Executive Summary

AppHealthCare, in collaboration with various agencies and community partners, has released the Community Health Report for Alleghany County. This report identifies public health priorities and provides a foundation for work that will take place in the following years.

The Community Health Report is published every three years in partnership with the Appalachian District Board of Health, AppHealthCare, and many other partnerships, individuals, and agencies. The Community Health Report follows an assessment process involving the community to identify and analyze community health needs and assets, prioritize those needs and then implement a plan to address significant unmet needs.

The Community Health Report provides results from a community input opinion survey and review of community data which includes income, poverty, employment, community safety, housing, behavioral health, and more. The information is used to guide the work of local health departments and community partnerships to address community concerns and monitor progress toward projected goals.

What Can We Do Together to Improve Our Community’s Health?

• Practice safe prescription medication use by taking correctly, storing securely, disposing properly, and never sharing.
• Health begins where we live, learn, work and play. Take action in building our neighborhood to be safe and healthy.
• Being healthy takes a community. Attend a Mental Health First Aid training and join local community groups that work to support mental health systems.
• Your opportunity for health starts long before you need medical care. Sign up for your local Women, Infant & Children (WIC) program through AppHealthCare.
• The opportunity for health begins in our families, neighborhoods, schools, and jobs. Participate in local bike and walk safety programs to and from school. Being healthy takes a community.
• Your neighborhood or job shouldn’t be hazardous to your health. Support tobacco-free living.
• Health starts—long before illness—in our homes, schools, and jobs. Investing in our mothers and children is investing in our future.
• Live active, eat local vegetables and fruits.
• All citizens have the opportunity to make the choices that allow them to live a long, healthy life. Support local policies for sidewalks and bike lanes.

Priorities

The health priorities below highlight key areas that community coalitions within Alleghany County will focus on and work to improve from 2020-2023:

• Mental/Behavioral Health
• Substance Use & Misuse
• Family & Social Support

This report completes the first phase in the Community Health Assessment process. The second phase is taking place now through the development of Community Health Improvement Plans that will guide work to the health priorities in Alleghany County.

Together, we will work toward a shared goal for a healthier Alleghany County.

To view the Community Health Report for Alleghany County, visit AppHealthCare’s website.

For additional information about AppHealthCare or other community resources and health-related data, please call our offices, Alleghany (336) 372-5641, Ashe (336) 246-9449, Watauga (828) 264-4995. For more information, visit our website at www.AppHealthCare.com and follow us on Twitter and Facebook.

Why Is This Important?

As in other states, North Carolina has experienced a sharp increase in the number of drug overdose deaths over the last decade, largely due to the opioid epidemic. Substance Use Disorder has devastating impacts on the life of the people who experience it, their families, and their communities.

Substance use disorders (SUDs) are chronic or recurrent conditions that, like other chronic illnesses, require ongoing care and treatment for individuals to regain health and maintain recovery. As with any chronic disease, prevention, identification, treatment, and recovery services and supports are essential to ensuring positive health outcomes. Effective treatments for SUDs and underlying mental and physical health problems exist; however, access to services and supports for SUDs varies greatly across the state.

Having a SUD affects an individual’s relationships with family and friends, ability to attend school or work, their overall physical and mental health, and may lead to problems with the legal system. In addition to increases in drug overdoses, the opioid epidemic has had devastating consequences including the spread of HIV and hepatitis B and C and increased rates of child maltreatment and entry into foster care as more and more parents and other relatives develop and struggle with SUDs.

Tobacco use remains the leading preventable cause of early death and disease in North Carolina and the nation. Tobacco use and secondhand smoke exposure are responsible for multiple causes of preventable morbidity and mortality in North Carolina. While combustible cigarette use has decreased among North Carolina’s youth, prevalence among adults has declined only slightly, and there are major disparities of tobacco-attributable disease and death among population groups. E-cigarette use among young people has become epidemic in North Carolina and the nation and poses a public health threat.  

Also, excessive drinking, a major cause of morbidity and mortality across the United States, has significant impacts on individuals, families, communities, and state and local economies. Alcohol is the third leading cause of preventable deaths in North Carolina.   

What We Do

Appalachian District Health Department's Peer Support Program will maintain or expand one or more syringe services programs (SSPs) through a host organization, Olive Branch Ministries, that has experience working with people directly impacted by drug use. Syringe services programs (SSPs) are community-based prevention programs that can provide a range of services, including linkage to substance use disorder treatment; access to and disposal of sterile syringes and injection equipment; and vaccination, testing, and linkage to care and treatment for infectious diseases. The PSS Program will also continue to work with justice-involved individuals and their family members, conduct Narcan and harm reduction trainings, and advocate for more harm reduction, recovery and prevention services. 

Source: CDC

Who We Serve

Any person who uses drugs and their family members, or newly in or seeking recovery. 

How We Impact

SSPs protect the public and first responders by facilitating the safe disposal of used needles and syringes. Providing testing, counseling, and sterile injection supplies also helps prevent outbreaks of other diseases. Nearly thirty years of research shows that comprehensive SSPs are safe, effective, and cost-saving, do not increase illegal drug use or crime, and play an important role in reducing the transmission of viral hepatitis, HIV and other infections.

Source: CDC

Status of Program for SOTCH Report

Through the Vital Strategies opioid settlement matching grant, AppHealthCare has been able to sustain the essential work of the peer support program. While initiation of a Post Overdose Response Team (PORT) is still a challenge, peer support staff have been able to work with Emergency Medical Services to distribute and train on use of naloxone.

