HNC 2030 Scorecard: Graham County (2021-2023)

Executive Summary

The executive summary can be found on pp. 6-8 of the 2021 Graham County Community Health Assessment Report. 

• 2021GrahamCountyCHA_Final3.24.22.pdf

CHA Priorities

The 2021 Graham County Community Health Assessment priorities are: 

• Mental Health and Substance Abuse
• Obesity and Heart Disease

Experience and Importance

How would we experience healthy, safe, and thriving residents in our community?

Graham County would see fewer suicide attempts and suicide related deaths. There would be a reduction in crime and domestic violence. There would be a reduction in child neglect and abuse. It would increase the number of employment eligible individuals in the county, thus improving the draw for those employers and industry. There would be easily accessable mental health resources in the county. Graham County wants to see all residents free from the infliction of mental health issues and empowered to find hope.

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

Suicide is the leading cause of death among youth ages 0-19 and the second leading cause of death in those age 20-39 in Graham County and occurs at a higher rate than the region and the state.  It is the seventh leading cause of death overall.  (CHA, 2021). The results of the WNC Healthy Impact Community Health Survey show reports of dissatisfaction with life, inability to obtain needed mental health services, and experiencing more than 7 days of poor mental health in the past month have all increased in recent years. This is occurring as reports of getting needed social and emotional support have decreased (WNC Health Network, 2021). The Kaiser Family Foundation polls have shown increased reports of negative impacts on individual mental health as a result of the COVID-19 pandemic and related stress (Panchal et al., 2021).

How would we experience decreased substance use in our community?

Graham County would see fewer overdoses, including both fatal and non-fatal. There would be a reduction in crime and domestic violence. We would see a reduction in child neglect and abuse. There would be fewer syringes in the county park, green spaces, and sidewalks. It would increase the number of employment eligible individuals in the county, thus improving the draw for those employers and industry. 

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

Substance use disorder was selected due to the alarmingly high rate of intravenous drug use, opioids, and methamphetamines. Graham County is in the top 5% in the nation for a Hepatitis C/HIV outbreak, so addressing SUD is a major health concern for the county. The impact of a successful intervention would be immense. Like mental health, feasibility is a concern, as no framework is in place. This will be developed from the ground up. It is important to note that more than half of respondents reported that their life had been negatively affected by substance use, whether this was personal use or use by someone else (WNC Health Network, 2021).

What Is It?

Community Linkage to Care (CLC) was identified by Substance Use Coalition as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in reducing substance use in our community. This is a ongoing program in our community that connects justice-involoved persons with resources they need (i.e. food, clothes, phones, sober living housing, Medication Assisted Treatment (MAT), menthal health providers, recovery treatment, and suppot groups). CLC also helps to connect justice-involved persons with the recovery community and provides hope and models recovery to clients. 

The priority population/customers for this Community Linkage to Care program are justice-involved persons, and the Community Linkage to Care program aims to make a difference at the individual/interpersonal behavior and policy level. Implementation will take place in the Graham County Jail and at the Graham County Department of Public Health. 

This strategy addresses health disparities by working with clients from all income levels, ages, races, and genders. People with low incomes have access to the same resources and services when working with us. 

Partners

The partners for this Community Linkage to Care include:

Progress in 2022

Progress continues to be made with the Community Linkage to Care program. In 2022, many of the clients in this program held jobs, got housing and kept it, got transportation needs met, and there was a 25% success rate. This program is continuing in 2023. 

Some things that didn't work well were:

• Diversion - lack of support with Sheriff's Office deputy's and justice system which hinders our Peer Support Specialists in helping their clients. 
• Tallulah Community Health Clinic - Contracted with Graham County Jail to provide medical services to inmates but are not holding up their end of the contract. Inmates with serious medical conditions are taking top priority but those who don't have serious medical conditions, aren't being seen and MAT services are not being provided. 

