Intervention North Carolina Healthy & Resilient Communities Initiative (NC HRCI)

Background

The North Carolina Healthy and Resilient Communities Initiative (NC HRCI) supports state-wide, local multi-sector coalitions in North Carolina who are working to address adversity and trauma at multiple levels (individual, organizational, and community) and who are working to build resilient and healthy communities by increasing protective factors and positive childhood experiences. NC HRCI uses the 4 Realms of ACEs framework to define adversity; this case study will focus on the initiatives addressing the third realm, “Adverse Climate Events.”

Climate Change Impact

North Carolina (NC), located in the southeast region of the United States (U.S.), is experiencing dramatic changes to its regular climate. According to the NC State Climate Office and the U.S. National Center for Environmental Information (NCEI), NC has experienced the following:

• A 2023 average temperature of 60.7°F/15.9°C, ranking it as the 7th-warmest year since 1895Ten hurricanes in the past 10 yearsTwo tropical storms and 21 tornadoes in 2023Drought, specifically in western NC, which led to low lake levels and an active autumn fire season.

According to the U.S. Environmental Protection Agency (EPA) in 2016, the majority of North Carolina has experienced a temperature increase of between half to one degree Fahrenheit, and sea levels are rising at a rate of approximately one inch per decade over the past century. This rising water is causing erosion of beaches, submersion of low-lying areas, heightened coastal flooding, and elevated salinity in estuaries and aquifers (EPA, 2016).

Climate-Related Mental Health Impacts in North Carolina

These unusual climate patterns, such as warmer winters or hotter summers, have notable impacts on mental health, as discussed in the North Carolina State Climate Blog, including:

• Drought conditions contribute to water scarcity, leading to stress and anxiety over water availability for agriculture, households, and industries (SAMHSA, 2023).High temperatures are linked to heightened irritability and symptoms of depression, as well as an elevated risk of suicide. The extreme heat can influence behavior, leading to a rise in aggression, higher occurrences of domestic violence, and increased substance use (APA, 2024).Hurricanes, which pose a risk of loss of life and disruption to transportation and communication services, and enabling isolative environments, have the potential to result in post-traumatic stress disorder (PTSD) and heightened levels of anxiety and depression (Raker et al., 2019).

Additionally, in North Carolina, one study found that self-harm and suicidal ideation peak in warm months (July), while anxiety and depression peak in cooler months (May and September) (Minor, Sugg, Runkle, 2023).

The North Carolina Healthy and Resilient Communities Initiative

North Carolina Healthy & Resilient Communities Initiative works with approximately 50 county-level multi-sector initiatives promoting community resilience to adversity and trauma including those resulting from the impacts of climate change. One of the key focal points for the NC HRCI is addressing “adverse climate events” to create these resilient communities. Their goals include:

1. Developing a unifying framework for addressing childhood adversity and promoting resilience protective factors relating to the impacts of climate change, including mental health impacts;Understanding, defining, and identifying conditions for success related to community resilience outcomes;Co-creating capacity building supports for local systems-change initiatives working to promote health, with attention to mental health, and resilience.

The Initiative employs systems-level collaboration, relationship building, and self-regulation skill training in order to build a physically and mentally resilient community. Numerous North Carolina communities invest in training programs like Psychological and Youth Mental Health First Aid, Community Resiliency Model (CRM), and Reconnect for Resilience (R4R), emphasizing not a change in practice but an enhancement of how existing practices are implemented.

As a resource to support local investments and aid decision-making that affects change in NC families, the NC HRCI team developed an interactive dashboard with visualizations, with data sourced by multiple government and non-government organizations at the local, state, and national levels. The selected indicators are based on the Center for Disease Control and Prevention’s (CDC) 5 Social Determinant of Health categories and markers of structural racism. The dashboard includes indicators, such as suicide rates, substance-abuse related deaths, number of households without vehicle access, number of mental health providers, can aid NC HCRI leaders, policymakers, and healthcare professionals determine the efficacy of their efforts.

The overall objective includes creating safe and supportive environments, providing comprehensive resources, and coordinating efforts across sectors.