Why Is This Important?

One in five adults (18.77 percent) in North Carolina has a mental health condition. More than half of adults in North Carolina (54.6 percent) with any mental illness report not receiving mental health treatment or counseling of any kind. One out of every three adults in North Carolina with mental illness are uninsured (Mental Health America 2020 Adult Data). People with mental and substance misuse disorders may die decades earlier than those without mental health or substance use disorders. This is mostly due to untreated and preventable chronic illnesses like hypertension, diabetes, obesity, and cardiovascular disease. Poor health habits such as lack of physical activity, poor nutrition, smoking, and substance misuse can worsen these chronic diseases.

What We Do

The Farmworker Health Program (FHP) at AppHealthCare strives to improve the health of farmworkers. Farm work is a dangerous occupation as workers face threats to their physical and mental health. Farmworkers most times lack medical coverage, and face language and transportation barriers.

Who We Serve

Seasonal and migrant farmworkers in Ashe and Alleghany Counties.

How We Impact

The Farmworker Health Program has been working on providing access to behavioral health services to farmworkers in Ashe and Alleghany Counties, and hopes to be able to provide a limited number of services internally in the coming months. Additionally, we seek to better bridge Peer Support services and Behavioral Services so that individuals with substance-use disorder can have access to mental health support.

Status of Program for SOTCH Report

While this goal is no longer being monitored as part of the 2020-2023 Community Health Improvement Plan, AppHealthCare continues to provide behavioral health and peer support services for farmworkers.

What We Do

AppHealthCare has onboarded contractors to work with local organizations to establish policies and/or programs to address suicide prevention. Additionally, contractors will work with organizations and community members to provide gatekeeper training for suicide prevention. Types of training will be determined with the input of community members.

Who We Serve

AppHealthCare hopes to train individuals in a variety of settings to ensure common language and awareness exist across communities.

How We Impact

The goal of this effort is to empower community members to respond in situations where someone may be at risk for suicide.

Status of Program for SOTCH Report

Two contractors have received train-the-trainer (T4T) for QPR, safeTALK, AMHFA, CALM and are about to attend the ASIST T4T after being selected through a competitive application process through the state. Two trainings were successfully held upon completion of T4T, with two additional trainings scheduled at the beginning of 2024.

Description

Community members are in the planning stages for a Health and Wellness event sponsored by Alleghany Lives: Suicide Awareness Coalition and Alleghany Wellness Coalition. It will be taking place on April 15th, 2023 from 1:00-5:00 pm at Crouse Park. The focus is on Suicide awareness and prevention and mental health awareness with the goal of bringing resources together. The goal for this event is to help break down the barriers and stigma for those needing help and to bring people together in a way that encourages unity and generates kindness and compassion for our community. The vision for the event is an interactive setting where vendors will provide their individual information in a creative way that engages attendees, especially children. There are plans for prizes and a door prize drawing near the close of the event and there will be a special presentation/program facilitated by Alleghany Lives Board members. Special guest speakers and some educational material will be included. The event will wrap up with a walk as a show of support for those who have lost loved ones to suicide, a demonstrative ‘Walk out of Darkness’, walking from the park to Main Street where Music on Main will be getting ready to begin its festivities.

Why Is This Important?

Social connectivity is a very important predictor of health. Social connectivity includes spending time with friends and family, taking part in group activities, or having a sense of community. Having strong social ties supports a person’s physical and mental health in many ways, from lowering rates of disease to decreasing stress during major life transitions. One recent study found that those who lacked supportive relationships had a fourfold increased risk of dying six months after open-heart surgery (Whole Health Action Management Peer Support Training Participant Guide).

Early childhood experiences have a great impact on health, educational achievement and financial security. Adverse childhood experiences such as abuse, neglect, or poverty can negatively affect brain development and increase a person’s risk for physical and behavioral health problems later in life. Providing children with safe and stable homes, relationships, and environments can protect against the impact of adverse childhood experiences, improve health, and generate increased financial security (NC Child Health Report Card 2018).

What We Do

AppHealthCare works with community partners and lead agencies to promote and support implementation of positive parenting strategies in an effort to better support parents and reduce child maltreatment. 

Who We Serve

The Positive Parenting Program team works with practitioners across the county to serve parents in a variety of settings, including non-profit and government agencies, schools, private providers settings, and more.

How We Impact

The Positive Parenting Program offers evidence-based strategies for responding to common behaviors in children. Practitioners work with parents to determine which strategies work best for their family. Parents feel more empowered to respond to their child's behavior and support their child's needs.

Status of Program for SOTCH Report

In 2023, 45 caregivers/parents received in-person support sessions from local providers throughout our district. Additionally, we saw active engagement from 86 caregivers/parents across Alleghany, Ashe, and Watauga Counties on Triple P Online - a resource available at no cost to families in North Carolina. AppHealthCare also hosted 3 Triple P workshops to enhance practitioner's skill and confidence, and trained four new practitioners within the district, reinforcing our commitment to empowering families and fostering positive parenting practices throughout our communities.

Progress on CHIPs

Public Health Priorities

The Alleghany Wellness Coalition, which focuses on improving programs, strategies, services, or policies that build on strengths and meet the priority health and emerging needs of Alleghany County, selected the public health priorities in August 2021. These priorities were chosen based on the 2020 Alleghany County Community Health Assessment. The public health priorities identified for Alleghany County include mental and behavioral health, family and social support, substance use and misuse prevention.