Progress in 2023

Progress continues to be made with the Community Linkage to Care program. In 2023, many of the clients in this program held jobs, got housing and kept it, got transportation needs met. In June 2023, one of the Peer Support Specialists resigned and that left an open position until it was filled in mid-September. While we were down one specialist, a lot of work still was accomplished. This program still faces challenges in the form of stigma, funding, limited services provided in our county, and the amount of people wanting to use these services. This program will continue providing services to our community in 2024. 

Some things that didn't work well were:

• Diversion - lack of support with Sheriff's Office deputy's and justice system which hinders our Peer Support Specialists in helping their clients. 
• Tallulah Community Health Clinic - Contracted with Graham County Jail to provide medical services to inmates but are not holding up their end of the contract. Inmates with serious medical conditions are taking top priority but those who don't have serious medical conditions, aren't being seen and MAT services are not being provided. 

What Is It?

Graham County Community Needs Assessment research study was identified by Graham County Department of Public Health, the Substance Use Coalition, and the Economic Development Director as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in persons who are in recovery and/or are actively using substances in our community. This is a new program in our community.

The priority population/customers for this Graham County Community Needs Assessment research study are in recovery and/or are actively using substances; 18 years or older; and a resident of Graham County, NC, and the Graham County Community Needs Assessment research study aims to make a difference at the individual/interpersonal behavior and the organizational/policy level. Implementation will take place in Robbinsville, NC. 

Partners

The partners for this Community Needs Assessment research study include:

Progress in 2022

The data from the Community Needs Assessment was reviewed and the following areas were found in need: 

• Treatment, Recovery, and Harm Reduction
  • More affordable access evidence-based treatment (MAT- Medication Assissted Treatment)
  • More inpatient (residential) treatment nearby
  • More Harm Reduction programming and services
• Social Determinants of Health
  • Housing options (including healthcre and Mental Health providers), housing assisstance 
  • Funding for healthcare, treatment
  • Medicaid expansion
• Education/Social
  • Stigma reduction education with employers, family members, and community

Progress in 2023

The Community Needs Assessment research study was used in 2023 to help plan and implement how to use the funds the Health Department received from the Opioid Settlement funds agreement. Work continues to be done with the Opioid Settlement funds in 2024. 

What Is It?

AVOID, Anti-Vaping Online Information Dissemination, was identified by Mountain Projects and Graham County Department of Public Health as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in Robbinsville Middle School in our community. AVOID is designed to educate students about the risks of vaping e-cigarettes, more commonly known as vapes. This is a new program in our community.

The priority population/customers for this curriculum are middle school students, and the curriculum aims to make a difference at the individual/interpersonal behavior level. Implementation will take place in Robbinsville Middle School.

Partners

The partners for this AVOID curriculum include:

Progress in 2022

AVOID was held again in the middle school during the fall to address the dangers of vaping to 6th, 7th, and 8th graders. This program has received a lot of positive reviews from students and school staff. We plan to continue this program in 2023 with the same age group of school students. 

Progress in 2023

Unfortunately, AVOID was not able to be taught during the spring or fall due to staffing. The Health Educator was moved into the Lab Manager role when the Lab Manager retired. Therefore, Health Education did not have anyone available to teach this curiculum. We briefly had a Health Educator, part-time, from September to November 2023 and then full-time November 2023 through the beginning of February 2024. We hope to get this program back up and running as soon as a the Health Educator role is filled. 

What Is It?

Justice-Involved Communicable Disease Vaccine and Education Program was identified by the Graham County Department of Public Health Communicable Disease nurses and the Peer Support Specialist as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in justice-involved persons in our community. This is a new and ongoing program in our community. The purpose is to provide communicable disease education to inmates at the Graham County Jail is to enhance awareness of prevention and identification of communicable diseases. 

The priority population/customers for this justice-involved program are justice-involved persons, and the program aims to make a difference at the individual/interpersonal behavior level. Implementation will take place in the Graham County Jail and the Graham County Public Health Department.

