HNC 2030 Scorecard: Cabarrus Health Alliance

The 2020 Community Health Needs Assessment (CHNA) conducted in Cabarrus County identified the following priority areas:

  1. Housing (CHNA pg. 23, 63)
  2. Mental and Behavioral Health (CHNA pg. 23, 73)
  3. Early Childhood Education and Development (CHNA pg 23, 52)

The CHNA process is intended to inform community stakeholders, as well as community members on how collectively and individually they all play a role in creating a healthier community for the residents of Cabarrus County. By September 2021, key stakeholders and community members were convened to assist with the development of Community Health improvement plans for each identified priority need. As instructed by the Community Planing Council and Healthy Cabarrus Executive Committee, Healthy Cabarrus staff will urge partners and community members to apply an equity lens to all proposed and recommended strategies, ensuring a positive impact among marginalized populations. When necessary or if not already established, community coalitions/taskforces will be created to carry out action plans.

The following Community Health Improvement Plans (CHIP) were created and submitted to the North Carolina Department of Health and Human Services (NCDHHS) on Tuesday, September 7, 2021. This document includes CHIPs associated with the top two priorities housing (Long-Term) and mental and behavioral health (Short-Term). Both plans meet the requirements outlined in the NC Local Health Department Accreditation and NC Department of Health and Human Services - Department of Public Health Consolidated Agreement.

 This Scorecard is a living document and is not intended to be a complete list of all programs or partners working on these issues in Cabarrus County. While Healthy Cabarrus and Cabarrus Health Alliance hope to continue to grow the programs and performance measures included, the intial Scorecards highlight targeted strategies that are focused on moving the needle on the identifed indicator. Use the icons to expand items and learn more:

  • R = Results we hope to see as our health improves
  • I = Indicators are data that concern us and the story behind the data that helps us understand why things are getting better or worse
  • P = Programs and partners working together to make things better
  • PM = Performance Measures are ways we are measuring success and describe how we are making a difference

Housing and Homelessness - Long Term CHIP
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Why Is This Important?

According to the Robert Wood Johnson Foundation, healthy homes promote good physical and mental health. Good health depends on having homes that are safe and free from physical hazards. In contrast, poor quality and inadequate housing contributes to health problems such as chronic diseases and injuries, and can have harmful effects on childhood development. Poor indoor air quality, lead paint, and other hazards often coexist in homes, placing children and families at great risk for multiple health problems. 

A shortage of affordable housing limits a family or individuals choice about where they live, causing lower-income families to be left with limited options, that primarly include substandard housing in unsafe, overcrowded neighborhoods with higher rates of poverty and fewer resources for health promotion (e.g., parks, bike paths, recreation centers and activities). The lack of affordable housing affects a families’ ability to meet other expense needs, placing many under tremendous financial strain. High housing-related costs place an economic burden on low-income families, forcing them to make decisions between paying for food, heating and/or other basic needs. 

The Cabarrus County Homelessness Task Force and the Cabarrus Housing Collaborative jointly identified eight populations of homeless individuals living in Cabarrus County. The populations listed below were identified because of their unique needs and specific types of housing supports necessary.

  • Families with Children (one or two parent)
  • Single Adults with Disabilites (male and female)
  • Young Adults Aging out of Foster Care (predominantly female)
  • Youth Runaways
  • Senior Adults (single and married)
  • Previously Incarcerated
  • Adults Needing Substance Use or Mental Health in-patient treatment and housing supports
  • Chronically Homeless

This results supports efforts to address with the following Healthy NC 2030 indicators:

  • Health Indicator 9: Severe Housing Problems
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The Salvation Army - Cabarrus County is in the final phases of fundraiser for their new emergency shelter, which includes expansion from 28 beds to 62 beds, and from 1 family room to 7 family rooms. The facility will offer congregate prepared meals and living space, monitored activities & programs Private sleeping space; shared shower and laundry. Will include community meal/soup kitchen; work opportunities for residents, staff and clinical space for offices, counseling, meetings, medical treatment and assessments; and access to transportation services and parking.