Health Priority: Mental and Behavioral Health

Update to Local Community Objectives

Integrated Behavioral Health

Behavioral health describes the connection between behaviors and the wellbeing of the body, mind, and spirit. Behavioral health includes not only our mental health, but how our behaviors—such as eating habits or use of alcohol—impact our wellbeing. The number of adults with a serious mental illness in the U.S. has increased from 4.6 percent from 2017-2018 to 5.6 percent from 2019-2020. With the increase in mental illness, AppHealthCare’s Health Clinic in Alleghany County continues to improve access to counseling, referral services, case management, and crisis management. One way this has been accomplished is by establishing a full time onsite Behavioral Health Consultant to provide integrated behavioral health, including tobacco treatment. 

Seeking primary healthcare is often the first step to accessing behavioral healthcare. Primary care providers are now moving toward a system of integrated care where both general and behavioral healthcare are provided. Integrating mental health and primary care services has been shown to produce the best outcomes for people with multiple healthcare needs. People with mental health and substance misuse disorders may die decades earlier than those without mental health or substance use disorders. This is mostly due to untreated and preventable chronic illnesses like hypertension, diabetes, obesity, and cardiovascular disease. Poor health habits such as lack of physical activity, poor nutrition, smoking, and substance misuse can worsen these chronic diseases. Trauma can also increase the risk of developing substance misuse, and substance misuse increases the likelihood that individuals will experience trauma. Building resilience in a community is a key strategy for addressing trauma and substance use. 

Farmworker Health Program and Behavioral Health

The Farmworker Health Program (FHP) at AppHealthCare strives to improve the health of seasonal and migrant farmworkers in Ashe and Alleghany Counties. Farm work is a dangerous occupation as workers face threats to their physical and mental health. Farmworkers most times lack medical coverage, and face language and transportation barriers. Through the FHP, AppHealthCare works to address these barriers by providing translation and transportation services, as well as access and financial assistance for medical, dental, and behavioral health needs. 

The Farmworker Health Program has been working on providing access to behavioral health services to farmworkers in Ashe and Alleghany Counties, and hopes to be able to provide a limited number of services internally in the coming months. Conversations continue around capacity of the behavioral health team to assist in providing services to both farmworkers and individuals with substance use disorders. Once a referral network is successfully established, we will track referrals served by the behavioral health team.

School Based Behavioral Health 

AppHealthCare works with the Alleghany School Health Advisory Council (SHAC) around student health, including disseminating the Youth Risk Behavior Survey (YRBS). YRBS results are provided to the SHAC team to help influence resources provided to students. The Assessment, Support, & Counseling (ASC) Center is a valuable program that supports Alleghany County School students in mental and behavioral health. As the school mental health program, the ASC Center works closely with schools and local partners to prevent suicide. According to the 2019 North Carolina Youth Risk Behavior Survey, 36.3% of high school students reported that they felt sad or hopeless for two weeks or more in a row during the past 12 months, 18.9% of high school students considered attempting suicide, 15.4% of high school students and 16.3% of middle school students made a suicide plan, and 9.7% of high school students and 11.5% of middle school students attempted suicide. The table below outlines this data, collected in 2021, locally in Alleghany County. More information through the NC Institute of Medicine about Youth Suicide & Suicide Attempts Rising in U.S. and N.C. can be found here. 

Distribution of Resource Cards

Alleghany Wellness Coalition has a subgroup focused on Mental and Behavioral Health. This subgroup understands that high doses of early adversity significantly increase an individual’s risk of suicide later in life. This group has discussed working with the School Health Advisory Council to distribute a Survive and Thrive resource card to ensure that Alleghany County citizens are aware of mental health services that are available to them. These cards outline signs of serious distress, helpful tips for reducing stress, and a list of local and national crisis resources.

Alleghany Youth Task Force

The Alleghany Youth Task Force is a group led by Western Youth Network that collaborates with organizations in the area to provide educational resources and promote programming that corresponds with different problem areas that youth face. Lately, mental health has been the main topic of these meetings. The members all have agreed to work with the Systems of Care grant through Vaya and will focus on family and youth engagement.

Mobile Crisis Management

Daymark Recovery Services offers Mobile Crisis Management services that provide a comprehensive crisis intervention in the least restrictive environment with a team perspective to meet any individual’s needs. The service operates year-round, seven days per week, twenty-four hours per day. 

National Alliance on Mental Illness

The National Alliance on Mental Illness (NAMI) is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI High Country, which includes Alleghany County representation, wants to make the High Country a safer space for those experiencing mental illness by ending the stigma associated with it. NAMI High Country wants to ensure that those who need help have access to affordable care and support. NAMI High Country is here to facilitate recovery and resiliency for families and individuals and ultimately empower those who join us to be able to serve their community. 

Health Priority: Family & Social Support

Update to Local Community Objectives

Adverse Childhood Experiences

Many health disparities begin early in life with Adverse Childhood Experiences (ACEs). ACEs are potentially traumatic events that can have negative, lasting effects on health and well-being. These experiences range from physical, emotional, or sexual abuse to parental divorce or the imprisonment of a parent. Initiatives such as the Positive Parenting Program and other family interventions through the Alleghany Partnership for children and the Alleghany County Schools are successful at addressing these challenges because they address the whole person in the context of our relationships and local environment. 

Family Based Intervention: Positive Parenting Program

Alleghany County practitioners continue to implement positive parenting strategies in hopes of reducing serious negative childhood outcomes. Healthy children equal healthy adults later in life. How do we know that the Positive Parenting Program is working locally? The program is showing high approval scores from families. Improved child behavior and decreased parent stress is being reported based on Client Satisfaction Questionnaires received. The Triple P Team is working with partners and practitioners to consistently collect this data to ensure that important feedback loop is sustained.

