HNC 2030 Scorecard: Tyrrell County 2021-2024

Executive Summary

Vision Statement

MTW District Health’s vision is to strive to promote healthier lifestyles, reduce risks, disabilities, and yearsof-life lost by providing personal and environmental health services. This vision will be accomplished through collaborative teamwork and commitment to quality of life with the communities under the leadership of competent health professionals.

Leadership

Leadership for the community health assessment process in Martin County can be described as traditional in the sense that it was conducted by the Health Director and Health Educators of MTW District Health. Partnerships/Collaborations MTW District Health collaborated with Health ENC to plan and implement this assessment.

Regional/Contracted Services

MTW District Health collaborated with Health ENC, the regional health initiative, to plan and implement this assessment.

Theoretical Framework/Model

The theoretical model used to guide this process was Mobilizing for Action through Planning and Partnerships (MAPP). This model is a community-driven strategic planning process for improving community health. It is facilitated by public health leaders and helps communities to apply strategic thinking to prioritize public health issues and identify the resources needed to address these issues.

Collaborative Process Summary

Collaboration with Health ENC helped guide the process of planning for the assessment. Planning for the 2021 CHNA started in February 2021. The assessment was administered from April to June of 2021 using surveys completed by community members.

Key Findings

The CHNA findings are drawn from an analysis of an extensive set of secondary data (over 100 indicators from national and state data sources) and in-depth primary data from community leaders, health and nonhealth 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 quality-of-life rankings were determined for Tyrrell County and are as follows: Low Income/Poverty, Substance Abuse, Lack of Community Resources, Transportation

Health Priorities

Based on a complete review of the data and consideration of existing resources and programming in the county, the significant health priorities identified by the county are as follows: Tobacco Use, Adult Obesity, Substance Use/Abuse

Next Steps

The next steps for developing the community health improvement plans are to hold meetings with our community partners and stakeholders to discuss the action steps we would like to take to address the above listed health priorities.

Priorities

Tobacco Use

Adult Obesity

Substance Use/Abuse

Description

We aim to promote and maintain a tobacco-free environment for people of Tyrrell County in their workplaces, as well as in public, by ensuring that all are protected from secondhand smoke exposure. Secondhand smoke is a well-documented danger to health. No one should be exposed to secondhand smoke when they are on the job, running errands, or accessing care. An environment free from triggers to use tobacco products is necessary to support anyone whose goal is to become tobacco-free or anyone who has quit using tobacco. According to cancer.gov, "tobacco use causes many types of cancer, including cancer of the lung, larynx (voice box), mouth, esophagus, throat, bladder, kidney, liver, stomach, pancreas, colon and rectum, and cervix, as well as acute myeloid leukemia." According to the CDC, smoking tobacco causes almost 9 out of every 10 cases of lung cancer. 

Description

CATCH My Breath is a nicotine vaping prevention program. It empowers students with the knowledge and skills needed to make informed decisions about e-cigarettes and resist social pressures to vape. MTW's tobacco coordinator is trained to go into the school system and teach these modules in grades 5-12. This program helps enforce the tobacco-free policy on school grounds, educate youth on the dangers of vaping, and even provides useful information for parents. In addition to schools, the coordinator can facilitate this program in churches, 4-H, or any other program with youth in the relevant grade levels.

Description

MTW has a Tobacco Cessation Coordinator who has a focus on increasing tobacco-free policies within the district. These policies include, but are not limited to, government facilities and grounds, school grounds, and public places. With the help of our regional manager, we can completely write the policies and provide all necessary Quitline information and signage. MTW's coordinator also goes into school systems and offers remedial counseling to students who are caught with vaping products as a suspension alternative. This program helps enforce the tobacco-free policy of school grounds. Increasing tobacco-free policies within the district allows for an environment free of secondhand smoke and triggers for persons who are trying to quit using tobacco. 

Description

The purpose of this program is to reduce the incidence of tobacco use and/or exposure to secondhand smoke by providing tobacco use screening and counseling to all clients seeking services at Martin-Tyrrell-Washington District Health Department; thereby, promoting better health and decreasing the likelihood of tobacco-related illnesses or conditions.  Any employee who has obtained certification in tobacco cessation counseling can provide this service.