Challenges and successes encountered in policy implementation

The Initiative faces several challenges including limited financial resources for implementation, absence of compensated Initiative leaders, and the misconception that responding with empathy to stress behavior is perceived as lenient on crime or misconduct. One successful outcome was the endorsement of NC HRI's strategy from leadership across diverse community systems, including local government, court administration, law enforcement, educational institutions, and healthcare facilities. Securing commitment from these leaders to invest in their personnel and systems was essential for affecting meaningful change within their respective regions.

Key insights and lessons learned

The communities’ motivations for participating in the Initiative varied. Some communities were motivated to take action as a response to traumatic events ranging from destructive climate events to school shootings. Other communities were motivated by an increased awareness of climate related trauma through media, such as through the ACEs Study and the 2016 film, “Resilience.” The approach taken by each community is distinctive, with interventions chosen based on perceived priorities and local needs.

Efforts to rectify unjust community environments cannot rely solely on programs. While effective in improving certain aspects of people's lives, programs often fall short in changing deeply ingrained systems designed for specific outcomes. Instead, efforts must be a comprehensive and holistic approach that combines community engagement, policy advocacy, education, collaboration, and economic empowerment which is essential for creating lasting change in unjust community environments.

Equitable leadership is pivotal, with endorsement from recognizable community leaders providing momentum. However, preventing "power hoarding" and ensuring diverse representation and shared decision-making, particularly by those with lived experience, are essential for genuine community coalitions. This demands fair compensation for the time of those with lived experience who contribute meaningfully to Initiative efforts.

A universal role for all coalition members involves removing systemic barriers of oppression. The willingness of participants to be receptive to altering established practices is crucial for success.

This practice is applicable across diverse contexts, requiring the presence and engagement of multiple sectors, lived experience representatives with decision-making power, and shared values focused on creating safe, thriving environments. It transcends a national program, respecting the autonomy of communities to choose their priorities and work collaboratively toward their goals.

Resources

• North Carolina Community Indicators (Interactive Indicator Map)4 Realms of ACE’sCommunity Resiliency Model (CRM)® — Trauma Resource InstituteResources for Resilience · Resources for Resilience™System Structure & Community Coalitions | Smart StartBuilding Healthy and Resilient Communities One Community at a Time (adobe.com)Kaiser Family Foundation Mental Health Statistics in North CarolinaCenter for Disease Control and Prevention, Social Determinants of HealthResilence Film

References

American Psychiatric Association. (2023). Extreme Heat Can Take a Toll on Mental Health. Retrieved from https://www.psychiatry.org/news-room/apa-blogs/extreme-heat-can-take-a-toll-on-mental-health#:~:text=Extreme%20heat%20is%20associated%20with,with%20an%20increase%20in%20suicide.

Minor, T., Sugg, M., & Runkle, J. D. (2023). Short-term exposure to temperature and mental health in North Carolina: a distributed lag nonlinear analysis. International journal of biometeorology, 67(4), 573–586. https://doi.org/10.1007/s00484-023-02436-0

Ethan J. Raker, Sarah R. Lowe, Mariana C. Arcaya, Sydney T. Johnson, Jean Rhodes, Mary C. Waters. (2019) Twelve years later: The long-term mental health consequences of Hurricane Katrina. Social Science & Medicine, Volume 242, 112610. ISSN 0277-9536, https://doi.org/10.1016/j.socscimed.2019.112610.

National Centers for Environmental Information. (2024.). Retrieved from https://www.ncei.noaa.gov/

North Carolina State University. (2024). Climate Blog. Retrieved from https://climate.ncsu.edu/climateblog/

North Carolina State University. (2024). Hurricanes - Landfalling. Retrieved from https://products.climate.ncsu.edu/weather/hurricanes/landfalling/

Substance Abuse and Mental Health Services Administration. (2023). Disaster Distress Helpline: Drought. Retrieved from https://www.samhsa.gov/find-help/disaster-distress-helpline/disaster-types/drought

U.S. Environmental Protection Agency. (2016). Climate Change in North Carolina: An Assessment of Impacts and Options for the Future. Retrieved from https://19january2017snapshot.epa.gov/sites/production/files/2016-09/documents/climate-change-nc.pdf

Written by

Mebane Boyd (She/Her), Resilient Communities Officer

The North Carolina Partnership for Children

Tulsi Modi, Senior Program Manager

Connecting Climate Minds, North America & Europe

Planetary Health Alliance