Health Priority: Substance Use and Misuse Prevention 

Update to Local Community Objectives

North Carolina Opioid Action Plan

AppHealthCare has committed to the incorporation of the North Carolina Opioid Action Plan, evidence-based opioid and substance use prevention strategies, harm reduction tactics and methods, including safer syringe and naloxone distribution programs. These efforts are directly aligned with our mission and values to ensure the continuation of support for the identified Health Priority of Substance Use and Misuse Prevention determined through the Community Health Assessment and reviewed by coalitions within Alleghany County. The NC Opioid Action Plan Objectives align with Alleghany County’s. These include the following: 

Prevention

• Cutting supply of inappropriate prescriptions and illicit opioids
• Supporting youth through targeted programs to reduce youth misuse of the drugs
• Improving maternal and prenatal care for women battling substance abuse

Reducing Harm

• Making the naloxone kits more widely available to the most burdened communities

Connecting to Care

• Expanding access to treatment and recovery support
• Addressing the needs of justice-involved populations 

A data dashboard developed by the NC Department of Health and Human Services helps to track and monitor the metrics in the Opioid Action Plan.

Peer Support Specialists

In 2019, AppHealthCare hired two, part-time, Peer Support Specialists (PSS) then applied for the Community Linkages to Care grant that, once received, allowed for the support of an additional (full-time) PSS to serve the district. There are three PSS that work across the district. The PSSs work as advocates for those struggling with substance use disorder by relating on a personal level through lived experience to promote trust among the people they serve. The PSSs work to serve the community through education, prevention measures, harm reduction, training, connecting individuals to care, working with justice-involved individuals, and helping with environmental and policy change work.

Current PSS initiatives are being captured and evaluated using a combination of pre- and post-test comparisons and follow up with program participants and agencies, as well as maintenance of data logs. The following are measures that are in place and have been tracked since February 2019 (when the NC CPSS program started):

• Board of Health resolution to support comprehensive strategies to address the opioid epidemic
• Total number of individuals served by NC Peer Support Specialists (PSS) across Alleghany, Ashe, and Watauga Counties: 591
• Total syringes returned: 51,932 (8,340 of those in Alleghany County)
• Total naloxone kits distributed: 3504 (498 in Alleghany County)
• Number of unique justice-involved persons served: 281 (80 in Alleghany County)
• Number of justice-involved people and their families or loved ones educated on harm reduction strategies before release, including (but not limited to) training on how to recognize an overdose, how to administer naloxone, and how to prevent an overdose: 130
• Number of justice-involved individuals reporting overdose reversals: 37
• Percent of justice-involved individuals who are given access to naloxone upon release: 100% are offered - approximately 30% receive kits
• Number of Narcan/Naloxone trainings in business and agencies: 13 (including ASU, community organizations, businesses, churches), 220 kits distributed to 184 participants
• Number of average contacts with each individual served: 11
• Number of individuals connected to medical, social services, emergency housing, transportation, food, treatment, behavioral health: 394

Post-Overdose Response Team

Community collaboration is a key component of this strategy to provide direct service to community members who have experienced an opioid overdose. AppHealthCare’s PSSs are called onto the location of the overdose or to the hospital to intervene with patients and family to provide support and resources. Initial conversations have begun with Alleghany Health (hospital) regarding the creation of a post-overdose response team.

Medication-Assisted Treatment

AppHealthCare has a physician certified to provide Medication-Assisted Treatment (MAT) services to patients with a diagnosis of Opioid Use Disorder (OUD). In 2021, the Alleghany clinic (of AppHealthCare) developed this program, working with AppHealthCare’s Peer Support Specialists. MAT is the use of medications in combination with counseling and behavioral therapies for the treatment of OUDs. This combination of therapies has shown to be effective in the treatment of OUD and can help some people to sustain recovery.

E-Cigarette and Vaping Awareness in Schools

Youth use of tobacco products—in any form, including electronic nicotine delivery systems (ENDS) like e-cigarettes—is unsafe. Such products contain nicotine, which is highly addictive and can harm the developing adolescent brain. Using nicotine in adolescence may also increase risk for future addiction to other drugs. AppHealthCare is working alongside Western Youth Network & the Regional Tobacco Prevention and Control Manager to initiate talks with Alleghany County Schools to implement the CATCH My Breath curriculum as well as to install vape detectors in school restrooms and locker rooms to further deter the use of electronic nicotine devices. 

While the results of the YRBS reflect that the number of students who used a vape in the past 30 days has decreased, we are noticing an increased outreach by administrators that are looking for guidance around the increase in the amount of vaping use that they are currently witnessing in the schools.  We are aiming to support ways to prevent and promote cessation with Alleghany County students.

Medicaid Tobacco Free Policy

Starting December 1, 2022, North Carolina Standard and Tailored Prepaid Health Plans serving Medicaid and uninsured patients will require contracted medical, behavioral health, and some intellectual/developmental disabilities (IDD)/traumatic brain injury (TBI) organizations to provide a 100% tobacco-free campus. On September 7th, 2021, DHHS released a memo to providers advising them of the new tobacco-related policy requirements going into effect December 2022. Daymark Recovery has begun to implement their tobacco-free campus policy and is working to make tobacco cessation part of the standard of care.

