Activities of NENCPPH
Healthy Weight Promotion Initiatives
The Northeastern North Carolina Partnership for Public Health (NENCPPH) has supported a variety of healthy weight promotion initiatives, including Faithful Families Eating Smart and Moving More (now called Faithful Families Thriving Communities), the CDC funded Obesity, Diabestes, Heart Disease, and Stroke Prevention Program, the regional Diabetes Prevention Program (DPP), the Partners in Community Health (PICH) regional healthy foods coalition, worksite wellness programs, and the regional walking challenge. NENCPPH also worked to increase awareness of healthy weight initiatives throughout the region, in part through a regional health events calendar.
Regional Walking Challenge
In order to promote active living amongst health department staff, the NENCPPH initiated an annual regional walking challenge between health departments in the fall of 2017. The health departments formed numerous teams of five staff members. The health department with the team walking the most steps in the allotted time frame was awarded the traveling trophy until the next year’s winner is announced. The first year the challenge lasted eight weeks; the second year it was reduced to six weeks. The individual with the most steps walked also received recognition. Health Departments were also encouraged to challenge other agencies or departments in their counties and come up with ways to encourage participants. During the first year of implementation, five health departments, 42 teams, and 207 team members participated in the eight-week challenge.
Healthy Food and Beverage Policy
The NENCPPH healthy weight action team drafted a healthy food and beverage policy which they recommended to the NENCPPH Board of Directors, and it was adopted. The action team also recommended that each member health department adopt this or a similar policy for their county(ies).
Faithful Families Thriving Communities (Formerly Faithful Families Eating Smart and Moving More)
As a means of addressing obesity in the Northeastern Region, the NENCPPH healthy weight action team chose the Faithful Families Eating Smart and Moving More (FFESMM) which changed its name to Faithful Families Thriving Communities initiative as one to implement throughout the NENCPPH region.
The FFESMM initiative works with faith communities to see what can be done to improve healthy eating and active living within their faith community. Individual as well as community efforts are stressed. Lay leaders from the faith communities assist to set-up classes and provide instruction of the 9-weeks of classes which target healthy eating and active living. The faith community is also asked to review and select an environmental and/or policy change which could have a positive impact on the health of the faith community as a whole. Examples of policy and environmental changes include: providing water whenever food and drinks are provided, or creating a walking trail on the property.
FFESMM Facilitators have been trained from each of the local health departments and/or Cooperative Extension Offices covering the 16 NENCPPH counties. Facilitators identify faith communities to work with, facilitate the classes along side of lay health workers from the faith communities, and work with the faith communities to identify and implement environmental and/or policy changes. The NENCPPH has provided support to the program through coordination, sharing between facilitators, and monetary support for training materials and food demonstrations.
Health Care Reform
Seeking to position local health departments within the NENCPPH to be effective partners in health care reform, different workgroups have formed and considered activities. Currently, a health care management workgroup is meeting to consider how the health departments can best position themselves and demonstrate to others that they are effective in providing care management as North Carolina is transitioning to managed care.
In order to place a greater emphasis on racial equity, the Racial Equity Institute (REI) Phase I workshops and debriefings were held in spring of 2017 and 2018 for local health department staff and partners in the region. Thanks to the Partnerships to Improve Community Health for funding the REI Workshop in 2017 and to the Blue Cross and Blue Shield of North Carolina Foundation for funding the workshop in 2018. The workshop provided participants with an opportunity to explore the historical basis of racial inequality in the United States as well as one’s personal experiences and feelings regarding race. The debriefing allowed participants to further process what they learned and discuss how they might be able address racial inequities in their personal or professional lives. Approximately thirty participants were able to take place in this two-day workshop.
In order to support workforce development within the health departments, the NENCPPH formed a taskforce to identify needs and strategies to address those needs. The taskforce reviewed and tweaked survey assessment tools. The resulting assessment was shared with the health departments in the NENCPPH, and asked that all levels of staff complete it. From the survey a few major areas of training needs were identified, including stress management, team building, conflict management, and leadership skills. In order to address the training needs, the NENCPPH decided to offer a one-day regional workforce development conference, and hold it on two consecutive days to allow for the greatest participation. The conference was organized by the task force members with assistance from Eastern AHEC. Public health champions were recognized, and some participated on a panel during the conference. The conference, “We Are the Champions! Moving Public Health Forward,” was held in the spring of 2018 with approximately 120 attendees.
Public Health Awareness
NENCPPH gathered member local health department representatives together, along with a representative from the North Carolina Institute for Public Health, to work collaboratively to develop a coordinated regional plan for increasing public awareness of core public health functions. Existing public health awareness initiatives were reviewed. Possible strategies were prioritized to reach the identified target populations. Possible strategies were drafted for consideration by the NENCPPH Board.