Partners

The partners for this Justice-Involved Communicable Disease Vaccine and Education Program include:

Progress in 2022

The Justice-Involved Communicable Disease Vaccine and Education Program has continued to go well. The Health Department staff goes every other week to talk to the inmates at Graham County Jail about communicable diseases and diseases that could be acquired while they are imprisoned. If a vaccine isn't needed, then education is gone over and our peer support specialist goes over the services that can be provided while in jail or when they get out. This program has helped get those who may not seek out healthcare, get the vaccines they need to stay healthy. 

Progress in 2023

The Justice-Involved Communicable Disease Vaccine and Education program has continued in 2023. The Health Department staff goes one to two times a month to talk to the inmates at Graham County Jail about communicable diseases, vaccines, and Community Linkage to Care programs. If a vaccine isn't needed, the inmate still gets education on communicable diseases that are possible to get in and out of prison if they are not vaccinated. Our Peer Support Specialists inform the inmates on their Community Linkage to Care programs and services that they can provide for them in and out of prison. This program contiues to help inmates get the vaccines they need to stay healthy and get education on communicable diseases. 

What Is It?

Sobriety Treatment and Recovery Team (START) was identified by the Substance Use Coalition, the Health Director, and the Director of Social Services as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in substance abuse treatment in our community. This is a new program in our community.

START is a program that incorporates addiction-services treatment, good child welfare practice, and family preservation into case management. Also included is an evaluation of program implementation, operations, and child-welfare and substance abuse treatment outcomes. 

The priority population/customers for this START team are the substane users, their families, and dss clients that fall into the aformentioned groups, and the START team aims to make a difference at the individual/interpersonal behavior and environmental change level. Implementation will take place in the Department of Social Services, the Graham County Department of Public Health and Hights. 

Partners

The partners for this START include:

Progress in 2022

This program started out slowly from late October to January as it was a new program and the logistics were still being worked on. Since January it has grown significantly and our counselor has 13 children he is seeing on a regular basis to help with mental health problems. According to the counselor, there has been progress in attitude and overall happiness in the students he is seeing. We have heard positive reports from the teachers and they are glad that the kids have this program to participate in. It is helping in so many ways. We look forward to what 2023 has in store for this new program.  

Progress in 2023

After our Health Director left in February 2023, the START program moved away from the Health Department and changed the direction of the program. Hights still has a counselor at Graham County Schools and is still seeing children and their families. Since this program has moved away from the Health Department, we do not have any new data on this. Unfortunately due to the changing of this program to something else outside of the Health Department, this program will no longer be part of our CHA, CHIP, or SOTCH in the coming years. 

What Is It?

Post-Overdose Response Team (PORT) was identified by the substance use coaltion, the peer support specialists, and the Health Director as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in the Substance Abuse population in our community. This is a new program in our community.

A Post-Overdose Response Team (PORT) is an overdose follow-up program that allows agencies to visit a person who has recently overdosed (within 24-72 hours). A follow-up visit conducted within days of a naloxone reversal, provides multiple opportunities such as directing the person(s) to harm reduction services; provide naloxone overdose prevention training and materials; and for stakeholders in our community to work together to reduce the overdose mortality rate. 

The priority population/customers for this PORT team are substance users who have overdosed, and the PORT team aims to make a difference at the individual/interpersonal behavior and environmental change level. Implementation will take place in Graham County, NC.

Partners

The partners for this PORT include:

Progress in 2022

This program has not started yet due to Health Director resigning and funding still being worked on. More work to come in 2023. 

Progress in 2023

The Post-Overdose Response Team (PORT) spent 2023 in the planning process. The Health Department's Lead Peer Support Specialist, Paramedicine Paramedic, and the EMS Director, along with other county employees worked this tirelessly to figure out the ins and outs of this program. We, at the Health Department, are excited to see more work to come in 2024. 

Experience and Importance

How would we experience reduced cardiovascular disease mortality in our community?

Graham County will be a healthier place, with healthier residents, with a reduce in cardiovascular disease. Heart disease has a number of comorbidities that negatively impact the health of county citizens. With a reduction in heart disease, we may see a reduction in diabetes and obesity, thus positively impacting mortality for other comorbidities.

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

Diseases of the heart were the leading cause of death for Graham County for the 2015-2019 time period, with a rate of 171.4 deaths per 100,000 population (NC SCHS, 2020). The availability of resources surrounding heart disease education and prevention is extensive, and programs can be implemented with existing systems. This is the most feasible of the selected priorities in terms of implementation. However, decreasing the prevalence of heart disease takes years. Obesity was identified as an issue due to its link to heart disease, mental health, and other chronic diseases, along with the high percentage of the community who fall in the Obesity and Obese categories; 45.5% of Graham County residents are obese, while 77.7% of the residents are overweight. This is an increase from 70% in 2018 (WNC - Healthy Impact Data Workbook, 2021).

What Is It?

Health and Wellness Fair was identified by partners as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in cardiovascular disease in our community. This is a ongoing program in our community.

The priority population/customers for this health fair are adults and youth, and the health fair aims to make a difference at the individual level. Implementation will take place in October 2022.

The health fair is free, and open to the public. Local and regional health providers attend, which will allow citizens to make connections, and allow providers to begin identifying individuals who may need their services.

Partners

The partners for this Health Fair include:

Progress in 2022

We were able to hold our "Well-O-Ween" Health Fair in 2022. This was the first time since COVID-19 began in 2020. We had 172 participants come through the Health Fair and we had 21 vendors set up. We had many compliments from participants and vendors saying how great the Well-O-Ween was and how much they enjoyed their time here. We are starting the planning process for the 2023 Well-O-Ween and hope to have even more vendors and community members participate. The overall satisfaction rating was 95%. 

Progress in 2023

We held our Well-O-Ween Health Fair on October 16, 2023. It was a cold and rainy day but we had 177 participants come through and 14 vendors set up. Due to the weather, and not having any indoor space to hold our Well-O-Ween, our numbers were down for both participants and vendors. Also our satisfaction rate was down to 84%. We had many compliments about the vendors that were set up and the information they were providing. There were also several comments about having Well-O-Ween indoors next year or having an indoor option as back up incase of bad weather. Overall, the Well-O-Ween was a success and we had a lot of children and vendors show up in costume which added to the fun. We are starting the planning process for the 2024 Well-O-Ween and hope to increase our vendor and participant numbers. 

What Is It?

Blood Pressure Monitoring Referral Program was identified by the CHA Prioritization Team as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in heart disease in our community. This is a new program in our community.

The priority population/customers for this blood pressure monitoring referral program are adults with heart disease, and the blood pressure monitoring referral program aims to make a difference at the individual behavior level. Implementation will take place in Graham County Department of Public Health.

Partners

The partners for this Blood Pressure Monitoring Referral Program include:

Progress in 2022

This program has not started due to staff shortage. Work to begin in 2023. 

Progress in 2023

The Blood Pressure Monitoring Program did not begin in the beginning of 2023 due to a high turnover in staffing. The Health Department did begin a 5 day a week clinic with a Nurse Practitioner in August 2023. Many of the patient's seen in clinic do have high blood pressure and it is being addressed in their clinic visits. Our Nurse Practitioner is able to refill medications so that the patient does not miss any doses and has time to follow-up with their Primary Care Provider (PCP). While the Blood Pressure Monitoring Program did not really start, the issue of high blood pressure and Heart disease is being met with medical care in our 5 day a week clinic. 

What Is It?

Community Wellness Program was identified by CHA Prioritization Team as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in the obese and overweight population in our community. This is a new program in our community.

The priority population/customers for this community wellness program are obese/overweight children and adults, and the community wellness program aims to make a difference at the individual behavior and environmental change level. Implementation will take place in Graham County, NC.

Partners

The partners for this Community Wellness Program include:

Progress in 2022

This program has not started due to shortage in staffing at the Health Department. More work to come in 2023. 

