Executive Summary

Haywood County 2021 Community Health Assessment Executive Summary

Community Results Statement

The ultimate goal for Haywood County is to build a healthy and resilient community.

Leadership for the Community Health Assessment Process

A data team of community partners and the public health education team from Haywood County Health and Human Services led the CHA process. Following internal review of both primary and secondary data, the data team received a condensed list. This team provided input to public health staff on which data to review during the prioritization process.

Partnerships                                                                                                                                                                                                       

Regional/Contracted Services

Our county received support from WNC Healthy Impact, a partnership and coordinated process between hospitals, public health agencies, and key regional partners in western North Carolina working towards a vision of improved community health. We work together locally and regionally to assess health needs, develop collaborative plans, take action, and evaluate progress and impact. This innovative regional effort is coordinated and supported by WNC Health Network. WNC Health Network is the alliance of stakeholders working together to improve health and healthcare in western North Carolina. Learn more at www.WNCHN.org.

Theoretical Framework/Model

WNC Health Network provides local hospitals and public health agencies with tools and support to collect, visualize, and respond to complex community health data through Results-Based Accountability™ (RBA). RBA is a disciplined, common-sense approach to thinking and acting with a focus on how people, agencies, and communities are better off for our efforts.

Collaborative Process Summary

Haywood County’s collaborative process is supported on a regional level by WNC Healthy Impact.

Locally, our process began with an internal public health education team reviewing a large list of primary (newly collected) and secondary data (existing). The team narrowed the list before sharing with a data team of community partners. The data team further reviewed the information and arrived at a ‘short list.’  Before and during prioritization meetings, participants received opportunities to review this data. Following a data presentation, participants used a ‘Local Rating and Prioritization’ worksheet to rate the relevance, impact, and feasibility of addressing the key issues presented. After arriving at their top three scores, each participant selected their top three key issues using an online poll. The three top-scoring areas overall are the county’s new health priorities. 
 

Phase 1 of the collaborative process began in January, 2021 with the collection of community health data. For more details on this process see Chapter 1 – Community Health Assessment Process.

Key Findings

Findings that were particularly telling included: 

• Chronic Disease

  • Over 72% of individuals are experiencing overweight or obesity (WNC Health Network, 2021), root causes for many chronic diseases. This was an increase from 2018.

• Substance Use and Mental Health

  • Over 88% reported feeling hopeful, but 23% of individuals experienced more than seven days of poor mental health in the past month, an increase from 2018. In addition, over 18% were unable to get necessary mental health care in the past year, also an increase from 2018 (WNC Health Network, 2021).

  • A decrease in all opioid use (prescription and non-prescription) was reported: 15.3% vs. 12.4% (WNC Health Network, 2021).

  • Alcohol continues to be a widely misused substance, with over 12% of adults reporting  past-month binge drinking, an increase from 2018  This was defined as five or more drinks for a man or four or more for a woman during any occasion (WNC Health Network, 2021). In addition, Haywood County residents made over 500 emergency department visits in 2021 for ‘alcohol abuse and dependence,’ a decrease from over 600 visits in 2018 (North Carolina Disease Event Tracking and Epidemiologic Detection Tool*, 2022). **NC DETECT is a statewide public health syndromic surveillance system, funded by the NC Division of Public Health (NC DPH) Federal Public Health Emergency Preparedness Grant and managed through collaboration between NC DPH and UNC-CH Department of Emergency Medicine’s Carolina Center for Health Informatics. The NC DETECT Data Oversight Committee does not take responsibility for the scientific validity or accuracy of methodology, results, statistical analyses, or conclusions presented.

• Violent Crime

  • A larger number of survivors were served by domestic violence shelters: 413 vs 320 (NC Department of Administration, 2021).

  • The community has experienced an increase in violent crime: 342.7 vs 326.8 per 100,000 (NC Department of Justice, 2021).

• Social Determinants of Health

  • Over 12% reported a loss of health Insurance during the pandemic, with 24% losing work hours or wages (WNCHN, 2021), affecting access to care. This is a point-in-time figure.  

  • In spite of a pandemic, fewer people reported experiencing food insecurity: 3.4% vs. 18.9% (WNC Health Network, 2021).

  • While over 13% of residents live below the poverty level, this figure sharply increases to 33% for those under age 5. This data point is unchanged, as we reviewed a 2015-2019 estimate (U.S. Census, 2021).

• The top three health priorities identified through the Online Key Informant Survey were the same as those emerging from health prioritization meetings.

Health Priorities

1. Mental Health

2. Obesity

3. Substance Use

      *Obesity and substance use received an equal number of votes during prioritization meetings.