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Coordinated Entry and Assessments would operate as a portal of entry process that aims to connect individuals and families who are homeless, or those at imminent risk of becoming homeless, to an existing available shelter/housing resource in the Cabarrus Community. The Cabarrus County Homelessness Task Force and the Cabarrus Housing Collaborative, both stressed the need for a central entry point to eliminate barriers for those in housing crisis.

Some Coordinated Entry Programs use the following definition of homeless. A homeless person is someone:

  • Living in in a place not meant for human habitation, or
  • Living in emergency shelter (including domestic violence shelter), or
  • Living in transitional housing for homeless persons, with an imminent exit date, or
  • Exiting an institution where they temporarily resided for up to 90 days (and were in a shelter or a place not meant for human habitation immediately prior to entering that institution)

In a Coordinated Entry system, households experiencing homelessness :

  • Know exactly where to go to get help;
  • Are assessed in a standard and consistent way;
  • Are matched with the housing/services that best meet their needs, as available. 

By assessing everyone the same way, the community can be strategic about its limited resources and where resources may need to be redirected or added. Coordinated Entry, however, is not a  housing program or a guarantee of shelter or housing.

 According to the National Alliance to End Homelessness, this approach is more efficient because it:

  • Helps people move through the system faster by reducing the amount of time spent moving from program to program before finding the right match
  • Reduces new entries into homelessness by consistently offering prevention and diversion resources
  • Improves data collection and quality and provides accurate information on what kind of assistance people need
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Critical Home Repair (CHR) programs address major safety concerns in homes by making necessary repairs at a subsidized rate, allowing homeowners to remain in their homes and preserving Cabarrus County’s dwindling affordable housing stock. The City of Concord, City of Kannapolis and Habitat for Humanity Cabarrus, all provide different levels and types of critical repair programs. More than a year ago, the three agencies began meeitng monthly to review critical repair applications that each of their agencies received. By meeting and reviewing jointly it has allowed them to assess if the application was more appropriate for another entity to accept and complete. This collaborative effort has ensured that more individual's home critical repair needs are met, as some individuals may have applied to the wrong jurisdiction or agency, previously making them ineligible for services.

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Cabarrus Health Alliance (CHA) is in fulls support of the North Carolina Department of Health and Human Services effort to improve the health and well-being of those that work, live, play and pray in our community. During the summer of 2017 NC DHHS met with key stakeholders across North Carolina who were interested in, or already working on, initiatives related to Social Determinants of Health (SDOH), learning about best practices and supports needed from the Department to continue their work. Following these meetings DHHS conducted a review of best practices related to screening and identifying SDOH and existing screening tools.

From this research DHHS in collaboration with stakeholders identified four priority domains:

  1. Food insecurity 
  2. Housing instability 
  3. Lack of transportation 
  4. Interpersonal violence

CHA has established an agency goal to implement the SDOH screening tool across all clinical and many community based programs.

Click here to review the full field test report from NC DHHS regarding standardized screening for health related resources needs. 

NCCare360SDOHScreeningTool.docx

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County Health Ranking Map

Severe housing problems

Percentage of households with at least 1 of 4 housing problems: overcrowding, high housing costs, lack of kitchen facilities, or lack of plumbing facilities.

The 2020 County Health Rankings used data from 2012-2016 for this measure.

 

CHR Link to County Level Data

Mental and Behavioral Health - Short Term CHIP
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Why Is This Important?

Mental and behavioral health continues to be a top identified need among Cabarrus County residents and community stakeholders. Mental health includes an individuals emotional, psychological, and social well-being. Good mental wellness is important at every stage of life, but limited access to services and providers, as well as the stigma associated with mental illness have left many individuals feel isolated and alone. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), people with co-occuring disorders are at risk for developing one or more primary conditions or chronic diseases (HIV, Hep C). The coexistence of both a mental illness and a substance use disorder, are known as co-occuring disorders. Evidence has also shown that individuals diagnosed with chronic health conditions or disease like cancer, diabietes, chronic pain and heart disease are at higher risk of suffering from a mental illness as well. 

