HRSA

Two glass vials that say "Naloxone HCL" and two wrapped syringes rest on a metal shelf at a needle exchange facility. In the background is a paper instructions on using the medication to reverse an opioid overdose

NC organizations fighting the rural opioid crisis receive a $4M federal boost

August 14, 2020 by Liora Engel-Smith

NC organizations fighting the rural opioid crisis receive a $4M federal boost - North Carolina Health News

Four agencies will tackle the opioid crisis in rural North Carolina with $1 million grants from the federal Department of Health and Human Services.

By Liora Engel-Smith

Amid signs that the state is losing ground in its battle against the opioid crisis, four North Carolina agencies on the front lines of addiction and recovery have received $1 million apiece to address the issue in rural areas.

Two recipients of the recent federal Department of Health and Human Services grants serve Wilson and Robeson counties, rural areas that had some of the highest overdose emergency department visit rates in the state as of last month.

Addiction, a disease fueled by isolation, economic instability and despair, is on the rise in the post-COVID world. The state has seen a 15 percent spike in opioid overdoses since the pandemic began. During that same time, coronavirus control measures have pushed thousands into temporary or permanent joblessness, and attention has diverted away from addiction treatment.

Though the state’s unemployment has declined somewhat from its peak of 12.9 percent in April and May, June’s 7.6 percent rate is twice as high as it was before the pandemic. The implications of this crisis to the state’s overall overdose death rate this year remain to be seen.

A graph that shows that emergency department visits for overdoses has increased during the coronavirus pandemic — North Carolina’s Emergency Department visits for opioid overdoses spiked during the coronavirus pandemic. Source: NCDHHS.

“The need doesn’t go away just because there is a pandemic,” said Bart Grimes, chief of behavioral health at Robeson Health Care Corporation, a recipient of one of the grants. “People may delay seeking [other types of] care, but with a psychiatric condition, they’re just going to show up.”

Opioid addiction isn’t a new challenge in the rural border county. Robeson Health operates six residential rehabilitation facilities with a collective 100 beds in Robeson and the surrounding counties, Grimes said. Demand for services has been steady for years, in part thanks to the trafficking of illegal substances through the county along the I-95 corridor, he added.

But the pandemic has taken its toll. At 22 visits per 100,000 residents, Robeson County had the highest rate of opioid-related emergency department visits in the state in June, sharing that spot with Stokes County, nearly 200 miles away on the Virginia border.

Who got funded?

The Health Resources and Services Administration awarded $1 million grants to 89 organizations serving rural areas nationwide, four North Carolina organizations included:

Robeson Health plans to assemble a consortium of local organizations that work with people along the continuum of recovery, uniting disparate agencies and their programs into one seamless system.

By “connecting the dots,” providers in the county plan to create a smoother transition for clients with substance use disorders as they move from detox to residential treatment and back to the community.

The consortium will also work to fill service gaps, including the lack of support groups and sober homes in the county, Grimes added.

Wilson County, another opioid overdose hotspot, also has an agency that got the federal grant. According to June state data, Wilson had the third-highest rates of opioid overdose emergency department visits in North Carolina.

June opioid hotspots

According to June data from the state department of health, five counties — all rural according to the N.C. Office of Rural Health — had the highest opioid overdose emergency department visits in the state per capita:

Robeson County: 22 overdoses per 100,000 people
Stokes County: 22 overdoses per 100,000 people
Wilson County: 20.9 overdoses per 100,000 people
Randolph County: 19.5 overdoses per 100,000 people
Rockingham County: 17.6 overdoses per 100,000 people

Source: NCDHHS

Wilson County already has a robust network of organizations working to address the opioid crisis, said Jeff Hill, director of the Wilson County Substance Prevention Coalition, the agency that got the federal grant. The coalition intends to spread the money among a plethora of agencies and initiatives such as increasing community access to the overdose reversal drug naloxone and training more providers to prescribe medications to treat opioid addiction.

The county faces unique challenges when it comes to the opioid crisis, Hill said, because it is home to a manufacturing facility of OxyContin maker Purdue Pharma, which is facing numerous lawsuits for its role in fueling the opioid crisis.

People who manufacture drugs may view opioids less as a threat and more as means to “put food on the table,” Hill said. That association with their livelihood, he added, could create a sense of familiarity that sometimes makes it easier to use and misuse opioids.

A big portion of the coalition’s work has focused on shifting that culture with initiatives such as provider education on safe prescribing practices and information campaigns to help parents and teens understand the risk of opioid misuse.

