used in classrooms, nurses’ offices, and by guidance counselors and social workers

Early Childhood Education

Cabarrus Partnership for Children

The Cabarrus Partnership for Children continues to lead the way by identifying and addressing needs of local childcare providers and families with children birth to five years old. 

Child Care Wage$ Program

The Cabarrus Partnership for Children provides education-based salary supplements to low-paid teachers, directors and family child care educators working with children ages birth to five years old through the Child Care WAGE$ Program. The program was created in response to research-based evidence that shows that the quality-of-care children receive is lowered by high turnover rates and inadequate teacher education. In November, the Partnership’s board voted to fully fund WAGE$ participants at a Tier II stipend. 

Lack of resources and an effort to maintain affordability for parents often make it difficult for individual child care programs to reward or encourage teacher education through salaries. As a result, many teachers leave the field or never even consider the profession an option. WAGE$ is designed to provide preschool children more stable relationships with better-educated teachers by rewarding teacher education and continuity of care.

Early Education Liaison Program   
In partnership with Rowan Cabarrus Community College (RCCC), the Cabarrus Partnership for Children created the Early Education Teacher Liaisons and Early Education Business Administrator Liaisons programs to address the needs of child care centers and strengthen the workforce within Cabarrus County.

The program addresses teacher education and business administration education for educators in child care facilities. The liaisons serve as a bridge between the college and local child care centers, offering academic support such as referrals for tutoring and scholarships for further education. Additionally, they place an emphasis on early education recruitment and business knowledge. 

The Chamber, Leading Business in Cabarrus - Legislative Agenda

The Chamber identified workforce recruitment and retention, as well as childcare challenges as the largest issues for local employers. Lack of access and affordability for childcare impacts worker availability as there are no third shift centers currently open in the community. It is also recognized that childcare centers have expensive overhead due to regulation and have difficulty hiring and retaining quality teachers, making it difficult for centers to afford healthcare and other benefits for staff.

The Chamber has incorporated five items within its Legislative Agenda to address increased access to childcare for workers:
•    Providing tax credits to businesses that provide childcare support for their employees.
•    Expanding the current Opportunity Scholarship* program to include Pre-Kindergarten education.
•    Revising existing childcare subsidy income limits to phase out subsidies rather than provide a hard income ceiling in order to encourage workers to seek higher paying opportunities.
•    Investing in additional childcare subsidies to help address the current worker shortage until long term solutions can be implemented.
•    Invest in pilot programs that seek innovative solutions to the current childcare shortage.

Mortality and Morbidity Changes

Mortality and Morbidity Data
Two measures commonly used for public health surveillance are mortality and morbidity. These measures can help describe and understand the progression and severity of a health event. Monitoring causes of death or rates of illnesses help public health professionals and epidemiologist to recognize cases or clusters of cases, to trigger interventions to prevent transmission or reduce morbidity and mortality.  Both are useful tools to learn about risk factors of diseases and compare and contrast health events between different populations, and identify appropriate health interventions.
The data within this section comes from the State Center for Health Statistics 2022 County Health Data Book and the Robert Wood Johnson Foundation – County Health Rankings. The data within the 2022 County Health Data Book spans 5 years, either 2016-2020 and is considered current for community health assessments and state of the county health reports due the March 2022. 
Source: https://schs.dph.ncdhhs.gov/data/databook/

Mortality

Infant and Child Death

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

Leading Causes of Death

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. It is also important to know that data from 2016-2020 is the first reporting period where deaths caused by COVID-19 are reported. COVID-19 did rank as the 10th leading cause of death, replacing suicide from the previous report. It should be noted that although suicide has fallen out of the top 10, it remains the 3rd leading cause of death for residents Ages 20-39.

Other Unintentional Injuries also moved up one place from 5th to 4th. The most common unintentional injuries result from motor vehicle crashes, falls, fires and burns, drowning, poisonings and aspirations. Falls are the second leading cause of unintentional injury death for North Carolinians of all ages, and in every year from 1999 to 2019. Diabetes has jumped from 9th leading cause of death to 7th, which is an indicator that Cabarrus County consistently sees disparities among the demographic populations most frequently diagnosed. 

The only change in Leading Cause of Death by Age (2016-2020) among Cabarrus County residents was within the 0-19 age category. Congenital anomalies (birth defects) actually switched rankings with Other Unintentional Injuries, going from 2nd to 4th leading cause of death.

2016-2020 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 compared to White, non-Hispanic residents and two times higher rate for nephritis/nephrosis (kidney disease) 
• African American females consistently have the highest rates of death caused by Breast Cancer and three times rate for Diabetes
• African American males have two times the rate of 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 rate

Cabarrus County saw a small drop in life expectancy (0.2 years), a similar decline was seen throughout the region and state. Two counties maintained a consistent life expectancy, Iredell and Union. It will be important for this data to continue to be monitored as it is anticipated to continue to be altered by pandemic impacts.

Morbidity
Morbidity is another term for illness, medical condition or being unhealthy from a disease. Morbidity often times refers to having a disease or a symptom of disease, or the amount of disease within a population.  Public health professionals are able to estimate morbidity among a population by using prevalence or incidence of the disease or illness. 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.
Terms:

• Prevalence describes the proportion of the population with a given symptom or quality.
• Incidence shows the frequency at which individuals within a specific population develop a given symptom or quality.

*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.

Emerging Issues

Oral Health - Increased Dental Decay

CHA’s Community Dental Program is designed to visit each elementary, middle and high school in Cabarrus County and Kannapolis City Schools twice per school year. As the program relaunched this school year, the team has been challenged to achieve this goal because patients are presenting with such higher rates of decay, requiring additional time at each school or the need to refer patients to a pediatric specialist. During the 22-23 School Year, 32% of Kindergarten children were reported to have untreated tooth decay. Oral Health Scorecard

CHA Dental staff are responsible for conducting decay screenings of the NC Pre-Kindergarten classes and the Head Start classes throughout the county. Public Health Hygienists have also done two days of education at preschools for children and caregivers while sending home education information. Staff also made themselves available to patients and families at childcare centers if a child does have a dental concern.

CHA recently hired a dental patient navigator; this position is a bilingual staff who will focus on the highest need patients and helping to close the loop on their dental care needs. Priority will be focused on patients with no insurance, missed appointments, and transportation barriers to their appointment.

Sexually Transmitted Infections and Sexually Transmitted Disease Rates  

According to 2021 Centers for Disease Control preliminary surveillance data, Chlamydia and Gonorrhea cases continue to increase with no signs of slowing. Cabarrus County has also experienced a steady increase in Chlamydia and Gonorrhea   cases since 2017 with the exception of 2020 where the county saw a slight decline in reported cases (due to the COVID-19 pandemic). Populations with highest rates of disease impact or infection are female residents and those who identify as Non-Hispanic Black/African American. Data shows that individuals between 15-29 years of age account for a majority of reported new cases. In 2022, there were more than 1,200 chlamydia and 400 gonorrhea new cases reported among Cabarrus residents. The CHA Epidemiology team is analyzing reinfection cases among priority subgroups and working with public health staff to develop education, engagement and outreach initiatives.

Red line represents Chlamydia cases. Blue line represents Gonorrhea cases.   

Workforce Shortages 

The pandemic caused a major disruption in our day-to-day lives, including our workforce. This impact and continued ripple effect has been referred to by many as The Great Resignation. Many sectors have become increasingly affected by growing workforce shortages over the last several years, and while COVID-19 left its impact, these shortages were already on the rise. According to an article from University of North Carolina - Chapel Hill's School of Government, North Carolina was already projected to face a shortage of around 12,500 nurses by 2033 before the pandemic and is now set to face projected shortages of up to 21,000 nurses in the coming decade due to burnout. Another profession heavily affected by shortages is teachers and school staff. A national survey indicated that nearly half of all teachers considered switching positions or professions. It February 2022, it was reported that 130 teachers left Cabarrus County Schools so far during the 22-23 School Year.  The district reported that many teachers left to teach elsewhere or got out of the profession completely. 

The leisure and hospitality industry, which includes restaurants and hotels, are still missing 7.2 percent of jobs. This reflects 1.2 million jobs statewide that haven’t been filled compared to job numbers before the pandemic, which has led restaurants to close, operate with alternative hours, or work with a smaller staff. Prior to the pandemic, stores and restaurants associated with Concord Mills Mall collectively represented 4,000 jobs in the county. 

New, Paused or Discontinued Initiatives

Public Health Surveillance Data Dashboards
According to the field of epidemiology, public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health-related data essential to planning, implementation, and evaluation of public health practice. Data monitoring and surveillance has long since been a role of public health, but during COVID-19 the public became much more aware and interested in their ability to monitor population health data. State and local dashboards were created to allow citizens to see the COVID-19 spread in their community, allowing them to consider their own health risk and adopt mitigation strategies that they believe necessary.  Cabarrus Health Alliance has launched three public health surveillance dashboards, with plans for more, all of which are publicly accessible and monitor both health and other social determinants which impact individuals' health and well-being. 
•    Influenza Like Illness
•    Housing
•    American Community Survey Dashboard

Cabarrus County Emergency Rental Assistance
Cabarrus County Government closed the Emergency Rental Assistance Program (ERAP) in late 2022. ERAP was funded through various state and federal COVID-19 relief programs and provided payments on behalf of residents for overdue rent and

utilities (electricity, gas, water and sewer, trash removal and energy costs).  To receive assistance, applicants documented financial needs related to the COVID-19 pandemic. Once approved, funds were sent directly to the vendor. Since March 2021, Cabarrus County has submitted over $13 million in vendor. The County also allocated $3 million in partnership with Cooperative Christian Ministry to help administer the program. The ERAP funds helped 2,158 households as of Dec. 31, 2022. 
 

Cabarrus Recovery and Resilience Coalition
Cabarrus Health Alliance (CHA) convened the Cabarrus Community Coalition for Recovery and Resiliency to discuss issues impacting our community as a result of the COVID-19 pandemic. The coalition met from May – December 2022 to routinely share their lived experience (personally and professionally), review data, and collect feedback from the community. The goal of the coalition was to identify: how the community has been impacted by the pandemic, what the community’s needs are post-pandemic, and how can we prepare our community and leaders now to address future emergencies in an improved manner?

Priority focus groups included adolescents, seniors, first responders and frontline workers, teachers, childcare providers, and Latinx community members. The coalition identified recovery needs and acknowledged constructive feedback from each group to improve responses to future emergencies (regardless of scale, public health, and non-public health incidents).

The coalition highly encourages all Cabarrus County leaders to consider these recommendations as response measures for future emergencies in their own organizations.
 

Overview

Progress on Community Health Improvement Plans

Mortality and Morbidity Changes

Emerging Issues

New, Paused or Discontinued Initiatives

Partners

The list of governmental and community based organizations below are actively engaged in the development and implementation of the Community Health Improvement Plan addressing emergency department admissions for behavioral health patients, as well as providing wrap around supports for those who were previously incarcerated or have experienced trauma.

• Amazing Grace Advocacy
• Atrium Health Cabarrus - Emergency Department
• AYA House
• Cabarrus County
  • County Commissioners - Mental Health Advisory Board
  • Emergency Medical Services
  • Department of Human Services
• Cabarrus County Partnership for Children
• Cabarrus County Schools
• Cabarrus County Sheriff's Department
• Cabarrus Health Alliance
• Cabarrus County's Juvenile Crime Prevention Council
• Concord Police Department
• Daymark Recovery Services
• Department of Juvenile Justice
• District Attorney's Office
• Genesis: A New Beginning
• Kannapolis Police Department
• Partners Behavioral Health
• Probation and Parole (NC DPS)
• Opportunity House
• RHA Behavioral Health
• S&H Youth and Adult Services

What Works

Alternative Destination Transport program provides pathways of care other than transport to the emergency department for 9-1-1 patients. This strategy would include transport of patients with low acuity medical conditions to urgent care centers and clinics for treatment, the transport of medically stable intoxicated patients directly to the detoxification center, and the transport of medically stable psychiatric patients directly to mental health facility for medical clearance and admission.

Co-responder Models for Individuals in Behavioral Health Crisis enhance law enforcement’s capacity to develop an immediate and targeted response to acute and non-acute situations. At its core, the co-responder framework typically features a specially trained team that includes at least one law enforcement officer and one mental health or substance abuse professional responding jointly to situations in which a behavioral health crisis is likely to be involved, often in the same vehicle, or arriving on scene at generally the same time.

Crisis Intervention Team Training and 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.

Mental Health First Aid (MHFA) is a training course to help laypeople know how to assist individuals with mental health problems or at risk for problems such as depression, anxiety, and substance use disorders. Courses last 8 to 12 hours and include information about signs and symptoms of mental health problems and appropriate responses, as well as interactive activities using MHFA’s five-step action plan: assess risk of self-harm, listen non-judgmentally, reassure and share information, encourage self-help, and encourage professional help. 

Question, Persuade and Refer (QPR) is intended to reduce suicidal behaviors and save lives by providing innovative, practical and proven suicide prevention training for general community members. The skills and techniques taught during this 1-hour training empowers all people, regardless of their background, to make a positive difference in the life of someone they know.

Peer Supports placed within the Emergency Department, assist individuals with the develop of crisis plans, support patients during their hospital stay if admitted to inpatient service, educate them on harm reduction, and link them with community-based resources after discharge. 

RECONNECT for Resilience trainings are trauma-informed and resiliency-focused, and offer practical strategies that individuals, organizations, and whole communities can use to promote balance and wellbeing. Attendees are taught about trauma, the brain, and the human nervous system in a way that participants of all ages, educations, or backgrounds can understand. Our simple, teachable format is designed for anyone to learn. The 14-hour Reconnect training is a strengths-based, somatic program. Through demonstrations and group practice, participants are given the “owner’s manual” to the body’s safety and threat management system and learn to use their own natural ability to find balance.

School-based social and emotional instruction (SEL) focuses on five core competency areas: self-awareness, self-management, social awareness, relationship skills, and responsible decision making¹. Such instruction typically includes efforts to develop skills such as recognizing and managing emotions, setting and reaching goals, appreciating others’ perspectives, establishing and maintaining relationships, and handling interpersonal situations constructively. Skills may be modeled, practiced, and then applied throughout the school day.

Telemental health services are mental health care services provided over a distance via telephone or videoconference. Services can include psychotherapy, counseling, supplemental support services accompanying face to face therapy, and self-directed services such as online cognitive behavioral therapy. Patients can receive care via their home computer through services such as Skype or be hosted at clinics or hospitals where telemedicine equipment is housed.

Trauma Informed Communities (TIC) includes the use a comprehensive, multi-stakeholder, and multilevel approach to support and strengthen traumatized and distressed residents and communities and address the effects of unresolved community trauma such as historical community disinvestment, poverty, inadequate and insufficient housing, violence, social isolation, and structural racism.

Action Plan

A Mental Health Action Planning retreat was held by Healthy Cabarrus virtually, due to COVID-19 restrictions, on January 28, 2021. During the retreat, a multi-sectoral group of community partners and individuals with lived experience were convened to review the Community Needs Assessment findings and identify strategies, partnerships or new initiatives that could address factors that are driving up psychiatric ED admissions and limiting individual's access to mental and behavioral health services. The discussion led to three main themes for the Mental Health Advisory Board and the associated task forces to focus on:

• Coordination of Services for Justice Involved Persons
• Data and Assessments
• Trauma Informed Communities

The table below outlines strategies identified to improve the mental and behavioral health of individuals in Cabarrus County. Lead agencies and recommended performance measures are also included. It should be noted that as interventions are implemented and data is shared across agencies, modifications may be necessary to best capture appropriate performance measures to highlight impact of efforts.

Additional Community Interventions and Strategies

• New In-Patient Mental Health Facility in Cabarrus County
• Amazing Grace Advocacy: Respond to the desperate need of support and case management for children in Cabarrus County with complex disabilities of the brain, involving mental health, childhood trauma, autism, intellectual disabilities, and neurological brain disorders.
• Atrium Health Cabarrus: Create an expanded behavioral health holding unit outside of the Emergency Department at Atrium Health Cabarrus. The new behavioral health holding unit will be a 3,623 square-foot locked space encompassing between 12 to 14 beds, a dedicated shower, a telepsych unit, and other behavioral health care needs.
• Cabarrus County and Kannapolis City Schools: RECONNECT for Resilience trainings are trauma-informed and resiliency-focused, and offer practical strategies that individuals, organizations, and whole communities can use to promote balance and wellbeing. 
• Cano Family Services: Provide culturally competent, specialized, behavioral health and parent education services to individuals and families in Cabarrus County.
• Camino Health Center: Support to launch a bilingual behavioral health services program and expand primary care services at Concord locations
• Genesis A New Beginning: Provide on-site therapy in Cabarrus County and Kannapolis City Schools.
• Kannapolis Head Start: Mental health provider to determine mental health needs within the Head Start program.
• Mental Health America: Emotional Toolbox for Building Resilient Communities is a comprehensive, county-wide initiative that serves to provide the community with access to the resources, awareness, education, and online screening tools needed to address mental health concerns for themselves, their families, friends, coworkers, and neighbors.
• Silver Linings for Seniors: Employ Community Health Workers (CHWs) to promote mental health services and provide mental health first aid training in communities. Provide direct services, mental health counseling to Cabarrus County residents (via teletherapy and in-person counseling).
• Vida Wellness Center: Mental health counseling services through individual sessions, family sessions, and group counseling services.

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

What We Do

In 2019, Cabarrus County Department of Human Services and Cabarrus County Detention Center partnered to maintain the Stepping Up Program initially launched through a state grant. The program under DHS supervision employed a team (3 staff) working with individuals both incarcerated and post-release. In June 2023, Cabarrus County Government and the Department of Human Services contacted CHA's newly formed Behavioral Health Division to assess interest in taking on oversight and expanding the Stepping Up program. CHA hired an additional case manager and clinician to ensure adequate staffing that could also manage the special watch and suicide watch programs within the jail.

CHA staff work with justice-involved persons from the point 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 take them through a more detailed questionnaire. Staff analyze where that individual is currently in their mental health needs, and together, they develop a 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 follow up with them even after they’ve left the detention center to be sure they kept those meetings.

Updated: October 2023

Who We Serve

How We Impact

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.

What We Do

MIssion Statement: To inspire and empower people to seek and maintain recovery, and health.

Daymark Recovery Services provides an array of outpatient and psychiatric services for the treatment of a mental illness, substance abuse problem, or developmental disability. Services are tailored to individual needs and delivered using evidence based approaches to increase effectiveness.

• Assertive Community Treatment (ACT)
• Assessment and Referral
• Day Treatment Program
• Dialectic Behavior Therapy (DBT)
• Intensive In-Home Program (IIH)
• IPS Supported Employment
• Mobile Crisis Management
• Mobile Medication Program
• Outpatient Treatment
• Psychosocial Rehabilitation (PSR)
• Residential Treatment Program
• Substance Abuse Intensive Outpatient (SAIOP)
• Treatment Services for Pregnant Women

Who We Serve

In addition to serving individuals adults with a mental health and/or substance use diagnosis, we serve children 3 years of age and older, adolescents, geriatric consumers, and families.

How We Impact

In Cabarrus County, Daymark Recovery Services provides Outpatient services, Facility Based Crisis and Mobile Engagement - which provide care to those in crisis in the community.

What We Do

Who We Serve

How We Impact

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.

Partners

The list of non-profit and community based organizations below are actively engaged in the development and implementation of the Community Health Improvement Plan addressing homelessness in Cabarrus County. Physical housing infratstructure is not the only form of housing support necessary when an individual or family find themselves seeking emergency shelter.

• AYA House
• Cabarrus Victims Assistance Network (CVAN)
• City of Concord
• City of Concord Housing Department
• City of Kannapolis
• Cooperative Christian Ministry (CCM)
• Habitat for Humanity
• Opportunity House
• Partners Health Management
• Present Age Ministries
• Serenity House
• WeBuild Concord
• The Open Door House
• The Salvation Army

What Works

Emergency Shelters are often where people experiencing chronic homelessness or the impact of sudden economic shock may first turn for support through a wide range of services. 

Emergency Housing Voucher programs are specifically designed for households who are:

• Homeless;
• At Risk of Homelessness;
• Fleeing or attempting to flee domestic violence, dating violence, sexual assault, stalking or human trafficking;
• Recently homeless and for whom providing rental assistance will prevent the family’s homelessness or having high risk of housing instability.

Coordinated entry and assessment can be used to differentiate the majority of people experiencing an acute housing crisis from the minority experiencing chronic homelessness, and to refer each group to the appropriate interventions. Accurate identification of those who are most likely to develop chronic patterns of homelessness in the future, in order to provide services to preempt this shift, is not feasible at this time.

Eviction Prevention Programs provide financial assistance to help renters facing eviction stay in their homes.  Programs provide assistance in the form of a grant that covers back rent owed, as well as court fees and late payment fees, where applicable. Programs may also provide caseworkers to eligible households to help them apply for government benefits and search for housing. Some also require or offer budgeting workshops and/or financial counseling for tenants receiving grants. These programs may be one tool of many that jurisdictions use to prevent evictions and encourage housing stability. Other eviction-prevention tools might include provision of legal services to tenants facing eviction, good cause eviction protections, or longer-term rental assistance. Local governments may choose to administer eviction prevention programs themselves, or they may provide support to non-profit agencies that provide these services.

Transitional Housing has long sense been a part of the housing continuum and is an intermediate step between emergency crisis shelter and permanent houseing. While temporary, it is a type of accommodation that is meant to bridge the gap from homelessness to permanent housing by offering structure, supervision, support (including for individuals struggling with substance use or mental health), life skills, and in some cases, education and training. 

Permanent Supportive Housing is a highly effective strategy that combines affordable housing with intensive coordinated services to help people struggling with chronic physical and mental health issues maintain stable housing and receive appropriate health care. 

Action Plan

Several initiatives were recently (September 2021) funded though the COVID-19 American Rescue Plan/Cabarrus Recovery Grants. Cabarrus Health Alliance and Healthy Cabarrus will work with community partners to identify strong performance measures that can be reported either monthly, quarterly or annually. UPDATED PLAN COMING Fall 2023.

• Cooperative Christian Ministry - Purchase or build a 90+ room hotel, uadrupling CCM’s current emergency and transitional housing capacity. Serve 180-220 adults and children.
• Operation Decisive Victory - Serve the rising number of homeless and at-risk families specifically within the veteran and first responder communities.
• Opportunity House - The day shelter provides assistance to an average of 43 people a day including meals, showers, and healthcare, but also computer lab sessions, for continuing education; and clothing closet visits, to keep cool or warm depending on the season.

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

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.

What We Do

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.

Who We Serve

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

Priority Populations                                                       Strategic Priorities

Individuals & Families in Crisis                                  Housing Stability & Recovery

Children Age 0-5                                                          Early Childhood Development

Working Age Adults                                                     Employment Transitions

Senior Adults                                                                 Senior Adult Well-Being

How We Impact

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. 

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.

Who We Serve

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

How We Impact

WeBuild will work with public and private partners to purchase land, properties, or units (joint ventures included) to develop affordable housing to serve households at or below 80 percent of the area median income (AMI). Add at least 80 units.

What We Do

Who We Serve

How We Impact

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.

Action Plan

The Early Childhood Task Force Advisory Board (ECTFAB) formed four workgroups comprised of diverse community stakeholders to look at benchmarks associated with the NC Early Childhood Action Plan (NC ECAP). The statewide ECAP was developed after the issuance of Executive Order 49 by Governor Roy Cooper in the summer of 2018. The order was to develop an action plan to improve early childhood outcomes with benchmarks set for impact by 2025. 

In mid-2022, the dedicated workgroups of the Cabarrus County ECTFAB completed the development of draft action plans with short-term and long-term strategies that align with the state’s four focus areas and 10 goals. The full action plan, and recommendation to focus on goals 8, 9 and 10 will go to Cabarrus County Commissioners for approval in early 2023.

The DRAFT Cabarrus County Early Childhood Action Plan (ECAP) focuses on the following areas:

Learning and Ready to Succeed: Children have access to affordable, individualized, high-quality early learning opportunities provided by highly qualified, knowledgeable, well compensated educators prepared to partner with families on the road to kindergarten readiness. (Goals 8, 9, 10)

Goal 8 – High-Quality Early Learning
Build capacity to ensure families with children 0-5 years of age have accessibility to high-quality child care so, they can be an active part of the workforce and/or go to school to further their education.
Increase the percentage of income-eligible children enrolled in NC Pre-K.
Decrease the percent of family income present on child care.
Goal 9 – On Track for School Success
 Increase the percentage of children who enter kindergarten at a level typical for their age group according to the NC Early Learning Inventory (NC ELI).
Goal 10 – Reading at Grade Level
Increase the percentage of children achieving high levels of reading proficiency according to the End of Grade Tests (EOG’s).

The full Action Plan, along with the recommendation to focus on the three goals for Learning and Ready to Succeed, is scheduled to be presented to the Cabarrus County Board of Commissioners in Spring 2023. 

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. 

What We Do

Cabarrus Health Alliance (CHA) provides home visits to mothers and newborns who receive Medicaid benefits as part of the Newborn Postpartum Home Visiting Program.  During home visits, a registered nurse will assess mother and baby, provide education, resources and referrals to other needed services.

Who We Serve

The Newborn Postpartum Home Visiting Program provides home visits to Cabarrus County mothers and newborns who receive Medicaid benefits.

How We Impact

Through the assessment of the mother and the baby the Newborn Postpartum Home Visiting program is able to screen and asses the mother, baby, and home. Following the assessment resources can be provided for what the mother or family needs to be able to best care for the baby. Support to the mothers is a key role of this program. The home visit provides the nurse time to talk with the mother about the importance of postpartum appointments and birth control options.

What We Do

Care Management for High-Risk Pregnancies (CMHRP), previously known as Pregnancy Care Management (PCM), is a statewide Medicaid care management program promoting healthy pregnancy and birth outcomes. The program consists of nurses and social workers who provide counseling, education and linkage to community resources for families. The program also provides services and support to women experiencing high risk factors during pregnancy and up to two months postpartum.

Who We Serve

Care Management for High-Risk Pregnancies (CMHRP) provide services for women experiencing high risk pregnancies living in Cabarrus County and have Medicaid (uninsured via grants). Examples of high-risk pregnancy factors include: previous or current Gestational Diabetes, Type 1 or 2 Diabetes, Hypertension, multi gestational pregnancy (pregnant with twins, triplets, etc.), history of preterm birth or low birth weight, behavioral health concerns, homelessness, domestic violence and /or substance use.

How We Impact

Care Management for High-Risk Pregnancies (CMHRP) strives to decrease infant mortality rates, low birth weights and C-section births. This program works to promote healthy birth outcomes for pregnant women (uninsured or covered by Medicaid) by increasing access to prenatal care for high risk pregnancies, and providing community resources and support to reduce toxic stressors.

What We Do

The Care Management for At Risk Children (CMARC), previously known as Care Coordination for Children (CC4C) is a statewide early childhood care management program serving children from birth to five years of age. CMARC care managers consist of nurses and social workers who provide support, assessment and screening, early childhood education, referrals to services, and information upon resources that are needed to support the health and welling being of child.  

Who We Serve

The Care Management for At Risk Children (CMARC) serves children in Cabarrus County that have special health care needs, are in foster care, discharged from the Newborn Intensive Care Unit (NICU) after delivery, or are experiencing toxic stress situations from birth up to age 5

How We Impact

The Care Management for At Risk Children (CMARC) focuses on positively impacting the long-term health and wellbeing of the child by providing continued support, education, and linkage to services for families during this crucial stage in a child’s life. CMARC aims to serve children from birth to age 5 who are of the highest risk in hopes of improving and maximizing health outcomes for these children.  

What We Do

The Positive Parenting Program (Triple P) is an internationally based program that started in Australia. North Carolina was the first to start the program at a statewide level in the United States. Triple P offers tools, strategies, and resources so that the parent is able to decide what works for them. There is support at levels range from gathering general information to private meetings with practitioners. The goal of the Triple P Program is to provide parenting support for every parent.

Who We Serve

The Positive Parenting Program (Triple P) at Cabarrus Health Alliance (CHA) serves parents, caregivers, and children in Cabarrus County. We also work to recruit and train practitioners so that we have a variety of services and options available for the parents that are a part of Triple P.

How We Impact

By providing resources, skills, and tools to parents we are able to empower parents to make the best decisions for their family. The Positive Parenting Program (Triple P) at Cabarrus Health Alliance (CHA) works with practitioners, schools, mental health professionals, and pediatric providers to make a positive on child well-being.