Charting the Course 2000-2010 

Overall Project Vision: Health and human services throughout Stanly County are provided in the most rational, coordinated, and focused manner possible, with full program effectiveness to all citizens needing such support and with strong program accountability to all funding sources.

  Stanly County Health & Human Services Community Needs Assessment Survey Results and Analysis

The analysis was overseen by a Steering Committee composed of representatives of the United Way of Stanly County, the Partnership for Children, Stanly County Department of Social Services, Stanly County Health Department, Stanly Memorial Hospital and other organizations.  The Committee selected Charlotte-based Scope View Strategic Advantage, then known as Strategic Developmental Services, to carry out the work and to prepare the comprehensive final report and analysis.

Between March and July 2000, 1,067 Stanly County citizens completed the Health and Human Services Survey that had been reviewed, modified and adopted by the Task Force in February. Of this total, 944 completed the form "in person" in a group setting, while the other 123 were taken and filed on-line at the web site of the Stanly County Department of Social Services or one of the cooperating organizations.

Approximately one in every forty-four local residents thus directly participated in the survey process. Considerable care was taken to insure that not only was the sample deep in terms of numbers, but also that those taking part were drawn from all segments of the county-- including geography, ethnicity, race, gender and age. Meetings were held in each municipality and in a number of unincorporated areas.

In the final analysis, the makeup of the participants generally reflected the makeup of Stanly County in many key aspects:

Male:  47.3%                Female: 52.7%

White: 85.0%                Black: 11.3%                Hispanic: 2.4%                Asian: 1.3%

While the gender division skews slightly to the female side, the racial percentages conform quite closely to the best estimates from the North Carolina Office of State Planning and the U.S. Census Bureau as to Stanly County’s current resident composition.

It should be noted that a number of participants did not fill out the demographic parts of the survey related to race or ethnicity, and that others did not indicate gender. With the exception of the material related to averages for the overall responses, then, the tables and charts that follow do not wholly reflect all forms completed. Still, the substantial number of forms did have all sections completed, and the information presented is statistically valid.

Overall Rating of the Community.

Participants were first asked to rate their community as a place to live by this system: 1= Excellent; 2 = Good;3 = Fair; and 4 = Poor. Unlike the rest of the averages generated by the survey, in this case the lower the number, the better the community is rated. The results overall and by community segment were:

Overall: 2.150. 

Whites: 2.015.     Blacks: 2.383.     Hispanics: 2.676.     Asians: 2.400. 

Males: 2.114.     Females: 2.236.

Participants were then requested to prioritize thirty-one community needs categories from the perspective of existing conditions in Stanly County. It is important to emphasize that the question was not whether an individual category is important, but rather how well that issue is currently being handled, and whether it does in fact constitute a real problem.

The following rating system was used:

1 = Not A Problem.

2 = Minor Problem.

3 = Moderate Problem.

4 = Major Problem.

"Don’t Know" could also be given as the answer.

If a respondent thought that an issue like "Public Education K-12" is critical to the county’s future, but also thought it is being very well handled, then the appropriate rating would have been a 1 or a 2. The higher the average number for a need, the greater the problem.

Participants were then asked to use a similar process to rate barriers to services– those potential or actual problems that might prevent people from using existing services that are available to them.

The rating system was:

1 = Not Serious.

2 = Somewhat Serious.

3 =Moderately Serious.

4 = Very Serious.

"Don’t Know" was again a possible response. As before, the higher the average, the bigger is the problem.

A third portion of the survey dealt with health education matters, and was developed for the most part by representatives of Stanly Memorial Hospital. It asked that respondents rate their interest in a series of potential education topics, delivery methods, timing and costs. These results are contained in the full report, but are not given in this Executive Summary.

With a base of some 1,000 participants, the difference of any one respondent choosing one number higher or lower than the next closest number equates to a difference in the overall average for that issue of .001. For example:

1,000 participants x 3 as an average rank = 3,000. 3,000/1,000 = 3.000 as an average.

(900 participants x 3) + (100 participants x 2) = 2,900. 2,900/1,000 = 2.900 as an average.

(990 participants x 3) + (10 participants x 2) = 2,990. 2,990/1,000 = 2.990 as an average.

(999 participants x 3) + (1 participant x 2) = 2,999. 2,999/1,000 = 2.999 as an average.

