Transylvania Public Health is committed to protecting and improving the health of all people in Transylvania County. One way we do this is through identifying and working to address important health needs in the community.

Every three years, we conduct a Community Health Assessment to investigate and describe current health conditions in the county. We work with community members from health care, government, social service organizations, and the general public to identify the top three priority health issues in Transylvania County. (View or download the 2015 Transylvania County Community Health Assessment here.) We receive support and assistance in data collection, analysis, and followup from WNC Healthy Impact, which is a partnership between hospitals and health departments in western North Carolina to improve community health. We also collaborate with Transylvania Regional Hospital.

We then work to bring community members together to develop action plans that will address these top health priorities. Together, these action plans form a Community Health Improvement Plan (or CHIP), which is a strategic plan for the entire community designed to encourage cross-sector collaboration.

This "e-CHIP" scorecard is a low-cost, easy-to-use tool that helps us track and display data related to these health priorities and organize community improvement efforts to improve health in Transylvania County.

Substance Abuse
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Why Is This Important?

Substance use and abuse are major contributors to death and disability in North Carolina. Addiction to drugs or alcohol is a chronic health problem, and people who suffer from abuse or dependence are at risk for premature death, comorbid health conditions, injuries, and disability. Therefore, prevention of misuse and abuse of substances is critical. Furthermore, substance abuse has adverse consequences for families, communities, and society, contributing to family upheaval, crime rates, and motor vehicle fatalities. (Healthy NC 2020)

Substance abuse is linked to a number of poor health outcomes in Transylvania County. Key informants reported that the most problematic substances for the county were prescription drugs and alcohol.

The entire WNC region sees high mortality rates due to unintentional poisoning related to medication and drug overdose. However, the most recent rates of unintentional poisoning related to drug overdose in Transylvania County were approximately 35% higher than the regional rates and 1.8 times the state rates. (Professional Research Consultants, Inc., 2015) (Centers for Disease Control and Prevention, 2013)

A second cause of higher-than-expected mortality is liver disease: although the percentage of “excessive drinkers” in Transylvania County falls below the state average and the Healthy People 2020 Target, there is a strong association between alcohol abuse and chronic liver disease and cirrhosis.

In addition, substance abuse is associated with suicide, which is the third cause of death in which Transylvania County rates are higher than the state rates.

Action Plan

Develop and disseminate messages about safe storage and disposal of prescription medications

  • Work to develop clear guidance messages about safe storage options for patients who bring prescription drugs home.
  • Develop partnerships with prescribers and pharmacists to disseminate clear, consistent messages about safe storage and disposal for prescription medications and co-prescribe naloxone where appropriate.
  • Conduct a community campaign to echo messages being disseminated by prescribers and pharmacists about safe storage and disposal of prescription medications
Progress Made in 2016

The following progress was made in 2016 on Substance Use in Transylvania County.

  • Transylvania Public Health continued its partnership with the C.A.R.E. Coalition to reduce misuse of prescription medication through safe storage and disposal messages.
  • Coalition members presented medical staff at Transylvania Regional Hospital with North Carolina Medical Board recommendations on opioid prescribing and use of the Controlled Substances Reporting System. The hospital has since revised its opioid prescribing policy.
  • An Opiate Overdose Prevention palm card was developed in December 2016, with information on local naloxone availability, signs of overdose, and instructions on what to do in case of an overdose. The card was distributed electronically to community and coalition members, and printed in small batches for distribution at partner pharmacies and a community health fair. 
  • An Rx Safety palm card was developed in December 2016, with instructions for safe use, storage, and disposal of prescription medications. The card was distributed electronically to coalition members and other community members, and is expected to be produced for distribution at local pharmacies in spring 2017.
  • A Drug Take-Back Event was held in October 2016 and promoted through a media campaign that also included safe storage and disposal messages. Approximately 155 pounds of unused and expired medications were collected at the take-back event and from dropboxes located at local law enforcement offices in 2016.
  • More than 200 lockboxes were distributed to county residents in 2016, along with instructions for safe storage and disposal; additional funding was received from a local church to purchase additional lockboxes. Lockboxes are important in reducing the availability of prescription medications in the community, and C.A.R.E. Coalition members followed up with previous lockbox recipients to see if they are actually using the lockboxes according to recommendations.

C.A.R.E. works toward creating a healthy, vibrant Transylvania County, free of underage drinking and substance abuse. Members include representatives from schools, law enforcement, health care, media, youth-serving agencies, civic and volunteer organizations, religious groups, mental health/substance use treatment programs, parents, and youth. C.A.R.E. is the recipient of a 5-year Drug-Free Communities grant and was awarded a new 4-year STOP grant for further work to prevent underage drinking.