Description

Supporting healthy weight initatives is important, especially in rural communities, because fast food and unhealthy food options in food deserts are prevalent. Tyrrell County only has one grocery store and only a handful of restaurants. The percent of households with SNAP benefits is 20% compared to the state of North Carolina at 13%. An estimated 23% of Tyrrell County residents live below the poverty level, as compared to NC at 15%. Because of the rural area, high poverty, and low resources, support of healthy weight initiatives is crucial to ensure that all people of Tyrrell County have adequate resources to keep the burden of chronic disease low. People with obesity have increased risk for chronic diseases such as heart disease, Type 2 diabetes, and some cancers. Chronic diseases lead to more health care needs, but Tyrrell County only has an 82.9% health insurance coverage rate. Of these, 17.3% of the population receive Medicaid, 7.9% receive Medicare, and 1.3% receive Tricare. In addition to lower insurance rates, Tyrrell County does not reach the requirement of 1 primary care physician for every 1,500 people per the NC Institute of Medicine. Tyrrell County is one of seven counties in North Carolina who were substantially below this requirement and is an area of interest for improvement of health care. 

Description

In order to reduce the impacts of COVID-19 and chronic diseases on communities of higher social vulnerability, we work with partners from HMPs to increase healthy food access through community-based policy, environmental change, and/or programmatic interventions, by establishment of policies supporting the availability of healthy food options at food pantries. These policies could include the addition of fresh fruits and vegetables or simply offering low/no sodium options as alternatives to the usual canned foods.

Description

There are several trails and walkways that citizens can use for free exercise. By highlighting them on our Facebook page, along with exercise tips and videos, we could spread awareness to these free options in Tyrrell County.

Description

Substance abuse disorder does not discriminate. It can affect anyone from any walk of life, regardless of race, income, gender, age, or incarceration history. Tyrrell County has a diverse population of races, income brackets, gender, and ages. All of these people of Tyrrell County deserve to have equitable access to services if they are affected by substance abuse disorder. Demographically, Tyrrell County's racial makeup is 55.4% white, 37.1% black or African American, and 6.9% Hispanic or Latino. From 2019-2020, Tyrrell County had an incarceration rate of 106 per 100,000 population which was less than the rate of the state of North Carolina. There is a prison work farm located in Tyrrell County. The aim of our substance use services is to reach all of these populations of people in a manner that is equitable and intentional. 

Description

The Hope Exchange is a Syringe Service Program (SSP) through MTW District Health. The goal of SSPs is to decrease the risk of Hepatitis C and HIV transmission through the use of dirty needles. This program will offer clean injection supplies to injection drug users, as well as the opportunity for participants to bring back their used needles for proper disposal. This method helps ensure that needles are not being left in the open for residents to be exposed to, as well as drug users sharing the needles therefore decreasing the risk of HIV and Hepatitis C transmission. In addition to clean injection supplies, the Hope Exchange also will give free condoms and lubricant to participants when they visit the exchange. Free HIV and HepC testing on-site will be offered once a month to participants that sign-up. Referrals to MAT, detox programs, and rehabilitation centers are available to participants who ask for these services. A free food and clothing pantry, as well as lunch are provided to participants in an effort to treat the whole person. 

Description

Naloxone will be readily available to all residents through the health department and syringe exchange. Each "kit" will come with an overdose prevention resource guide that includes how to recognize and respond to an overdose. Naloxone will also be readily available to all Rescue/EMS or Law Enforcement Officers. 

Description

Referral to substance abuse treatment services are offered to Hope Exchange participants who ask. We also receive calls from outside sources who refer clients to us. Through the referral of clients, we are able to help these clients seek the help they need to become clean. 

Progress on CHIP

As of the end of 2022, progress has been made on several of our CHIPs. The Hope Exchange has been constantly growing and combatting substance abuse disorders in Martin County. We applied for and received a fund matching grant from Vital Strategies to continue our opioid efforts in Martin County and expand into Washington and Tyrrell counties. There were 19,700 syringes distributed to participants in 2020, with 5,919 returned. We gained 26 new participants, distributed 295 naloxone kits, and received reports of 37 overdose reversals. To increase the environmental conditions and decrease the prevalence of cancer in the county, we worked on tobacco-free policies in 2022. MTW had a new policy written stating that all buildings and grounds were 100% tobacco-free. There was staff turnover during 2022, but the new tobacco cessation coordinator was able to attend trainings to implement the CATCH My Breath curriculum in schools. The coordinator has reached out to schools and hopes to be able to facilitate this semester. She is scheduled to take the Duke-UNC Tobacco Treatment Specialist training in March. This training will allow her to offer tobacco cessation counseling for the agency. Our equity coordinator hosted a food drive among MTW staff to collect donations of healthy food items for a new food pantry in Tyrrell County. This was in an effort to support healthy weight initiatives and we received about 75 different food items. We have not been able to post about free exercise access yet.

Morbidity and Mortality Changes Since Last CHA

New data has not yet been released to determine if there have been morbidity and mortality changes since the 2021 CHA.

Emerging Issues Since Last CHA

No new issues have emerged since the last CHA. COVID-19 is still endemic in the county and new variants keep arising. MTW is still offering COVID vaccines and are contracting with OptumServe to offer testing.

New/Paused/Discontinued Initiatives Since Last CHA

Tobacco cessation counseling has been put on pause until the Tobacco Cessation Coordinator can complete her training and get the program up and running.

Free exercise access initiatives and healthy food in pantries have been paused until we can gather enough information to post about the free public walkways in the county and guage the needs of food pantries. 

New program: We received a 3-year $70,000 per year fund matching grant from Vital Strategies to help in our substance abuse efforts. With this money, we will expand the Hope Exchange SSP program into Washington and Tyrrell counties. We will also start a post-overdose response team in all three of the counties in the district. 

Progress on CHIP

The Hope Exchange has been trying to grow and combat substance abuse disorders in Tyrrell County. We applied for and received a fund matching grant from Vital Strategies to continue our opioid efforts by expanding our Martin County program into Washington and Tyrrell counties. After receiving the Vital Strategies grant, we were able to increase the capacity of our program by purchasing harm reduction stands to place around the county. Those will go into effect soon. Data was input in Scorecard by fiscal year, but in the full-year of 2023, we distributed 14,605 syringes and 3,745 were returned. Over the whole district, there were 8 reported overdose reversals using naloxone provided by our program and we distributed 270 naloxone kits. Of these naloxone kits, 248 were nasal sprays and 22 were intramuscular kits. We enrolled 17 new participants and saw 394 participants throughout the year. Overall, all Tyrrell County residents have equitable access to substance use disorder services.

Our tobacco cessation began in 2023 after our tobacco cessation coordinator completed Duke-UNC Tobacco Treatment Specialist training. Three counseling appointments were made from June 2023 - December 2023, but all three were no-shows. Great collaboration was shown between MTW District Health and Tyrrell County Schools to implement policies and facilitate programs related to e-cigarette use and maintaining a tobacco-free school campus. Tyrrell County residents live in a community in support of tobacco-free lifestyles.

A lot of efforts were not able to be made toward combatting adult obesity in Tyrrell County due to lack of funding and lack of staff capacity at MTW District Health. A new food pantry was opened in Tyrrell County in December 2023 with one of our health educators sitting on their advisory board. This food pantry will provide healthier and easier food access to the residents of Tyrrell County. Additional work needs to be completed towards free and safe exercise access.

Morbidity and Mortality Changes Since Last CHA

According to the Robert Wood Johnson County Health Rankings, Tyrrell County is ranked as #10 out of 100 counties in North Carolina. 

Emerging Issues Since Last CHA

Variant strains of COVID-19 still seem endemic to the county as we continue to vaccinate our community. In addition, there has been a rise in RSV. 

New/Paused/Discontinued Initiatives Since Last CHA

Tobacco cessation counseling has been put on pause until the Tobacco Cessation Coordinator can complete her training and get the program up and running. 

Free exercise access initiatives  have been paused until we can gather enough information to post about the free public walkways in the county.

Access to healthy food in food pantries has been discontinued because we lost funding from the Advancing Equity grant to carry out this strategy.

New program: We received a 3-year $70,000 per year fund matching grant from Vital Strategies to help in our substance abuse efforts. With this money, we expanded the Hope Exchange SSP program into Washington and Tyrrell counties. In addition to our usual opioid and efforts, including fentanyl education, we also spread information on xylazine as a newly rising safety concern for drug users.