Live Vape Free NC

A media campaign aimed to help push vaping cessation among youth launched in Spring 2022.  The campaign is called Live Vape Free and is a digital campaign that will target youth.  The ads will drive those who click on the ad to a webpage where they can sign up to start the cessation program.  This campaign runs in a ten county region.

CTTS Training

AppHealthCare staff continue to work with providers across the district to obtain Comprehensive Tobacco Treatment Training. There is also a newly trained faculty member at Alleghany County Schools. This training through Duke-UNC aims to train health professionals to provide evidence-based treatment for tobacco use and dependence. The program provides an impactful education experience for a wide variety of professionals, including clinicians, nurses, pharmacists, social workers, public health policy-makers, and more.

Quitline

AppHealthCare staff is also able to offer Quitline services to clients by referring them through their online referral platform. QuitlineNC provides free cessation services to any North Carolina resident who needs help quitting commercial tobacco use, which includes all tobacco products offered for sale, not tobacco used for sacred and traditional ceremonies by many American Indian tribes and communities. Quit Coaching is available in different forms, which can be used separately or together, to help any tobacco user give up tobacco.

Morbidity and Mortality Changes Since Last CHA

Emerging Issues Since Last CHA

Food Access

Under our Healthy Communities strategy our goal is to increase the number of new community venues providing access to healthy foods and/or the number of existing community venues providing enhanced access to healthy foods. This includes new efforts for implementation as a result of COVID-19. Healthy foods are defined by the USDA as nutrient-dense foods across and within all food groups and are mentioned in the USDA’s Dietary Guidelines for Americans 2020-2025. The Alleghany Farmer’s Market, located in Sparta, NC, is a small but burgeoning seasonal, producer-only market in a county of approximately 11,000 residents.  AppHealthcare is supporting the Cooperative Extension and the Farmer’s Market with outreach efforts for the Double Up Food Buck program which matches your SNAP/EBT dollars so you get twice the amount of fruits and veggies. The program is set to begin in Spring 2022.

Physical Activity/Walkability

Crouse Park

Crouse Park is close to the Alleghany Farmers Market, just a block from Main Street, and within walking distance from all of downtown Sparta.  Crouse Park is a busy park, with a walking path, playground, picnic structures, skate park, and music stage.  AppHealthcare is working with the Town of Sparta to support significant infrastructure changes and renovations to Crouse Park that will be taking place this spring/early summer. These improvements will bring more foot traffic and customers to the farmers market on Saturdays and the addition of a new splash pad that the citizens raised money for will significantly increase the number of children who frequent the park. 

There has been interest from community activists that are associated with the Special Olympics for the installation of bocce ball courts. Bocce is an Italian game. The basic principle of the sport is to roll a bocce ball closest to the target ball, which is called a palina. Bocce as a Special Olympics sport provides people with special needs the opportunity to have social contact, develop physically and to gain self-confidence. Next to soccer and golf, bocce is the third most participated sport in the world.

Sam Brown Park

Sam Brown Park is located behind Alleghany High School. The park offers many different recreational opportunities including pavilion shelter, charcoal grills, playground equipment, outdoor basketball, hiking, and mountain biking. AppHealthcare is working with Parks and Recreation to support enhancement of various areas of the park, including the addition of more park benches as well as placing additional disc golf baskets and soccer goals on the property for citizens to utilize and enjoy. The disc golf course located at Sam Brown Park  is free to the public and will be open from dawn till dusk daily. This course has plenty of parking across two parking lots. This disc golf course will be closed during Professional Disc Golf Tournaments, inclement weather, and at dusk daily. The amenities of the course are continuously being upgraded.

New/Paused/Discontinued Initiatives Since Last CHA

Drug Users Health Program

In 2019, AppHealthCare’s Recovery Peer Support Specialists started collaborating and volunteering with Olive Branch Ministry to provide harm reduction resources and services to Alleghany County residents and businesses. These resources and services include increased availability of Narcan/Naloxone and training, and safer supplies for drug users. AppHealthCare also collaborates with Olive Branch Ministry to receive TA and fulfill requirements of the Community Linkages to Care grant, which is a grant to help to increase access to care and working with justice-involved individuals. 

Advancing Equity Initiative

In 2021, AppHealthCare received a new opportunity to focus efforts on health equity for Historically Marginalized Populations (or HMPs). Under this initiative, AppHealthCare staff have reconvened the Equity Performance Improvement Team (or PIT) to guide internal efforts to improve agency policies and practices towards health equity, particularly regarding COVID-19 prevention and mitigation. The Advancing Equity initiative will also involve external efforts to engage community partners to collaboratively improve COVID-19 infection outcomes and as well as other long-term outcomes that disproportionately impact HMPs

Progress on CHIPs

Health Priority: Mental and Behavioral Health

Update to Local Community Objectives

Gatekeeper Training

AppHealthCare recently realigned grant strategies to further focus resources toward mental health based on conversations with and feedback from community partners. AppHealthCare is in the process of onboarding contractors to work with local organizations to establish policies and/or programs to address suicide prevention. Additionally, contractors will work with organizations and community members to provide gatekeeper training for suicide prevention. Types of training will be determined with the input of community members. The goal of this effort is to empower individuals in a variety of settings to respond in situations where someone may be at risk for suicide. 