Progress in 2023

The Community Wellness Program did not begin in 2023 due to a high turnover in staffing. The Health Department did begin a 5 day a week clinic with a Nurse Practitioner in August 2023. Many of the patient's seen in clinic do have health issues and it is being addressed in the clinic visits. Our Nurse Practitioner is able to refill medications so that the patient does not miss any doses and has time to follow-up with their Primary Care Provider (PCP). While the Community Wellness Program did not officially start, the issue of obesity and heart disease is being met with medical care in our 5 day a week clinic. There has been an uptick in wellness panels being ordered and drawn in our Laboratory and our Clinic Nurse Practitioner is helping to address obesity and heart disease when patient's are unable to get in to see their PCP. Also, a Fitness Center Taskforce was created in 2023 to start the planning process of getting a Fitness Center here in Graham County. We hope to continue this process to help our obese population and those who also have heart disease. 

Progress on CHIPs

Click on each program/ strategy below to find and review 2022 progress/ updates in the individual“Progress in 2022” note tabs. 

Mental Health and Substance Abuse

•  Community Linkage to Care

• Community Needs Assessment research study

• AVOID School Anti-Vaping Curriculum

• Justice-Involved Communicable Disease Vaccine and Education Program

• START (Sobriety Treatment and Recovery Team)

• PORT (Post-Overdose Recovery Team)

Obesity and Heart Disease

• Health and Wellness Fair

• Blood Pressure Monitoring Referral Program

• Community Wellness Program

Significant/ Notable Changes in Morbidity and Mortality

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

• NC Opioid Dashboard

• RWJF County Health Rankings

Emerging Issues Impacting Health

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

• COVID-19 pandemic

• Nationwide baby formula shortage

New/ Paused/ Discontinued Initiatives/ Activities

The following is information on new/ paused/ discontinued initiatives or activities in our community in 2022:

• Recovery to Work grant ended for our Peer Support Specialists

• Health Director puts in resignation

• Family Planning Grant renewed 

Progress on CHIPs

Click on each program/ strategy below to find and review 2023 progress/ updates in the individual“Progress in 2023” note tabs. 

Mental Health and Substance Abuse

•   Community Linkage to Care

•  Community Needs Assessment research study

•  AVOID School Anti-Vaping Curriculum

•  Justice-Involved Communicable Disease Vaccine and Education Program

•  START (Sobriety Treatment and Recovery Team)

•  PORT (Post-Overdose Recovery Team)

Obesity and Heart Disease

•  Health and Wellness Fair

•  Blood Pressure Monitoring Referral Program

•  Community Wellness Program

Significant/ Notable Changes in Morbidity and Mortality

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

• Graham County
  Age Group	Rank	Leading Cause of Death	# Deaths	Death Rate
  00-19	1	Congenital anomalies (birth defects)	1	10.2
  		Suicide	1	10.2
  20-39	1	Motor Vehicle Injuries	3	33.3
  		Other Unintentional injuries	3	33.3
  	3	Cerebrovascular disease	2	22.2
  40-64	1	Cancer - All Sites	31	219.2
  	2	Diseases of the heart	21	148.5
  	3	Suicide	8	56.6
  65-84	1	Cancer - All Sites	73	839.0
  	2	Diseases of the heart	61	701.1
  	3	Chronic lower respiratory diseases	26	298.8
  85+	1	Diseases of the heart	43	3713.3
  	2	Cancer - All Sites	18	1554.4
  	3	Chronic lower respiratory diseases	11	949.9

• NC Opioid Dashboard

Emerging Issues Impacting Health

These are the new or emerging issues in our community in 2023 that were not identified as priorities in our CHA.

• Graham County Urgent Care closure

• WIC Formula Shortage/Recall on Gerber Soothe Formula

• The number of STD visits at the health department increased in 2023 with 41 visits. This was an increase from 2022, which was 20 visits. The communicable diseases must commonly seen for are the following: 

  • Chlamydia

  • Gonorrhea

New/ Paused/ Discontinued Initiatives/ Activities

The following is information on new/ paused/ discontinued initiatives or activities in our community in 2023:

• Health Director resigns and new Interim Health Director began March 2023.

• Health Department now offers non-primary care clinic 5 days a week.

• Health Department starts a Fitness Center Taskforce to begin working on getting a Fitness Center in Graham County.