HNC 2030 Scorecard: Pamlico County 2021-2024 Cycle

Executive Summary

Our Mission Statement and Vision for the Future

We, here at the Pamlico County Health Department, strive to promote the optimal health of our community’s residents by providing high quality & professional services. Our aim is to foster public trust and to minimize identified public health risks so we can help to ensure the well-being of our community and the safety of its environment for future generations.

CHA Leadership & Partnerships/Collaborations

The 2021 Community Health Assessment for Pamlico County was able to be developed as a result of various partnerships between the Pamlico County Health Department and other organizations, community members, and stakeholders. The 2021 CHA Executive Committee was formed in the Spring of 2021. Its members consist of employees that hold key roles within the organizations from which they came. The organizations consisted of the three local health departments involved in the assessment and the hospital that serves our entire region. The Executive Committee also received insight and guidance from many community stakeholders. These stakeholders assisted the committee in analyzing the Primary and Secondary Data that was received. They also gave their interpretation regarding how this data was applicable to determining which key health priorities should be chosen for the upcoming cycle. The Executive Committee were fortunate in that these stakeholders represented a wide variety of agencies and organizations that held operations throughout Pamlico, Craven, and Jones Counties. The following types of agencies/groups were represented:

• County and city government

• Faith-based organizations, including refugee ministry

• Health care providers

• Public service providers

• Educational Institutions

• Substance use prevention

• Mental health

CHA Regional/Contracted Services

Currently, CHAs/CHNAs were required to be created at least once every three years (hospitals) or four years (health departments). The guidance given from the oversite authorities allowed for a wide variation in the construction of these reports. Hence, a CHA submitted in one county could have little resemblance to another offered in the next county over. To streamline the process, for the last two CHA Cycles the Pamlico County Health Department, and nearly all other eastern NC Counties, have partnered with Health ENC in the completion of their Community Health Assessment reports. The group “Health ENC” grew from the conversations that different health care leaders in eastern North Carolina had about improving the entire CHA/CHNA process. Partnerships were formed and we now have a standardized process for the health departments and hospitals in our region. This new process allows for vast improvements and assistance on gathering health data, and it gives new & innovative ways regarding how we can utilize it. The Health ENC organization assists in the collection of the data needed while, most importantly, still allowing the local health departments the freedom to select which priorities they find to be most important in their communities.

Theoretical Framework/Model

The state sets “Standards” for what each Community Health Assessment needs to include and how that should be accomplished. These standards are guided by the Consolidated Agreement that each Local Health Department has with the state and by using Essential Services & Benchmarks/Activities provided to them through their required Accreditation Process. The Standards are divided into 8 Phases.

1. Phase 1 – Establish the CHA Team a. February 2021

2. Phase 2 – Collect Primary Data a. March 2021-Partnered with Health ENC b. April-June 2021-Survey collection Period

3. Phase 3 – Collect Secondary Data a. July-September 2021-Collection of Secondary Data

4. Phase 4 – Analyze and Interpret County Health Data a. September-October 2021- Collection and Analyzation of Primary & Secondary Data

5. Phase 5 – Determine Health Priorities a. November 2021-Presentation Made for Stakeholders, Discussions Held, Priorities Identified

6. Phase 6 – Create CHA Document a. June 2022- CHA Document Completed, Submitted to State for Acceptance

7. Phase 7 – Disseminate CHA Document (August 2022)

8. Phase 8 – Develop Community Action Plan (August 2022)

Collaborative Process Summary

The information found in this Community Health Assessment (CHA) provides the foundation that is needed by multiple organizations to advise and guide them on improving the well-being of the residents in their community.

First, an Executive Committee was formed by combining employees found in key roles from each of the organizations found in our region. (These organizations consisted of: Pamlico County Health Department, Craven County Health Department, Jones County Health Department, and CarolinaEast Health System.) Each organization had already individually established a partnership with the Health ENC group and were preparing for the collection of Primary Data. “Primary Data” is information that is gathered from a 1st party source. In this case, the information is given to us directly from members of the community, in the form of surveys. Meetings were held by the Executive Committee to establish a plan and to make decisions on how to distribute the survey so that the primary data could be gathered and analyzed.

The Health ENC Group had previously been hard at work generating the survey that would be used. When creating the survey, they were sure to choose questions that addressed relevant and important items regarding the health of the community. It was developed in a way that would give insight into each respondent’s perception on the topics that were discussed and could give clarity to the organizations that utilized it. (See pg. 14 for details on this process.) The data received would act as a starting point for establishing the Health Priorities based on the information given. Decisions were made on how the survey would be distributed to the community, and discussions were held on how the information would be organized and submitted to each organization.

The focus then shifted to Secondary Data collection. “Secondary Data” is information that is gathered from an alternate source. This data is typically research that has been previously gathered and can be accessed and used by a 3rd party. While collecting secondary data, only reputable sources of information were utilized. The sources used for this CHA included mostly online governmental agencies such as: countyhealthrankings.org, datausa.io, censusreporter.org, data.census.gov, N.C. Injury & Violence Prevention Branch, and the NC State Center for Health Statistics. This data is used to lend an unbiased opinion on the state of the community’s health and give evidence on various topics. When analyzed, this data -combined with the primary data provided via survey by residents- assisted in determining what priorities should be set to promote the health and well-being of the community of Pamlico County.

The CHA Executive Committee used all of the data gathered and used it to guide discussions that were then held with Community Members and Stakeholders. The guidance from those discussions, the culmination of the primary and secondary data that was gathered were all combined to form Pamlico County’s 2021 Community Health Assessment.

Key Findings

After combing through the data collected for purposes of creating this assessment, we learned most residents feel that Pamlico County is a good place to grow old in. They also feel that there are good parks and recreational facilities here. Even though statistics prove that our county is sorely lacking in the amount of healthcare providers (per capita) the majority of the respondents feel that the ones that we do have here, are good healthcare facilities. We have a High School Graduation rate that is higher than our counterparts, and a dropout rate that is lower. Our county’s unemployment rate has been falling since 2011, but began to rise again in 2020, likely due to the COVID-19 Pandemic. About half of those surveyed feel that Pamlico County is a good place to raise children and that it is easy to find and purchase healthy foods. But many agree that there is a lack of economic opportunity and wish there were more affordable housing. When asked to select the “Top Three Issues” that they believe affect Quality of Life in Pamlico County, participants identified these 5 the most: Low Income/Poverty (24.43%), Drugs/Alcohol (i.e.: Substance Misuse) (19.76%), Lack of Affordable Housing (12.82%), Transportation (12.07%), and Lack of Community Resources (8.75%). Pamlico County Health Department will create Community Health Improvement Plans (CHIPs) that will address the issues named above. Work will be done to develop strategies and goals of partnering with community organizations in efforts of alleviating these issues.

Health Priorities

Using the data available to complete this assessment, several issues were determined to be priorities to the community of Pamlico County -as well as to the Pamlico/Craven/Jones County Region as a whole. The priorities set in this Community Health Assessment are as follows:

• Behavioral Health

• Community Wellness

• Workforce Development

Next Steps

The North Carolina Department of Health and Human Services require all local health departments to conduct a Community Health Assessment (CHA) every three-or-four years. These assessments are required to provide the foundation for improving the health of county residents and are paramount to identifying the health priorities that most need attention in the community. That document will then be used, by the local health department, to create Community Health Improvement Plans (CHIPs) that will aid in achieving a desirable outcome for the population towards the priorities that were set in the CHA. Community Health Improvement Plans (CHIPs) are the documents that are created as a roadmap of how to work towards achieving successful outcomes in the priority areas. They usually include the involvement of and collaboration with many of the health departments community partnerships and work with community stakeholders. A State-of-the-County’s Health (SOTCH) Report is required to be completed by local health departments during each of the interim years that a CHA is not required. SOTCH Reports give us the ability to relay updates to leaders, partners, and community members on the progresses that have been made on each of the Community Health Improvement Plans. It also allows health departments to disseminate the status of the objectives that were set and/or achieved regarding the priorities identified in the previous CHA. Ultimately, all work done is done with one goal in mind, improving the health of our community. This document will be shared with community members, leaders, and stakeholders by various methods. Presentations will be made to the Board of Health/Board of County Commissioners and to the Pamlico County Community Collaborative. (Please see Page 2 Distribution information)

Priorities

• Behavioral Health
• Community Wellness
• Workforce Development

Why Is This Important?

What We Do

PCHD is developing, in collaboration with Pamlico County Schools (administrators, guidance counselors, social workers, and school nurses) and Region 10 Tobacco Prevention Coordinator, a tobacco/vaping cessation program in lieu of suspensions.  

Provide and conduct presentations to regional collaboratives, partner and county commissioners regarding the benefits of Tobacco Free government buildings, grounds, vehicles, parks/recreation areas and smoke free public places. Promote the benefits of cessation and tobacco free living during events such as the Great American Smokeout, Take Down Tobacco and Kick Butts Day. Encourage cessation efforts within schools and support school personnel to attend CATCH My Breath and You Quit Two Quit trainings. Be available to promote evidence based curriculum and trainings through presentations and handouts for resources on tobacco prevention, suspension and tobacco/vaping cessation. Spread the message regarding QuitlineNC via social media, mass media campaigns, cards and brochures, at community events and through presentations, among area providers.

Who We Serve

Pamlico County students: grades 6-8 (Pamlico County Middle School) and grades 9-12 (Pamlico County High School)

How We Impact

Vaping is serious and worthy of concern in Pamlico County. Just about all vape products contain nicotine, a highly addictive drug, and the negative health effects are broad and can be serious. The vast majority of people with nicotine addiction started using a nicotine product before age 21.  PCHD tobacco/vaping cessation program will reduce the number of disciplinary suspensions and tobacco/vaping users in Pamlico County Schools. 

What We Do

PCHD offers in-house rapid (CLIA waived testing) and chain of custody urine drug screening for pre-employment, random, and suspicious non-DOT, DOT, and court-ordered testing. In-house rapid testing is perfomed in the PCHD lab and results are provided immediately to the client seeking proof of soberity.  PCHD serves as a collection agency for chain of custody urine drug screenings and send specimens per protocol to outside laboratory agencies for testing. Chain of custody testing usually takes 3-5 business days to receive results.  

Who We Serve

Any Pamlico County residents may request by appointment an in-house rapid or chain of custody urine drug screening. 

How We Impact

PCHD's ability to perform local in-house rapid and chain of custody urine drug screenings will impact individuals who have limited access and transporation to participate in drug screenings for pre-employment, random, or court-ordered drug screenings.  This service provides proof of soberity, identifies individuals needing and/or requesting referrals to substance abuse counseling, and reduces work-related injuries. 

What We Do

Who We Serve

How We Impact

Description

New Beginnings Addiction Clinic:

• Between the ages of 18-70

• Be a resident of Pamlico, Craven, or Beaufort County

• Agree to attend support group meetings

• Must be able to attend appointments as scheduled

• Must be willing to commit to your recovery

• Please note that New Beginnings is not a Suboxone or Methadone based maintenance program. 

Why Is This Important?

What We Do

PCHD began providing mass influenza vaccination clinics to vulnerable populations, specifically targeting 18-64 year olds and 65+ year olds in 2022.  PCHD partnered with Pamlico County Senior Center to provide vaccines to seniors.  PCHD is also partnering with Pamlico County local government to provide mass influenza vaccination clinics to employees. PCHD bills Medicaid, Medicare, and third-party payers. 

Who We Serve

18-64 year olds and 65+ year olds residents in Pamlico County

How We Impact

Prior to implementing mass influenza vaccination clinics, flu vaccines were only available to citizens by appointment only due to staffing shortages.  Flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs. It can cause mild to severe illness, and at times can lead to death. The best way to prevent flu is by getting a flu vaccine each year. In 2022, Pamlico County hired a new health director, director of nursing, and support staff to offset staffing shortages and to revitalize the department and its purpose. As a result, PCHD is improving its community partnerships, establishing new support among community leaders, citizens, and the Board of Health, and seeking appropriate funding to implement activities including, but not limited to, mass vaccination clinics.

What We Do

PCHD reactivated its Child Fatality Prevention Team (CFPT) in 2022 to identify and reduce preventable child fatalities through: systematic, multidisciplinary, and multiagency reviews of child fatalities; data-driven recommendations for legislative and public policy initiatives; assisting local teams; interdisciplinary training, and promotion of community-based prevention education. 

Because the CFPT and Community Child Protective Team (CCPT) consists largely of the same representatives, PCHD and Pamlico County DDS elected to partner to combine teams.  The interdisciplinary teams consist of the following representatives: Chief Court Judge, Pamlico County District Attorney, Pamlico County Sheriff, Pamlico County DSS Board of Directors Chairman, DSS Director and Social Worker, Pamlico County Health Department Health Director and Director of Nursing, Pamlico County Schools Superintendent, Pamlico County Emergency Manager, Pamlico County Commissioner Appointees, Parent of a Child Fatality, Pamlico County Childcare, Mental Health, Coroner/Chief Medical Examiner, and Guardian at Litem. 

Meetings occur quarterly. 

Who We Serve

Pamlico County mothers and families at risk for preventable child fatalities and participation with community child protective services.  

How We Impact

PCHD's participation in CFPT and CCPT interdisciplinary team meetings will reduce the number of child fatalities and reduce the need for community child protective services in Pamlico County by identifying resources, establishing partnerships, and providing education to mothers and families at risk.  

What We Do

PCHD offers car seat installation training to Pamlico County residents.  PCHD's car seat technician completed a national Child Passenger Safety certification training course in 2022.  CPS technicians and instructors use their considerable knowledge and expertise at a variety of community-based activities, such as child safety seat checks, where parents and caregivers receive education and hands-on assistance. CPS technicians and instructors also keep up-to-date on the latest technical information about child passenger safety through seminars and other continuing education opportunities.  PCHD is partnering with WIC, Pamlico County Partnership for Children, Pamlico County DSS, and Pamlico County Heart Works to offer car seat safety training and outreach.  

Who We Serve

PCHD's child health and WIC programs serves low-income families and individuals eligible for WIC services from birth to 5 years old.  Any residents of Pamlico County may request car seat technician services. 

How We Impact

Motor vehicle crashes remain the leading cause of death of children, ages 3-14. However, many of these deaths can be prevented through the proper use of child safety seats. According to the National Highway Traffic Safety Administration (NHTSA), child safety seats can reduce fatal injury by 71 percent for infants and by 54 percent for toddlers, ages 1-4.  PCHD's ability to provide car seats to eligible families and car seat technician services will help reduce preventable injuries and child fatalities in Pamlico County.  

What We Do

PCHD has a trained breastfeeding peer coordinator who offers breastfeeding counseling.  PCHD has breastpumps available for eligible clients participating in the WIC program.  PCHD partners with CarolinaEast Medical Center to provide breastfeeding classes to mothers wishing to breastfeed. 

Who We Serve

Any residents of Pamlico County may request breastfeeding peer counseling.  PCHD provides breastfeeding peer counseling to mothers enrolled in the WIC program wishing to breastfeed. 

How We Impact

Breastfeeding has several benefits including: 

• Breast milk is the best source of nutrition for most babies.
• Protect babies against some short- and long-term illnesses and diseases.
• Lower risk of asthma, obesity, type 1 diabetes, and sudden infant death syndrome (SIDS). Breastfed babies are also less likely to have ear infections and stomach bugs.
• Breast milk shares antibodies from the mother with her baby. These antibodies help babies develop a strong immune system and protect them from illnesses.
• Mothers can feed their babies anywhere and at any time. Mothers can feed their babies on the go without worrying about having to mix formula or prepare bottles. 
• Breastfeeding can reduce the mother’s risk of breast and ovarian cancer, type 2 diabetes, and high blood pressure. 

PCHD's ability to provide breastfeeding resources and access to a peer coordinator increases access to Pamlico County residents wishing to breastfeed. 

Description

Hope Clinic is a private, 501(c)3 nonprofit organization that provides free medical care to those in need in Pamlico County and surrounding communities. More than 20% of our families, friends, and neighbors live in poverty. They struggle every day between paying their rent or utilities, or accessing medical care. The stress level of living in poverty is something most of us cannot imagine, but for these folks, it's become their "normal."   

https://www.hopeclinic.net/copy-of-about-hope-clinic

What We Do

Who We Serve

How We Impact

Description

Pamlico County Food Advisory Council will work to improve food safety and help restaurants and other food establishments improve their grade resulting in fewer food-borne illnesses. The purpose of the Food Safety Advisory Council (FSAC) is to assists the food industry in understanding laws, regulations, and the reasoning behind them. FSAC is a collaborative effort between businesses and government, comprised of representatives from the retail food industry, related businesses, and Food Protection Program Staff. The overall goal of the Council is to enhance cooperation, involvement and understanding between county government and the food industry.

Description

Mosquito/vector control is a service that is complaint driven by Pamlico County residents and supported by landing counts of mosquitoes.  Pamlico County is a low-lying coastal region and is surrounded by various waterways. Environmental Health specialists who are North Carolina licensed pesticide applicators spray locations within Pamlico County who report increased mosquito/vector activity. The purpose of trappings and landing counts is to identify species of mosquitos and to help identify health risk, proper pesticide control, and increase community awareness for prevention (e.g. tip and toss method for standing water). Environmental Health specialists who are qualified provide education and larvicide materials to citizens during high vector seasons and outreach activities. 

Description

Pamlico County has provided rabies prevention for _____ years.  Recently, Animal Control added microchipping as an optional service.  It currently costs $10.00 per vaccine and $10.00 per microchipping.  Pamlico County residents may elect to choose 1 year or 3 year vaccination per animal. Individuals who request 3 year vaccination for their pets must provide previous records to obtain 3 year vaccines.  The Animal Control Officer is supervised by the County Manager.  PCHD communicable disease nurse investigates human rabies exposure.  The health director participates in all dangerous dog hearings.  Microchipping is a public health measure in locating an animal/pet who may be involved in a possible rabies exposure.

What We Do

Pamlico County Environmental Health provides water sampling for new wells, existing wells annually by request or after a natural disaster event (e.g. flooding), and farms with wells. Specimens are collected by environmental specialists. 

Who We Serve

Pamlico County residents. 

How We Impact

The purpose of water samples are to maintain safe water supplies for residents and to protect aquifers. 

Why Is This Important?

What We Do

PCHD offers Department of Transportation/Federal Motor Carrier Safety Administration (FMCSA) and United States Coast Guard/Merchant Mariner physical assessments. PCHD has a certified advanced provider practitioner who performs DOT/CDL/USCG physical assessments to individuals who need commercial driver's licenses and/or medical cards for employment.  

Who We Serve

Any Pamlico County resident wishing to schedule an appointment seeking medical cards/physical assessments for employement including truck drivers, farm workers, captain's license, merchant mariners, etc.  

How We Impact

Pamlico County has a large number of residents who are employed by companies requiring DOT/CDL or USCG physical assessments and medical cards. Residents include individuals working in agriculture, commercial/private fishing industry, and self-employed business owners.  PCHD's ability to provide these services locally improves accessibility for residents and employers. 

What We Do

Who We Serve

How We Impact

Description

Pamlico County Health Department has partnered with Duke University School of Nursing and Global Studies to provide learning activities for undergraduate, graduate, and professional students.  The purpose of this program is to strengthen the nursing workforce through education and training to provide culturally aligned quality care in rural and underserved areas and training of diverse nursing students to address and manage Social Determinants of Health (SDOH) factors and improve health equity and health literacy of vulnerable populations in rural and underserved communities through nurse-led mobile health training sites. The Nurse Education, Practice Quality and Retention - Mobile Health Training Program (NEPQR-MHTP) will create and expand experiential learning opportunities for nursing students, including: the provision of high-quality culturally sensitive care, identify and understand SDOH in local communities, engagement in critical thinking, and clinical practice highlighting a collaborative team approach to care.

Program Goals

1. Establish or expand Nurse-led mobile units to provide care to the target vulnerable populations in rural and underserved areas.

2. Expand the nursing workforce by creating experiential learning opportunities emphasizing advanced nursing skills and care delivery in rural and underserved communities.

3. Provide didactic nursing education geared toward the delivery of culturally competent care, addressing SDOH while developing skills in leadership, communication, and critical thinking in a technologically innovative and collaborative practice environment.

4. Foster a community-based learning environment which mentors nursing students to identify and implement evidence-based best practices in rural and medically underserved communities.

5. Increase the diversity of the nursing workforce by recruiting and supporting students and faculty from diverse populations, including those from disadvantaged backgrounds and underrepresented racial and ethnic minorities.

Program Objectives

• Develop or enhance nurse-led mobile health units to provide quality health care to rural and underserved communities;

• Utilize the NEPQR-MHTP as an experiential platform for nursing students;

• Expand access to health care services in underserved and rural communities through the use of the mobile health unit and innovative technology solutions;

• Enhance current curriculum to integrate SDOH concepts, providing a foundation for nurses/nursing students to address and improve patient health outcomes;

• Implement professional development programs and share resources with faculty and preceptors related to social determinants; and

• Develop a nursing workforce that address the needs of the target populations being served in rural and underserved communities.

Description

Coastal Community Action, Inc. (CCA) is a 501(c)(3) corporation which has a very public mission. Incorporated in 1965, the agency came into being as part of a nationwide, federally-funded, community action movement whose focus is to intimately involve poor people in developing their own solutions to persistent poverty. A common thread through all of our services, be they Family Services, Senior Services, or Housing Services, is that we help change lives by providing needed resources and support. Coastal Community Action, Inc. provides needed services to thousands of residents in our region annually.

What We Do

Who We Serve

How We Impact

Description

The Pamlico County Career Resource Center provides a convenient location for job seekers and employers to connect with employment and training assistance. Services are provided in coordination with local and regional partner agencies through referral. These agencies include but are not limited to Pamlico Community College, NCWorks, Eastern Carolina Workforce Development Board, Inc., Vocational Rehabilitation, Coastal Community Action, the Division of Employment Services, and the Small Business Center.

For job seekers, the Career Center offers:

• Locating employment through NCWorks, etc.

• Career counseling

• Resume review software

• Training information and connection

• Career Readiness Certificates, and much more

Progress on CHIPs

Each year every Health Department is required to create an assessment, that reports on the Public Health standing of the community they serve. The largest one required is the Community Health Assessment (CHA). It is required to be completed at least every three to four years. This assessment provides an overview of the significant community health needs that are identified within the community itself. Data is gathered in many forms and assembled into the CHA which is then disseminated to the community and stakeholders.

The purpose the CHA is to provide organizations comprehensive information about the community's current health status, needs, and issues. The CHA identifies and offers meaningful knowledge and information on Public Health Priorities by the analysis of the data collected and to offer guidance to address those needs. Special attention is typically offered to vulnerable, at-risk populations, health disparities, health inequities, and input attained directly from the community.

The CHA is used in conjunction with other reports including the Community Health Improvement Plan (CHIP), the State of the County’s Health (SOTCH), and Health Department’s Strategic Plan. Community stakeholders and partners usually assemble, with the Health Department, to create the CHIP. Progress on the priorities identified in the CHA as well as the strategies identified in the CHIP are documented so the community’s public health may be monitored. Any emerging issues impacting public health may also be included, as well as new initiatives created to address concerns.

The main reason for the creation and utilization of these documents is to provide and connect community members with the resources they need to improve public health challenges they may experience. 

Pamlico County Health Department has experienced significant change since the last CHA and SOTCH reporting.  In June 2021, the Pamlico County Health Director retired, and an interim Health Director appointed.  In October 2021, the interim Health Director was officially confirmed.  Soon following, a new Director of Nursing and a new Environmental Health Coordinator were hired to lead clinical operations and environmental health.  Under its new leadership, PCHD prioritized restructuring its programs and services and reorganizing its organizational chart to efficiently utilize staffing and resources to address Pamlico County’s health disparities and inequities as identified in the most recent CHA.   With the support of the Board of Health, new staff were hired to help fill vacancies and onboarding conducted to strengthen employees’ knowledge of public health and to bring awareness to local concerns. Onboarding included training to establish a team approach to data and monitoring of information gathered as related to accreditation and regulatory reporting.  As a result of PCHD’s renewed sense of purpose and restructuring, the department achieved full accreditation with honors in October 2022. This was a historical event for PCHD.   PCHD has also addressed infrastructural needs.  Renovations continue to be an ongoing concern until the County may secure funding for a new facility. Thus far, PCHD has replaced antiquated flooring and carpeting to decrease safety risks and transmission of disease, updated interior wall paint, purchased ADA compliant signage, furniture, and resources, and replaced obsolete IT equipment and data management systems. 

Unfortunately, we do not have data to compare 2021 and 2022. Many new initiatives have taken shape since January 2022 and PCHD leadership change. PCHD coordinated with the community stakeholders and partners to identify Pamlico County’s vulnerable population and to explore opportunities to increase access to health care.

In 2022, the Administrative Assistant assigned to the Health Promotions role resigned.  The accreditation team was developed and established a meeting schedule to meet monthly to discuss quality assurance and improvement, CHA, CHIP, SOTCH, and Strategic Plan. The accreditation team are currently participating in the Winter CHIP training for Scorecard. A newly appointed public health nurse has been employed as PCHD’s health educator and they will assume the lead in accreditation and reporting.

Overview of the items encountered in 2022:

• Leadership and staffing transition
• Staffing and provider shortages
• Restructuring of organization
• Onboarding of new staff
• Renovations
• Pandemic 
• Accreditation

Morbidity and Mortality Changes Since Last CHA

According to the 2020 Detailed Mortality Statistics for Pamlico County, there were approximately 189 deaths including 149 White, Non- Hispanic (84 males, 65 females), 40 African American, Non-Hispanic (23 males, 17 females), and zero Hispanic. The 2021 and 2022 Detailed Mortality Statistics for Pamlico County data has not been released.  The leading causes of death in Pamlico County includes:

• Diseases of the Circulatory System (59) – Including common heart-related illnesses (e.g. hypertension, myocardial infarction, heart failure, ischemic heart disease, hemorrhage, cardiac arrhythmias, peripheral vascular disease, etc.).
• Malignant Neoplasms (40): An abnormal mass of tissue in nature can invade other parts of the body. Including common malignant illnesses (e.g. colon, stomach, esophagus, skin, pancreas, liver, breast, nasopharynx, female and male genital organs, thyroid, etc.).
• External Causes of Morbidity (21) – including accidents, accidental and exposure poisoning, intentional self-harm, falls, motorcycle, exposure to smoke, fire, flames, complications from medical procedures, etc.).
• Diseases of the Respiratory System (16) – including common respiratory illnesses (e.g. influenza, pneumonia, respiratory failure, chronic obstructive pulmonary disease, etc.).
• Diseases of the Endocrine, Nutritional, and Metabolic Diseases - (12) – including common endocrine system (e.g. diabetes, obesity, hyperlipidemia, metabolic disorders, thyroid disorders, etc.).
• Diseases of the nervous system/disorders of mental, behavioral health, and neurodevelopmental (10) - including psychological and physiological conditions (e.g. dementia, Alzheimer’s disease, Parkinson’s disease, epilepsy, anoxic brain injury, etc.).

Emerging Issues Since Last CHA

Pamlico County Health Department has identified the following emerging issues that prompted discussion, collaboration, and actions towards addressing the issues:

• Increased opioid abuse. Pamlico County has been identified as one of the leading counties in North Carolina experiencing an opioid crisis.  PCHD has researched North Carolina’s Syringe Service Program as a possible solution to address opioid, mental health, and communicable disease in Pamlico County.  In 2022, Pamlico County Rescue Squad reported receiving 71 calls to respond to opioid-related overdoses and stated they administered 400 doses of naloxone.  These numbers do not reflect opioid-related overdoses not reported to authoiries or EMS. 
• Increased events reported in North Carolina Electronic Disease Surveillance of Pamlico County residents testing positive for pertusis and spotted fever rickettsiosis when tested by primary care facilities.  Additional information has been provided to primary care providers regarding pertussis and spotted fever rickettsiosis laboratory testing, North Carolina Communicable Disease Manual’s case definitions of confirmed pertussis and spotted fever rickettsiosis events, and tick and immunization prevention (e.g. TDaP vaccine).
• Increased number of teen pregnancy.  In 2022, Pamlico County identified a rise in the number of teen pregnancies (7). In addition, Pamlico County has noted an increase in the number of reported and confirmed STI/STD (59) and Hep B/C (22) events.
• Lack of healhcare access and transportation.  Unfortunately, Pamlico County does not have a public transportation system.  Residents must rely on private vehicles, CARTS, and/or BATS for transportation to health care appointments resulting in an increase in health disparities and inequities. 
• Continued COVID-19 crisis.  The pandemic has affected Pamlico County greatly. Many of the businesses who were forced to reduce their hours and/or closed for extended periods of time have had trouble staffing vacancies resulting from those transitions.  Many of these rural businesses are owner/operator establishments and the financial ramifications continue to proliferate in the community.

New/Paused/Discontinued Initiatives Since Last CHA

Pamlico County Health Department has recognized in efforts to decrease health disparities and health inequities in Pamlico County the necessity to explore new opportunities and the expansion of resources, services, and programs. PCHD has initiated several new initiatives in 2022 to address behavioral abuse/mental health, community wellness, and workforce development concerns identified in the CHA. 

The following are new initiatives identified in the Scorecard:

• Acute Care/Sick Visits
• DOT/CDL/USCG medical physicals
• Pre-employment work physicals
• Non-DOT and DOT chain of custody urine drug screenings
• In-house PPMP CLIA Waived laboratory procedures (e.g. venipuncture, Wet Mounts, Gram Staining, urine drug screenings (rapid))
• Child Safety Car Seat Technician
• Mass Vaccination (flu, COVID, Meningococcal, Tetanus)
• CPR/First Aid/AED certification training
• Breastfeeding Peer Coordinator (counseling and training)
• Duke University School of Nursing Preceptorship
• Duke University Global Studies Student Research Team
• Rabies Clinics: Vaccine and Microchipping
• Reinstatement of the Child Fatality Prevention Team

Pending approval by the Board of Health:

• CDC Public Health Associate Program
• Interpreter Services
• Mosquito/Vector Trapping
• Participation Physical Examination (Sports Physicals) and Hydration testing
• Syringe Service Program
• Workforce Development Training (e.g. Justice Involved, re-entry, CPR, ServSafe, Youth Mental Health First Aid)
• Tobacco/Vaping Cessation Program for Schools (approved by BOH, pending Board of Education approval)

Progress on CHIPs

Each year every Health Department is required to create an assessment, that reports on the Public Health standing of the community they serve. The largest one required is the Community Health Assessment (CHA). It is required to be completed every three to four years. This assessment provides an overview of the significant community health needs that are identified within the community itself. Data is gathered in many forms and assembled into the CHA which is then disseminated to the community and stakeholders.

The purpose of the CHA is to provide organizations comprehensive information about the community’s current health status, needs, and issues. The CHA identifies and offers meaningful knowledge and information on Public Health Priorities by the analysis of the data collected and to offer guidance to address those needs. Special attention is typically offered to vulnerable, at-risk populations, health disparities, health inequities, social determinants, and input attained directly from the community.

The CHA is used in conjunction with other reports including the Community Health Improvement Plan (CHIP), the State of the County’s Health (SOTCH), and Health Department’s Strategic Plan. Community stakeholders and partners usually assemble, with the Health Department, to create the CHIP. Progress on the priorities identified in the CHA as well as the strategies identified in the CHIP are documented so the community’s public health may be monitored. Any emerging issues impacting public health may also be included, as well as new initiatives created to address concerns.

The main reason for the creation and utilization of these documents is to provide and connect community members with the resources they need to improve public health challenges they may experience.

Pamlico County Health Department (PCHD) continues to experience significant change since the last CHA and SOTCH reporting. Under its new leadership, PCHD continues to prioritize restructuring of programs and services to efficiently utilize staffing and resources to address Pamlico County’s health disparities and inequities as identified in the most recent CHA and vulnerability study conducted by Duke University Global Health Institute Student Research Team. With the support of the Board of Health, PCHD has advertised to help fill staff vacancies. PCHD also received approval to increase provider hours from 16 hours per week to 24 hours per week to meet anticipated client increases and community needs.  Onboarding and program specific training has been conducted to strengthen employees’ knowledge of public health and to bring awareness of local concerns. PCHD has also addressed infrastructural needs. Renovations continue to be an ongoing concern until the County may secure funding for a new facility. Thus far, PCHD has replaced antiquated flooring to decease safety risks and transmission of disease, updated sinks and counter tops in examination rooms, replaced a portion of roofing that exhibited damage from ongoing leaks, updated interior wall paint in the lobby and clinic areas, purchased ADA compliant furniture and desks, added essential laboratory equipment, and replaced obsolete electronic equipment and data management systems. 

Many new initiatives have taken place since January 2022 and the last CHA and SOTCH reporting. PCHD coordinated with stakeholders and partners to identify Pamlico County’s vulnerable population and to explore opportunities to increase access to health care.     In October 2022, PCHD successfully completed its accreditation site monitoring visit, using an accreditation team approach.  In March 2023, PCHD was awarded accreditation with honors, a historical event for Pamlico County.  In July PCHD’s application for Centers of Disease and Prevention (CDC) Public Health Associate was accepted; however, due to restructuring and budgeting constraints encountered by the CDC, PCHD was not matched with a candidate. In October 2023, PCHD’s public health nurses were awarded North Carolina Credentialed Public Health Nurse (CPHN) credentials.  This credential will soon be required of all public health nurses. 

Since PCHD the last CHA and SOTCH reporting, a newly appointed public health nurse was employed as PCHD’s health educator and assumed the lead in accreditation and report. In October 2023, this newly hired staff member resigned their position.  The position has since been advertised and continues to be vacant.  PCHD plans to seek approval from its Board of Health to hire a full-time public health nurse and a full-time health educator/preparedness coordinator.  

Overview of the items encountered in 2023:

• Staffing and provider shortages
• Restructuring organization, job descriptions, and duties
• Restructuring billing and coding policies and procedures
• Restructuring onboarding and training for staff and board members
• Renovations
• Residual pandemic impacts
• Preparation for Medicaid transformation
• Increasing outreach activities and partnerships
• Increasing provider hours and services to meet community needs
• Increasing student internship/preceptorship opportunities
• CHA new cycle
• Accreditation new cycle 
• Vacancies/Recruitment of Advisory Board of Health members
• New Environmental Health Specialist (Intern) (Seeking authorization in December/January for On-Site Wastewater)
• Increased participation with professional organizations (e.g. NACCHO, EDNCPHA, NCPHNA, etc.)

Morbidity and Mortality Changes Since Last CHA

According to the 2022 Detailed Mortality Statistics for Pamlico County, there were approximately 218 deaths including 180 White, Non-Hispanic, 30 African American, Non-Hispanic, four Other, Non-Hispanic, and four Hispanic with the highest percentage of deaths occurring in the month of July (26). The most current Detailed Mortality Statistics for Pamlico County data has not been released.  The leading causes of death in Pamlico County includes:

• Diseases of the Circulatory System: Including common heart-related illnesses (e.g. hypertension, myocardial infarction, heart failure, ischemic heart disease, hemorrhage, cardiac arrhythmias, peripheral vascular disease, etc.).

• Malignant Neoplasms: An abnormal mass of tissue in nature can invade other parts of the body. Including common malignant illnesses (e.g. colon, stomach, esophagus, skin, pancreas, liver, breast, nasopharynx, female and male genital organs, thyroid, etc.).

• External Causes of Morbidity: Including accidents, accidental and exposure poisoning, intentional self-harm, falls, motorcycle, exposure to smoke, fire, flames, complications from medical procedures, etc.).

• Diseases of the Respiratory System: Including common respiratory illnesses (e.g. influenza, pneumonia, respiratory failure, chronic obstructive pulmonary disease, etc.).

• Diseases of the Endocrine, Nutritional, and Metabolic Diseases: Including common endocrine system (e.g. diabetes, obesity, hyperlipidemia, metabolic disorders, thyroid disorders, etc.).

• Diseases of the nervous system/disorders of mental, behavioral health, and neurodevelopmental: Including psychological and physiological conditions (e.g. dementia, Alzheimer’s disease, Parkinson’s disease, epilepsy, anoxic brain injury, etc.).

Emerging Issues Since Last CHA

Pamlico County Health Department has identified the following emerging issues that prompted discussion, collaboration, and actions towards addressing the issues:

Opioid Abuse.  Pamlico County has been identified as one of the leading counties in North Carolina experiencing an opioid crisis. PCHD has researched North Carolina’s Syringe Service Program as a possible solution to address opioid, mental health, and communicable disease in Pamlico County. In 2023, Pamlico County Rescue Squad continues to respond to opoid-related calls reported (to date 63 calls compared to 71 in 2022) and states they administered 8-12 mgs of naloxone per individual (e.g. equates to approximately 252 doses compared to 400 doses in 2022). In contrast and according to the local EMS Chief, "each opoid overdose is requiring more milligram dosing per individual to revive the individual." This observation requires further investigation.  These numbers do not reflect opioid-related overdoses not reported to authorities or EMS.  These findings and possible solutions were presented by PCHD to Pamlico County Board of Health. Pamlico County’s Board of Health opted to decline the proposed North Carolina Syringe Service Program at this time.  PCHD received a one-time shipment of naloxone from NC Department of Health and Human Services (DHHS) and donated the shipment to Pamlico County Rescue Squad EMS.  Currently, PCHD is exploring and evaluating suggested interventions provided by NC DHHS to address the opioid crisis in Pamlico County. 

Child Fatality and Protection Awareness.  In 2023, Pamlico County's Child Fatality Prevention Team (CFPT) and Community Child Protection Team (CCPT) met quarterly to identify at-risk children and discuss strategies to reduce child fatalities in Pamlico County.  In addition to providing car seat safety training through PCHD's WIC department, PCHD requested 200-gun locks to reduce potential child fatalities resulting from accidential shootings.   PCHD received a Safe Sleep trainer to share with partners to train staff and parents methods to reduce sleep-related deaths.  In 20023, PCHD's WIC distributed 76 car seats and provided 76 car seat safety training sessions to Pamlico County residents.  WIC received a $5000.00 grant from Pamlico Partnership for Children to purchase additional car seats. 

Tobacco use/Vaping in Public Schools.  PCHD and Pamlico County Schools are collaborating to develop a vaping cessation program for public schools.  PCHD is actively participating in the reinstatement of Pamlico County Schools' Student Health Advisory Council (SHAC) to develop alternatives to address tobacco product use by students and staff.  SHAC is scheduled to meet quarterly and will be comprised by a variety of partners including school administration, school nurses, social workers, local law enforcement, parents, and students. 

Communicable Disease.  PCHD's laboratory testing and events reported in North Carolina Electronic Disease Surveillance System (NCEDSS) demostrates an increase in positive test results for syphilis, HIV+, and latent tuberculosis (LTBI) in Pamlico County.  In 2023, Pamlico County has had six newly diagnosed cases of syphilis, one newly diagnosed HIV+, and six newly diagnosed LTBI.  This does not include individuals already living with diagnosed communicable diseases, those who have not been tested, or events not yet reported. Additional information has been provided to primary care providers and to the community regarding communicable disease transmission, screening, treatment, and prevention.  PCHD has recently included Urine Nucleic Acid Amplification Testing (NAAT) for Chlamydia and Gonorrhea as an option to increase male client participation in STD screenings.   

Health Care Access and Transportation.  Lack of access and transportation for health care services continues to negatively impact Pamlico County residents seeking care.  Pamlico County does not have a public transportation system.  Residents must rely on private vehicles, CARTS, and/or BATS for transportation to health care appointments resulting in an increase in health disparities and inequities.  PCHD is actively collaborating with several non-profit organizations to identify opportunities to address lack of access and transportation in Pamlico County (e.g. Community Health Workers, Volunteers, Urgent Care, etc.) Collaborating with Duke University Global Health Institute, Duke University School of Nursing, and East Carolina University Allied Health to conduct research and increase student internships/preceptorships to help supplement provider shortages to accommodate expected increased client needs in Pamlico County.   PCHD has developed plans to strategically increase provider hours per week.  The additional provider hours will increase access to health care by supplementing local health care agencies, qualify for in-network insurance participation, and provide additional primary care access to accommodate Medicaid expansion, and improve the overall social determinants of Pamlico County residents.  

Billing and Coding Reimbursements.  PCHD has recently discovered billing and coding discrepancies in their policies and procedures.  Historically, due to staffing shortages and leadership turnover, PCHD has not designated specifically trained staff to address billing and coding needs.  PCHD has been working with its electronic health records vendor, State consultants, and neighboring local health departments who utilize similar electronic systems to identify and correct billing and coding practices.  PCHD received approval from their Board of Health to reclassify designated staff and provide specific training to address billing and coding needs.  Monthly chart audits are being performed to track quality assurance since new practices have been implemented. PCHD has set a new goal of achieving 95% accuracy with first-time billing submissions.   

Residual COVID-19 Crisis.  The pandemic continues to affect Pamlico County greatly. Many of the businesses who were forced to reduce their hours and/or close for extended periods of time have had trouble staffing vacancies and recovering.  Many of these rural businesses are owner/operator establishments and the financial ramifications continue to proliferate in the community.  PCHD has observed vaccination for COVID, testing, and COVID cases are waning compared to 2022 due to individuals not testing or reporting COVID events.  In 2023, Pamlico County reported one COVID-related death.  This does not include the number of Pamlico County residents hospitalized with COVID or COVID-related symptoms nor deaths reported during hospitalization. 

New/Paused/Discontinued Initiatives Since Last CHA

Pamlico County Health Department has recognized in efforts to decrease social determinants in Pamlico County the necessity to explore new opportunities and the expansion of resources, services, and programs. PCHD has initiated several new initiatives since the last CHA and SOTCH reporting to address behavioral abuse/mental health, community wellness, and workforce development concerns as identified in the CHA.

The following are new initiatives identified in the Scorecard:

• Department of Social Services CAP/Disabled Adults Nurse Assessments  
• Participation Physical Examinations (Sports Physicals) and Hydration Testing
• East Carolina University Allied Health Student Internships (Public Health)
• Duke University School of Nursing Mobile Prevention and Care Team (MPACT)
• Certified Medical Interpreter (Spanish) and Audio/Visual Interpreter System
• Reinstatement of Pamlico County Schools' School Health Advisory Council

Pending discovery/approval:

• Centers of Disease and Prevention (CDC) Public Health Associate Program (pending resubmission of application and candidate match for 2024). In 2023, application accepted by the CDC; however, PCHD was not matched with an associate. 
• Increased provider hours to 32 hours per week (Stage 3 of Provider Needs).
• Vitamin Angel (Prenatal vitamins)
• Vaxcare (Immunizations and LARCS)
• Telehealth and Community Health Workers
• NCDIT Digital Champion Grant 

Paused:

• NC Syringe Service Program (approval denied by BOH)
• Tobacco/Vaping Cessation Programs for Schools (approved by BOH, pending Board of Education approval)