Farmworker Health Program and Behavioral Health

The Farmworker Health Program (FHP) at AppHealthCare strives to improve the health of seasonal and migrant farmworkers and their families in Ashe and Alleghany Counties. Farm work is a dangerous occupation as workers face threats to their physical and mental health. Farmworkers  face challenging conditions such as pesticide exposure, heat stress, lack of shade, long work hours and inadequate drinking water. Most farmworkers are under or uninsured and face language, transportation, and cultural barriers. Some have a fear of using healthcare services. Through the FHP, AppHealthCare works to build trustful relationships with farmworkers while helping overcome barriers by providing translation and transportation, as well as connecting to services such as dental, primary care, urgent care, and vision. The FHP continues to explore options for behavioral health and other specialty services. 

School Based Behavioral Health 

AppHealthCare works with the Alleghany School Health Advisory Council (SHAC) around student health, including disseminating the Youth Risk Behavior Survey (YRBS). YRBS results are provided to the SHAC team to help influence resources provided to students. The Assessment, Support, & Counseling (ASC) Center is a valuable program that supports Alleghany County School students in mental and behavioral health. As the school mental health program, the ASC Center works closely with schools and local partners to prevent suicide. According to the 2019 North Carolina Youth Risk Behavior Survey, 36.3% of high school students reported that they felt sad or hopeless for two weeks or more in a row during the past 12 months, 18.9% of high school students considered attempting suicide, 15.4% of high school students and 16.3% of middle school students made a suicide plan, and 9.7% of high school students and 11.5% of middle school students attempted suicide. The table below outlines this data, collected in 2021, locally in Alleghany County. New data will be available in 2023. More information through the NC Institute of Medicine about Youth Suicide & Suicide Attempts Rising in U.S. and N.C. can be found here. 
 

Alleghany Youth Task Force

The Alleghany Youth Task Force is a group led by Western Youth Network that collaborates with organizations in the area to provide educational resources and promote programming that corresponds with different problem areas that youth face. Recent efforts of the Task Force include  assisting Alleghany School

Counselors in getting trained in the CATCH My Breath Curriculum, tabling community events, providing Resilience Toolkits to Alleghany Students, and providing funding for Vape Detectors in Alleghany County Schools.

Unity in the Community; Linking Lives in Alleghany County

Community members are in the planning stages for a Health and Wellness event sponsored by Alleghany Lives: Suicide Awareness Coalition and Alleghany Wellness Coalition. It will take place on April 15th, 2023 from 1:00-5:00 pm at Crouse Park. The focus is on mental health awareness, including suicide awareness and prevention. The goal for this event is to help break down the barriers and stigma for those needing help and to bring people together in a way that encourages unity and generates kindness and compassion for our community. The vision for the event is an interactive setting where vendors will provide their individual information in a creative way that engages attendees, especially children. There are plans for prizes, including a door prize drawing near the close of the event. There will also be a special presentation/program facilitated by Alleghany Lives Board members, including guest speakers and some educational material. The event will wrap up with a walk as a show of support for those who have lost loved ones to suicide, a demonstrative ‘Walk out of Darkness’, from the park to Main Street where Music on Main will be getting ready to begin its festivities. 

Health Priority: Family & Social Support

Update to Local Community Objectives

Adverse Childhood Experiences

Many health disparities begin early in life with Adverse Childhood Experiences (ACEs). ACEs are potentially traumatic events that can have negative, lasting effects on health and well-being. These experiences range from physical, emotional, or sexual abuse to parental divorce or the imprisonment of a parent. Initiatives such as the Positive Parenting Program and other family interventions through the Alleghany Partnership for children and the Alleghany County Schools are successful at addressing these challenges because they address the whole person in the context of our relationships and local environment. 

Family Based Intervention: Positive Parenting Program

Alleghany County practitioners continue to implement positive parenting strategies in hopes of reducing serious negative childhood outcomes. Healthy children equal healthy adults later in life. In 2022, the focus of Triple P has been on building capacity of existing practitioners and identifying new practitioners to train. As of the end of 2022, Triple P is available through six different agencies in Alleghany County. Improved child behavior and decreased parent stress is being reported based on Client Satisfaction Questionnaires received. The Triple P Team is working with partners and practitioners to consistently collect this data to ensure that important feedback loop is sustained.

Health Priority: Substance Use and Misuse Prevention 

Update to Local Community Objectives

Opioid Settlement

In July 2021, Attorney General Josh Stein announced a historic $26 billion agreement that will help bring desperately  needed resources to communities harmed by the opioid epidemic. The agreement resolves litigation over the role of  four companies in creating and fueling the opioid epidemic. A Memorandum of Agreement (MOA) between the State and local governments directs how opioid settlement funds are distributed and used in our state. To maximize funds  flowing to North Carolina communities on the front lines of the opioid epidemic, the MOA allocates 15 percent of settlement funds to the State and sends the remaining 85 percent to NC’s 100 counties and 17 municipalities.  

The overdose death rate in Alleghany County was 9 out of 100,000 people in 2020. This represents 1 person in Alleghany who died from overdose in that year. For every death, there are more non-fatal overdoses. While we are  not able to capture all opioid overdoses, emergency department visits for overdoses are one way to measure the number  of overdoses happening. The overdose emergency department visit rate in Alleghany County was 90 out of 100,000 people in 2020, where there is a population of just over 11,000. This represents 10 emergency department visits by Alleghany residents for overdose in that year. 

