Team MATCH

- Mobilizing for Action to Improve Community Health - - Community Health Ambassadors Program (CHAP) - - Master of Public Health, Campbell University, NC -

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Macro Post #4

Wrapping Up

Team MATCH had a nontraditional practicum experience, but through group collaboration and perseverance, we wrapped up this semester accomplishing more than we initially thought was possible. Throughout the semester we found ourselves comparing the progress and accomplishments of our group to the other groups in our class and feeling like we were behind. I know I personally found myself still believing this even in our final class when we were watching other groups present their practicum experiences. It wasn’t until my team member started our presentation that I realized how much we had accomplished as a group and how much I personally grew.

Overview:

During our first meeting with our preceptor, team MATCH was challenged with identifying community health disparities that exist not only in Harnett County but are also prevalent across the state of North Carolina and conducting research to develop a new training curriculum that can be used across the state by North Carolina Cooperative Extension agents to recruit, engage, and train community leaders to help eliminate health disparities in their communities. CHAP, the Community Health Ambassador Program, was implemented once in North Carolina with some documented successes, and thus served as the inspiration behind our program and curriculum development.

Limitations and Barriers

There were barriers and limitations that we experienced, the same as every other practicum group. Like everyone else, the reality of living in a COVID-19 world presented us with many hardships. In our first meeting, our preceptor regrettably informed us that we wouldn’t be able to complete the community assessment portion of our practicum through bootstrapping and active field work as she would have hoped. In light of this, our preceptor encouraged us to utilize data that had already been collected and build off of the existing CHAP framework. Right from the start, our group struggled to understand what exactly CHAP was, who ran it, and what they did. There is no website, and we were unable to find contact information for anyone involved with the program. Unlike other practicum groups, we had to deal with and overcome losing our preceptor one month into our project. With no direction or guidance and unable to find information about CHAP online, we had a hard time getting our footing for how to start our project.

Living in the COVID-19 world made outreach to various community leaders and public health officials even more difficult. Many officials are not in their current offices and instead are working remotely from home. Eventually, after a lot of calling around to numerous NC public health offices, we obtained contact information for the NC Department of Health and Human Services, Office of Minority Health and Health Disparities, Executive Director, Cornell Wright. Mr. Wright was able to share with us that CHAP was previously implemented at the state-level, however, this was not a program that was being funded or implemented anymore. This was disappointing news to our team as we were hoping that their leadership would be able to take us under their wing and function as a makeshift and interim preceptor. Despite this news, team MATCH attempted to schedule a meeting to discuss the previous CHAP implementation, what we had designed thus far, and solicit feedback, however, we were unsuccessful in this networking attempt and weren’t able to gain a meeting.

Successes:

Throughout the semester, as a group we (a) thoroughly reviewed various years of State of the County Health Reports (SOTCH), Community Health Assessment (CHA), Community Health Needs Assessments (CHNA), and North Carolina Healthy 2030; (b) identified four health disparities to be addressed, including diabetes, cancer, heart disease, and substance use; (c) researched the health disparities; (d) complied a comprehensive curriculum to train community leaders; (e) suggested creative solutions to combat health disparities; (f) designed a logo for our CHAP program; (g) created an advertisement to promote CHAP and encourage enrollment; and (h) experienced the difficulties of networking.

Our comprehensive curriculum (a) introduces key concepts of what public health is, ethics, bias; (b) spans across four common health disparities; (c) explains the relevance both across North Carolina and in Harnett County; (d) educates background information about the health topic; (e) suggests programs and initiative to combat the disparity; (f) provides information about current resources your community; (g) gives examples of policy changes; (h) suggests options for funding and grants; and (i) contains a ToolKit to helpful resources.

Final Thoughts

While our practicum group may have not had the amount of hands-on community interaction that the other practicum groups experienced, we were able to be creative in the face of adversity and develop an extremely comprehensive training manual, that if funded, can be distributed to communities across North Carolina to help eliminate diabetes, cancer, heart disease, and substance use. I’m extremely proud of the work that my teammates and I accomplished and wouldn’t trade my experience with team MATCH for anything.

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The end of the practicum semester is here and team MATCH finished up by creating an advertisement/video explaining what CHAP is, promoting the program, and encouraging community leaders to take action and join a program near them! Check out this short and captivating video created by four Campbell Public Health Students. 