A difference of a tenth of a point (.1), then, between the average score of two needs areas is the equivalent of a one point difference of opinion between 100 respondents, or a two point difference between 50 respondents or some similar combination. Any difference six hundredth of a point (.06) or more represents a real separation of need areas. Anything of three hundredth of a point (.03) or less is insignificant.

[The tables and charts that immediately follow this page show the results of the needs prioritization, and the ranking of the barriers to service. Summary results are given for overall responses, and then broken down by racial and ethnic segments.]

1. "Inadequate Public Transportation" was the dominant top priority in the rating of problems and in the barriers to services portions of the survey.

It was the third highest problem area overall, and ranked #3 by Whites, #7 by Blacks, #2 by Hispanics, and #10 by Hispanics. It was the only one of the thirty-one listed needs that ranked in each of these group’s top ten needs. In the Barriers to Service section, it was #1 overall, #4 with Whites, #1 with Blacks, #1 with Hispanics and #4 with Asians. Not surprisingly, it was ranked as a higher need by those outside the Albemarle zip codes than with those living within.

Focus group discussions, survey notes and other comments made it clear that this was not a negative feeling for the Stanly County Umbrella Services Agency (SCUSA), which carries out transportation programs in such areas as Medicaid, elderly and disabled and some general public support as well as contracted services. Indeed, SCUSA was well regarded for what it accomplishes. Rather, the low rating reflects the limited services that can be provided under existing funding arrangements, and the distance from some service providers to consumers– especially outside of Albemarle proper.

2. The Black, Hispanic, and Asian populations of Stanly County view almost all needs as having greater intensity than do Whites.

Differences of .3 and more between Whites and others were not uncommon, even when all groups placed the same needs area in a similar ranking as compared to other needs. For example, the ratings for "Drug Abuse" showed it to be the #1 problem area for Whites, #2 for Blacks, and #2 for Asians. The category had a 3.031 average by Whites, a 3.455 average by Blacks, and a 3.486 by Asians. The issue was rated only #12 by Hispanics, but still had a 3.382 average– 11.6% higher than it was rated by White participants. It had the third highest rating among all respondents.

3. There is a clear recognition of the growing diversity of Stanly’s population.

"Language Barriers" was ranked as the # 2 barrier to service by Hispanics, and #1 by Asians and #6 by Blacks. Overall, it ranked third. Even Whites ranked it #1 service barrier.

4. Illiteracy is a major problem for the Hispanic and Asian populations of Stanly County.

Both groups rated this area as its top problem. There is a clear need for increased participation in English as a Second Language initiatives as well as for service providers to have translation abilities in-house.

5. There is general agreement geographically across the county as to the top priority needs and barriers to service.

There was very strong concurrence throughout Stanly County geographically on the needs rankings. Only in the above noted area of "Transportation" was any discernable difference identified.

6. Local elected officials share the same basic concerns as the citizens they represent.

There was a very positive correlation between general rankings and the weight assigned to those rankings by elected officials taking part in the survey and by citizens at large.

7. Men and women generally see things the same way.

Gender responses differed on certain issues, but overall closely coincided. Each group had eight common needs in its top ten– Drug Abuse, Teen Pregnancy, Inadequate Transportation, Not Enough After School Programs, Alcoholism, Crime, Shortage of Affordable Housing, and Insufficient Support for the Elderly.

8. There is a fairly high degree of lack of knowledge about a moderate number of certain needs areas in the county.

"Don’t know" was a frequent response to some problem areas by all groups surveyed– in some instances surprisingly so. Participants simply felt they didn’t know enough about the issue to give an informed rating.

9. Current "Emergency Care" and "Hospital Services" received strong votes of endorsement.

Virtually every population segment that took part in the survey rated these two areas as having the least problems. They were ranked #30 and #31 in need (out of 31 issues) by Whites and Blacks, Females and Males, #27 and #28 by Hispanics, and #25 and #29 by Asians. They were also the two lowest need areas overall.

10. Although the universe of internet participants was somewhat small, a case can be made that the so-called "digital divide" among racial and ethnic groups exists to some extent in Stanly County.

92% of those individuals completing the survey on the internet were White. 4.4% were Black– notably short of their percentage of the county’s population. The remaining 3.6% were Hispanic. No participants identified themselves as Asian. While web sites offer great long term potential as a health and human services information source, their limited delivery status should be carefully considered in any current educational activities aimed at particular target populations.