In November 2022, Alleghany County agencies and partners initiated a Results-Based Accountability (RBA) action planning process in which focus areas were determined for the next four years. In February 2023, the Alleghany County Commissioners approved the utilization of $108,178 to fund one-year pilot projects based on Exhibit A strategies in the MOA. In alignment with guidelines set by the North Carolina Attorney General’s Office and North Carolina Department of  Health and Human Services, Alleghany County will consider funding agencies to implement the following Exhibit A strategies: 

1. Collaborative strategic planning
2. Evidence-based addiction treatment
3. Recovery support services
4. Recovery housing support
5. Employment-related services
6. Early intervention
7. Naloxone distribution
8. Post-overdose response team
9. Syringe Service Program
10. Criminal justice diversion programs
11. Addiction treatment for incarcerated persons
12. Reentry programs

Priority will be given to projects that align with the top 5 focus areas determined through RBA action planning: 1) Harm reduction, 2) Connections to care, 3) Treatment, 4) Support for people in treatment and recovery, 5) Prevention.

In 2023, AppHealthCare in partnership with the County will release a Request for Proposals to fund eligible organizations to implement evidence-based, high-impact strategies to address the opioid epidemic in Alleghany County, North Carolina. In addition, this RFP builds capacity and local  infrastructure to respond to the overdose crisis in Alleghany County, North Carolina. The goal of the RFP is to reduce overdose deaths, emergency department visits for overdose, and illicit opioid involvement.

Peer Support Specialists

In 2019, AppHealthCare hired two, part-time, Peer Support Specialists (PSS) then applied for the Community Linkages to Care grant that, once received, allowed for the support of an additional (full-time) PSS to serve the district. There are one fulltime and one ½ part time PSS that work across the district. The PSSs work as advocates for those struggling with substance use disorder by relating on a personal level through lived experience to promote trust among the people they serve. The PSSs work to serve the community through education, prevention measures, harm reduction, training, connecting individuals to care, working with justice-involved individuals, and helping with environmental and policy change work.

Current PSS initiatives are being captured and evaluated using a combination of pre- and post-test comparisons and follow up with program participants and agencies, as well as maintenance of data logs. The following are measures that are in place and have been tracked since February 2019 (when the NC CPSS program started):

• Board of Health resolution to support comprehensive strategies to address the opioid epidemic
• Total number of individuals served by NC Peer Support Specialists (PSS) across Alleghany, Ashe, and Watauga Counties: 591
• Total syringes returned: 51,932 (8,340 of those in Alleghany County)
• Total naloxone kits distributed: 3504 (498 in Alleghany County)
• Number of unique justice-involved persons served: 281 (80 in Alleghany County)
• Number of justice-involved people and their families or loved ones educated on harm reduction strategies before release, including (but not limited to) training on how to recognize an overdose, how to administernaloxone, and how to prevent an overdose: 130
• Number of justice-involved individuals reporting overdose reversals: 37
• Percent of justice-involved individuals who are given access to naloxone upon release: 100% are offered - approximately 30% receive kits
• Number of Narcan/Naloxone trainings in business and agencies: 13 (including ASU, community organizations, businesses, churches), 220 kits distributed to 184 participants
• Number of average contacts with each individual served: 11
• Number of individuals connected to medical, social services, emergency housing, transportation, food, treatment, behavioral health: 394

Post-Overdose Response Team

Community collaboration is a key component of this strategy to provide direct service to community members who have experienced an opioid overdose. AppHealthCare’s PSSs are called onto the location of the overdose or to the hospital to intervene with patients and family to provide support and resources. Initial conversations have begun with Alleghany Health (hospital) regarding the creation of a post-overdose response team.

Medication-Assisted Treatment

AppHealthCare has a physician certified to provide Medication-Assisted Treatment (MAT) services to patients with a diagnosis of Opioid Use Disorder (OUD). In 2021, the Alleghany clinic (of AppHealthCare) developed this program, working with AppHealthCare’s Peer Support Specialists. MAT is the use of medications in combination with counseling and behavioral therapies for the treatment of OUDs. This combination of therapies has shown to be effective in the treatment of OUD and can help some people to sustain recovery.

E-Cigarette and Vaping Awareness in Schools

Youth use of tobacco products—in any form, including electronic nicotine delivery systems (ENDS) like e-cigarettes—is unsafe. Such products contain nicotine, which is highly addictive and can harm the developing adolescent brain. Using nicotine in adolescence may also increase risk for future addiction to other drugs. AppHealthCare is working alongside Western Youth Network & the Regional Tobacco Prevention and Control Manager to initiate talks with Alleghany County Schools to implement the CATCH My Breath curriculum as well as to install vape detectors in school restrooms and locker rooms to further deter the use of electronic nicotine devices. Since the Spring of 2022, three counselors have been recently trained in CATCH My Breath with the Train the Trainer option. The curriculum is continuing to be implemented during the 22-23 school year. 

While the results of the YRBS reflect that the number of students who used a vape in the past 30 days has decreased, we are noticing that administrators are increasingly seeking guidance around the vaping use that they are witnessing in the schools.  We continue to explore how to best support our schools around preventing use and promoting cessation among students.

Medicaid Tobacco Free Policy

Starting December 1, 2022, North Carolina Standard and Tailored Prepaid Health Plans serving Medicaid and uninsured patients will require contracted medical, behavioral health, and some intellectual/developmental disabilities (IDD)/traumatic brain injury (TBI) organizations to provide a 100% tobacco-free campus. On September 7th, 2021, DHHS released a memo to providers advising them of the new tobacco-related policy requirements going into effect December 2022. Daymark Recovery has begun to implement their tobacco-free campus policy and is working to make tobacco cessation part of the standard of care.