Progress Made in 2017

Transylvania Public Health continued its partnership with the C.A.R.E. Coalition to reduce misuse of prescription medication through safe storage and disposal messages. The following progress was made in 2017 on our action plan interventions for substance abuse in Transylvania County.

  • Work to develop clear guidance messages about safe storage options for patients who bring prescription drugs home.
    • Transylvania Regional Hospital C.A.R.E. Coalition members worked with representatives from Mission Hospitals to co-brand and mass produce an Rx Safety flyer with information about safe storage and disposal, as well as how to recognize the signs of opiate overdose and how to respond. This flyer is being distributed to every patient discharged from Transylvania Regional Hospital in their discharge packet.
  • Develop partnerships with prescribers and pharmacists to disseminate clear, consistent messages about safe storage and disposal for prescription medications and co-prescribe naloxone where appropriate.
    • TPH staff and C.A.R.E. members presented information about ways prescribers can help encourage proper use, storage, and disposal of opiates through messages to their patients at a Transylvania Regional Hospital staff meeting.
  • Conduct a community campaign to echo messages being disseminated by prescribers and pharmacists about safe storage and disposal of prescription medications
    • C.A.R.E. Coalition members continue to distribute lockboxes with a pledge card that recipients must sign promising to safely store and dispose of their medications and providing instructions on how to do so. In 2017, lockboxes were distributed at 3 community centers, the Halloweenfest local street festival, 3 health fairs, and other venues, as well as by individual request and word of mouth. 
    • C.A.R.E. and local law enforcement again partnered to conduct two medication take-back events.
    • Beginning in October 2017, Transylvania County was selected to receive support and funding through RHA as part of the CURES grant, which will provide additional resources for lockbox distribution, rack cards and posters, and media campaigns to enhance the reach of the safe storage and disposal messages.

These efforts seem to be having an impact on the community. A community survey conducted by C.A.R.E. in 2017 showed that 20% of respondents said they locked up medications (compared with 18% in 2014) and 28% disposed of medications properly (compared to 22% in 2014). However, less than 10% of respondents who take a prescription said that their doctor or pharmacist had spoken with them about safe storage or disposal, so there is still room for improvement here.

Additionally, the following progress was made in 2017 on substance abuse in Transylvania County.

  • C.A.R.E. staff worked to apply for a federal CARA grant to expand the impact of their substance abuse work related to opiates within Transylvania County, including more outreach to schools, advocacy for behavioral health programs, increased screening of youth, increased use of peer-to-peer support models, and building community support to increase youth protective factors such as parenting resources and less use of opiates by adults.
  • The Coalition launched its "We CARE" media campaign, which is modeled on one used in Iceland to dramatically decrease substance use among teens by asking communities to pledge to show that they value our youth and support healthy outlets for risk-taking and thrill-seeking. More than 70 businesses, organizations, agencies, and individuals have signed the pledge. For more information, visit transylvaniacare.org.
  • The TAFFY youth workgroup continued their grassroots efforts around reducing substance use among teens, adding 4 members in 2017. TAFFY members implemented 2 sticker shock campaigns to increase awareness of alcohol content in beverages, organized a Snapchat contest during National Drug and Alcohol Facts Awareness week, and partnered with the local bowling alley to expand opportunities for youth recreation. They were selected as part of Cardinal Health's "pHARMing Effects Collaborative" broadcast messages on "How to be a caring adult" on the local radio station, and spoke to local elected officials to gain their support of the "We CARE" campaign.
  • Work continues on efforts to reduce teen alcohol use, including promotion of the Talk It Out campaign to parents through partnership with Transylvania County Schools and efforts to increase local retail compliance with underage sales laws in collaboration with Brevard College and local law enforcement. 
  • C.A.R.E. staff also presented "Hidden in Plain Sight" at multiple venues throughout the county to educate parents on the early signs of teenage drug use.
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Mental Health
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Why Is This Important?

Mental health is a new health priority for Transylvania County, related to mortality and morbidity statistics, an understanding of the relationship between substance abuse and mental health issues, and a lack of necessary mental health treatment and counseling options in the county, especially for those who have little income or no insurance.

Mental health is closely tied with many other health issues. One study suggested that more than 68 percent of adults with a mental disorder had at least one medical condition. (Goodell, Druss, & Walker, 2011) Medical disorders may lead to mental disorders, mental conditions may place a person at risk for certain medical disorders, and mental and medical disorders may share common risk factors. It is also closely tied with our first priority: substance abuse, and with our three causes of death that rate higher than the state average.

Transylvania County has experienced much economic turmoil in the past decade, resulting in a lack of good-paying jobs for those without higher education. Although some sectors of the community are quite wealthy and the county attracts many tourists and retirees, many others in the community are stuck in poverty with no job prospects and no way to improve their life circumstances.