Next Steps

• Monthly action team meetings based on each health priority;

• Engage existing and new partners in health priority action teams;

• Select priority strategies and performances measures to help us evaluate community health improvement progress;

• The evidence-based strategy, Results-based Accountability (RBA), will be utilized to guide decision-making to create swift and effective health improvements;

• The county’s health action teams will hold ‘Getting to Strategies’ meetings during spring 2022. These meetings will include discussing the quality of life conditions desired for the county, the county’s progress on related data points, partners with a role to play, and possible evidence-based strategies.

• Following completion of strategy development for each priority area, the Community Health Improvement Plan (CHIP) will be published using electronic scorecard software. The scorecard allows anyone to monitor progress of the CHIP, the current plan shown here. A CHIP, built from evidence-based strategies, is submitted to the North Carolina Division of Public Health.

• To access the full data set(s) (primary and secondary data), community members are encouraged to contact megan.hauser@haywoodcountync.gov.

CHA Priorities

1. Mental Health
2. Obesity
3. Substance Use

      *Obesity and substance use received an equal number of votes during prioritization meetings.

Experience and Importance

How would we experience improved physical activity, healthy eating, and quality healthcare in our community?

• Physical activity

  • Emphasis on physical activity; community is more physically active

  • Increasing mobility

  • Active lifestyles

  • Less screen time

  • Regular physical exercise

• Decreased barriers

  • Access to care/access to nutritional services

  • Access to information

• Socioeconomics 

  • Affordable housing

• Built environment

  • More resources for more people to walk, outdoor recreation options

  • People using recreational options

• Happier community

What information led to the selection of this health issue and related result?

The Healthy Haywood Coalition and Wellness Action Group received Community Health Assessment data. Both groups discussed the relevance, impact, and feasibility around obesity, specifically considering weight, physical activity, chronic disease, nutrition, economic (poverty), insurance/access to care and stress data. The community members in attendance then unanimously voted to move forward with the obesity priority as a result of evaluating the primary and secondary community health data. This is a continuation from previous years’ health priorities.

• Weight

  • Adult overweight/obesity- 72% (increase) (WNC Health Network, 2021)

  • Adult healthy weight- 26.3% (decrease) (WNC Health Network, 2021)

  • Child overweight/obesity (ages 2-18)- 29.9% (Eat Smart, Move More, 2017)

  • Challenges to accessing affordable food: ‘Foods found at convenience stores and ‘dollar’ stores in less populated geographic areas tend to be highly processed, high in sodium & sugar, etc.’  -Community Leader (Online Key Informant Survey-WNCHN, 2021)

• Physical activity

  • No past-month leisure-time physical activity- 21.7% (decrease) (WNC Health Network, 2021)

  • Meeting physical activity recommendations- 22.2% (increase) (WNC Health Network, 2021)

  • Strengthening activity- 31.7% (increase) (WNC Health Network, 2021)

  • Qualities of a healthy community: ‘Access to free or low-cost healthy activities, such as walking trails, community parks, etc.’  -Community Leader (OKIS-WNCHN, 2021)

• Chronic disease

  • Diabetes- 18.6% (increase) (WNC Health Network, 2021)

  • Pre-diabetes- 2.9% (decrease) (WNC Health Network, 2021)

  • Heart Disease- 10.9% (decrease) (WNC Health Network, 2021)

  • High Blood Pressure- 40.2% (decrease) (WNC Health Network, 2021)

  • High Cholesterol- 31.8% (decrease) (WNC Health Network, 2021)

• Nutrition 

  • Fruit and Vegetable intake (five or more daily servings)- 5.1%  (increase) (WNC Health Network, 2021)

  • Food and Nutrition Services (SNAP) participation- 8,930 individuals (UNC-CH Jordan Institute for Families, 2021)

  • Free/reduced lunch participation- 7,131 (average daily membership) (NC Department of Public Instruction, 2021)

  • Food Insecurity- 18.9% (decrease) (WNC Health Network, 2021)

  • Access to nutritional/healthy food- 23% have difficulty buying fresh produce (WNC Health Network, 2015)

  • Strengths- ‘The amazing network of people who ensure that food is consistently available.  During COVID the flexibility and creativity that included food being delivered to homes without transportation, strong partnerships to move food to reduce waste.’  -Community Leader (OKIS-WNCHN, 2021)

• Economics: Poverty (2015-2019 estimate) (US Census Bureau, 2021)

  • Total Population (~60,256) 

    • 8,087 residents below poverty [13.4%] 

  • Children under 18 (~10,743)

    • 2,423 residents below poverty [22.6%] (down)

  • Children under 5 (~2,962)

    • 2,962 residents below poverty [33.4%] (up)

  • Populations impacted- ‘Low income, working-class and historically marginalized communities’ and ‘Older adults on fixed incomes and families with low income jobs or multiple jobs.’  -Community Leader (OKIS-WNCHN, 2021)

• Insurance/access to care

  • No health insurance coverage- 20.2% (increase) (WNC Health Network, 2021)

  • Lost health insurance during pandemic- 12.1% (WNC Health Network, 2021) (point-in-time)

  • Qualities of a healthy community: Ability to see a provider when needed—insurance and free/reduced cost clinics, pop-up free clinics including dental/vision clinics.’  -Community Leader (OKIS-WNCHN, 2021)

• Stress

  • Typical day is extremely/very stressful- 12.0% (decrease) (WNC Health Network, 2021)

  • Confident in ability to manage stress- 87.3% (point-in-time) (WNC Health Network, 2021)

What Is It?