 

 

 

Stress Management                    43.35%

Weight Management                   39.53%

Physical Activity and Exercise     32.24%

Heart Attacks/Strokes                 31.69%

Nutrition                                     30.97%

CPR/First Aid                             26.23%

Blood Pressure                           24.23%

Blood Cholesterol                       22.22%

Tobacco/Smoking                        9.47%

Doctors                                            53.01%

Television/Radio                                43.72%

Friends, Family and Other Sources     41.35%

Newspapers/Magazines                     40.80%

Reference Books                               18.94%

Other Health Professionals                 14.21%

Health Promotions at Work                  6.38%

Voluntary Health Organizations            6.01%

Pamphlets and Written Materials       49.91%

Talks by Experts (Seminars)             44.63%

Classes and Courses                        27.14%

Screenings                                      24.04%

Films and Videos                             22.22%

Employee Assistance Programs        21.49%

Discussion Groups                           18.76%

Contests and Incentive Programs        7.47%

Evening Hour                43.35%

Early Morning               26.96%

Lunch Hour                   14.94%

Would Not Participate     7.65%

Weight Control Group       39.71%

Stress Management         38.43%

Walking Group                 37.89%

Parenting Group               21.68%

Blood Pressure               46.08%

Fitness Assessments      39.53%

Breast Cancer                 39.16%

Blood Cholesterol            38.43%

Body Fat                         29.69%

Skin Cancer                    27.69%

Blood Glucose (Sugar)     27.14%

Colon-Rectal Cancer       20.22%

Hearing                          19.49%

Male Cancers                 14.21%

Glaucoma                      12.57%

Oral Health                     10.38%

7. What constitutes a reasonable cost for health screenings?

$5 - $10                 34.06%

Free                      21.86%

$10 - $20               19.49%

Less than $5          11.48%

Greater than $20      5.28%

8. Where would you be likely to attend health education services?

Hospital                     42.62%

Agri-Civic Center         30.24%

Church                       28.23%

Local Library               17.85%

Local Park                   9.47%

IF A DOWNTURN COMES.

The 1990's were a period of almost constant and significant economic growth nationally and internationally. While there were some plant closings and layoffs locally, it was a generally a time of positive developments for the region and the state. It was within this framework that Stanly County’s health and human service agencies functioned.

Despite these economic conditions, many of these organizations were hard pressed to serve all Stanly Countians seeking assistance. Client waiting lists were not uncommon, and many agencies are faced with the continuing problem of allocating finite resources to address substantial needs.

Many economists doubt that the first decade of this century will be marked by the same on-going economic expansion that characterized the last ten years. If and when a slowdown occurs, the impact on Stanly County could well be significant. As there is a direct correlation between economic conditions and the need for many of health and human service programs, such a downturn would have a major effect on the ability of agencies, many of them already challenged, to deliver support to all Stanly Countians looking for help.

HEALTH/HUMAN SERVICES AND ECONOMIC DEVELOPMENT.

In much the same way that the ability of health and human service agencies to be able to expand service through additional tax dollars generated by an expanded local tax base, Stanly’s economic development will depend in part on how well health and human services are being provided. The relationship between these two areas can be very direct.

Stanly County has an aggressive economic development program in place, and a new director with strong ties to the North Carolina Department of Commerce. To an increasing extent, her ability to recruit new businesses will depend on how well various health and human service responsibilities are currently being conducted. While some companies look only or primarily at such basic factors as the costs of land and labor and the availability of utilities in their site searches, quality of life factors can come into play.

Issues such as student performance in the public schools, hospital services, and the quality of the county health support can all be critical to the company’s locational decision-making process– especially when that firm will be relocating people to the area. It is becoming increasingly common for economic recruiters to be asked by their prospects for hard statistical measures of health and human service factors locally.

Without exception, those health and human service professionals interviewed for this report agreed that starting such a council would be a positive development. There are a number of informal discussions among agencies that already occur, but there is no formal setting or regular agenda. There needs to be. Even in the preliminary conversations with the agency heads, a number of potentially significant benefits were identified– for the public as a whole as well as for the organizations.

Meetings should take place monthly, with the primary objective of developing and implementing coordinated programs of service delivery, and recognizing how the assets of each agency can be used to benefit the others.

Very little in the way of criticism was directed during the health and human service survey process toward any specific agency; most citizens appeared to feel that each is doing a good job in its defined field. At the same time, there were comments and questions regarding whether organizations were working together as much as possible. It’s a legitimate question, and the interagency council approach would go a long way to addressing both the perception and the reality of the matter.