Mental health issues in Transylvania County are compounded by the lack of adequate mental health care facilities, especially for those who have additional barriers to care such as lack of health insurance, poverty, and lack of transportation. When talking to employers, social workers and law enforcement, the issues of mental health and substance abuse are often identified as problems that have not be adequately addressed in Transylvania County or North Carolina.

Action Plan

Support improvements to mental health care through screening, referrals, and collaborative care

  • Educate providers on available community resources for mental health services; update resources on a bi-annual basis
  • Provide training and support for local primary care providers and ob/gyns (and their staff) to improve routine screening for mental health disorders and referral to treatment
  • Improve clinical and community support for active patient engagement in treatment goal setting and self-management

Provide information about navigating the mental health care system to community members

  • Engage local mental health providers to participate in a community forum to educate patients and families on navigating and overcoming challenges in the mental health care system
  • Produce easy-to-understand printed and electronic resources for patients and families describing available services, how to access them, and when to access them
  • Update and disseminate resource list on at least a bi-annual basis
Progress Made in 2016

The following progress was made in 2016 on Mental Health in Transylvania County.

  • Transylvania Public Health partnered with Transylvania County Commissioners and Vaya Health to host a community forum on mental health services in the county in October 2016. A panel of providers shared information about the services offered by their agencies, how to contact them, and when to seek support. Panelists represented Vaya Health, RHA Health Services, Meridian Behavioral Health Services, Mission Health, Blue Ridge Health, local private practitioners, and the local affiliate of the National Alliance on Mental Illness. In addition, 25 mental health and behavioral health providers were available for one-on-one questions and discussion with attendees after the panel presentation. The forum was attended by 42 community members.
  • Based on information gathered at the forum, Transylvania Public Health compiled a listing of services offered by the providers who attended in November 2016. This listing was supplemented with other resources, including data from Vaya Health and professional listings from Psychology Today (as recommended by one of the local providers). This listing will be shared with the United Way 2-1-1 referral system and published for distribution.
  • Transylvania Public Health and Transylvania County Commissioners partnered with Vaya Health in efforts to bring a mental health screening kiosk to the county. The kiosk offers anonymous screening of six common mental health concerns, gives feedback on screening results, and provides referrals to treatment, including a direct VoIP line to the Vaya Health customer call center. The same screening tool will be available online for use in other places. 
Progress Made in 2017

The following progress was made in 2017 on our action plan interventions for mental health in Transylvania County.

  • Support improvements to mental health care through screening, referrals, and collaborative care
    • A MindKare mental health screening kiosk was installed in the first floor lobby of the Community Services Building located at 106 E. Morgan St. in downtown Brevard. The kiosk was unveiled at a presentation with remarks from Vaya Health CEO Brian Ingraham, Transylvania County Commissioner Page Lemel, Transylvania County Commissioner Chair Larry Chapman, and Transylvania County Health Director Elaine Russell. In addition to media coverage of the kickoff event, posters, palm cards, and social media have been used to promote use of the kiosk and online screening tools. TPH staff receive monthly updates of kiosk usage.
  • Provide information about navigating the mental health care system to community members
    • TPH staff attended a local forum hosted by a local church on addressing suicide. Panel members and community members requested a common source for local resources on mental health and suicide, and TPH staff volunteered to add any requested materials to the Community Resources page available at transylvaniahealth.org. 
    • Multiple social media posts regarding mental health and access to resources were published and promoted by TPH in 2017, with a total reach of more than 300 people.
    • Mental health resources listed on the TPH Community Resources webpage were updated at least twice in 2017.
    • In early 2018, TPH staff were selected to moderate a panel discussion on suicide hosted by a community collaborative with members that include Transylvania County Library, SAFE (domestic violence prevention agency), The Family Place (parent resource center), Transylvania County Parks and Recreation, and others. Panel members included a school social worker, the local EMS director, RHA regional crisis response coordinator, a parent of a son lost to suicide, and a suicide survivor. TPH staff was able to share information about accessing resources and screening tools, as well as increasing awareness of warning signs and knowing what questions to ask.

Additionally, the following progress was made in 2017 on mental health in Transylvania County.

  • Local provider Meridian begin offering mental and behavioral health services in Transylvania County Schools. TPH school nurses are able to make referrals to counseling as needed.
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Nutrition, Physical Activity, and Weight
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Action Plan

Provide Social Support for Physical Activity

  • Recruit volunteers to coordinate walking groups
  • Group leaders will recruit group participants, select physical activity goals, and coordinate groups to achieve those goals
  • Provide encouragement to group leaders and check on participants’ progress
  • Lead group discussion about negative views of exercise and other barriers to change

Support the Local Corner Store Initiative

  • Identify at least one small retail store owner willing to stock fresh fruits and vegetables
  • Collaborate with MountainWise to assist interested store owners in implementing sales of fresh produce in their stores
  • Develop or reproduce marketing materials to promote the purchase and consumption of fruits and vegetables in retail stores and community venues

Why It Matters?

Nutrition, physical activity, and health are closely related to cultural norms and traditions, and well as geography and the economy. A rural county with a limited number of well-paying jobs and high cost of housing results in long commutes, less money for groceries and recreation, and limited access to stores that sell nutritious foods.

Although we have an environment conducive to outdoor activity, a large percentage of our community does not have an active lifestyle. Bike riding is a popular recreational activity and actually draws a number of visitors to the county, and some residents are drawn to the county based on the downtown’s “walkability.” However, among some populations, riding a bicycle or walking as a form of transportation may be seen as evidence of being unable to afford a car.

Transylvania County has a long history of self-sustenance, and it is popular to grow a small garden for fresh herbs and vegetables and visit the thriving Farmer’s Market. However, for some of the population, eating out is still a symbol of prosperity. For others, a busy lifestyle, long distances to and from work, and lack of knowledge about how to properly prepare nutritious foods contribute to a “fast-food culture.” Cooking home-style foods with an emphasis on red meat and potatoes may be expected and appreciated by others. Families who are stretching their grocery budget may not see how they can afford nutritious food, or may not be able to travel to stores that sell nutritious items. Families who must rely on food pantries may not have access to much more than the shelf-stable items available from those sources.

This issue, too, is related to the other selected health priorities. Stress contributes to weight gain and a desire for foods that fill an emotional rather than nutritious need. However, physical activity can reduce stress and contribute to better mental health.

Progress Made in 2017

The following progress was made in 2017 on our action plan interventions for nutrition, physical activity & weight in Transylvania County. 

  • Provide Social Support for Physical Activity
    • TPH staff worked with several local employers in 2017 to initiate worksite wellness programs that will promote physical activity. Gaia Herbs hosted a health fair with physical activity options, and TPH staff are working to identify possible options that will encourage employees to be physically active on-site, such as yoga classes. TPH staff collaborated with Transylvania County's human resources and employee wellness staff to form an Employee Wellness Committee and recruit representatives from all departments near the end of 2017. This committee will focus on increasing opportunities for physical activity, healthier diets, and stress reduction, but had not begun to work on specific tasks by the end of the year. 
    • Two bike repair stations--provided by MountainWise--were installed in Transylvania County, one at the library and the other on the bike path that connects Pisgah National Forest with Brevard Middle School. This effort required collaboration with City of Brevard's planning and public works departments and Transylvania County's library and parks and recreation staff. The repair stations were publicized in the local newspaper to encourage use and show appreciation to partners.
  • Support the Local Corner Store Initiative
    • In partnership with MountainWise consultants, TPH staff assisted two local small retail venues in obtaining their N.C. Healthy Food Retail designation, signifying that they carry a specific selection of vegetables, fruits, dairy, grains, protein, and water. The recipients were promoted in the local newspaper and on social media outlets to increase awareness of these locations as a source of healthy food options and promote consumption of nutrition foods in remote areas of the county. 

Additionally, the following progress was made in 2017 on nutrition, physical activity & weight in Transylvania County.

  • The first Mobile Food Truck delivery was made to seven food pantries located in remote/food desert areas of Transylvania County in January 2017. This initiative was coordinated by the Hunger Coalition and supported by TPH staff. Although these are not small retail venues, these remote food pantries are the closest source of food for residents in these areas. Providing fresh produce, milk, and eggs to these community members through partnerships with the food pantries is a step in the right direction to support healthier diets among families facing food insecurity.
  • WIC staff conducted a social media campaign to increase case load numbers and promote healthy nutrition. In 2017, WIC provided $367,000 to the local economy, all in healthy, nutritious food purchases. WIC also supports breastfeeding, which is known to be a protective factor against overweight and obesity.
Progress Made in 2016

The following progress was made in 2016 on Physical Activity, Nutrition & Weight in Transylvania County:

  • Transylvania Public Health is working with the Hunger Coalition of Transylvania County to support its efforts in providing healthy foods to outlying areas of the county identified as food deserts. The Hunger Coalition is developing partnerships with leaders of local food pantries located in these areas to deliver fresh produce (as well as milk, eggs, fresh bread, and other pantry staples) to supplement non-perishable goods.
  • The Hunger Coalition held an Action Organizational Meeting in November 2016 to provide direction for the coalition's efforts and form groups to address the administrative functions of marketing, funding, volunteer recruitment and coordination, and resource distribution.
  • Transylvania Public Health has continued to assist the Hunger Coalition by updating its Food Pantry Map with distribution schedules, contact information, and locations for all food pantries in the county. The Hunger Coalition and its partners distributed electronic and print copies of the maps to low-resourced families in Transylvania County.
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