These deeply ingrained beliefs may mean that the county may never fully address the opioid crisis, especially not within a three-year grant cycle, Hill said. But his approach is simple: “Let us do as much work as we can, within [that] time frame.”

An African American mother and her baby bond together as an illustration of maternal health and maternal and child health.

Federal health officials ask how they can help NC improve maternal health. They get an earful.

January 29, 2020 by Anne Blythe

Federal health officials ask how they can help NC improve maternal health. They get an earful. - North Carolina Health News

U.S. Department of Health and Human Services, Medicaid, Medicare administrators came to Raleigh for guidance on North Carolina’s maternal health needs.

By Anne Blythe

Health care administrators traveled from the nation’s capital to the state capital this week as part of a listening tour on how the federal government could help North Carolina address some of its thornier maternal health issues.

They got plenty of feedback from the dozens of North Carolina caregivers, patients, administrators and health care advocates gathered at the state Division of Public Health offices on Monday.

“We need to hear from all of you in order to help us do our jobs,” said Tom Engels, administrator for the federal Department of Health and Human Services’ Health Resources and Services Administration. “We’re here looking for ways to improve.”

The federal office that Engels became head of in late 2019 is responsible for enhancing health care access for the economically and medically vulnerable in the country’s more isolated areas.

Much of that population in North Carolina lives in rural areas, but they also are scattered among the more populous urban and suburban areas, too, speakers told Engels and other federal administrators at the listening session.

Ideas flow

Between Engels’ opening and closing remarks, Michael Warren, associate administrator of HRSA’s Maternal and Child Health Bureau and a Sampson County native who went to college and medical school in North Carolina, and Cara James, director of minority health at the Centers for Medicare and Medicaid Services, moderated a panel discussion.

Among the more weighty topics: The prominent racial disparities in North Carolina’s infant mortality rates, as well as in the maternal death rates during childbirth and in the weeks and year afterward.

Mandy Cohen, the state secretary of health and human services, often calls those poor birth and maternal outcomes a “black eye” for North Carolina. She has assigned task forces, commissions and others to develop plans for closing the gap.

Those plans, as the federal administrators heard, pull from many threads across the state as health care advocates work to stitch together a stronger safety net for black women and children, along with finding ways to support financially strapped women in rural North Carolina.

The ideas and suggestions ran the gamut, ranging from making sure the state’s incarcerated pregnant women have access to top-notch care to providing coverage and care for women through what they call a fourth trimester — the year after birth when caring for a new baby can be emotionally and physically draining.

NCDHHS Sec. Mandy Cohen is speaking to an audience at a listening session on maternal health. — NC Secretary of Health Mandy Cohen speaks briefly to dozens gathered Monday, Jan. 27, 2020, for a listening tour by federal health administrators.
Photo credit: Anne Blyth.

Another idea that came up during the discussion, one that drew some skeptics, was a new focus on Long-Acting Reversible Contraception, or LARCs. In a state still stained from a eugenics program in which more than 7,000 people were sterilized — and many against their wills — panelists stressed that any such programs should be fully explained and opted into only with full and educated consent.

Most of the discussion focused on the racial disparities in maternal and infant mortality and the diminishing access to health care for many of North Carolina’s rural residents.

Can family practitioners fill gaps?

In recent years, North Carolina’s rural hospitals have struggled to stay financially afloat, creating a closure trend that has left many pregnant women in the far eastern and western parts of the state in a pickle.

Many women might be able to get perinatal and postnatal care at local health department facilities, health care provided in large part through county taxes and grants. But the loss of obstetricians and gynecologists in those areas near the shuttered hospitals means many women are forced to travel great distances to give birth in a hospital setting. Some forgo that option for riskier choices, decisions that can lead to problems during birth for the mothers and infants.

Greg Griggs, executive vice president and CEO of the North Carolina Academy of Family Physicians, suggested a fix that could evolve if family physicians were to add obstetrics to their practices.

“We are closing OB-units,” Griggs said at the listening session. “At the same time, we’re losing family practitioners to other states.”

Griggs has said previously that though almost 30 percent of rural primary care physicians throughout the country practice obstetrics, that number dwindles to about 11 percent in North Carolina.

Lengthy wish list

Others on the panel and in the audience, which included North Carolina first lady Kristin Cooper, had suggestions for the federal administrators to keep in mind as they shape the next federal budget.

Among them were:

More funding and focus on programs to reduce maternal mortality, especially those that can help reduce the racial disparities.
Medicaid coverage of doulas, particularly in rural counties, where they can help advocate for pregnant women and new mothers.
Dedicated funding for programs to connect mothers and families to community resources for those experiencing poverty, including federal housing and food programs, as well as health services designed to treat the mind and body.
Create Centering Pregnancy/ Parenting programs designed especially for black women, who share harrowing stories about health care providers who do not always respond to their questions or listen to their needs.
Better collection, streamlining of and use of data that can highlight successes and expose deficiencies.
Don’t forget the local health departments, which in North Carolina, have facilities in each of the 100 counties and provide what they call “wrap-around care.”

“HRSA’s mission is to make the United States one of the safest nations in the world for women to give birth,” HRSA’s Engels said.

Cohen, the state’s secretary of health since 2017, noted progress made in recent years, such as drops in the infant mortality rate by 47 percent since 1991. But she also stressed that North Carolina continues to struggle with the fact that African American births result in infant mortality at a rate 2.5 times the rate of white births.

“We also know there’s a lot of work and opportunity ahead,” Cohen said.

Appalachian Community Health Centers to Open After Delays

February 4, 2016 by Carolina Public Press

Appalachian Community Health Centers to Open After Delays - North Carolina Health News

By Margaret Williams

This story first appeared in Carolina Public Press and is published by N.C. Health News through a content-sharing agreement.

Initially scheduled to open in Asheville last fall, Western North Carolina’s newest community health center has seen substantial delays, but the facility’s director says he expects it to open Feb. 8.

Nic Apostoleris is director of the new Appalachian Mountain Community Health Centers. Photo credit:

Appalachian Mountain Community Health Centers, awarded a $704,167 federal grant last May, had been scheduled for a September 2015 opening.

“Delays on our end [came from] trying to nail down contracts [and] doing this the right way,” director Nic Apostoleris told Carolina Public Press in October when the center was only a few weeks behind.

That same month, representatives of the U.S. Health Resources and Services Administration, which oversees such health centers, visited Asheville and “provided training and technical assistance,” Apostoleris said.

Some regional leaders of other health centers saw the visit as a sign that HRSA was investigating the new organization or at least scrutinizing its progress more closely, in part because of its close ties with a major hospital, Mission Health, and the Mountain Area Health Education Center, as Carolina Public Press reported Oct. 19.

After a two-year process, Appalachian Mountain had been awarded status as a federally qualified health center – independent nonprofit organizations that provide care to “medically underserved populations/areas or special medically underserved populations comprised of migrant and seasonal farmworkers, the homeless or residents of public housing,” according to HRSA guidelines.

“Since approval [in May], we’ve been working to iron out the details,” Apostoleris said, responding to the criticism. Some of the 16 sites listed in Appalachian Mountain’s federal application were dropped from its plans, he said. Others were still being negotiated.

“What we all want is to do this the exact right way,” Apostoleris said.

As the new year arrived, none of Appalachian Mountain’s proposed sites had been opened.

Asked about the nature of the fall 2015 visit to Asheville and the reason for the delay, HRSA spokesperson Elizabeth Senerchia said the agency “utilizes a variety of methods to monitor health-center program grantees throughout the year to support continued compliance with program requirements.”

The agency can’t comment on progress at a specific health center, she said.

“We also work to identify areas where technical assistance might be beneficial (and work) with grantees to resolve identified issues while also focusing on continuity of service so that people in the communities the health centers serve can continue to receive high quality primary care.”

A few weeks into 2016, Apostoleris reported, “Now it’s coming, and it’s real. We’re opening on Feb. 8.”

He also said, “It’s been a difficult birth process.”

Appalachian Mountain will launch services at 7 McDowell St., a location selected and prepared with cooperation with MAHEC and the Asheville Buncombe Community Christian Ministry, he explained. The new access point, or NAP, will be named after Dr. Dale Fell, a former chief medical officer at Mission Health, MAHEC board member and longtime healthcare advocate in the region.

Despite other delays along the way, “we’re getting it right,” Apostoleris said. “We’re ready to go.”

He emphasized the regional need for affordable care, Appalachian Mountain’s independence as a health organization and the community-based mission of aiding the underserved. He’s assembled “a good clinical team” for the Dale Fell Health Center, he said, and he’s close to announcing satellite locations in the region.

Jeff Heck, director of MAHEC, helped establish Appalachian Mountain. MAHEC is continuing its collaboration with the new organization, he said.

Mission spokesperson Susan Dunlap said the hospital isn’t aware of “any change of status [for] Appalachian Mountain Community Health Centers.” Nor is there “any change regarding Mission Health’s involvement with the new health center.”

Appalachian Mountain will help “expand access to critically needed services in Western North Carolina,” she said.

Apostoleris, the former interim chief operating officer of a community health center in Massachusetts, had served as board president for the National Health Care for the Homeless Council. He’s used his experience to “rework” Appalachian Mountain’s model “and align the details with what community health centers are supposed to do,” he said.

The Dale Fell clinic will complement other local organizations that help the homeless, and new access points across the region will help those who need affordable care, Apostoleris said.

“We’ve made a lot of progress [on Dale Fell and satellite locations]. This is a starting line.”

NC Health Centers Get $11.4 M to Repair, Expand

May 7, 2012 by Rose Hoban

NC Health Centers Get $11.4 M to Repair, Expand - North Carolina Health News

Uninsured and low income patients will get a little more access to health care, thanks to some money released by fed last week.

By Rose Hoban

Community health centers around North Carolina are on the receiving end of $11.4 million in federal dollars to repair, improve, and build several much-needed health centers (see table below).

“While those grants were helpful, they aren’t addressing the complete need we have for capital improvement,” said Ben Money, head of the NC Community Health Center Association. “And given the number of people we continue to see who are uninsured, there continues to be an increased demand for community health centers.”

PiedmontHealthCenter_Carrboro — Piedmont Health Services main building in Carrboro, Photo courtesy Chapel Hill-Carrboro Chamber of Commerce

According to the latest numbers from the NC Institute of Medicine, North Carolina has about 1.3 million adults under the age of 65 who lack any health insurance, a total of 23.6 percent of adults from the ages of 18-64. (The IOM calculated their totals from the most recent US Census data.)

About 300,000 more North Carolina adults are uninsured than at the start of the economic downturn in 2008.

Brian Toomey, head of Piedmont Health Services, said community health centers are some of the most efficient providers of care.

“We can take care of someone for an entire year for less than $500, including their medications,” Toomey said. “That’s $300-$400 cheaper than one emergency department visit. And people come to us on an average of 3-4 times a year.”

Toomey’s organization received half a million dollars to renovate one of their six locations, a building in rural Alamance County that Toomey says is more than 85 years old.

“It’ll allow us to upgrade and do repairs,” Toomey said about the Burilngton clinic that sees 6,000 patients annually.

“We were going to have to decide whether we could afford the repairs. If this money had not come through, I’m not sure we could have stayed in that location,” Toomey said.

Politics impede growth

Both Toomey and Money bemoaned the political climate in Washington that’s stymied the ability of community health centers to serve more people.

Money said the state Institute of Medicine estimates 1.1 million North Carolinians will be newly eligible for Medicaid in 2014 if the federal health care reform law survives it’s current challenge in the Supreme Court, and the election this fall.

Money explained that in the Affordable Care Act, passed in 2010, Congress created an $11 billion trust fund to be spent on community health centers over the course of 5-6 years. The goal was to double the number of patients served by centers around the country.

“By 2014, there would be a sufficient amount of capacity to meet the new needs,” Money said. “But the legs got cut out from under it.”

As a result of political fights in Congress in the wake of the 2010 mid-term elections, $600 million in annual appropriations to community health centers has been eliminated.

“The demand continues to increase exponentially and the financial support comes in in dribbles and with uncertainty,” Toomey said. “That’s making it incredibly challenging to take care of people who need to be taken care of.”

The federal Health Resources and Services Administration has made up that money by taking from the community health center trust fund, leaving few dollars to create new health centers. Money said only 67 new centers have been created nationwide, instead of the 250 new centers originally planned.

“That was one of the ways that folks who didn’t like Obamacare could undermine it,” Money said, “by taking away base funding, by taking away the trust fund.”

Grantee Organization	City	County	Award
Immediate Facility Improvement Grant Awards
Piedmont Health Services, Inc.	Carrboro	Orange	$500,000.00
The C.W. Williams Community Health Center, Inc.	Charlotte	Mecklenburg	$500,000.00
Goshen Medical Center, Inc.	Faison	Duplin	$500,000.00
Rural Health Group, Inc.	Roanoke Rapids	Halifax	$500,000.00
Stedman-Wade Health Services, Inc.	Wade	Cumberland	$200,028.00
Building Capacity Grant Awards
West Caldwell Health Council, Inc.	Collettsville	Caldwell	$568,934.00
Goshen Medical Center, Inc.	Faison	Duplin	$4,550,000.00
Rural Health Group, Inc.	Roanoke Rapids	Halifax	$577,320.00
Carolina Family Health Centers, Inc.	Wilson	Wilson	$3,507,460.00

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