Live Vape Free NC

A media campaign aimed to help push vaping cessation among youth launched in Spring 2022 and ran through December 2022.  The campaign is called Live Vape Free and is a digital campaign that targets youth. The ads drive those who click on the ad to a webpage where they can sign up to start the cessation program. This campaign runs in a ten-county region.

Quitline

AppHealthCare staff is able to offer Quitline services to clients by referring them through their online referral platform. QuitlineNC provides free cessation services to any North Carolina resident who needs help quitting commercial tobacco use, which includes all tobacco products offered for sale, not tobacco used for sacred and traditional ceremonies by many American Indian tribes and communities. Quit Coaching is available in different forms, which can be used separately or together, to help any tobacco user give up tobacco.

Tobacco 21

In December 2019, the FDA made a rule to change the age of purchase for tobacco products from 18 to 21.  North Carolina General statute still has 18, which makes enforcement on a local level a gray area. AppHealthCare Board of Health passed a resolution in support of a strong Tobacco 21 law

Morbidity and Mortality Changes Since Last CHA

Emerging Issues Since Last CHA

Food Access

Under our Healthy Communities strategy our goal is to increase the number of new community venues providing access to healthy foods and/or the number of existing community venues providing enhanced access to healthy foods. This includes new efforts for implementation as a result of COVID-19. Healthy foods are defined by the USDA as nutrient-dense foods across and within all food groups and are mentioned in the USDA’s Dietary Guidelines for Americans 2020-2025. There is a subgroup of the Alleghany Wellness Coalition focused on food access who meets regularly. Conversations have focused on the partnership with Blue Ridge Women in Agriculture and the Food Hub, as well as reducing the stigma around using the local food pantry and how we can better support that pantry. The group is waiting to hear back from a grant to run a Food As Medicine program in partnership with Sparta United Methodist Church.

Through our Advancing Equity strategy, our goal is to work with partners from historically marginalized populations to increase healthy food access through community-based policy, environmental change and/or programmatic interventions. We have been actively forming relationships with community partners and touching base on how to best support their efforts. We hope to continue to increase and/or enhance distribution networks supporting local, healthy foods. 

Physical Activity/Walkability

Alleghany Sparta Trail Association

The Alleghany Sparta Trail Association (ASTA) is a volunteer-led and run organization founded in 2016. The mission of Alleghany Sparta Trail Association is to provide pathways for outdoor recreation that promote healthy lifestyles, connect enthusiasts with nature and contribute to the economic vitality of our local community. AppHealthCare and Alleghany Wellness Coalition in partnership with  Alleghany Sparta Trails Association have begun exploring the ease of walkability connecting all three parks, the library/community college and potentially the hospital.

New/Paused/Discontinued Initiatives Since Last CHA

Paused- Distribution of Resource Cards

In previous years, the Alleghany Wellness Coalition has had a subgroup focused on Mental and Behavioral Health. This subgroup understood that high doses of early adversity significantly increase an individual’s risk of suicide later in life. This group previously worked with the School Health Advisory Council to distribute a Survive and Thrive resource card to ensure that Alleghany County’s youngest citizens were aware of mental health services available to them. These cards outlined signs of serious distress, helpful tips for reducing stress, and a list of local and national crisis resources. While the resource cards are still available through AppHealthCare, Alleghany Wellness Coalition has focused on other initiatives related to the selected priorities, including supporting the efforts of Alleghany Youth Task Force.

Progress on CHIPs

AppHealthCare monitors progress on it's priorities through these programs: 

Positive Parenting Program 

AppHealthCare Gatekeeper Training 

AppHealthCare Substance Use Interventions

Morbidity and Mortality Changes Since Last CHA

No notable changes in morbidity and/or mortality have occurred since the last CHA with the exception of increased deaths from COVID-19.

Emerging Issues Since Last CHA

Youth Risk Behavior Survey (YRBS)

AppHealthCare works with the Alleghany School Health Advisory Council (SHAC) to disseminate the Youth Risk Behavior Survey (YRBS) on a biennial basis, with 2023 being the most recent dissemination. The 2023 survey included a new question asking about use of Delta 8 and Delta 10, a newer cannabis-derived substance of concern discussed during SHAC meetings. 

Questions included in the survey related to Delta 8/10 include: 

• “During the past 30 days have you used Delta 8 or Delta 10?”

  • 7.4% of AHS students reported using Delta 8/10 during the past 30 days.

• “How much do you think people risk harming themselves physically or in other ways if they smoke Delta 8 or Delta 10?” 

  • 17.6% of AHS students reported that they believe that smoking Delta 8/10 poses no risk to harming them physically or in other ways.

Recent SHAC meetings have also included discussions around students and healthy relationships. In the YRBS, the following related questions are asked:

• “During the past 12 months, how many times did someone you were dating or going out with force you to do sexual things that you did not want to do? (Count such things as kissing, touching, or being physically forced to have sexual intercourse.)”

  • 5.7% of AHS students reported that they were forced to do sexual things by someone they were dating. 

• “During the past 12 months, how many times did someone you were dating or going out with physically hurt you on purpose? (Count such things as being hit, slammed into something, or injured with an object or weapon.)”

  • 6.8% of AHS students reported that they were physically hurt on purpose by someone they were dating. 

AppHealthCare continues to monitor data trends related to health concerns brought up by school staff and community partners in hopes of contributing to positive change in these areas.

New/Paused/Discontinued Initiatives Since Last CHA

AppHealthCare is no longer monitoring progress for the following initiatives:

Expand Behavioral Health services to farm workers and individuals with Substance Use Disorders.