It would also be highly beneficial to develop an intergenerational approach among all agencies to health and human service delivery– to look at needs in Stanly County holistically. Certainly, each organization will always have its defined set of responsibilities, limited in some cases by geography, age group, income level or other factors. It is important, however, to develop to the fullest possible extent an approach that emphasizes how the various program pieces should and can fit together.

2: Each public health and human services agency should have a plan in place by January 15, 2001 to maintain an accurate geographically precise definition of needs and service delivery.

Stated simply, needs and service data should always be localized and quantified. During the process of collecting and analyzing statistics on Stanly County and its health and human services, it was often difficult to get data specific to any area smaller than countywide. There are significant differences– economic and otherwise– within the county, and it is hard for comprehensive planning to occur without understanding and targeting these differences. Some agencies have a good feel for these distinctions, some have clearly defined them, while others haven’t addressed this issue.

The 1990 U.S. Census divided Stanly into the eleven census tracts. As detailed in Section IV of this report, there are considerable differences among them in such key matters as per capita income, percent on public assistance, and adults and children living in households with income below the poverty level. For example, the per capita difference in 1990 between the highest tract and the lowest was $6,712, or 43.2%. (This information will be updated as soon as the 2000 Census material is available.)

Recognizing that client confidentiality may sometimes limit how data is compiled and used, it is strongly recommended that each agency look closely at how it is presently gathering information on location of client needs. Wherever possible, geographic clusters of need should be precisely spelled out, and that material shared with other agencies.

Initial results from the 2000 Census should be available over the next year, with more detailed sub-county unit information being issued thereafter. While that will be a good point for agencies to enhance their needs identification activities, it is not enough. If that is all that is done, some agencies will be in precisely the same situation as they are now– relying on Census information that gets increasingly older and hence less relevant as time advances beyond the year when the Census was taken.

3: Each public health and human services agency should document service performance as precisely as possible and from all relevant frames of reference.

From a performance standpoint, units of service delivered is often a reasonably good way of defining how public and private dollars are being spent and needs addressed. Often, however, there is no broader context shown in Stanly County. The real questions are not only how many people are being served in Stanly for how many dollars, but also how those ratios compare with state and national standards– standards that are available for almost any performance category. While some local agencies do well in this regard, it was hard to find that information in many cases. By providing this larger framework, Stanly agencies can enhance their standing with the community and with their funding sources.

4: Get more people to the services or more services to the people.

Either way, it’s a key need. "Transportation" was defined across the board on the surveys as a major problem area and a barrier to service. Almost every focus group discussion, agency interview and general comments raised this matter.

Some combination of additional SCUSA financial support or other transportation services and taking agency services out into the more rural sections of the county is a high priority. There appear to opportunities for organizations with facilities outside Albemarle to have them used by other agencies as well to deliver services. The practicality of every possible arrangement– contractual and otherwise– should be explored in detail. The interagency council will provide a logical forum within which to do this.

5: There should be a heavy on-going emphasis on quality care for Stanly’s youngest citizens.

While "Child Care" was not ranked as a particularly high problem area by participants as a whole or by any sub-group of those taking part, there were questions raised as to the actual quality of children’s services. The scientific evidence is straightforward and compelling as to quality care in the early years making a profound difference in children’s lives as they grow into adulthood.

The issue has particular currency in North Carolina as the state transitions from rating child care centers and homes from either A or AA to a more sophisticated five level star rating program.

The Stanly County Partnership for Children will place continuing emphasis on insuring that definable quality enhancement be the core justification for any grant funds awarded to local child care providers.

Significantly, the Stanly County Department of Social Services lists five family and children’s issues among its top needs for increased services: child protective services, foster care, child enforcement, family preservation and additional child care support. A great need for additional pediatric dental care has been defined by both the Stanly County Partnership for Children and the Stanly County Health Department. That project is currently being pursued.

The "School Readiness" initiative of the North Carolina Board of Education, the State Department of Public Instruction and the North Carolina Partnership for Children should be of particular worth in the years immediately ahead. This program is geared to insuring that not only are young children ready to enter school to start their formal education, but also that the schools are ready to accept them and make the most of the potential for educational and social development that each of those individuals has within.

Stanly County spends fewer local tax dollars per capita on its schools than do most counties in the state. Recent results from the ABC testing demonstrate that local students are performing very well on a number of levels and at a high percentage of local facilities, although SAT scores lag below the state average. The county per capita rate should be brought into alignment with the state figure, and a five year plan to achieve that result has been proposed. It is worthy of approval.