As part of its public health awareness initiatives, the NENCPPH maintains a website (www.nencpph.net), Facebook page (www.Facebook.com/nencpph), and a regional health events calendar located on its webpage and Facebook page. The NENCPPH also publishes a quarterly newsletter, Partnering for Public Health (see previous editions by clicking on http://www.nencpph.net/reports/).
Discussion ensued around developing a public health exhibit which could be shared throughout the region and State.
Regional Health Assessments
The NENCPPH, after discussing the benefits and challenges of conducting a regional health assessment has joined with others from a larger region in Eastern North Carolina to develop the structure and procedures for voluntary participation in a regional community health assessment. The first of these joint community health assessments has begun collecting data in 2018.
An updated NENCPPH regional health assessment using secondary data was completed in 2012. In 2003-2005, the NENCPPH conducted and published a regional health assessment and focused studies of diabetes, HIV/AIDS and heart disease/stroke in the region. All include statistical health data and community opinions and concerns. Reports were distributed to residents, health and social service agencies, legislators, the state public health division and community organizations in the region. A link to the regional NENCPPH health assessment is below:
- Established a workgroup to discuss behavioral health needs and initiatives regionally
- Networking with Healthy Carolinians task forces, Active Routes to School, Partnerships to Improve Community Health (PICH), and other community coalitions and organizations to share ideas, identify community problems and resources and address public health problems
- Seeking funding to implement regional programs to address regional health concerns
- Developing ways to address common internal needs of the partnering health departments
Substance Abuse Initiatives
The NENCPPH identified substance abuse as one of its top priorities to address for FY 2013-14. One issue which was recognized as an increasing problem was that of prescription drug overdose and poisoning.
The NENCPPH applied and was accepted to attend the Injury-Free NC Academy which focused on prescription drug poisoning and overdose. A multi-disciplinary team was assembled and sent to the Injury-Free NC Academy in Chapel Hill. Initially, the focus identified was community prevention education, however, the focus changed while at the Academy to provider education, and registration in and use of the Controlled Substance Registry System (CSRS). Awareness of prescription drug abuse was provided not only to the team, but to the NENCPPH Board of Directors during one of its meeting. The Health Directors in the NENCPPH were asked to send out letters to providers in their counties to notify them of the trainings being provided on chronic disease and prescription pain medications. Providers were given an opportunity to register on the CSRS at that time. The subsequent step was for interested communities to form community coalitions to further identify strategies to implement in their communities.
Subsequently, a NENCPPH substance abuse task force was formed. An inventory of programs was completed by East Carolina University. Local forums and educational opportunities have been provided throughout the region. A regional roundtable to share ideas was also held a number of times for local health department staff.
Rabies CME Course
In order to provide rabies education relevant to North Carolina, the NENCPPH partnered with Albemarle Regional Health Services, AHEC, and experts in the State to develop a web-based rabies course providing CME credit. The Course is intended for physicians, nurses, veterinarians, and other medical providers and covered human rabies risk assessment and post exposure management. The course was made available in the spring of 2017. The course was provided free of charge to the first 38 registrants.
Improvements to disease surveillance in the region were reviewed by the NENCPPH. A regional disease surveillance discussion was held with Communicable Disease Nurses, Preparedness Coordinators, Health Educators and a Health Director from the partnering local health departments, an Epidemiologist from Vidant Medical Center, and the facilitator from the North Carolina Institute of Public Health. NCDETECT also provided input during the meeting. The group reviewed which indicators should be used to monitor disease surveillance, as well as the frequency of reporting, the format for reporting, and to whom the reports should be sent.
After further review and discussion by the NENCPPH Board, an improved reporting and surveillance system was developed and put into use in the region. NCDETECT also has agreed to provide annual reports on selected indicators for each county with comparisons to the NENCPPH region and the State.
Vaccine-Preventable Disease Initiatives
In the spring of 2013, the NENCPPH identified Vaccine-Preventable diseases as a priority health indicator to address. An initial Regional Immunization Workgroup was held for local health department staff involved with immunizations in the fall of 2013.
The Regional Immunization Consultants from the Division of Public Health (DPH) were invited to attend and share with the group regional data on vaccines, and possible strategies for increasing coverage rates. Barriers to immunizing all age groups were also discussed.
On the group's recommendation to meet again, the NENCPPH set up a Regional Immunization Conference to include the local health department staff, as well as staff from private providers offices in the spring of 2014. Based on suggested topics from participants, the Regional Immunization Consultants from DPH presented information to the participants on adolescent immunizations, visits from the State, and possible regional strategies. CME credit was provided to those who attended.