Haywood 4 Good is a free wellness initiative that addresses physical, spiritual, emotional, and community wellness.  The program operates in six-month sessions and offers continuous enrollment.  Participants have the opportunity to participate in at least three wellness challenges each month.  Unlike the typical heart health or weight loss challenge, Haywood 4 Good is more broad and inclusive.  Challenges such as screen time, water consumption, and volunteerism are accessible by a wider range of people and ability levels.    

Haywood 4 Good was identified by the Healthy Haywood Wellness Action Group as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in adult overweight and obesity prevalence in our community. This is an ongoing program in our community.

The current intervention shows promise.  Of participants registered for the 2022 program (January-June session), nearly 26% of participants reported not getting any flexibility and balance (stretching) training per week.  During the closing survey for January-June 2022, the percentage of participants reporting no flexibility and balance training dropped to 0.  Vegetable consumption was also a challenge, as nearly 13% of January-June 2022 participants reported rarely eating vegetables.  During the closing survey for this time frame, the percentage of participants who reported rarely eating vegetables dropped to zero.  The primary limitation for the program's evaluation is that fewer participants completed the closing survey, demonstrating a gap in behavior change data.  In addition, some participants registered more than once, causing duplicate results.  

The priority population/customers for this community wellness program are Haywood County residents, and the Haywood 4 Good aims to make a difference at the individual level. Implementation takes place in a virtual format, as all activities may be done individually.

This strategy addresses health disparities by providing a free program that does not require transportation or internet access to complete.  

2022 update:

• From July-December, the number of participants reporting 2-3 cups of daily vegetable consumption increased by 12%.  
• The second half of the year saw a decline in registered participants.  While registration is not required for challenge activities, it gives participants the chance to earn incentives. 
• The program reintroduced small incentive items, randomly drawn from participants who report their activity points.
• The program maintains an active Facebook page. 
• The Haywood County Public Library supports this program by placing packets in several branches.  The HCPL is an active member of the Wellness Action Group.  

2023 update

• Participation numbers have declined and the health department is trying to better understand the story to make future improvements.  
• Resource information was shared with the program's e-mail list to support involvement in program challenges.    
• A limited number of participants were randomly selected to receive small prizes based on participation and tracking program points.  
• During registration for the January-June  2023 program, 9.5% of participants reported rarely eating vegetables.  The percentage of participants who reported rarely eating vegetables was zero during the July-December 2023 program.  The number of registrants varied slightly between sessions and some participants did not register for both rounds of the 2023 program.    
• Data limitations include: Due to a transition in data collection and storage methods, 2023 numbers may not accurately represent final totals or are unavailable.  Due to some duplicate participant registrations and some participants enrolling in both rounds of the program, the 2023 participant number was calculated as an average.  Not all individuals who follow challenge activities choose to officially enroll.  Limited distribution of midpoint and closing surveys, as well as response to surveys, makes evaluating program participation and satisfaction difficult.   

Partners With A Role To Play

The partners for this community wellness program include:

Work Plan

Evaluation & Sustainability

Evaluation Plan:

We plan to evaluate the impact of the community wellness challenge through the use of Results-Based Accountability™ to monitor specific performance measures. We will be monitoring How Much, How Well, and/or Better Off Performance Measures. Our evaluation activities will be tracked in the Work Plan table, above. 

Data limitations: There is a chance of participant duplication.  For example, participants may complete the registration form more than once, resulting in duplication of data.  

Sustainability Plan:

The following is our sustainability plan for the community wellness challenge: 

• Sustainability Components
  • Participant registration numbers, percent of participants following recommended health behaviors, and participant feedback will be evaluated.  This information will be used to determine the future of the program and justify necessary funding to stakeholders.  
  • The challenge is not a typical nutrition or weight loss program, but will instead have a comprehensive focus of physical, spiritual, emotional, and community wellness.  Unlike previous programs, the wellness challenge will not focus on gym membership or have a cost, increasing the likelihood that participants will continue healthy habits over time.  These features will allow us to engage a more diverse group of community members.  
  • Haywood County Health and Human Services Agency (HHSA) has a history of conducting a community fitness challenge and has strong support from community partners.  The HHSA is committed to providing staff time for this program.  

What Is It?

Faithful Families Thriving Communities (FFTC) was identified by members of the Wellness Action Group as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in fruit and vegetable consumption and overweight/obesity prevalence in our community. This is a new program in our community.

FFTC is led by program facilitators and lay leaders.  The curriculum features nine sessions addressing topics such as nutrition, meal preparation, and becoming more physically active.  The program encourages changes at the organization and community levels, such as having a policy to serve water during events.  

The priority population/customers for this educational program are members of faith communities, and the educational program aims to make a difference at the individual and organizational levels.  Implementation will take place in churches and other faith-based organizations.  

This strategy addresses health disparities by connecting individuals with free, evidence-based education in a convenient setting.  

Cook Smart, Eat Smart (CSES) was identified by members of the Wellness Action Group as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in fruit and vegetable consumption and overweight/obesity prevalence in our community. This is an ongoing program in our community.

CSES is led by a trained instructor through North Carolina Cooperative Extension.  This four-session program provides recipes demonsrations and instruction about simple cooking techniques.   

The priority population/customers for this educational program are adults and older teenagers, and the educational program aims to make a difference at the individual level. Implementation will take place in a community organization.

This strategy addresses health disparities by demonstrating that a healthy diet is accessible even when funds are limited.  

Both programs were identified by Haywood County Cooperative Extension as priorities and programs with potential.  CSES was offered successfully in the past.  

Med Instead of Meds

2022 update:

Cooperative Extension staff offered Cook Smart, Eat Smart in October.  Six participants completed the four-class series.  The program was enhanced by offering an Instant Pot® to one randomly-selected participant.  

2023 update:

Nutrition education programs offered by Cooperative Extension staff included: 

• The Med Instead of Meds series offered brief lessons, recipe preparation, and focused on the Mediterranean style of eating.  The program was enhanced by offering an Instant Pot® to one randomly-selected participant. 
• The Cook Smart, Eat Smart series offered brief lessons and recipe preparation.  
• The NC Steps to Health program was offered twice.  This program addresses healthy eating for those with limited budgets.  
• Take Control is a program addressing chronic disease prevention.  This was offered at the Maggie Valley Congregate Nutrition Site.  
• Color Me Healthy is a program focused on both nutrition and physical activity.  This was offered to pre-k students at Hazelwood, Clyde, North Canton, and Meadowbrook Elementary Schools.  
• 2023 program successes from Cooperative Extension included some participants reporting increased fruit and vegetable consumption (20 participants) and others reporting increased physical activity (15 participants) (provided by Haywood County Cooperative Extension, 2023).  

Potential data limitation- some individuals may have participated in more than one program, possibly causing them to be counted more than once.  

Partners With A Role To Play

The partners for evidence-based nutrition programs include:

Work Plan

Experience and Importance

How would we experience improved health and resiliency in our community?

Haywood County would be healthier and happier as a result of reduction of substance misuse. According to previous community partner meetings, community members would experience the following:

• A community that offers support to people experiencing substance use disorder (SUD).
• Overall health, optimizing well-being, a community in which all are supported doing those things.
• Stigma-free environment: people feel comfortable and no ashamed by reaching out for help.
• Access to and affordable primary care.
• Whole-person focus from providers.

What information led to the selection of this health issue and related result?

• Opioid Use/Substance Use
  • 12.4% Used Opiates/Opioids in the Past Year, With or Without a Prescription (decrease) (WNC Health Network, 2021)
  • "Story" Data (Online Key Informant Survey-WNCHN, 2021) 
  • • Qualities of a healthy community: ‘Having a ‘no wrong door’ approach.  If you cannot help someone, you offer a warm handoff and connect them with someone who can help.’  -Public Health Representative
    • Challenges from COVID-19: ‘The drug prevention education classes normally offered to eighth-grade students at public middle schools in Haywood County were unable to be held due to the COVID-19 pandemic.’  2020 State of the County Health report
• Alcohol Use
  • 12.5% Binge drinking[Single Occasion - 5+ Drinks Men, 4+ Women] (increase) (WNCHN, 2021)
  • 17.4% Excessive drinking (increase) (WNCHN, 2021)
• Tobacco Use
  • 13.3% Currently smoke (decrease) (WNCHN, 2021)
  • 3.2 % Use vaping products (such as e-cigarettes) (decrease) (WNCHN 2021)
• Secondary (Hospital/EMS) Data (NC Opioid Action Plan Dashboard, 2021)
  • Accidental Overdose Death
    • 14 in 2018 (22.6 per 100,000 residents); 17 in 2019 (27.3 per 100,000 residents)
  • Emergency department visits with an Opioid Overdose Diagnosis
    • 54 in 2019 (86.7 per 100,000 residents); 63 in 2020 (101.1 per 100,000 residents)

The Healthy Haywood Coalition and Substance Use Prevention Alliance were presented with relevant community health assessment data (above). Both groups received information about the relevance, impact, and feasibility around substance misuse, specifically looking at opioid, tobacco/vaping, and alcohol data. Social determinants of health data such as poverty, community resiliency estimates, and other community-based data were also provided. The community members in attendance then unanimously voted to move forward with the substance abuse priority as a result of evaluating the primary and secondary community health data. This is a continuation from previous years’ health priorities. 

Known risk factors for this issue are as follows: 

• Family
• Social Network/Support Networks
• Adverse Childhood Experiences (ACEs)
• Income Level/ Experiencing Poverty
• Educational Attainment

What Is It?

WNC Anti-Stigma Messaging Campaign was identified by community members and the Substance Use Prevention Alliance as an action, when combined with other actions in our community, that has a reasonable chance of making a difference in 'Life has been negatively affected by substance use (self or someone else),' 'Past-year opioid use (with or without prescription), 'Emergency department visits for unintentional medication or drug overdoses' in our community. This is a new program in our community, though related messaging was previously placed by another partner on a smaller scale.

The priority population for this anti-stigma messaging campaign is individuals living in Haywood County misusing substances, living with Substance Use Disorder (SUD), and those who are indirectly affected by SUD. The anti-stigma messaging campaign aims to make a difference at the interpersonal, community, and organizational levels. Implementation will take place at the community and organizational levels.

2022 update:

Public health staff and partners helped plan a regional anti-stigma campaign, which is actively seeking funding.  During this process, participants focused on the overall direction, listening and learning, planning their approach, and designing the messages.  Many participants were previously involved in a nationally-recognized COVID campaign.  

2023 update:

Two social media campaigns aired in 2023.  View from Here WNC was a broad campaign with healthy eating, active living, vaccine resource, mental health, and substance use messaging.  The scorecard performance measures for this program only include metrics for the substance use-specific ads.  For campaign metrics related to all ad types, click the performance measure for View From Here - Campaign Reach. The See Me WNC campaign focused on anti-stigma messaging related to substance use.  For both campaigns, English and Spanish ads were placed in the region.  Each participating organization received a menu of ads and chose what ran in their community.  Point of data clarification: some individuals may have viewed more than one campaign, therefore 'number of Haywood County residents reached' was calculated as an average.  

Partners With A Role To Play

The partners for this campaign include:

Work Plan

Evaluation & Sustainability

Evaluation Plan:

We plan to evaluate the impact of the anti-stigma messaging campaign through the use of Results-Based AccountabilityTM to monitor specific performance measures. We will monitor How Much, How Well and Better Off Performance Measures. Currently, we plan to evaluate the 'number of advertisements placed,' 'Number of advertisement engagements,' 'Number of clicks from online advertisements,' and 'Number of Haywood County residents reached.' We will track evaluation activities using the draft Work Plan table. 

Sustainability Plan:

The following is our sustainability plan for Haywood County's anti-stigma messaging campaign: 

• Sustainability Component:
  • Consistent evaluation of program performance measures to ensure ongoing effectiveness and demonstrate successes to funders and other key stakeholders.
  • Participate in monthly meetings with WNCHN and stakeholders to ensure all are in agreement and concerns are addressed.
    • Consistent efforts in identifying new community partners/stakeholders.
  • Ensuring we have the capacity to accomplish documented goals

Experience and Importance

How would we experience improved mental health in our community?

Decreased stigma and barriers to care, injury/self-harm prevention, those with mental health challenges obtain the care they need from reliable mental health practitioners, increased mental health care support for families, and improvements in the broader mental health care system that ensure seamless and continuity of care.

What information led to the selection of this health issue and related result?

Since 2018, self-reported data from Haywood County adults shows increases in the following areas: past-30 day poor mental health, an inability to access needed mental health care or counseling in the last year, not receiving needed social and/or emotional support, and being dissatisfied or very dissatisfied with life. Prioritization team members attributed increases to: nearly 21% of individuals reporting no health care insurance, an increase in the number of individuals reporting homelessness, and stigma for seeking mental health care (WNC Health Network, 2021). 

What Is It?

Establishing a Trauma-Informed System of Care was identified by various community members and the Substance Use Prevention Alliance as an action, when combined with other actions in our community, that has a reasonable chance of making a difference in 'Life has been negatively affected by substance use (self or someone else)', 'Past-month binge drinking', and 'Emergency department visits for unintentional medication or drug overdoses in our community.' This is a new program in our community.

The priority population for establishing a trauma-informed system of care are all Haywood County residents using health, human, or public services (any organization serving Haywood County residents) and the establishment of a trauma-informed system of care aims to make a difference in the community, organizational, and policy levels. Implementation will take place at the organizational level.

Although anyone can experience trauma and especially adverse childhood experiences, this strategy addresses health disparities due to the higher prevalence of trauma in populations experiencing poor social determinants of health such as unstable housing, low income, and racism. Addressing trauma at the socio-ecological level mentioned above will create a more equitable environment to access quality healthcare, access to education, and increase social and community support among all Haywood County residents.

2022 update:

• The Haywood Connect collaborative continues meeting monthly.  Members distributed a holiday resilience guide, included in food bags for Head Start students. 
• County health educators completed trauma-informed care training and educated staff from public health and social services.  A training session was also offered to the Domestic Violence/Sexual Assault/Elder Abuse Task Force. 
• Health educators and community partners, primarily school staff, were educated about the Trust-Based Relational Intervention® model. 

2023 update: 

• The Haywood Connect Adverse Childhood Experiences (ACEs) and resilience collaborative continues to meet virtually, with quarterly in-person meetings.  
• A job loss resilience guide was created and distributed following the 2023 Canton Mill closure.  
• Training sessions were offered to board members and staff of Haywood County Health and Human Services, as well as Reach of Haywood.  
• Potential data limitations- If an individual attended more than one session, they may be duplicated in the participant count.  In addition, the number of organizations and staff trained may vary.  Due to staff turnover in 2023, it is difficult to confirm training totals and dates.    

Partners With A Role To Play

The partners for establishing a trauma-informed system of care include:

Work Plan

Evaluation & Sustainability

Evaluation Plan:

We plan to evaluate the impact of the trauma-informed system of care initative through the use of Results-Based AccountabilityTM to monitor specific performance measures. We will be monitoring How Much, How Well and Better Off Performance Measures. Currently, we plan to evaluate 'Number of HHSA staff who complete training sessions about trauma-informed care and ACEs', 'Number of members who participate in the ACES Collaborative group (Haywood Connect)', and 'Number of organizations who complete training session about trauma-informed care and ACEs'. Our evaluation activities will be tracked in the Work Plan table, above (ongoing). 

Sustainability Plan:

• Sustainability Component:
  • Consistent evaluation of program performance measures to ensure ongoing effectiveness and demonstrate successes to funders and other key stakeholders.
  • Monthly meetings with Haywood Connect and stakeholders to ensure all are in agreement and concerns are addressed.
    • Consistent efforts in identifying new community partners/stakeholders.
  • Ensuring we have the capacity to accomplish documented goals.

What Is It?

Trauma-Informed Care (Adverse Childhood Experiences) and Question, Persuade, Refer suicide prevention training (QPR) programs are existing programs being utilized and promoted by our Substance Use Prevention Alliance (SUPA) coalition. Coalition partners recommend continuing these programs and think that when combined with other actions in our community, they have a reasonable chance of making a difference to improve mental health and mental health care in our community.  

The priority population/customers for Trauma-Informed Care and QPR-Suicide Prevention Training are health care and social work professionals. The goal is to make a difference at the individual/interpersonal behavior level for staff and the clients they serve.  The intent of this goal is to develop a community-wide workforce skilled at recognizing suicidal ideations and individuals affected by adverse outcomes, resulting in quick, appropriate services and care for at-risk populations they serve. 

2022 update:

The SUPA scheduled local National Alliance on Mental Illness members for an early 2023 training.  The program, 'In Our Own Voice,' shared lived experiences of presenters.  Vaya Health (MCO) staff presented at a SUPA meeting about training options available to the community.  Sessions include Mental Health First Aid and Question, Persuade, Refer.    

2023 update:

Haywood County Health and Human Services (HHSA) partnered with coalition member Vaya Health MCO to offer two sessions of Mental Health First Aid (MHFA).  Sessions were open to HHSA staff/board members and community partners.  Leaders from the National Alliance on Mental Illness (Haywood chapter) offered In Our Own Voice, where two adults shared their lived experiences with mental illness.  Other coalition members offered sessions sharing the benefits of Qi Gong and Somatics; these took place during health coalition meetings. 

For most sessions, follow-up surveys were administered asking three questions: 1) Has this training positively influenced your life or the lives of those you serve? 2) Do you recommend this training for co-workers or other agencies? 3) Please explain your answers (optional).  

Data limitations- There is some duplication in the count of individuals attending trainings, as some participated in multiple sessions.  Some individuals did not complete follow-up surveys.  A survey was not administered following the Somatics training.  

Partners With A Role To Play

The partners for Trauma-Informed Care and mental health trainings include:

Work Plan

Evaluation & Sustainability

Evaluation Plan:

We plan to evaluate the impact of QPR and other mental health trainings and Trauma-Informed Care/ACES through the use of Results-Based AccountabilityTM to monitor specific performance measures. We will be monitoring How Much, How Well and/or Better Off Performance Measures. Our evaluation activities will be tracked in the Work Plan table, above.

Sustainability Plan:

The following is our sustainability plan for QPR and Trauma Informed Care/ACES trainings: 

• Sustainability: Performance measures will be used to assess the effectiveness of the programs to communicate to community partners and leaders that advocating for and investing in a workfoce trained to recognize and quickly provide appropriate mental health care improves the well being of all residents.  
  • Numbers of professional staff attending training will be maintained as well as assessing
    • Staff acknowledgement that training enhanced their ability to recognize and care for clients with mental health concerns
    • Staff satisfaction with the training
    • Their willingness to recommend other staff and agencies for this training
    • Six-month follow up that programs have made a difference in their behavior and the behavior of clients they serve

Progress on CHIPs

The following links provide 2022 updates for Haywood County's priority strategies:

Obesity

Offer evidence-based nutrition programming 

Haywood 4 Good Community Wellness Program

Mental Health 

Community-level trauma-informed/ACEs education initiative 

Promote and coordinate mental health trainings and awareness 

Substance Use 

Participate in anti-stigma communications project 

Significant/Notable Changes in Morbidity and Mortality

The following represent significant morbidity and mortality changes in our community.

• Leading Causes of Death Table - Age-Adjusted Death Rates per 100,000 Population

  1. Heart Disease (Rate: 172.1)

  2. Cancer (Rate: 154.9)

  3. All Other Unintentional Injuries (Rate: 58.1)

  4. Chronic Lower Respiratory Diseases (Rate: 51.1)

  5. Cerebrovascular Diseases (Rate: 35.4)

• NC Opioid Dashboard

  • Death rate - 24.1 (2020) vs. 43.3 (2021) per 100,000 residents 

  • Emergency Department visits - 141.2 (2020) vs 105.9 (2021) per 100,000 residents 

  • Unemployment among working - age residents- 6.6% (2020) vs. 2.7 (2021)

• RWJF County Health Rankings 

  • Alcohol-impaired driving deaths (health behaviors) - 0 (2019) vs. 13 (2020)

  • Dentists (clinical care) - 2150 (2019) vs. 2250 (2020)

  • Poverty (social and economic factors - 17% (2019) vs. 21% (2020)

Emerging Issues Impacting Health

These are the new or emerging issues in our community in 2022 that were not identified as priorities in our Community Health Assessment.

• Food insecurity remains a community health issue in Haywood County.  In 2018, Feeding America reported over 8200 or 13.6% of Haywood County experienced food insecurity.  Over 19% of children in the county are impacted (NC Child).  The pandemic greatly increased the number of those seeking assistance.  Food distributions increased, with creative solutions such as holiday food bags for students and drive-through events.  Unfortunately, decreasing food donations and increasing fuel costs hit the community hard.     

• Gun violence- Fourteen individuals visited an emergency department due to firearm injuries of all intents (*NC DETECT, 2022).   

• Suicide- The county saw 12 suicides, nine due to gunshot wounds (Haywood County Health and Human Services, 2022).  Over 330 individuals visited an emergency department with suicidal ideations (NC DETECT, 2022).  

• Health equity- Over 13% of the total population lives below the poverty level, with over 22% of those under 18 affected (U.S. Census Bureau. (2021). Poverty Status in the Past 12 Months: ACS 5-Year Estimates. [Data tables]. Available from http://census.data.gov).  This impacts access to healthy food, transportation, and other non-medical influences on health.  

• Social media misinformation is defined as "any claims or depictions that are inaccurate" and disinformation is defined as "a subset of misinformation intended to mislead" (American Psychological Association). The dissemination of misinformation and disinformation has been a trending topic due to the uncertainties caused by the COVID-19 pandemic. Misinformation surrounding COVID-19 was so rampant that the World Health Organization declared a parallel "infodemic" in 2020. Haywood County is no different and has certainly been affected by the spread of misinformation and disinformation potentially impacting the community's trust in local government agencies. 

*NC DETECT is a statewide public health syndromic surveillance system, funded by the NC Division of Public Health (NC DPH) Federal Public Health Emergency Preparedness Grant and managed through collaboration between NC DPH and UNC-CH Department of Emergency Medicine’s Carolina Center for Health Informatics. The NC DETECT Data Oversight Committee does not take responsibility for the scientific validity or accuracy of the methodology, results, statistical analyses, or conclusions presented.

New/Paused/Discontinued Initiatives/Activities

The following are new initiatives or changes in our community in 2022:

• The county received a $1.5 million Substance Abuse Prevention and Treatment Block Grant.  This program will navigate participants to substance use and mental health treatment, as well as other services needed to promote health.  

• A portion of American Rescue Plan Act funding was dedicated to a regional health communications campaign.  The campaign is in the planning phase.  It is led by the WNC Health Network and will include input from county stakeholders.   

• The county began developing its first Comprehensive Recreation Master Plan, including public surveys and input sessions.  The plan was approved in early 2023.  

• The county received $7 million in funds to support affordable housing.  

Progress on CHIPs

2023 updates can be found in the 'what is it?' note tab for each of the strategies.  

Click below for updates on obesity priority strategies:

Haywood 4 Good Community Wellness Program

Offer evidence-based nutrition programming

Click below for updates on mental health priority strategies: 

Community-level trauma-informed/ACEs education initiative 

Promote and coordinate mental health trainings and awareness 

Click below for updates on substance use priority strategies: 

Participate in anti-stigma communications project 

Morbidity and Mortality Changes Since Last CHA

Mortality 

• The county experienced 772 deaths in 2023, a 5.5% decrease from 2022.   This is provisional data (NC DHHS, accessed February 2024).    
• In 2022, 24 of the county's deaths were confirmed as 'Deaths of Despair.'  Such deaths are caused by suicide, alcohol, drugs or more than one of these factors (Haywood County Health and Human Services, data provided February 2024).  
  • Potential data limitation: Some deaths are pending investigation and it is unknown at this time whether these are Deaths of Despair.    

Morbidity

• Confirmed cases of Chlamydia increased by more than 13% from the 2021-22 to 2022-23 fiscal years (Haywood County Health and Human Services, accessed February 2024).   
• The number of emergency department visits for county residents with alcohol withdrawal symptoms decreased by 30% from 2022 to 2023.  This may have not been the primary reason for a person's visit (NC DETECT*, accessed February 2024).  
• The number of emergency department visits for county residents related to cannabis use increased by nearly 24% from 2022-2023.  This may have not been the primary reason for a person's visit. (NC DETECT*, accessed February 2024). 
  • Potential data limitation: Cases for residents of other counties sometimes appear in these reports by error.   

  • *NC DETECT is a statewide public health syndromic surveillance system, funded by the NC Division of Public Health (NC DPH) Federal Public Health Emergency Preparedness Grant and managed through collaboration between NC DPH and UNC-CH Department of Emergency Medicine’s Carolina Center for Health Informatics. The NC DETECT Data Oversight Committee does not take responsibility for the scientific validity or accuracy of methodology, results, statistical analyses, or conclusions presented.

Emerging Issues Since Last CHA

• Food Security 
  • Food prices in 2023 increased by 5.8% (5% for 'food-at-home' and 7.1% for 'food-away-from-home' (United States Department of Agriculture, accessed February 2024).  
• Housing
  • The county's housing costs increased 12.1% since January 2023 (Rocket Homes, accessed February 2024).  
• Youth Substance Use
  • The 2023 Monitoring the Future Survey collected Delta-8 THC use data for the first time.  Nationally, 11.4% of 12th grade students reported past-year use (University of Michigan, accessed February 2024).  According to the Food and Drug Administration, ''Delta 8 THC has psychoactive and intoxicating effects (FDA, accessed February 2022).''
• Climate Health
  • The year 2023 was the hottest in recorded history.  Asheville experienced 21 'risky heat days' that year (WUNC 91.5, accessed February 2024).  
• Homelessness
  • Haywood Pathways Center provided shelter to 295 unique individuals as compared to 233 unique individuals in 2022.  It is worth noting that there are additional individuals who did not access this resource (Haywood Pathways Center; provided February 2024).    
  • The national Point-in-Time Estimate showed that over 650,000 people experienced homelessness on one night in January 2023; this figure is up 12% from 2022 (U.S. Department of Housing and Urban Development, accessed February 2024).  

New/Paused/Discontinued Initiatives Since Last CHA

• Access to Care
  • Medicaid Expansion launched in North Carolina on December 1, 2023.  Those enrolled in the limited family planning benefits were automatically enrolled in full Medicaid (NC DHHS, accessed February 2024).  
• Employment
  • One of the county's largest employers, Evergreen Packaging, closed its Canton location in 2023 after more than 100 years.  This affected several hundred workers in the county and businesses in other communities (WLOS, accessed February 2024).  Subsidies helped displaced workers afford health coverage in between jobs (WLOS, accessed February 2024).  
• Food Security
  • Supplemental Nutrition Assistance Program recipients saw a decrease in benefits due to the ending of Pandemic EBT benefits (NC DHHS, accessed February 2024).  
  • Free breakfast and lunch are available to all Haywood County Schools' students for the 2023-2024 school year (Haywood County Schools, accessed February 2024).  
• Mental Health
  • Haywood County Health and Human Services (HHSA) was awarded a $24,000 mental health communications grant from the Haywood Health Foundation.  The grant will fund projects such as radio and print ads and billboards in 2024 (The Mountaineer, accessed February 2024). 
  • A social media/internet campaign through WLOS was viewed more than 227,000 times during December 2023/January 2024.  A sponsored article was viewed more than 770 times (WLOS, provided February 2024).  An e-mail ad through iHeart Media was opened by more than 6,700 individuals and a social media campaign was viewed more than 250,000 times (iHeart Media, provided December 2023).  All ads focused on the 988 Suicide and Crisis Lifeline. 
    • Potential data limitation: Some individuals may have seen multiple ads or viewed the same ads multiple times, leading them to possibly be counted more than once.