In May 2000, Stanly County voters approved a $26 million bond package for new schools by a two-thirds approval. This is the start of a process to address facility needs, not the end. The student population of the Stanly County Schools is growing at an annual rate of approximately 2-3%. The School Board has indicated its preference for a basic neighborhood schools policy and for maintaining each elementary school enrollment at no more than 600 students.

All of this translates into the need for construction of a new school every two or three years. Also forecast is the need for a new high school in about five years. As a result, there will be a need for a second bond referendum or some other financing mechanism in the foreseeable future if these standards are to remain in force.

The United Way of America played a major part in getting the Federal Communications Commission to designate 2-1-1 as the telephone number for health and human service information nationally in the same way that 9-1-1 is used for emergencies. The FCC officially approved that action in July 2000.

The United Way of Stanly County is greatly interested in serving as a pilot for implementation in North Carolina. It is anticipated that the agency will pursue that project with considerable energy in the months ahead. "Lack of Information" was ranked on the Stanly County Health and Human Services Survey as a major barrier to the effective provision of services, and 2-1-1 activities would be directly aimed at improving that area.

As shown earlier, the three leading causes of death in Stanly County all have much higher rates here than in the state as whole. Local health experts agree that poor diet and lack of exercise are the prime reasons for this fact. The statistics are so much greater in Stanly County that they have a certain shock value, an aspect that should be capitalized on through a major public information program stressing the importance of good dietary practices and exercise programs throughout one’s lifetime. All health and human services organizations should use a common theme and materials to make this point. The issue’s profile should be virtually impossible to avoid for Stanly Countians.

Almost one in five Stanly Countians will be age 65 or older in 2020. The North Carolina Office of State Planning estimates that the age 65+ population of Stanly County will have grown by 35.2% from 1996 to 2020. That will be greater by far than any other age segment in the county.

National figures show that thanks to medical advances the fastest growing sector of the older population in the country is those individuals 85 years of age and older, a trend that will increase even more in the future.

While a high degree of independence is maintained by most older people, it should be emphasized that all health and human service agencies will face the challenge of satisfactorily addressing the increased needs for the aging population caused simply by the sharp expansion of that population itself.

The Stanly County Senior Services Department has identified existing acute needs in the county, including home delivered meals and in-home services. In the latter instance, there is currently a waiting list of 100 people. There is also a need for that agency to expand its out-reach services to older residents not living in the immediate Albemarle area.

The real issue here is how well health and human services agencies can anticipate and plan for the needs of this growing population, and whether appropriate levels of financial support will be provided for that service delivery.

Health and human services agencies should make every reasonable effort to develop their linguistic capability to effectively communicate with these citizens. Right now, residents often must provide their own translators to access services. At the same time, these population communities and the individuals comprising them should make every reasonable effort to use all possible means to develop English speaking skills. The responsibility for overcoming language barriers falls on all parties involved.

Acting in response to the Supreme Court Opinion in the case of Olmstead v. L.C., a case based on discrimination under the Americans with Disabilities Act (ADA), the North Carolina Department of Health and Human Services holding a series of public meetings across the state concerning the development of a plan to provide services for people with developmental disabilities in the community. There is clear judicial mandate to prevent the institutionalization of these citizens and integrate them as fully as possible into the community in general. Other health and human services organizations should cooperate with such agencies as The Arc of Stanly County and Piedmont Behavioral Healthcare in making Stanly County as community-friendly as possible to those individuals and their families.

The use of overall statistics for Stanly County tends to blur the fact that there are widely varying degrees of well-being and need within the county. While Stanly often ranks in the middle of North Carolina’s counties by many of the socio-economic indicators shown on the five previous pages, an analysis of individual parts of the county shows that there are, in fact, areas of substantial need for economic, health and human service support.

The 2000 U.S. Census divided Stanly into the eleven census tracts. There are substantial differences among them in such categories as per capita income, percent on public assistance, and adults and children living in households with income below the poverty level. Compared below are the per capita incomes of those sub-units. The far right column of the table shows each area’s income figure as a percentage of the Stanly County average per capita income in 1999. The difference between the highest tract (9904) and the lowest (9905) was $7,605, or 52.8%. This is almost 10% greater than similar differences shown by the 1990 Census.

Similar, although somewhat more tightly clustered, are the 1999 income distinctions among the four Block Groups in the wealthiest Stanly County Census Tract– 9604: