HNC Scorecard: Dare County 2021-2024

Executive Summary

Dare County is pleased to present its 2021-2022 Community Health Needs Assessment (CHNA). This report provides an overview of the methods and processes used to identify and prioritize significant health needs in Dare County.  This document serves as the 2021-2022 CHNA for The Outer Banks Hospital and Dare County Department of Health & Human Services.

Mission Statement

The Dare County CHNA serves as a document and process to describe the current health status of Dare County with the following overarching goals:

• Evaluate the impact of Community Health Improvement Plans from the 2018-2019 CHNA
• Collect and analyze primary and secondary data to identify areas of need within the county
• Report findings to the residents of Dare County and key stakeholders
• Engage the community to determine priorities that need to be addressed
• Develop a community health improvement plan to address identified health priorities

Vision Statement

The 2021-2022 CHNA provides a structured process for Dare County to prioritize health needs, and to plan and act upon unmet community needs. The process provides a strong foundation that will  support and promote optimal health and wellbeing for all individuals who live in Dare County.

Leadership

Local public health agencies in North Carolina (NC) are required to conduct a CHNA at least once every four years. The CHNA is required of public health departments in the consolidated agreement between the NC Division of Public Health (NCDPH) and the local public health agency. Furthermore, a CHA is required for local public health department accreditation through the NC Local Health Department Accreditation Board (G.S. § 130A-34.1).

As part of the US Affordable Care Act of 2011, non-profit hospitals are also now required to conduct a community health (needs) assessment at least every three years. Recognizing that duplicate assessment efforts are a poor use of community resources, LHDs and non-profit hospitals across the state have models for collaboratively conducting the community health assessment process.

Since 2013, Dare County Department of Health & Human Services and The Outer Banks Hospital serve as the local leadership for the CHNA process. This long-term collaboration has been a successful partnership for over a decade.

Healthy Carolinians of the Outer Banks Partnership

Healthy Carolinians of the Outer Banks (HCOB) is a Partnership working towards a healthier Dare County. Coordinated by the Dare County Department of Health & Human Services, and The Outer Banks Hospital, the partnership has input and representation from over 25 local organizations and agencies. The Healthy Carolinians process supports our community in mobilizing people and resources to address community health challenges.

One of the essential functions of the HCOB Partnership is overseeing the Community Health Needs Assessment process every three years. The partnership participates in the gathering and analysis of primary and secondary data. Once the data is reviewed HCOB prioritizes the identified health opportunities and forms task forces to address concerns as needed.

Healthy Carolinians of the Outer Banks Structure

Healthy Carolinians of the Outer Banks includes a partnership board and executive committee. The executive committee includes the HCOB Coordinator, Chair, Vice-Chair, previous Chair (if available) and Community Health Needs Assessment Coordinators and leadership from both The Outer Banks Hospital & Dare County Department of Health & Human Services.

Healthy Carolinians of the Outer Banks Executive Committee Members

• Gail Hutchison, HCOB Chair
• Dianne Denny, HCOB Vice Chair
• Sheila Davies, Dare County Health & Human Services Director                    
• Ronnie Sloan, The Outer Banks Hospital President
• Amy Montgomery, The Outer Banks Hospital

Community Health Assessment Coordinators

• Kelly Nettnin, Dare County Health & Human Services
• Laura Willingham, Dare County Health & Human Services
• Jennifer Schwartzenberg, The Outer Banks Hospital
• Lyndsey Hornock, The Outer Banks Hospital

Healthy Carolinians of the Outer Banks Members

Table 1. Types of Partners on HCOB Partnership

Regional & Contracted Services

Health ENC

Health ENC is a collaborative initiative of health departments and hospitals in eastern North Carolina. The collaborative serves 34 counties with 34 participating health departments and 31 participating hospitals. The collaborative uses a shared approach for primary and secondary data collection to produce a comprehensive Regional Community Health Needs Assessment every three years that can be used to partially satisfy requirements for North Carolina Local Health Department Accreditation and the Internal Revenue Service requirement under the Patient Protection and Affordable Care Act for charitable hospitals.

Health ENC Member Organizations

Health ENC serves the following counties: Beaufort, Bertie, Bladen, Camden, Carteret, Chowan, Craven, Cumberland, Currituck, Dare, Duplin, Edgecombe, Franklin, Gates, Greene, Halifax, Hertford, Hoke, Hyde, Johnston, Jones, Lenoir, Martin, Nash, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Sampson, Tyrrell, Washington, and Wayne Counties.

On the regional scale, Health ENC coordinates the regional CHNA efforts for the 34 counties of eastern North Carolina. As part of their contracted services, Health ENC provides specific data and interpretation for each of the counties based on surveys and secondary data.

Theoretical Framework

In compiling the 2021-2022 Dare County Community Health Needs Assessment, the HCOB Partnership used a Community Health Business Model to ensure that a collaboration of entities have a presence in the discussions and implementation plans to address the community needs identified in the assessment. Improved outcomes occur when a variety of organizations and services engage together to examine the needs and possible solutions.

Collaborative Process Summary

An essential function of the HCOB Partnership is to oversee the Community Health Needs Assessment process every three years. For the 2021 - 2022 assessment, HCOB began the planning process in December 2020 with trainings and webinars led by Health ENC. The data collection process took place in two sections: March-April 2021 was when the secondary data was received from North Carolina and the primary data was collected through online and paper surveys from the end of April 1, 2021- June 30, 2021. Data analysis took place from July 2021-October 2021 and data was shared with the HCOB key stakeholders at the end of October 2021. HCOB set the health priorities in November 2021.

Evaluation of Progress Since 2019-2020 CHNA

The community health improvement process should be viewed as an iterative cycle. An important piece of that cycle is revisiting the progress made on priority health topics set forth in the preceding community health needs assessment. By reviewing the actions taken to address priority health issues and evaluating the impact those actions have made in the community, it is possible to better target resources and efforts during the next round of the CHNA cycle.

As part of the 2019-2020 Community Health Needs Assessment, substance use, mental health, chronic diseases, and older adults were selected as prioritized health needs. A detailed table describing the strategies/action steps and indicators of improvement for each priority area can be found in Appendix A.

Community Feedback on Prior CHNA

The 2019-2020 Dare County Community Health Needs Assessment was made available to the public via hard copy access at all three Dare County library locations. Electronic copies are available on HCOB’s website, Vidant Health System’s Website, and The Outer Banks Hospital’s website. Community members were invited to submit feedback via various community events and/or presentations and by email to the CHNA coordinators. No comments had been received on the preceding CHNA at the time this report was written.

Key Findings

The 2021-2022 CHNA findings are drawn from an analysis of an extensive set of secondary data and in-depth primary data from community leaders, health and non-health professionals who serve the community at large, vulnerable populations, and populations with unmet health needs. Through a synthesis of the primary and secondary data the significant health needs were determined for Dare County and are displayed in Table 2.

Table 2. Significant Health Needs

Selected Health Priority Areas

As explained later in this report, Dare County has selected the following priority areas:

Mental Health

Substance Use

CHNA leadership will work to develop Community Health Improvement Plans around these two public health concerns.

Next Steps

Distribution

An electronic copy of this report is available on the following websites:

www.HealthENC.org

www.Darenc.com/hcob

www.vidanthealth.com/About-Vidant-Health/Community-Health-Needs-Assessments

www.theouterbankshospital.com/About-Us/Community-Health-Needs-Assessments

Paper copies of this report are available in all three Dare County Libraries.

Community Health Improvement Plans

The prioritization of the identified significant health needs will guide community health improvement efforts of Dare County. Following this process, Dare County will outline how they plan to address the prioritized health needs in their Community Health Improvement Plans. Members of the Dare County community are invited and encouraged to become a part of the journey towards optimal health by joining one of the HCOB taskforces. Community Progress made on these priorities will be available during the years between CHNA by the State of the County Health Report.

Priorities

Dare County has selected the following priority areas:

Mental Health

Substance Use

CHNA leadership will work to develop Community Health Improvement Plans around these two public health concerns.

Why Is This Important?

Experience and Importance

How would we experience this result in our community if we are successful?

• Individuals with substance use concerns would be receiving professional services
• Decreased crime rates
• Decreased drug poisioning deaths
• Decrease in drug overdose death rates

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

• Calls to Mobile Crisis for substance use increased from 2019 to 2020 (34→38).
• From 2019 to 2020 Mobile Crisis assisted 75 (34 in 2019; 41 in 2020) individuals who requested detox services. A total of 41 individuals were linked to detox.  
• Rate of unintentional medication/drug overdoses death in Dare (2014-2018) is 24.5 compared to 16.7 statewide (NC DPH IVP2019).
• Rate of unintentional opioid overdose death in Dare (2014-2018) is 21.7 compared to 13.6 statewide (NC DPH IVP2019).
• Rate of outpatient opioid pills dispensed per NC resident in 2018 for Dare County 46.7 compared to 43.7 statewide (NC DPH IVP 2019)

Alignment

Alignment
Substance use is aligned with the following Healthy NC 2030 objectives:

• Health Behaviors- Chapter 5

Description

Harm reduction plays a significant role in preventing drug-related deaths and offering access to healthcare, social services, and treatment. These services decrease overdose fatalities, acute life-threatening infections related to unsterile drug injection, and chronic diseases such as HIV/HCV.

Our Partners

• Dare County Department of Health & Human Services
• Saving Lives Task Force
• Town of Kill Devil Hills
• Walgreens Pharmacy in Kill Devil Hills
• Walgreens Pharmacy in Kitty Hawk
• Dare County Sherriffs Office
• Community Care Clinic of Dare

We want to assure all residents have access to harm reduction methods, which include:

• Safe and convenient pill disposal methods. 
• Naloxone Kits
• Syringe Services Program

We serve all residents of Dare County.

Our services are free of cost and anonymous..

What We Do

North Carolina Recovery Courts are designed to assist chemically dependent offenders with their court ordered treatment plans. Recovery Courts handle chemically dependent individuals in adult criminal court, juvenile, and abuse, neglect and dependency cases.

Who We Serve

Participants are primarily those individuals who have been diagnosed with severe substance use disorders and who have been convicted of felony offenses. 

How We Impact

As part of their probationary sentences, participants must be actively engaged in a course of substance use treatment recommended by their providers and approved by the Recovery Court board. Further, they are required to attend all Recovery Court sessions as scheduled and report their progress to the Court. These sessions occur between one and two times monthly. Each participant is also expected to comply with terms and conditions of supervised probation including, but not limited to; drug testing no less than twice per week, submitting to warrantless searches, abiding by a curfew, and securing gainful employment and stable substance-free housing.

What We Do

Dare County Department of Health & Human Services’ Health Educators implement evidence-based programs for women in Dare County Detention Center and various locations throughout the community. Women of Worth includes: Helping Women Recover and Beyond Anger & Violence.

Who We Serve

Women in recovery in Dare County.

How We Impact

These programs offer an environment that supports and promotes safety, trustworthiness, choice, collaboration and empowerment.

Story Behind the Curve

The "Story Behind the Curve" helps us understand why the data on the negative affect of mental health problems on the people of Dare County is the way that it is. When we understand the root causes of our community problems, we have a better chance of finding the right solutions, together. 

What's Helping? These are the positive forces at work in our community and beyond that influence this issue in our community.

• Public recognition of the issue of mental health.
• Support, including: peers, family, and agencies.
• Stigma is decreasing.
• Collaboration amongst agencies working on the issue.

What's Hurting? These are the negative forces at work in our community and beyond that influence this issue in our community.

• Lack of availability for appointments with professionals.
• Struggle to recruit professionals that can provide mental health services.
• Lack of affordable housing for professionals who can provide mental health services, and those in recovery.

Partners

Partners in our Community Health Improvement Process:

• Dare County Department of Health & Human Services
• Breaking Through Task Force
• Saving Lives Task Force
• Community Partners
• Dare County Schools
• PORT Health
• Trillium Health
• Mobile Crisis

Why Is This Important?

Experience and Importance

How would we experience this result in our community if we are successful?

• Individuals with mental health concerns would be receiving professional services
• Decrease in substance use
• Decrease in self-harm, EMS calls for self-harm
• Decrease in deaths due to mental, behavioral and neurodevelopmental disorders
• Decrease in suicide death rate

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

• Suicide death rate slightly decreased (19.9→19.3) Dare’s rate is higher when compared to NC rate (13.4).
• Calls to Mobile Crisis increased for children's mental health needs from 2019 to 2020 (17→24).
• Calls to Mobile Crisis for individuals 19 to 25 years of age more than tripled from 2019 to 2020 (6→19)

Alignment

Mental Health is aligned with the following Healthy NC 2030 objectives:

Chapter Three- Social & Economic Factors

What We Do

The Breaking Through Task Force provides a community involved approach to address mental health, while being mindful of the three levels of prevention (primary, secondary and tertiary). One of their main areas of focus is on eliminating stigma related to mental health.

Who We Serve

Our strategies are designed to address the general public, high risk situations, and for those who are living with mental health concerns.

How We Impact

The Breaking Through Task Force impacts Dare County through public awareness activites that include PSAs, comprehensive website, outreach, and educational initiatives.

What We Do

Dare County Department of Health & Human Services has individuals trained to provide the Youth Mental Health First Aid Program and Adult Mental Health First Aid Program. Mental Health First Aid is a globally-recognized, evidence-based program developed to teach people how to help an individual who is experiencing a mental health or addictions challenge or is in crisis.

Who We Serve

Mental Health First Aid can be helpful for anyone: Employers, Police Officers, Hospital Staff, First Responders, Teachers, Faith Leaders, Community Members, and Caring Individuals.

How We Impact

The course introduces common mental health challenges and teaches a 5-step action plan for how to help individuals in both crisis and non-crisis situations. Topics covered include anxiety, depression, adverse childhood experiences, substance use, psychosis and trauma.  Evidence-based professional, peer and self-help resources are provided.

Description

State of the County Health Report 2022
Conducting a Community Health Needs Assessment is an ongoing process that engages diverse agencies, providers, and individuals in identifying community assets and strengths, as well as unmet needs. Leadership for this collaborative process is provided by Healthy Carolinians of the Outer Banks. The following State of the County Health (SOTCH) Report, serves as an update and documented progress following the findings of the 2021-2022 Community Health Needs Assessment. The 2022 Dare County SOTCH was submitted to North Carolina Department of Human Services (NCDHHS) on March 6, 2023.

Information provided within this report is specific to the identified priority health issues: mental health and substance use. The report also provides updated data and information specific to Dare County mortality and morbidity rates; COVID-19 response, emerging issues and new initiatives. 

Communication with stakeholders and community members regarding the identified community health priorities and progress to-date is vital to community health improvement. Following review by the Dare County Board of Health & Human Services and Healthy Carolinians of the Outer Banks Executive Committee, access of the 2022 State of the County Health Report will be shared with Healthy Carolinians of the Outer Banks, other community partners, and the community. Hard copies will be available in our department lobbies.

About Dare County
Dare County is located in Northeastern North Carolina and stretches along approximately 110 miles of shoreline known as the Outer Banks. Manteo is the County seat and is around 200 miles east of Raleigh. The Virginia Beach area is nearby and offers residents a quick trip to popular restaurants, shopping and an airport in Norfolk. 

Dare County is home to the Outer Banks. The area is a popular resort and vacation attraction and during the summer season over 300,000 weekly tourists visit for vacation.  Dare County is home to the Cape Hatteras National Seashore, the Wright Brothers National Monument, the Fort Raleigh National Historic Site, the Alligator River National Wildlife Refuge, the Pea Island  National Wildlife Refuge, Jockey's Ridge State Park, the Elizabeth II State Historic Site, the Roanoke Island Festival Park, the North Carolina Aquarium and the Nags Head Woods Nature Preserve.

Six municipalities are located within the county: Duck, Kill Devil Hills, Kitty Hawk, Manteo, Nags Head and Southern Shores. The county has a Commissioner / Manager form of Government. The seven members of the Board of Commissioners serve staggered four-year terms.

The Census Bureau, 2021 American Community Survey estimates Dare County's population to be 36,718, with male and female breakdown very close to 50/50.

Source: American Community Survey, 2021, https://data.census.gov/table?q=Dare+County&tid=ACSDP5Y2021.DP05

Dare County residents are older when compared to North Carolina, Dare County's median age is 47.8 years while North Carolina's median age is 39.4 years. Almost 20% (18.7%) of residents are under 18 years of age and another 21.9% of residents are 65 years of age or older. 

Progress on CHIPs

The CHIP Scorecard was created and submitted on  September 5th, 2022 in order to meet the requirements for the Dare County Long and/ or Short Term Community Health Improvement Plans. This scorecard has metrics which are updated yearly for the State of the County Health Report that reflect prograss on Dare County CHIPs.

This section will contain updates on ongoing initiatives or programs of interest that are not able to be captured by metrics or the initaitive only occured during this calendar year.

Cross Cutting

Suicide Awareness: Event & Documentary
The Breaking Through Task Force, Saving Lives Task Force, Be Resilient OBX, and Dare County Department of Health & Human Services partnered to host a town hall event on September 27, 2022 at First Flight High School.With approximately 90 individuals in attendance, the main feature of the event was the recently filmed documentary Shattering the Silence: A Documentary about Suicide in Dare County. The thirty-minute documentary included stories of six Dare County residents who have been impacted by the suicide of a loved one or suicidal ideations.

Attendees had the opportunity to enjoy refreshments and explore resources in Dare County related to mental health prior to the documentary viewing. After the documentary, a panel was held and members of the audience were able to ask questions of these local professionals. The panel included: Benny Baldwin,Documentary Videographer; Christie McEwan, Outer Banks Counseling Services; Susan Lee, Documentary Counselor; Kristen Krischoff, Mobile Crisis; Tracey Webster, Trillium; Dr. Ashley Clower, Surf Medicine & Dare County Department of Health & Human Services Board Member. Watch the documentary here.

Substance Use
Dare County is part of North Carolina’s historic $26 billion agreement that will help bring desperately needed relief to communities impacted by opioids. In Dare County, these funds will be used to support treatment, recovery, harm reduction, and other life-saving programs and services. Because Dare County is a “can do” community, a portion of the funds was allocated towards mini grants.

The mini grant application period was open from August 16, 2022 until September 6, 2022. Applications were reviewed and approved by the Saving Lives Task Force Board. The following projects were funded:

• Dare County Recovery Court: Assist those in the justice- involved population and recovery with reentry services and post-treatment support.

• Just in Case: Provide Narcan and Fentanyl test strips in a free, convenient, and discreet manner in the form of a vending machine.

• Community Care Clinic of Dare: Implement medically-assisted treatment (MAT) for opioid use disorder (OUD).

• OBX Room in the Inn: Fund qualified and dedicated Dare County residents to become certified Mental Health First Aid Trainers.

• Cross Roads OBX: Increase organizational capacity to help those with substance use disorders in Dare County.

• Interfaith Community Outreach: Provide monetary assistance to residents with addiction who have completed a treatment program.

• Outer Banks Yoga: Provide a 75-minute weekly yoga/meditation class, designed specifically for individuals recovery from drug addiction.’

• Changing Tides: Cover costs associated with services and treatment for qualified Dare County residents.

• Outer Banks Dare Challenge: To provide a more intense focus on setting up Dare County residents with the tools necessary for long term success in recovery.

• Contracted Community Peer Support Specialist: Attend Recovery Court Sessions monthly and assist participants and professionals. Work with Dare County Detention Center to set up needed programs.

Progress on these initiatives will be shared in the next SOTCH.

Substance Use Summit Held
The Faith-Based Subcommittee of the Dare County Saving Lives Task Force hosted a Substance Use Summit and workshop for Faith leaders. The event was held on Thursday, March 31st at St. Andrews by the Sea, Nags Head, from 10:00am - 1:30pm.

Eric Landry, with the Faith-Based Community Initiatives from Tennessee, shared the successes of their faith community in addressing substance disorder issues in their congregations and local communities.

The event’s goal was to provide participants and their congregations with a better understanding of Substance Use Disorders and how we can use faith in prevention, treatment, and recovery efforts. Participants were also introduced to the “Saving Lives, Faith-Based Committee Substance Use and Mental Health Resource Guide” which includes organizations and local resources available to help.

Mental Health
The Breaking Throught Task Force ordered three children's mental health workbooks: How to Handle Bullying, We are all Special, and How to Handle Stress and Conflict. The workbooks were made available at the following locations:

• Kill Devil Hills Library
• Manteo Library
• Hatteras Island Library
• Surf Pediatrics & Medicine
• New Horizons
• Manteo Elementary School
• Cape Hatteras Elementary School
• Nags Head Elementary School
• First Flight Elementary School
• Kitty Hawk Elementary School

Workbooks were also placed at the following Dare County Department of Health & Human Services locations:

• Manteo Lobby
• Nags Head Lobby
• Frisco Lobby
• Child Health Pod
• Family Services Pod
• Childrens Services Pod
• WIC Program Office

In 2022, a total of 2,500 workbooks were issued to these locations. 

Mental Health Counselors Roundtable
At the request of the HCOB Executive Committee, The Breaking Through Task Force partnered with Dare County Department of Health & Human Services to hold a mental health counselors roundtable event. The purpose of the event was to collect information from counselors regarding themes they are observing in their practice and collaborate on opportunities to better assist them in their work. 

All known counselors currently practicing in Dare County were invited to participate in the forum. The event was held on May 3, 2022 at DCDHHS campus in Manteo. A total of 12 counselors participated. Key staff from BTTF and DCDHHS were in attendance.

The forum was a simple process and participants were asked questions about:

• Themes and observations in their practice

• Concerns among their patients and the community at large

• Broad resolution ideas

The following are observations shared by the attending counselors.

General Observations

• Depression and anxiety seem to be the most common concerns.

• Seeing/hearing about more overdoses since COVID-19.

• Substance use seems to be the top issue among justice-involved persons.

• Any coping skills present in patients seem to have been reduced or removed after COVID-19 pandemic.

• Cost of living in Dare County and other environmental stressors have skyrocketed since COVID-19.

• Breaking Through Task Force has done a good job at addressing and breaking mental health stigma for individuals seeking individual counseling.

• Toxic stress in workplaces is a common theme observed among counselors.

Access Concerns

• Not enough mental health providers to meet the needs of our community. Current provided have limited capacity, waitlist, or are not taking new patients.

• Many individuals relocating to the area are having a hard time finding a counselor with availability.

• Primary care providers are not taking new patients, which impacts patients who may be in need of medication.

• Individuals who require Medication Assisted Treatment face many challenges and barriers to getting medications in Dare County (from provider availability/willingness to limited scheduling and availability) 

• Not a lot of Medicare providers in the area.

• Blue Cross & Blue Shield of North Carolina have changed their policies regarding telehealth, all of their providers must provide services through Teladoc, which is blocking access to services for patients.

School System & Youth

• A group of students have not rebounded from COVID-19 setbacks.

• There are some students who are developmentally delayed due to COVID-19.

• Anxiety is common amongst elementary aged students.

• School counselors have observed a shift in focus from the individual to the family needs.

• Generational issues seem to be more common on Hatteras Island.

• Working on establishing mental health and substance use modules for teachers to promote consistency on all school levels.

• Teenagers are in need- counselors who work with this population have had to stop accepting new patients.

• Students are struggling with returning to school in person and handling academic stress again.

• More young people with addictions such as substance use and pornography.

• Lack of social skills and coping skills have been observed with these young people.

• Parents coping skills are lacking and impacting their children.

Items to Investigate Further

• A group of students have not rebounded from COVID-19 setbacks.

• There are some students who are developmentally delayed due to COVID-19.

• Anxiety is common amongst elementary aged students.

• School counselors have observed a shift in focus from the individual to the family needs.

• Generational issues seem to be more common on Hatteras Island.

• Working on establishing mental health and substance use modules for teachers to promote consistency in response on all school levels.

• Teenagers are in need and counselors who work with this population have had to stop accepting new patients.

• Students are struggling with returning to school in person and handling academic stress again.

• More young people with addictions such as substance use and pornography.

• Lack of social skills and coping skills have been observed with these young people.

• Parents coping skills are lacking and impacting their children.

Next Steps

This group plans to reconvene quarterly and identify goals and objectives the group can work towards to improve mental health services for our community members. Due to staffing, the quarterly meetings will begin in March of 2023.

Morbidity and Mortality Changes Since Last CHA

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

Dare County Cancer Incidence Rates (2010-2014; 2013-2017; 2015-2019)

* indiciates 3 or fewer cases

Source: https://www.statecancerprofiles.cancer.gov/incidencerates/

Morbidity data indicates an increase in liver & bile duct and breast cancer. From 2015-2019 Dare County saw a decrease in incidence rates of: oral, lung,bladder, prostate, colorectal and all cancers.

Diabetes & Obesity Prevelance (2014, 2015, 2016, 2017, 2019)

Source: County Health Rankings, Dare County Profiles (2022, 2021, 2020, 2019, 2018)

The percent of adults with diabetes decreased, while the percent of obese adults increased.

COVID-19 Cases

More than 75% of COVID cases were residents. The gender breakdown was somewhat close to an acurate representation of the population with 45.6% of cases being in males and 54.4% of cases being in females. The most common age group to test positive were individuals 25-49 years of age (34.6%) followed by 50-64 years of age (23%), and 65 plus years of age (18.2%). 

Mortality Data

Source: NC State Center for Health Statistics, County Health Data Book (2018, 2019, 2020, 2021, 2022) Mprtality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; https://schs.dph.ncdhhs.gov/data/databook/

Since the previous Community Health Needs Assessment period, there have been increases in the rates of deaths due to cerebrovascular disease, Alzheimer's, unintentional non-motor vehicle injuries, nephritis, nephrotic syndrome & nephrosis. 

Emerging Issues Since Last CHA

Access to Healthcare

In July of 2022, Manteo Board of Commissioners established an Access to Healthcare Task Force to work on re-establishing primary care options in the town of Manteo. Meetings began in August of 2022 and members of the task force include local government, public health, hospital staff/board members, residents, and business owners. Prior to the end of the year, Outer Banks Health was able to reopen a clinic and re-establish care for residents who had lost their primary care due to the initial clinic closing. 

Access to Healthcare data has been collected to begin to determine the need of further work in this area.

Rate of Healthcare Providers (per 10,000) over time in Dare County

Source: https://nchealthworkforce.unc.edu/interactive/supply/

Physical Healthcare Providers in Dare County overtime have increased. However, when compared to North Carolina, Dare falls behind the standard.

Affordable Housing

For several years, Dare County officials have worked diligently to find a solution to the challenges that many seasonal and year-round workers face when it comes to securing safe and affordable housing on the Outer Banks.

Since the beginning of 2022, Dare County has made significant strides in its ongoing efforts to determine suitable locations for essential and workforce housing developments — as well as to attract and retain private developers who possess the skills and experience necessary to construct such housing projects on these sites. 

Thanks to the public-private partnerships that Dare County has formed with two private developers since the start of the year—Coastal Affordable Housing and Woda Cooper Companies—the county’s efforts are paying off and making clear progress. Plans are currently underway for multiple projects that aim to provide high-quality and affordable housing options for members of the community's essential workforce.

New/Paused/Discontinued Initiatives Since Last CHA

Opioid Settlement Funding
A meeting which was called by North Carolina Attorney General Josh Stein on October 20, 200, featured comments from several key stakeholders and local officials, including Dare County Board of Commissioners Vice Chairman and Saving Lives Task Force Co-chair Wally Overman, Dare County Commissioner Ervin Bateman, Dare County Department of Health & Human Services Director Dr. Sheila Davies, Dare County Sheriff Doug Doughtie, Dare County Department of Health & Human Services Director of Health Education & Outreach Services and Saving Lives Task Force Co-chair Roxana Ballinger, and Dare County Recovery Court Coordinator Emily Urch.

During the meeting, local officials detailed Dare County’s plans to address the ongoing opioid crisis utilizing the national opioid settlement funds that were secured following a settlement with four pharmaceutical manufacturers and distributors. Of the $26 billion settlement, $750 million was allocated to North Carolina, of which 15 percent will go to the state, with the remaining 85 percent of funds to be utilized by local governments, including Dare County, which is slated to receive a total of $3.4 million over the next 18 years. 

Approximately $420,000 that has been designated for Fiscal Year 2023 will be used to fund a local overdose response coordinator position; an additional probation officer for Recovery Court; community distribution of Naloxone and Fentanyl testing strips; a “Fentanyl Kills” mass public awareness campaign; various community initiatives, such as contract services and mini grants; and linkage to care/social determinants of public health, which can include funding an individual’s admission into a treatment facility, providing transportation or assisting with housing. 

Dare County Health & Human Services Cuts Ribbon on Expanded & Renovated Facility
A ribbon-cutting ceremony to celebrate the completion of the newly renovated Dare County Department of Health & Human Services facility was scheduled to be held at 4 p.m. on Tuesday, May 24, 2022. The ribbon-cutting ceremony featured several speakers who will discuss the importance of the wide array of programs and services that are provided by the Dare County Department of Health & Human Services, as well as the significant and positive impact that renovating the facility has had on the community.  

The construction project consisted of renovating the two existing and outdated buildings on the Dare County Department of Health & Human Services campus, which is located at 109 Exeter Street in Manteo. In addition to undergoing extensive renovations to modernize the facility, the two separate buildings were also connected with the construction of a 6,500-square-foot addition between them that now sMerves as the building’s lobby and main entrance. erging the Public Health Division and the Social Services Division into a singular facility provides patients and clients with one convenient check-in location, which allows the department to more efficiently and effectively provide its many services to the residents of Dare County.
 

Description

State of the County Health Report 2023
Conducting a Community Health Needs Assessment is an ongoing process that engages diverse agencies, providers, and individuals in identifying community assets and strengths, as well as unmet needs. Leadership for this collaborative process is provided by Healthy Carolinians of the Outer Banks. The following State of the County Health (SOTCH) Report, serves as an update and documented progress following the findings of the 2021-2022 Community Health Needs Assessment. The 2023 Dare County SOTCH was submitted to North Carolina Department of Human Services (NCDHHS) on March 4, 2024.

Information provided within this report is specific to the identified priority health issues: mental health and substance use. The report also provides updated data and information specific to Dare County mortality and morbidity rates, emerging issues and new initiatives. 

Communication with stakeholders and community members regarding the identified community health priorities and progress to-date is vital to community health improvement. Following review by the Dare County Board of Health & Human Services and Healthy Carolinians of the Outer Banks Executive Committee, access of the 2023 State of the County Health Report will be shared with Healthy Carolinians of the Outer Banks, other community partners, and the community. Hard copies will be available in our department lobbies.

About Dare County
Dare County is located in Northeastern North Carolina and stretches along approximately 110 miles of shoreline known as the Outer Banks. Manteo is the County seat and is around 200 miles east of Raleigh. The Virginia Beach area is nearby and offers residents a quick trip to popular restaurants, shopping and an airport in Norfolk. 

Dare County is home to the Outer Banks. The area is a popular resort and vacation attraction and during the summer season over 300,000 weekly tourists visit for vacation.  Dare County is home to the Cape Hatteras National Seashore, the Wright Brothers National Monument, the Fort Raleigh National Historic Site, the Alligator River National Wildlife Refuge, the Pea Island  National Wildlife Refuge, Jockey's Ridge State Park, the Elizabeth II State Historic Site, the Roanoke Island Festival Park, the North Carolina Aquarium and the Nags Head Woods Nature Preserve.

Six municipalities are located within the county: Duck, Kill Devil Hills, Kitty Hawk, Manteo, Nags Head and Southern Shores. The county has a Commissioner / Manager form of Government. The seven members of the Board of Commissioners serve staggered four-year terms.

The Census Bureau, 2021 American Community Survey estimates Dare County's population to be 36,718, with male and female breakdown very close to 50/50.

(Data Source: https://data.census.gov/table/ACSDP5Y2022.DP05?q=Dare%20County)

(Data source: 2022 ACS https://data.census.gov/table/ACSST5Y2022.S0101?q=Dare%20County)

Dare County residents are older when compared to North Carolina, Dare County's median age is 47.3 years while North Carolina's median age is 39.2 years. Almost 20% (18.4%) of residents are under 18 years of age and another 23.0% of residents are 65 years of age or older. 

Progress on CHIPs

The CHIP Scorecard was created and submitted on  September 5th, 2022 in order to meet the requirements for the Dare County Long and/ or Short Term Community Health Improvement Plans. This scorecard has metrics which are updated yearly for the State of the County Health Report that reflect prograss on Dare County CHIPs.

This section will contain updates on ongoing initiatives or programs of interest that are not able to be captured by metrics or the initaitive only occured during this calendar year.

Substance Use

Opioid Settlement Funds
Dare County is part of North Carolina’s historic $26 billion agreement that will help bring desperately needed relief to communities impacted by opioids. In Dare County, these funds will be used to support treatment, recovery, harm reduction, and other life-saving programs and services. 

Funds have been allocated for the following initiatives:

• Overdose Response Coordinator

• Recovery Court Case Manager

• Naloxone & Xylazine Testing Strips

• Linkage to Care

• Social Determinants of Health

Because Dare County is a “can do” community, a portion of the funds was allocated toward community initiatives/mini grants. The following progress was made in fiscal year 2022-2023 with use of the community initiatives/mini grant funds:

• Dare County Recovery Court received a grant to assist those in the justice- involved population and recovery with reentry services and post-treatment support. At the end of the fiscal year, a total of 47 individuals were enrolled in the program. There were six program graduates. Six participants graduated to the lowest level of monitoring. Eleven of our participants are enrolled in residential treatment. Twenty-four enrolled in outpatient treatment. Funds eliminated cost as a barrier for individuals served and allowed for individuals to participate in several substance-free events. It has received really positive feedback from the participants.

• Interfaith Community Outreach was able to provide monetary assistance to residents with addiction who have completed a treatment program. This grant allowed ICO to provide rental assistance to nine residents as they continue their sober living.

• Outer Banks Yoga offered a 75-minute weekly yoga/meditation class, designed specifically for individuals in recovery from drug addiction. They hosted 16 free yoga classes in our community over a four-month period from January to May 2023. Services were provided to 15 participants with eight attending on a regular basis, 100% reported improvements in their well-being after yoga class 

• Cross Roads OBX received funds to increase organizational capacity to help those with substance use disorders in Dare County. Cross Roads OBX was able to hire a second part-time peer support specialist in July 2023. More than 50% of individuals served by Cross Roads OBX between October 2022 and June 2023 are now in a more stable housing and employment situation. Over 95% of program participants were impacted by opioid abuse. Cross Roads also serves as a linkage to care for its program participants with 80% being referred to care at a detox facility, longer term rehabilitation facility, and/or sober living house. 

• Changing Tides was able to help cover costs associated with services and treatment for qualified Dare County residents.  These residents were able to obtain quality treatment, and most likely would not have been able to afford any treatment at all without the grant funding.  All clients who were assisted completed their semesters in compliance without alcohol or drug use.  These individuals were discharged with stable housing, improved family relationships and employment.

• Outer Banks Dare Challenge received funds to better set up Dare County residents with the tools necessary for long-term success in recovery. In 2023, 37 men were enrolled in our program.  Six  men have graduated from the program and have made the commitment to stay on as interns and staff. Two graduates were recently married and are employed. 

Fentanyl Kills Campaign

28 Businesses were delivered the following:

222 Boxes of Naloxone (total of 444 doses)

138 Fentanyl Test Strip Displays (of which 58 are display shelves and combined with Naloxone)

552 Fentanyl Test Kits which includes:

• 1,104 Test Strips for Fentanyl

• 552 Test Strips for Xylazine

• 1,500 pens

• 50 bags

• 750 stickers

• 450 posters

Digital Ads were delivered to the following Target Audiences:

• VUSIC Concert Attendees:  22-Jun, 14-Jul, 15-Jul, 22-Jul, 27-Jul, 29-Jul, 2-Aug, 4-Aug, 6-Aug, 10-Aug, 18-Aug

• Party Scenes: Top performing locations: 7-11 Manteo, Blue Crab Tavern Colington, 7-11 KDH, 7-11 Kitty Hawk, Outer Banks Brewing Station KDH, Avalon Pier KDH, Poor Richard’s

• Commercial Fishermen: Top performing locations: Shallowbag Bay Manteo, Pirates Cove Manteo, Wanchese Marina, Hatteras Harbor Marina 

• Parents: Top performing locations: Front Porch Manteo, USPS Manteo, Avenue Grill Manteo, USPS Kitty Hawk, Dare County Rec Dept KDH, Fessenden Center, Front Porch Nags Head

• General Targets: Top performing locations: Buxton, Avon, Frisco

• Young People: Top performing locations: Front Porch Manteo, TW’s Kitty Hawk, First Street Beach Access KDH, Abalone Street Beach Access KDH, Secret Spot Surf Shop Nags Head, Waveriders Nags Head, Front Porch Nags Head, Ashley’s Espresso Parlour KDH, Byrd Street Beach Access Kitty Hawk, Avalon Pier, Jennette's Pier, WRV Kitty Hawk

Radio PSAs

• 2 radio PSAs were distributed by East Carolina Radio

Bulletin Board

• Billboard in Manteo was updated with Fentanyl Kills message

Recovery & Overdose Support Services

Recovery & Overdose Services (ROSS) are designed to assist those struggling with substance use and misuse. This is achieved by helping individuals with mental health and trauma challenges, supporting family and friends of those who struggle, and/or providing harm reduction education and resources. The following are accomplishments achieved in 2023: 

• Staff became EMS affiliates, which allows for a more efficient overdose response program within Dare County.

• Naloxone & Fentanyl test strip distribution locations have increased. 

  • EMS has a more robust leave-behind program, where staff provide Naloxone prior to leaving overdose scenes. 

  • Kitty Hawk lifeguards now have a supply of Naloxone on hand for employees to use if necessary. 

  • First Flight Rotary now partners with Dare County Department of Health & Human Services to implement its Naloxone distribution grant. 

  • College of the Albemarle- Dare Campus now has a supply of Naloxone on hand in the event an individual overdoses on school property. 

  • Outer Banks Health also keeps a supply of Naloxone on hand to provide to patients who visit the emergency department.

  • Room in the Inn also has a supply of Naloxone and fentanyl test strips on hand for any participants who may need them.

• Staff partnered with Fishing Partnership Support Services to hold Harm Reduction Education in March of 2023.

Keeping Current

Keeping Current is an interactive program designed to empower and equip adults with the tools necessary to prevent teen substance abuse. The program features education on technology and apps; how to communicate with teens; and a mock teenage bedroom with items that could indicate a substance abuse concern. We recommend the program for any adult who is around youth - parents, teachers, youth pastors, caring adults, and community members.

In 2023, Dare County Department of Health & Human Services received an anonymous grant award to purchase items to update the mock teenage bedroom and other equipment used to implement the program.

Mental Health
Dare County becomes a NAMI Affiliate

NAMI Affiliates are created by groups of individuals who embrace the mission of NAMI and its commitment to building a community of hope for all of those in need. Volunteer leaders come to NAMI with a passion to dedicate their time and resources to facilitate support groups, teach NAMI signature programs, advocate for mental health systems change, and foster peer relationships that empower and strengthen new leadership.

Out of the Shadows Walk

The first annual Out of the Shadows Suicide Awareness Walk was scheduled for October 14, 2023 from 10 a.m. to 1 p.m. at the First Flight High School track in Kill Devil Hills. The goal was to offer an important opportunity for the community to come together and work toward breaking the stigma and silence that often surrounds suicide and mental illness. 

A collaboration between the Breaking Through Task Force, Dare County Department of Health & Human Services (DHHS), Saving Lives Task Force, SMART Recovery and other dedicated community members, the event was to include a keynote speaker, vendors, mental health professionals, suicide education and awareness materials, live music and food. 

Due to the possibility of inclement weather on October 14, 2023, the walk was canceled and rescheduled for May of 2024.

Children’s Mental Health Workbooks

The Breaking Through Task Force continues to provide three children's mental health workbooks: How to Handle Bullying, We are all Special, and How to Handle Stress and Conflict. The workbooks continue to be made available at the following locations:

• Kill Devil Hills Library

• Manteo Library

• Hatteras Island Library

• Surf Pediatrics & Medicine

• New Horizons

• Manteo Elementary School

• Cape Hatteras Elementary School

• Nags Head Elementary School

• First Flight Elementary School

• Kitty Hawk Elementary School

• Dare County Department of Health & Human Services

• Manteo Lobby

• Nags Head Lobby

• Frisco Lobby

• Child Health Pod

• Family Services Pod

• Children's Services Pod

• WIC Program Office

Mental Health Counselors Roundtable
In 2022, at the request of the HCOB Executive Committee, the Breaking Through Task Force partnered with Dare County Department of Health & Human Services to hold a mental health counselors roundtable event. The purpose of the event was to collect information from counselors regarding themes they are observing in their practice and collaborate on opportunities to better assist them in their work. 

All known counselors currently practicing in Dare County were invited to participate in the forum. The meeting was so beneficial, the group elected to reconvene on a quarterly basis and identify goals and objectives the group can work toward to improve mental health services for our community members. 

Four meetings were held in 2023: March 21, June 20, September 19, December 5. In 2023, the group established a charter, supported a grant application to increase access to mental health care, and began planning quarterly continuing education initiatives to be added onto 2024’s quarterly meetings.

Morbidity and Mortality Changes Since Last CHA

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

Diabetes & Obesity Prevelance (2014, 2015, 2016, 2017, 2019, 2020)

(Chart source: County Health Rankings, Dare County Profiles (2023, 2022, 2021, 2020, 2019, 2018)

Percentage of adults 20 years of age and older with diabetes and obesity both have declined in Dare County.
 

Cancer Incidence Rates (2010- 2014, 2013-2017, 2015-2019, 2016-2020)

(Chart Source: https://www.statecancerprofiles.cancer.gov/incidencerates/)

All cancer incidence rates are on the decline in Dare County, with the exception of breast and bladder.

Mortality

Mortality Data (2012-2016, 2013-2017, 2014-2018, 2015-2019, 2016-2020)

(Chart Source: NC State Center for Health Statistics, County Health Data Book (2018, 2019, 2020, 2021, 2022) Mprtality, Race-Specific and Sex-Specific Age-Adjusted Death Rates by County; https://schs.dph.ncdhhs.gov/data/databook/)

Total mortality rates have increased since last period. Death rates due to heart disease, cancer, chronic lower respiratory disease, suicide, liver disease & cirrhosis, septicemia, diabetes, and pneumonia & influenza have all decreased. Death rates due to cerebrovascular disease, Alzheimer's disease, unintentional non-motor vehicle injuries, and nephritis have all increased.

Emerging Issues Since Last CHA

Access to Healthcare

Access to Healthcare data has been collected to begin to determine the need of further work in this area.

Rate of Healthcare Providers (per 10,000) over time in Dare County

(Chart Source: https://nchealthworkforce.unc.edu/interactive/supply/)

Healthcare Providers in Dare County overtime have increased. However, in 2022 the ratio of primary care physician assistants, primary care physicians, generalist physicians, and dentists have decreased when compared to the previous year. When compared to North Carolina, Dare has less physician assistants (all specialties) physicians (all specialties) and dentists.

Affordable Housing 

For several years, Dare County officials have worked diligently to find a solution to the challenges that many seasonal and year-round workers face when it comes to securing safe and affordable housing on the Outer Banks.

To address the ongoing issues and opposition to housing developments—and to create an atmosphere of collaboration among local governments—Dare County formed a task force in October 2023 that is dedicated to finding solutions to the housing issues that exist throughout the county.

The Dare County Housing Task Force will consist of approximately 25 stakeholders, including various Dare County officials and representatives from each of Dare County six municipalities, among other members. The first meeting of the Housing Task Force will take place at 9 a.m. on Thursday, January 18, 2024 in Room 168 of the Dare County Administration Building, which is located at 954 Marshall C. Collins Drive in Manteo.

New/Paused/Discontinued Initiatives Since Last CHA

Human Trafficking Task Force Begins

Outer Banks Hotline and the Dare County Sheriff’s Office have partnered to combat human trafficking. The two agencies recently received a large grant through the U.S. Office for Victims of Crimes for the planning and implementation of a joint human trafficking task force (the North Carolina Eastern Region Human Trafficking Task Force) to cover Dare, Camden, Currituck and Pasquotank counties. The task force will help expose local trafficking offenses, those who commit them and victims previously hidden from view.

Several factors contribute to the trafficking problem in Dare County including, but not limited to, activities related to the agricultural, hunting and fishing industries; a large hospitality and tourism industry; and location just below the Virginia border. Dare County also has a large number of transient occupants and visitors which contribute to the problem.

Health & Human Services staff has been assigned to work with the task force. 

Community Care Clinic of Dare- Medically Assisted Treatment

Community Care Clinic of Dare implemented a medically-assisted treatment (MAT) for opioid use disorder (OUD). Six staff members at the Community Care Clinic of Dare have been thoroughly trained in the purchasing, dispensing, preparation and injection of Extended-Release Naltrexone (Vivitrol). Six Vivitrol doses were ordered and are stored at the clinic. For the counseling piece of Vivitrol treatment, local options have been identified for patients to choose: individual counseling sessions with the health department's LCSW, one-on-one sessions with the peer support specialists, local AA meetings, local SMART Recovery sessions (one is held weekly at the clinic), and referral to PORT Health Services if appropriate. Processes are in place to ensure Vivitrol clients are given their first injection prior to dismissal from jail or treatment. The individuals are transported to the Community Care Clinic of Dare for the first injection and will meet with the clinic's nurse case manager for assessment of social determinants of health. The goal is to identify needs they will have once dismissed and have referrals made in advance of dismissal. Furthermore, awareness and education initiatives have improved within the healthcare provider community, with a 28% increase in provider screening for high-risk opioid use. There has also been a 15% increase in providers referring to MAT.