In the summer and fall of 2014 and again in June 2015 representatives from the local health departments and the State met again to further discuss immunization coverage, successes, and barriers. Regional Goals and objectives and possible regional initiatives were identified and a workgroup formed to further plan for the implementation and funding of the selected initiatives. The regional goal identified was: to increase the vaccination rates of 12-24 month-olds by 2% by one year from project initiation both at the county and regional level." The initiatives recommended were immunization education and an opportunity for one's name to be entered into a drawing if their child is fully immunized.
Healthy Lifestyle Choices PromotionIn August 2013, the NENCPPH received a grant of $27,185 from the Region 9 Community Transformation Grant Project to support a Healthy Lifestyle Choices Promotion (HLCP) initiative. The HLCP initiative was a regional public health awareness initiative covering 12 counties in Region 9 to promote healthy lifestyles choices, particularly those targeting obesity. The effort was coordinated with the Region 9 CTGP Coordinators to provide maximum coverage in the region.
Billboards, gas pump toppers, and newspaper ads promoting healthy eating and active living were developed and erected or published. Farmer's Markets, Roadside stands, and local produce were promoted for the healthy eating messages. Promotion of joint-use agreement areas and locally available means of getting exercise were promoted for the active living messages. The same design which was used for the billboards or gas pump toppers, was also used for the newspaper ads. The billboard campaign began in March 2014 and continued for up to a year. The gas topper campaign featured for 2 - 3 months, depending on the site, and the newspaper ads ran for 4 - 7 weeks.
Heart Disease and Stroke Prevention
The CDC-funded NC HDSP Program focused on systems-level change to create health promotion and cardiovascular disease prevention. Because of the complexity and prevalence of cardiovascular diseases and risk factors, no single program working alone could make a difference.
The NC HDSP Program sought to work with multiple partner organizations – both public and private – in settings across the state to address chain of survival issues and secondary prevention with a focus on the ABCS (Aspirin Therapy, Blood Pressure and Cholesterol Control, Smoking Cessation, and reduced Sodium intake); while supporting collaboration with other NC Chronic Disease and Injury Section Branch-funded efforts in addressing physical activity, unhealthy eating, tobacco use, diabetes, and overweight/obesity, as well as emergency response and acute health care systems for heart attack and stroke.
The NC HDSP Program identified African Americans as a priority population because health surveillance data showed that this group bears a disproportionate burden in terms of heart disease and stroke death rates and risk factors in NC.
Four regions in NC were supported by HDSP Regional Coordinators, including Northeastern and Eastern NC. The Northeast NC HDSP Program Regional Coordinator worked closely with the Eastern Regional Coordinator of the Program to manage the Eastern NC Stroke Network (ENCSN). Anyone who is a stroke champion was able to become a member. There were approximately 500 members of the ENCSN representing 30 eastern NC counties.
The vision of ENCSN was to be recognized as a leading resource for voluntary collaboration on stroke best practices in eastern NC communities. The mission of ENCSN was to improve the prevention, treatment, and quality of stroke care in eastern NC through a coordinated regional system.
Quality Improvement: LEAN and QI 101
The health departments comprising the Northeastern Partnership are committed to continuous quality improvement. One means to achieve quality improvement was to apply models from successful businesses.
In conjunction with consultants, the Northeastern Partnership has reviewed business model assets such as Lean and Six Sigma which can be applied toward solving high priority public health problems and organizational challenges. These models map current business practices and develop teams that can look at tailoring new business practices in ways that address local public health department issues, such as billing practices, clinic efficiency, and client satisfaction with services at the local health department.
Lean trainings, as well as two on-site kaizen events, were provided to each health department in the Partnership using the Lean model. During the kaizen events, staff and facilitators work together on-site to analyze and improve upon practices and procedures. Health departments reported great improvements to their clinic efficiencies, and a positive return on their investment thanks to the Lean trainings and kaizen events.
Additionally, some of the health departments in the Northeastern Partnership partnered with the North Carolina Center for Quality Improvement to look at other areas of improvement using their QI 101 course, which also utilizes concepts from Lean.
Eliminating Health DisparitiesThe NENCPPH completed a Community Focused Eliminating Health Disparities Initiative from the State Office of Minority Health and Health Disparities which was focused on increasing awareness of health disparities and developing solutions with local Disparity Gap Coordinators.
Each health department had allocated a health educator from their staff to serve as a Disparity Gap Coordinator. These Coordinators help to link the Partnership to community coalitions such as Healthy Carolinians and school health advisory councils, and help to implement programs conducted by the NENCPPH. In addition, the Disparity Gap Coordinators attended quarterly trainings on how to implement culturally appropriate public health programs. For examples on activities which occurred in the various counties, take a look at the newsletter, “Giving Clarity to Disparities.”