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I wanted to share with you all three specific slides that are included in the substance use portion of the CHAP curriculum about overdoses!

The first image above outlines two laws in North Carolina that were passed to benefit public health by encouraging individuals to call for medical help if they themselves or someone they know is overdosing, and by encouraging civic bystanders to engage and act to help save lives. 

The second image outlines what the common signs of an overdose are, what you should do if you find someone who has overdosed, and a picture illustrating what the correct overdose recovery position is. 

The third image explains what Naloxone is, how to get it, how to administer it, and recommendations of who should have it. The recommendations of individuals who should have Naloxone came from the United States Surgeon General, Dr. Jerome Adams, in public health advisory emphasizing the importance of naloxone in savings lives, in 2018. Here is a link to a website where you can get access to more information: https://www.naloxonesaves.org

Like many other areas of healthcare such as heart attack or stroke, early and fast action is key in reducing the effects of overdosing! Do your part, educate yourself and share this with others who can help to! 

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Macro Post #3

Glimpse at the substance use curriculum!

I wanted to share with you all a glimpse of the substance use curriculum that can be used to train community leaders to combat the substance use epidemic in their communities. In this post, I will address the different types of substance use disorders, an introduction to the DSM-IV, addiction and the brains reward center, and examples of evidence-based programs.

DSM-5

The DSM-5 is a diagnostic criteria manual that outlines clear guidelines to help providers in diagnosing and treating various mental health disorders. The six most common types of drugs that individuals can develop substance use disorders for are alcohol, tobacco, marijuana, opioids, stimulants, and hallucinogens. The DSM-5 has outline 11 possible criteria or symptoms for diagnosis. Below is a picture that provides a list of the possible symptoms or criteria. There is a ranking system to determine the severity of a diagnosis based off of how many symptoms or criteria the individual meets. A mild diagnosis (2-3 criteria), moderate diagnosis (4-5 criteria), and severe diagnosis (6+ criteria). Finally, the 11 different symptoms or criteria fall into one of four different groupings, including, impaired control, social impairment, risky use, and finally, pharmacological criteria for tolerance or withdrawal.

In 2013 the DSM-5 got rid of the terms substance abuse and substance dependence, and instead created a new classification system for substance use disorders (SUD). The term “abuse” is not widely used by professionals anymore as the terminology provides a negative connotative and enhances the stigma surrounding substance use. Stigma is a leading factor in why individuals don’t seek treatment. This is especially true for individuals who live in rural areas where their acquaintance density is high, and their anonymity is low. Check out this website to learn more about stigma and how you can help fight it in your community. 

https://www.shatterproof.org/our-work/ending-addiction-stigma

Addiction

Addiction is a chronic medical condition, just like asthma, diabetes, and hypertension. Just like those other conditions, addiction and substance use disorders can be prevented and treated. However, unlike those conditions, when individuals relapse, they are met with harsh judgement and isolation, rather than compassion and support. The image below shows a graph depicting that individuals who suffer from asthma and hypertension are more likely to relapse and be non-compliant with their treatment protocols than individuals who are being treated for substance use disorders. Instead of demonizing individuals who relapse, we should meet them with the same compassion to determine why they were unsuccessful and come up with new treatment protocols to assist them in living healthier lives.

So how does addiction work? 

Our brains have a built in reward system. This reward system releases chemicals and neurotransmitters such as dopamine, when we do something good, to make our bodies feel good, and thus encourage us to engage in that behavior again. Some of the common behaviors that activate our reward system include eating, exercising, and having sexual intercourse. Well drugs act in the same way. When an individual uses a substance, the reward pathway becomes overactivated and their bodies are immensely rewarded, causing them to feel very good. Unfortunately, drugs change and rewire the reward system in our brain, causing us to want those immensely levels of “feel good” or euphoric chemicals. When the reward system is rewired in this nature, their bodies are no longer able to feel good for doing common behaviors such as  eating or exercising, which leads them to feeling very bad and experiencing symptoms of withdrawal. Overtime and with continued drug use, the number of “feel good” chemicals, such as dopamine, that are released decrease. When this happens, people stop using drugs to experience the euphoric feelings they once had, but instead return them to their baseline level of feeling normal.

What can be done?

Addiction and substance use disorders are treatable, however, individuals who reside in rural areas face more barriers when trying to access treatment when compared to their urban counterparts. There are limited resources in these areas for prevention, treatment, and recovery. There are four main types of programs that can be implemented including, prevention, harm-reduction, treatment, and recovery. An example of a harm-reduction program that can be implemented and provide benefit in rural communities is the syringe exchange program (SEP). While this is a controversial topic, there is significant evidence indicating that these programs can have a substantial and beneficial public health impact. Below is a link to a website that allows you to learn more about SEP and find SEP in North Carolina near you.

https://www.ncdhhs.gov/divisions/public-health/north-carolina-safer-syringe-initiative/syringe-services-program-north

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Following our meeting with our faculty, team MATCH went ahead and finalized our outline to make sure that our project would fulfill all of our competencies. Additionally, I continued research on the types of substance use disorders, outlined what this section would include, and began plugging in information. 

Check out what the outline of the substance use curriculum will look like in our program!!!

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This week our group meet with two of our faculty members to review our progress thus far and develop strategies to further enhance our community engagement. Our group is moving forward by setting up community engagement meetings. Currently, I am in the process of setting up a group meeting with the NC Department of Health and Human Services, Office of Minority Health and Health Disparities, Executive Director, Cornell Wright, to discuss the previous CHAP that was implemented at a state-level, share with him what we have completed thus far, an solicit feedback. 

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CHAP Logo (☑️)

This week we came together and finalized the designed for our new CHAP logo! The trunk of the tree resembles the figure of a human. This represents the people of the community, who have strong roots in their environment. With the collaboration and support of public health interventions such as CHAP, communities can and will continue to experience flourishing growth.

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Macro Post #2

Rural areas are distinct from urban areas. Not only in their geography or population density. But also, in the prevalence and severity of various health topics. Additionally, the risk factors for individuals who live in rural areas are different than those who live in urban areas, even for the same health topic. Rural residents are disproportionally affected by things such as lower educational and socioeconomic status, higher rates of unemployment, geographic isolation, less stable housing, and more likely to be un- or underinsured. There are other key characteristics of rural communities that represent their unique culture. For example, hardiness and self-reliance are common characteristics of rural residents. This hardiness and self-reliance often leads to individuals delaying seeking treatment, causing their disease progression to be further along and more severe. There are other challenges and barriers in regard to the availability, accessibility and acceptability of health care resources. Availability of resources relates to the number of providers and facilities near them and the type of resources that they provide. Accessibility of resources relates to the factors that influence whether or not individuals can get to and afford treatment if it is available. Typical availability factors include having reliable transportation to and from the doctor’s office, having insurance or money saved to pay for the associated bills, and the ability to take time off of work. Acceptability, in particular, is an astronomical challenge for rural residents. In rural areas, a low population density corresponds with a high acquaintance density. In other words, in small rural towns, everyone knows everyone. Due to this and their health care provider shortages, rural residents cannot be selective with who their doctor is. Rural providers often have dual-roles, meaning that your doctors aren’t just your doctor, but also a member at your church, or the parent of a child at your children’s school. This lack of anonymity is a deterrent for some residents in not seeking care. There are many risk factors that come from living in rural areas, however, being a rural resident there are certain protective factors that you experience, unlike urban counterparts. Due to the high-acquaintance density, there tends to be a lot of community support for their fellow neighbors. This in combination with strong, traditional family values and the importance of religiosity create a buffering affect against some of the other identified risk factors.

Due to all of the mentioned risk and protective factors mentioned above, Team MATCH wanted to try and alleviate some of these issues through the development of our comprehensive Community Health Ambassador Program training curriculum. To do so, each teammate will address a specific health disparity that is prominent in Harnett County. The majority of the curriculum will be focused on education and eliminating misunderstandings. Within each of the training outlines, there will be specific, evidence-based suggestions for types of programs the future Community Health Ambassadors can complete, and suggestions for the types of legislative policy changes that can be brought to government attention. In addition to those resources, in terms of advocacy, there are links to resources of how to lead policy advocacy campaigns and enact the change that your community needs to see happen. Overall, team MATCH is excited to continue addressing the disparities mentioned above through our creative training program.

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This week I began adding more generalized information to our PowerPoint training to educate the future CHAs about public health, bias, cultural humility, ethics, and privacy. All of these components lay a critical foundation for their success for when they are going out to do field work and actively engaging with the community members.

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This week we came together to discuss our individual findings from the previous weeks research and had a meeting with our faculty advisor. We are moving right along with compiling our research on the different areas of health and inserting that information into our shared PowerPoint!

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Macro Post #1

Learning, Learning, Learning!

This week was more individualized and heavily research focused on learning more about NC Cooperative Extension and the Community and Rural Development branch, Community Health Ambassador Program (CHAP), and my health area, substance use.

NC Cooperative Extension:

The North Carolina Cooperative Extension functions as an extension operation of the two land grant universities, North Carolina State University and North Carolina Agricultural and Technical State University. Each of the above-mentioned universities coordinates programs with local government, state government, and the U.S. Department of Agriculture's National Institute of Food and Agriculture (USDA-NIFA). The Cooperative Extension office builds partnerships and programs to enact research-based solutions for problems identified in communities. Specifically, Harnett County Center focuses on the issues of Food and Nutrition, Family and Consumer Sciences, 4-H Youth Development, and Community and Rural Development. The Community and Rural Development (CRD) “leverages, connects, and strengthens the research and education in Extension Programs to transform communities and promote economic prosperity” by “building engaged leadership, inclusive partnerships, and innovative solutions”

Community Health Ambassador Program (CHAP):

Team MATCH is working to expand the current Community Health Ambassadors Program (CHAP) which is housed under the North Carolina Department of Health and Human Services, Office of Minority Health and Health Disparities. CHAP is a statewide training and education program that recruits community leaders and trains them to be Community Health Ambassadors (CHAs) so that they can engage with their communities to help eliminate the health disparities that exist throughout North Carolina. CHAP aims to engage the community leaders to gain a local perspective rather than imposing preconceived perspectives onto them.

North Carolina Substance Use Statistics:

Tobacco is the leading cause of early preventable death in NC. Cigarette smoking results in over 14,000 deaths each year, or 1 out of 5 deaths in NC each year. NC Healthy 2030 outlines aims to reduce the prevalence of youth tobacco usage from 20% to 9%. There is a rapidly rising rate of e-cigarette or vaping product usage within youth and young adult populations. This is of a particular public health concern because the strict advertising and marking laws that apply to traditional tobacco products, like cigarettes, don’t apply to the newer products as well. An ecological momentary assessment (EMA) study done in Ohio, found a correlation between recent advertisement or marketing exposure, and increased likelihood of immediate and delays tobacco use.

Alcohol is the third leading cause of preventable death where deaths are associated with unsafe alcohol intake, and the number of deaths has been steadily rising over the past 6 years. Unsafe alcohol consumption is typically characterized by one of two behaviors: binge drinking or heavy drinking. Binge drinking, simply explained, is consuming too many alcohol beverages within a small window of time. Whereas, excessive drinking, can be thought of as consuming too many alcoholic drinks, too many days in a row over an extended period of time. Binge-drinking is most commonly associated with individuals of lower ages and is positively associated with an increase in risk-taking behaviors. Heavy drinking typically afflicts males at twice the rate of females and can have devasting health outcomes such as liver disease, hypertension, and cancer.

Drugs can be characterized by either prescription or illicit, and both contribute to the rising epidemic across America, and in North Carolina. Everyday 6 NC residents die from unintentional overdose and there has been a 98% increase in overdose-related deaths over the past 10 years. As will be mentioned in further detail below, there is a growing concern for synthetically manufactured drugs as they are currently accounting for approximately 70% of overdose-related deaths in North Carolina. In Harnett County, residents ranked substance abuse prevention as the number one health behavior that the community needed more information and support about, over the past 3 years. However, despite this consistent cry for help from the community, local county health department and public health partners have failed to rank substance use as one of their top four health priorities in the Community Health Assessments. As we have learned throughout this semester, there are data lags and community members often know what they need best. The community voice about the plague that substances are having on them needs to be heard and valued.

Substance Use Risk Factors & Rurality

I mapped out the following riskscape for substance use. The web diagram below illustrates some of the socioeconomic influences that exert force onto individuals or groups and increase the level of risk of substance use affecting them. There are six main ideas that particularly influence substance use in rural areas: (1) overprescribing; (2) accessibility; (3) lack of stable and meaningful employment; (4) geographic isolation; (5) youth prevalence; (6) treatment failures. I will discuss two. Consider accessibility in combination with isolation. Synthetic drugs are able to be cheaply produced and widely distributed in rural areas that are geographically isolated. The isolation allows for the mass manufacturing of the drug to go undetected by law enforcement. Additionally, in terms of isolation, there is a mind set of “having nothing else to do”, from a lack of leisure activity availability. Finally, when looking at isolation, rural regions are particularly disadvantaged from the lack of substance use providers or treatment facilities, and the far distances that need to be traveled to obtain those services.

1. Our vision. NC State Extension Web site. https://www.ces.ncsu.edu/our-vision/.3.

2. About CRD (community and rural development). NC State Extension - Community Development Web site. https://communitydevelopment.ces.ncsu.edu/program-impacts/.

3. Our goals and objectives . NC State Extension Web site. https://www.ces.ncsu.edu/LRP/.

4. How extension works. NC State Extension Web site. https://www.ces.ncsu.edu/how-extension-works/.

5. Current programs and services : Community health ambassadors program (CHAP). NC Department of Health and Human Services Web site. https://www.ncminorityhealth.org/services/current.htm.

6. Pullen-Smith B, Carter-Edwards L, Leathers KH. Community health ambassadors: A model for engaging community leaders to promote better health in north carolina. Journal of Public Health Management and Practice. 2008;14(6):S73-S81. https://journals.lww.com/jphmp/Fulltext/2008/11001/Community_Health_Ambassadors__A_Model_for_Engaging.13.aspx. doi: 10.1097/01.PHH.0000338391.90059.16.

7. Roberts, M. E., Keller-Hamilton, B., Hinton, A., Browning, C. R., Slater, M. D., Xi, W., & Ferketich, A. K. (2019). The magnitude and impact of tobacco marketing exposure in adolescents' day-to-day lives: An ecological momentary assessment (EMA) study. Addictive Behaviors; Addict Behav, 88, 144-149. doi:10.1016/j.addbeh.2018.08.035

8. North Carolina Institute of Medicine. Healthy North Carolina 2030: A Path Toward Health. Morrisville, NC: North Carolina Institute of Medicine; 2020.

9. Harnett health system - 2019 community health needs assessment. Harnett Health. 2019.

10. 2017 state of the county health report. Harnett County Health Department. 2018.

11. N.C. summary data - Core overdose data slides november 2019 [PowerPoint slides]. NCDHHS Division of Public Health Web site. https://www.injuryfreenc.ncdhhs.gov/DataSurveillance/Poisoning.htm. Updated 2019.

12. 2018 state of the county health report. Harnett County Health Department. 2019.

13. 2019 harnett county community health assessment . Harnett County Department of Public Health. 2020.

14. County overdose slide sets - harnett county [PowerPoint slides] . NCDHHS Division of Public Health Web site. https://www.injuryfreenc.ncdhhs.gov/DataSurveillance/Poisoning.htm. Updated 2019.

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This week team MATCH had our first in person group meeting! During this time, we began discussing what elements our training program will need and began constructing our PowerPoint. Prior to this meeting, I personally dug a little deeper into the CHA, CHNA, and State of the County Health reports (SOTCH). This research revealed rising prevalence and high community concern pertaining to substance use. With this in mind, team MATCH decided to add a fourth area of health, substance use, to our CHAP training program. Next week will involve a lot of individual research on the area of health designated to us.

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Team MATCH had our first meeting with just the four of us, and I couldn't be more excited to work with the other three amazing women on my team! Everyone is so helpful, respectful, and creative. 

This session involved a lot of discussion, brainstorming, and organization as we begin to develop our plan of action. We discussed findings from the Harnett County, 2019 Community Health Needs Assessment and Healthy North Carolina 2030. These findings helped lead us to the conclusion of including Diabetes, Cancer, and Obesity as the health disparity topics that we will address in our Community Health Ambassador (CHA) training program. 

Accomplishments include us picking which domain role we would lead, deciding what three areas of health our training program will revolve around, making a plan for next week, and developing group cohesion!

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Off to the Races!

Meeting number two is in the books for Team MATCH! 

MATCH stands for, Mobilizing for Action to Improve Community Health. Our team will be working to develop a training program for the Community Health Ambassador Program (CHAP) that can be shared by Cooperative Extension Agents with communities across all of North Carolina.  

We have a lot of leg work ahead of us but are excited to dive in and collaborate hand-in-hand with one another.

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Let’s get it started

Welcome to the new class of Fall 2020!  Follow me and I’ll follow you back.