Just like physical health, mental health needs to be taken care of and maintained, with available, affordable, and timely access to care. Access to mental and behavioral healthcare has been identified as a priority need in Cabarrus County since 2012. This result statement and local community health improvement plan (CHIP)align with Healthy NC 2030 indicator:

  • Health Indicator 19: Suicide Rate or Self Harm
FHLI-NC
HNC2030
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2019
12.6
2
-3%
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Description

The Cabarrus County First Responder Collaborative Crisis Assistance Program (CCAP) is an initiative to provide community mental health first response to our citizens by responding to crisis involving mental health, addiction, and homelessness collaboratively.  The partners involved in this initiative are the Cabarrus County Department of Human Services, Cabarrus County Emergency Medical Service, the Cabarrus County Sheriff’s Office, and Partners Health Management.  This program will be partially modeled after the Crisis Assistance Helping Out On The Streets (CAHOOTS) program in Eugene, Oregon.

The CAHOOTS model mobilizes two-person teams consisting of a medic (a nurse, paramedic, or EMT) and a crisis worker who has substantial training and experience in the mental health field. The CAHOOTS teams deal with a wide range of mental health-related crises, including conflict resolution, welfare checks, substance abuse, suicide threats, and more, relying on trauma-informed de-escalation and harm reduction techniques. CAHOOTS staff are not law enforcement officers and do not carry weapons; their training and experience are the tools they use to ensure a non-violent resolution of crisis situations. They also handle non-emergent medical issues, avoiding costly ambulance transport and emergency room treatment.

The initial phase of the Cabarrus County CCAP initiative will take place in the Cabarrus County Detention Center to supplement the virtual mental health provider that is currently being contracted through Southern Health Partners.  The new model would utilize a licensed mental health clinician employed by Cabarrus County Department of Human Services to meet with and provide services to inmates at the Cabarrus County Detention Center placed on Special Watch status per NC Administrative Code for Jails and Local Confinement Facilities, 10A NCAC 14J.

Special watch shall be used for the following reasons:

  1. an inmate with a medical record maintained and preserved by the jail as required by Rule .1001(b)(7) of this Subchapter that indicates the inmate has attempted suicide at a previous time, unless the inmate is seen by a physician who determines a special watch is not needed.

  2. an inmate who reports a previous suicide attempt or threatens to commit suicide during their initial screening upon admission required by Rule .1001(b)(1) of this Subchapter, unless the inmate is seen by a physician who determines a special watch is not needed.

  3. an inmate who has been assigned to special watch by medical or mental health personnel of the jail or an officer.

  4. an inmate who displays any of the following behavior:

    1. physically hitting or trying to hit an officer.

    2. verbal abuse of other people.

    3. threatening other people or threatening to or engaging in self-injury.

    4. screaming, crying, laughing uncontrollably, or refusing to talk; and

  5. an inmate who is intoxicated by alcohol or drug use as determined at intake by one of the following:

    1. a blood alcohol content level of .15 or greater as measured.

    2. use of slurred speech; or

    3. the inability to control body movement.

The goal would be to coordinate with the Stepping Up program in providing needed services to the detention population and move inmates from Special Watch status to general population allowing them to receive post release services. A later goal would be to completely replace the contracted mental health services received from Southern Health Partners. This clinician would be under the supervision of the Department of Human Services while coordinating with Detention Center supervision.  Appropriate office space would be provided by the detention center as determined once the workflow of the process is developed.

The next phase of the CCAP initiative would be to split the daily work activity between the detention center and working in the field.  In the field, the Mental Health Clinician would partner with a Cabarrus County Emergency Medical Services Community Paramedic to respond to mental health related calls and needs in the county.  This two-person unit would be dispatched by the Cabarrus County Communications Center to calls deemed appropriate for their services.  Dispatchers would be trained to recognize non-violent situations with a behavioral health component.  This training would be provided by Partners Health Management.  As parameters are established, this team could work in conjunction with Partners Health Management Mobile Crisis as a valuable resource to provide services to our citizens while preventing law enforcement services from being dispatched when their services are not needed, or to clear officers from a de-escalated scene quicker.  The CCAP team may be dispatched independently or in conjunction with law enforcement in call types such as:

  • Welfare checks

  • Suicidal subjects

  • Disputes or conflict resolution

  • Substance abuse

  • Trespass/homeless.

After meeting with the individual, the CCAP team could assist in connecting them with services provided by Partners Health Management. The CCAP team could also follow-up in the community to provide or assist with services as determined with healthcare partners. 

The overall goal of this program would be to provide first responder mental health services, both in detention and in the field, to fill gaps in the system.  Dispatching of this team should reduce the calls for service to law enforcement and reduce their workload, but more importantly to keep law enforcement officers from attempting to provide services that are beyond their training and abilities.  Although law enforcement may be needed to respond to some of these incidents for safety and security purposes, ideally, after an incident has de-escalated and deemed secure and safe, the absence of a law enforcement officer may make the individual in crisis feel more comfortable and ready to accept services.  Officers would continue to receive CIT training to better equip them to assist those in crisis through better communication and recognition of when CCAP or Mobile Crisis services could best serve the individuals.

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S&H Youth and Adult Services (SHYAS) has partnered with Atrium Health Cabarrus - Behavioral Health Unit to provide Peer Support services for individuals admitted to the emergency department for mental health or substance use disorders. Peer Bridger Serivces are provided by SHYAS's peer support counselors who have two or more years of recovery and use their strength hope and experience to help others overcome their life challenges. The Peer Bridger Program is an evidence-based intervention aimed at improving outpatient service engagement, quality of life and reduce re-hospitalization rates after discharge from psychiatric hospitals. 

SHYAS provides One on One and Group Adult Peer Support Services that includes assistance with

  • Obtaining Meals
  • Engaging in Social Activities and Developing Natural Supports; 
  • Identifying, Obtaining & Maintaining Educational Resources & Employment; 
  • Identifying, Securing, and Maintaining Housing; 
  • Pre-Crisis and Post Crisis Support; 
  • Demonstrating Self Advocacy; 
  • Addressing Health Concerns and Facilitating Total Wellness; 
  • Promoting Self Help
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The lack of mental health crisis services across the U.S. has resulted in law enforcement officers serving as first responders to most crises. A Crisis Intervention Team (CIT) program is an innovative, community-based approach to improve the outcomes of these encounters. CIT programs create connections between law enforcement, mental health providers, hospital emergency services and individuals with mental illness and their families. Through collaborative community partnerships and intensive training, CIT improves communication, identifies mental health resources for those in crisis and ensures officer and community safety.

The goals of a local CIT program are:

  1. To improve safety during law enforcement encounters with people experiencing a mental health crisis, for everyone involved.
  2. To increase connections to effective and timely mental health services for people in mental health crisis.
  3. To use law enforcement strategically during crisis situations—such as when there is an imminent threat to safety or a criminal concern—and increase the role of mental health professionals, peer support specialists, and other community supports.
  4. To reduce the trauma that people experience during a mental health crisis and thus contribute to their long-term recovery.

Cabarrus County Sheriff's Office, Concord Police Department and Kannapolis Police Department are all working towards the goal of having 100% of law enforcement CIT trained. In partnership with the Mental Health Task Force, all three local law enforcement agencies are working to captured improved data on utilization skills and knowledge gained in CIT training in the field.

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In 2016, Cabarrus County committed to becoming a partner of the national Stepping Up initiative. The initiative focuses on reducing the number of people with mental illness in jails. The concept of mental health overhaul is tremendous; however, acknowledging and responding to a problem that affects one of our own programs was a starting place.

According to the Stepping Up Initiative, two million people with serious mental illness are admitted to jails across the nation each year. Almost three-quarters of these adults also have drug and alcohol use problems. Once incarcerated, individuals with mental illness tend to stay longer in jail and upon release are at a higher risk of returning to incarceration than those without these illnesses.

Cabarrus County Department of Human Services employees a team (3 staff) that works with individuals both while incarcerated and post release. Staff work with justice involved persons from the point of when they are arrested and taken into custody, at which time detention officers perform medical screenings that Stepping Up staff review. Certain questions within the screening tool are designed to determine if an individual has a mental health or substance use disorder. When reviewing the screenings, staff determine which individuals might need additional follow-up and then takes them  through a more detailed questionnaire. Staff analyze where that individual is currently in their mental health needs, and together they, staff and the justice involved person, design a treatment and transition plan.

As part of that plan, Stepping Up staff assist individuals with setting up appointments with treatment providers when they are released and follows up with them even after they’ve left the detention center to be sure they kept those meetings.

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May 2021
29
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107%
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