A Regional Health Disparities Coordinator was spearheading the development of a large collaborative, the Eastern Health Network, that would create collaborations between faith based organizations, community based organizations, health departments, schools, and government. The aim of the project was to create avenues to strengthen communities via capacity and infra-structure building and sharing resources across county lines to eliminate health disparities in the eastern region of North Carolina. Other activities conducted by the Regional Health Disparities Coordinator included conducting focus groups, holding meetings and trainings, assisting the Disparity Gap Coordinators to review and revise their county action plans, working with church youth groups regarding diabetes/kidney disease, and planning a leadership conference. Due to changes in funding at the State-level, the position of Regional Health Disparities Coordinator was discontinued.
The 4th Annual Health Disparities Leadership Conference, “Bringing Communities Together, Connecting the Pieces” was held on June 24, 2011 at the Bob Martin Center in Williamston. Approximately 100 participants shared and learned about ways we can come together for the betterment of our communities.
Epidemiologic Capacity of Local Health DepartmentsAn epidemiologist was hired by the Partnership to analyze and present county and regional health data for 11 local health departments in the Partnership at the time. In addition, the epidemiologist has provided region-wide training for health department staff. Trainings have included Principles of Epidemiology, Epi Info software, and Presenting Health Data. The Epidemiologist has responded to health department requests for data and other technical assistance.
Touch No TobaccoTNT was a tobacco prevention program aimed at teens in 11 of the counties served by NENCPPH. The purpose of the program was to prevent tobacco use initiation, eliminate exposure to secondhand smoke, promote tobacco cessation, and reduce health disparities attributable to tobacco use. A Project Coordinator, four Youth Tobacco Prevention Coordinators and a Media/Marketing Specialist formed the staff of the program which was funded by the Health and Wellness Trust Fund. The project developed a list of tobacco-free restaurants in Northeastern North Carolina.
Diabetes Sentinel ProgramThrough this project, the Northeastern Partnership increased its capacity to prevent, diagnose and medically manage diabetes among African Americans, and sought to reduce health disparities in the 19-county region.
The Diabetes Sentinel program was a collaboration of 30 African American churches and public health providers for diabetes prevention, outreach and policy change. Each participating congregation identified adult and youth leaders for training as lay advisors (Sentinels), created a committee to support this effort, established and implemented policies that promote healthy lifestyles, and sponsored workshops on diabetes, nutrition, and exercise.
College Tobacco PreventionThis Tobacco-Free Colleges Initiative served 18-24 year olds attending college in Beaufort, Chowan, Dare, Edgecombe, Halifax, Hertford, Martin, Pamlico and Pasquotank counties. Funding for the project was provided by a NC Health & Wellness Trust Fund grant (2006). Statewide efforts to address tobacco use and exposure to secondhand smoke (SHS) have been primarily focused on youth ages 12-17 and adults. However, studies at the time showed that 18-24 year olds represented the only group in which smoking rates were rising rather than falling.
College students are especially vulnerable to tobacco addiction. Nationally, 29% of college students were current smokers. In North Carolina, 27.8% of 18-24 year olds smoked and of those, 58% had tried to quit in the last year. Colleges and universities across North Carolina were challenged with helping the three-quarters majority to remain non-smokers, and encourage current smokers to quit.
The Northeastern Regional grant provided services and support to the following institutions:
- Beaufort Community College*
- Chowan University
- College of the Albemarle**
- Edgecombe Community College
- Halifax Community College
- Martin Community College
- Pamlico Community College
- Roanoke-Chowan Community College**
**Indicates total smoke/tobacco-free policy
Project goals included:
- Preventing the initiation of tobacco use
- Reducing exposure to environmental smoke
- Providing information on treatment options for those wishing to quit through cessation techniques including Quitline NC
- Reduce health disparities attributable to tobacco use
- Advance the adoption of Tobacco-Free Campus policies
Health in Motion: a Mobile Outreach ClinicNENCPPH launched the mobile clinic project, Health in Motion, in northeastern North Carolina. The goal of the NENCPPH mobile clinic was to provide at risk populations access to Human immune virus (HIV) prevention and primary care and treatment services. The mobile clinic also visited communities to provide screenings for cholesterol, diabetes, hypertension, and infectious diseases. Health in Motion received funding from a Ryan White Title II grant and a Kate B. Reynolds grant.
The Northeastern Partnership's Regional HIV Program expanded the partners' capacity:
- To deliver Primary Medical HIV care at five regional mobile care sites (Bertie, Beaufort, Dare, and Halifax Counties in the NENCPPH region, and also to Lenoir County)
- To provide nontraditional HIV/STD testing services targeting communities considered at risk (573 individuals were tested for HIV in 2007)
- To raise awareness of HIV and provide HIV prevention education (40 outreach activities occurred in 2007).
The partnership received additional funding through grants to promote and sustain this initiative through increased staffing of a regional coordinated care team, funding two regional nontraditional testing coordinators, and funding a jail HIV/STD testing coordinator.