Internship Product

Durham County Department of Public Health
Parris Mitchell
Integrated Learning Experience Product
Spring 2018
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Table of Contents
Introduction…………………………………………………………………..3
Potential Evidence-Based Strategies………………………………………....4-6
Listening Session Schedule…………………………………………………..7
Community Health Assessment Listening Session Facilitator’s Guide……...8-17
Listening Session Results from Durham County South Regional Library….18-23
Listening Session Results from Durham Center for Senior Life…………….24-30
Listening Session Results from Durham County East Regional Library……31-39
Listening Session Results from LGBTQ Center…………………………….40-45
Listening Session Results from CAARE……………………………………46-54
Listening Session Results from Duke Regional Hospital…………………...55-60
Qualitative Data Analysis……………………………………………………61
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Introduction
The 2017 assessment process included 358 resident surveys from randomly selected
households. The 2016 Durham County Community Health Assessment Survey asked residents to
rank their top three community issues, health problems and services needing improvement. A
random sample of households throughout the county were chosen in addition to a random sample
of neighborhoods with more than 50% Latino households.
To narrow down the results of the 2016 Durham County Community Health Assessment Survey,
an online survey in both English and Spanish was distributed. The survey was also conducted in
person at grocery stores, libraries, Durham County Department of Public Health clinics, and bus
stations during January and February 2018. Based upon the new top health priorities the
Partnership for a Healthy Durham will vote on which committees to focus on from 2018-2021 at
the April 18, 2018 Quarterly meeting. The Partnership will then begin creating a community
health improvement plan (CHIP) to address the top priorities.
Durham County’s top five health priorities are listed below:
Durham County Health Priorities

1. Affordable housing
2. Access to healthcare and health insurance
3. Poverty
4. Mental health
5. Obesity, diabetes, and food access
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Potential Evidence Based Strategies
Affordable housing
 Healthy home environment assessments

Train volunteers and professionals to help residents access and remediate environmental
home health risk ad recommend low cost changes.
http://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-
health/policies/healthy-home-environment-assessments
 Affordable housing tax increment financing (TIF)

Create designated tax districts that generate revenue to invest in affordable housing
initiatives, blight remediation, and economic development efforts. In tax increment
financing (TIF) districts, a district’s tax "base" is defined by local property values before
improvements are made. Some or all of the tax revenue above the base rate is designated
to support affordable housing, sidewalk improvements, utility upgrades, and other
infrastructure investments in the TIF district.
health/policies/affordable-housing-tax-increment-financing-tif
Access to healthcare/health insurance
 School based health centers

Provide primary and preventive health care services on school campuses for elementary,
middle and high school students.
https://www.healthypeople.gov/2020/tools-resources/evidence-based-resource/health-
equity-school-based-health-centers
 Behavioral health primary care integration

Revise health care processes and provider roles to integrate mental health and substance
abuse treatment into primary care. Doing this brings mental health and/or substance
abuse screenings and treatment into primary care settings.
health/policies/behavioral-health-primary-care-integration
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Mental health
 Mental Health First Aid

Mental health first aid is an 8 hour course that teach individuals how to identify,
understand and respond to mental health illnesses and substance use disorders. The
programs gives individuals the skills to provide initial help and support to those who may
developing a mental health disorder or experiencing a crisis.
https://www.mentalhealthfirstaid.org/
 Project Launch
Project Launch is a program that aims to promote the wellness of young children (age’s
birth to 8) by addressing physical, social, emotional, cognitive, and behavioral aspects of
their development. One strategy Project Launch focuses on is infant and early childhood
mental health consultation in early care and education programs.
https://healthysafechildren.org//grantee/project-launch
 Mental health benefits legislation

Mental health benefits legislation regulates mental health insurance to increase access to
mental health services. Under Mental health benefits legislation health insurance plans
have no greater restrictions for mental health coverage than for physical health coverage.
health/policies/mental-health-benefits-legislation
 Telemental health services

Telemental health services are mental health care services provided over a distance via
telephone or videoconference. Services can include psychotherapy, counseling,
supplemental support services accompanying face to face therapy, and self-directed
services such as online cognitive behavioral therapy.
health/policies/telemental-health-services
Obesity, diabetes, and food access

 CATCH (Coordinated Approach to Child Health)
CATCH is a program designed to help kids move toward healthier lifestyles and prevent
childhood obesity by using a holistic approach to child health promotion targeting child
nutrition services, the classroom, physical education, parents, and the broader school
community. The program aims to create behavior change by enabling children to identify
healthy food choices and increasing the amount of moderate to vigorous physical activity
children engage in on a daily basis. CATCH includes programs for schools K-8,
preschools and afterschool programs and summer camps.
https://catchinfo.org/about/
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 Farm to Work
Farm to Work is an initiative that works to promote individual and group level change by
increasing access and availability of fresh fruits and vegetables from local farms in the
work place.
https://sustainablefoodcenter.org/programs/farm-direct/farm-to-work
 Shape NC
Shape NC is an initiative created to increase the number of children starting kindergarten
at a healthy weight. Shape NC uses a comprehensive and integrated approach to help
communities and child care centers develop environments, practices and policies that
encourage young children to be healthy.
http://www.smartstart.org/shape-nc-home/
 Work Well NC
Work Well NC provides worksites evidence based and practice based tools and strategies
to create and support effective workplace wellness programs.
http://www.workwellnc.com/
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Listening Session Schedule
 Durham County South Regional Library, Feb 24th, 10:00AM-12:00PM
 Durham Center for Senior Life, Mar 6th, 11:00AM-1:00PM
 Durham County East Regional Library, Mar 6th, 5:30PM-7:30PM
 LGBTQ Center, Mar 8th, 1:30PM-3:30PM
 CAARE, Mar 14th, 12:30PM-2:30PM
 Duke Regional, Mar 15th, 12:30PM-2:30PM
The purpose of the listening sessions was to talk with Durham County residents about the top
health priorities and their ideas to address them. The Partnership for a Healthy Durham hopes to
obtain specific, actionable feedback to use on the 2018-2021 community health improvement
plans.
The goals of the sessions were to:

 Gather feedback from Durham residents about barriers for the top health priorities and
discuss strategies to address them
 Obtain qualitative data from the community
 Ensure that all ideas are heard, valued and captured
 Collect and share data with community agencies, organizations and partners about how to
address issues concerning Durham residents
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Community Health Assessment Listening Session Facilitator’s
Guide
February/March 2018
*Facilitators and notetakers should arrive 30 minutes prior to the scheduled start time*
Session format:
Assuming there are a minimum of 15 participants, the sessions will follow this format:
 Brief presentation of Community Health Assessment (CHA) results and prioritization survey.
(This will occur while people are still settling in and getting their food.)
 Describe the fish and lake analogy to attendees to set the context for discussing ways to
address health priorities. (Using a systems level approach instead of individual-based)
 Ask questions #1, #2 and #3. (This will be in small groups with a facilitator and note taker
with each group. Each group will cover the top 5 health priorities with a limit of 15 minutes
each topic.)
 Report back to the large group
 One of the facilitators will inform the group of next steps.
Listening Session Ground Rules for Small Groups:

 Everyone participates, nobody dominates
 Keep your responses brief and to the point
 Everyone’s opinion is valuable
 Listen carefully and not interrupt
 Don’t be afraid to repeat ideas
 Respect the confidentiality of other participants
 Be respectful of the other participants
Questions:
1. What does it look like to you to have (insert health priority)? The purpose of this
question is to find out what the optimal state is for the health priority.
2. What are barriers to you having (insert health priority?)
3. What ideas do you have to address these barriers?
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An example of how the series of questions would work is on the following page. The topic of
affordable housing was used in the small group run through.
What would it look like for What are barriers to What ideas to you have to
you to have affordable affordable housing in Durham? address these barriers?
housing in Durham?
 High rent, gentrification leads  Policy changes/fines for
 Landlord provides free to high rent landlords if don’t respond
basics (safe, even stairs,  Low wages within a specific time for
light bulbs, updated  Slumlords- neglecting duties, tenant repairs
features) resident requests, eviction  Prohibited from threatening
 Not stress about paying rent threat eviction in response to tenant
 Money left after rent to pay  Felony/criminal record request
bills, eat, live  Violence in “affordable area”  Tenant discounts on rent for
 Not living check to check  City/County leadership not community volunteering
 Stable rent, not forced out supportive/paying attention  Appeal to elected officials
(less displacement)  Application process/credit  Safer neighborhood
 Fair housing laws/fair check environment, less robbery
enforcement for law  Feelings of judgement and guns
abiding residents  Rent control policy
 *Facilitator will need to ask
No lead, asbestos, roaches,  Changes to qualification
mold, sagging roofs in follow up questions to get at the
process/approval
housing (no housing that root of the barrier and more
makes you sick) details by what the individual
 A safe place that’s also means to get to the larger issue.
affordable
Discussion questions:
One question for each topic is a personal question to be used with community members. A more
general question is to be used when trying to gain a different perspective such as from healthcare
providers.
AFFORDABLE HOUSING
 What would it look like for you to have affordable housing in Durham?
 What would it look like if everyone in Durham had access to affordable housing?
ACCESS TO HEALTHCARE
 What would it look like for you to have access to the healthcare you needed?
 What would it look like if everyone in Durham had access to the healthcare they needed?
POVERTY
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 What would it look like for you to have the money and resources you needed to live?
 What would it look like if there was no poverty in Durham?
MENTAL HEALTH
 What would it look like for you to be mentally well?
 What would it look like if everyone in Durham was mentally well?
OBESITY and DIABETES

 What would it look like for you to be able to maintain a healthy weight/manage diabetes
or other chronic health condition?
 What would it look like if everyone in Durham was able to maintain a healthy
weight/manage diabetes or other chronic health condition?
Listening Session Logistics:
Roles:
 Facilitators: There will be one facilitator at each table. The facilitator will ask the
questions provided and encourage attendees to participate. Facilitators should not ask
leading questions or offer their own ideas. It is up to the facilitator to probe to ask for
more details if responses are to general.
 Notetaker: The notetaker will keep the group on schedule, organize responses and work
to compile answers.
 Timekeeper: Leads the entire room, acts as guide for the meeting. Keeps the room on
track by keeping time and giving reminders. There will be 15 minutes each for the 5
topics discussed. Provides a five minute warning for each 15 minute segment.
 Floaters: Will answer questions and assist as needed. They will also provide support to
tables as needed and remind facilitators about time.
NOTE: Facilitators should avoid correcting participants or allowing table arguments over the
"correctness" of a participant’s thinking. Different ideas, experiences, and perceptions must be
allowed. Participants may have ideas or beliefs that do not reflect what others believe or know to
be true.
Listening Session Items:

 2018 CHA Prioritization Survey data sheets
 Stop watch/timer
 Notepad/Flipchart for each group
 Easels to hold up flip charts for each group
 Markers
 Pens
 Paper
 Sign in sheets
 Media release forms
 Camera
 Participation waivers
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 Copies of facilitation guide for each facilitator
Facilitator and Notetaker Guidelines:

 Write questions on easel pad paper before the session
 Have questions available on a piece of paper to give to participants at the beginning
of the session
 Set up tables in room for groups between 5-8 individuals.
 Switch notetakers during the session so one person isn’t writing on the large easel
pads the entire session
 Make sure participants stay within each question to make notetaking easier. If
participants start answering questions #2 or #3 before it’s time, ask them to focus on
current question.
Time Agenda Item Process Notes On Projector Screen

(Prior Sign in All High level agenda
to start  Direct attendees to sign in
time)  Let attendees know we will be taking
pictures and ask if it is okay to
photograph them. If it is, ask them to
sign a media release
 Let attendees know we will be
recording the conversation so we can
capture the discussion and identify
key themes later. Attendees must
sign a waiver in order to participate
in the session.
10 Welcome & Overview Timekeeper High level agenda
mins (Can be done while  Welcomes everyone, thanks them for
attendees sign in and get coming, & gives brief overview of
food) day
 Note the purpose of the meeting,
what hope to accomplish
 Do a quick round of introductions-
name and why attended listening
session that day
10 CHA Overview DCoDPH Staff person (Denver) Slides on CHA
mins  Staff from Durham County
Department of Public Health will
present on the CHA process and how
we got to listening session
3 mins Transition to Small Group Marissa Info on "Parking Lot"
Discussion  Explain the fish and the lake analogy
(There should be no more  Explain the small group setup Introduce the anonymous
than 10 attendees at one  Outline ground rules small comment box
table)  "Parking Lot" in the back (butcher
paper) for ideas or comments that
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don't get covered in the table
discussion
 Turn over to Facilitators and
Notetakers
Facilitators and Notetakers

 Introduce themselves
15 Discussion Topic #1 Lead Facilitators Topic #1 Title
mins 1. What does it look  Read question aloud
like to you to have (insert  Give participants 30 seconds to think
health priority)? The individually (Attendees who RSVP’d
purpose of this question were emailed the questions prior to
is to find out what the the listening session.)
optimal state is for the  Ask attendees to share their ideas
health priority.  (There will be preset responses
2. What are barriers to available to the first question based
you having (insert health on survey results. At least three or
priority?) four prewritten responses will be
3. What ideas do you needed to guide the lake level
have to address these discussion. Attendees can add to list
barriers? for no more than 5 total.)
Notetaker 1
 Label your flip chat with topic and
question number
 Write responses from attendees.
Follow example on page 2 for set up.
Make sure to place responses for
each question on separate flip chart
sheets. Place sheets next to each
other so attendees can see how they
relate.
 If similar ideas are shared from
multiple people, add to what exists
instead of writing similar answer
again.
Notetaker 2
 Take detailed notes on the
discussion. Notes will be used to
identify themes later.
Facilitators
 Remind participants that all of their
ideas will be captured and shared.
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 Remind participants to keep thinking
of the lake level and not the fish
during the process.
 Remind participants to keep their
thoughts brief in order to allow
everyone to share their ideas. Let
people know ahead of time that
anyone who is dominating the
conversation will be gently reminded
to allow others to contribute to the
conversation.
health priority)? The individually
purpose of this question  Ask attendees to share their ideas
is to find out what the  (There will be preset responses
optimal state is for the available to the first question based
health priority. on survey results. At least three or
2. What are barriers to four prewritten responses will be
you having (insert health needed to guide the lake level
priority?) discussion. Attendees can add to list
3. What ideas do you for no more than 5 total.)
have to address these
barriers? Notetaker 1
question number
relate.
again
Notetaker 2
Facilitators
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 If needed, continue to remind
participants to keep thinking of the
lake level and not the fish during the
process.
purpose of this question  Ask attendees to share their ideas &
is to find out what the write ideas on flip chart paper
optimal state is for the  (There will be preset responses
health priority. available to the first question based
2. What are barriers to on survey results. At least three or
you having (insert health four prewritten responses will be
priority?) needed to guide the lake level
3. What ideas do you discussion. Attendees can add to list
have to address these for no more than 5 total.)
barriers? Notetaker 1
question number
relate.
again
Notetaker 2
Facilitators
 If needed, remind participants to
keep thinking of the lake level and
not the fish during the process.
5 min Break Facilitators and notetakers- Encourage
participants to stand up, stretch, get
food, etc. Session will start again in 5
minutes.
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barriers?
Notetaker 1
question number
relate.
again
Notetaker 2
Facilitators
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barriers?
Notetaker 1
question number
relate.
again
Notetaker 2
Facilitators
2 mins Choose spokesperson Facilitators "Identify a spokesperson
 Ask for representative to share for your table."
table's answers with the room
Select top idea for each question based

on consensus or voting.
15 Report Out Lead Facilitator (Marissa) "Reporting out"
mins  Explain the reporting out, remind
about time available.
Each table will share their top idea for
each question (2 mins).
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 Note that the report out will be
recorded but everyone's answers will
be captured.
 Timekeeper invites group
spokesperson to share one at a time.
Spokesperson
 Shares their group’s top idea for each
question.
5 mins Conclusion & Follow Up Lead Facilitator (Marissa) Details on next steps and
 Thanks everyone for attending where people can find
 Give details about next steps- more information.
sharing data, Partnership committees
 Explain where people can find more
information
 All feedback will be compiled into a
single document
 Tell attendees they can continue
conversation using butcher paper
station or interview.
Things to remember:
 Let listening session participants know all ideas may not be addressed.
 Remind participants to keep thinking of the lake level and not the fish.
 Have a box at each session where people can submit anonymously ideas that didn’t make it
into the small groups.
 Have a parking lot to address issues that weren’t discussed during the session.
 To save time, pull responses from the 2016 CHA survey and research to list under question
#1. Start with three to four bullet points and have participants add.
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Listening Session Notes from South Regional Library
Notetaker 1
Mental health
What would it look like to be mentally well?
-Less stress about basics, all basic needs met (enough money)
-Ability to manage stress (therapy, exercise, etc.)
-Enough motivation to work and laugh
-Increased community belongings
-Lack of isolation
-Social support system
-Lower levels of toxic stress
-Less bullying and more resources for it
What are the barriers to mental health in Durham?
-Not having good health care and trauma informed physicians
-Adverse childcare experiences, lack of providers to address these issues
-Stigma
-Lack of access
-Lack of diversity from providers
-Lack of mental health coverage
-Affordability
-Lack of counselors or trainings in schools
-Lack of ability to identify people with mental health issues
-Lack of overall solutions/options for people
What ideas do you have to address these barriers?
-Mental health for everyone such as in schools and at work
-More available programs such as EAPs
-Mental health assessments for children on a yearly basis
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-Shift priorities to mental health evidence based programs/programs that work
-Support for parents
-More education for parents, schools, and providers on diagnosis disparities
-More education on options for mental health range and treatments
-Implement other options before turning to medication as the first option
-Education for parents on medication effects
-Offer meditation in schools as an option
-Change expectations of teacher perspectives for children in schools
Affordable housing
What does it look like for you to have affordable housing in Durham?
-Able to pay basic expenses (emergency money)
-Job availability
-Rental assistance programs
-Rent below fair market rate
-Range of housing options for people across all income spectrums (multiple price points)
-Options for people with disability
-Income based rent on variable schedules
-Protect existing affordable options for renters and owners
-More options for ownership like land trust homes
-Smaller/modest affordable options
-Recourse for those under eviction threat
What are barriers to affordable housing in Durham?
-No incentive for affordable options
-Non-competitive incomes/salaries
-Legal/legislative restrictions to affordable housing mandates
-Lack of credit, job history, and jobs for late teens/young adults
-Housing application fees
-Property tax increase because gentrification
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-City/county advocacy for affordable housing
-Regulations for developers
-Address systemic racism
-Accountability around affordable housing requirement
-Distinguish low income from low resource for those eligible
-Accountability for landlords (ex. safe housing)
-Determine short and long term solutions (Bell’s mayor challenge for vets, loosen restrictions on
income requirements, room for growth)

What would it look like for you to have access to the healthcare you needed?
-Easy to navigate health insurance
-Mental and physical health services available
-Increased focus on preventative care
-More options for middle income categories
-More diversity in providers (POC, LGBTQT, database of providers)
-Medicaid expansion
-Holistic health
What are barriers to having access to healthcare?
-Cost of insurance, copays, medications
-Transportation
-Difficult to navigate system, system to complicated (especially for 16-24 year olds)
-insurance, providers, etc.
-lack of knowledge of how to navigate
-Not prioritizing patient provider relationship
-Lack of provider-provider communication
-Education on primary care providers
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-Sliding fee scale insurance, medications, etc. (replicating Lincoln model for private insurance,
more clinics)
-Cultural competency/racial equity training for providers
-Involve incentives to insurance companies
-Increase accountability of pharmaceutical companies
-Increase emphasis on holistic approaches
Poverty
What would it look like for you to have the money and resources you needed to live?
-Living wage mandatory
-Affordable childcare
-Smiling happy people
-Social services
-Less crime because there are more options for money
What are barriers to having the money and resources needed to live?
-Lack of free preschool
-Long with for childcare subsidy
-Strict income restrictions for subsidy qualifications
-Complicated system, too many documents
-Gender wage gap
-Education for regular living wage jobs
-Quality education
-Lack of generational wealth in communities of color
-Free preschool/universal daycare
-Reparations
-Targeted job fairs and increased training for competitive jobs
-Scale up existing programs
-Supporting entrepreneurs, build wealth
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-Short term jobs to pick up liter
What would it look like for you to be able to maintain a healthy weigh/manage diabetes or
other chronic health condition?
-People out exercising, walking, being happy
-Fresh food instead of processed
-More sidewalks-connect to places
-Affordable, fresh food-support for farmer’s markets, more hours
-More spaces to be safely active
-More farm stands and farmer’s markets
-Less food deserts
-Safe modes of transportation other than cars
-Safe ways to get places
-Education on food labels and food shopping
-Better labeling for WIC approved food and education for grocery store staff
-More appealing to be vegetarian
What are barriers to being able to maintain a healthy weight/manage diabetes or other
chronic health condition?
-Processed food is cheaper than fresh food and more accessible
-Misleading food labels
-Not enough healthy food options
-Lack of affordable and healthy food options in workplaces
-Emotional attachment to food
-Lack of affordable gym options and trainers/coaches with personal weight loss experience
-Education for children on how to eat healthier
-Better healthier options for free reduced lunches
-Put healthy foods first in lunch line
-Workplaces encourage spaces for healthy foods and physical activity-culture change
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-Fruit stands at workplaces
-Redo pathways on relationships with food from childhood
-Black farmers get land back
-Affordable gym options, coaches for people trying to lose weight, peers who’ve got through it
-Incentives for coaches to volunteer hours
-More sidewalks and greenways
-Invest $2 million dollars on sidewalks and trails and save $6 million a year on medical costs
-Farmer’s markets more accessible- hours and location so families make one stop
-Make sure sidewalks and trails go to parks, health centers, workplaces, and gyms
-Activity for older adults homebound
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Listening Session Notes from Durham Center for Senior Life
Notetaker 1
Affordable housing
What would it look like for you to have affordable housing in Durham?
-Clean and safety housing
-Affordable housing for older adults
-Housing for older adults that’s separate from young children
-Enough money left over after paying for housing to enjoy life and pay for other things
-Adequate parking
-Taking homeless people off the street
-Tax rates that protect fixed incomes
-Diverse communities
-Affordable options for all ages
-Reasonable utilities
-Income
-Private investors not building affordable housing
-Parking
-Transportation from place of residence to other places
-Affordable housing for seniors, in particularly
-Convenience to stores, medical facilities, etc.
-Lack of incentives for builders to build affordable housing
-Lack of knowledge about where to find what you need
-Zoning/eminent domain
-Info not distributed well
-Higher taxes/gentrification
-No laws/mandates (set asides)
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-No focus on vulnerable, low income and middle class
-Racism
-Political/social norms/mindset
-Lack of diversity
-No focus on disabled/aging
-Access to better resources
-Resources clear and easy enough for seniors to understand
-Individuals should be more proactive
-Increase the amount of money that goes towards affordable and low income housing
-Give the city more money to go towards low income housing
-Set asides at county level
-Civics in education curriculum
-Involving community members in housing development
-More effective info distribution (publicity)

-Universal insurance so everyone has the ability to go to the doctor and afford medications
-Putting healthcare services in places where people already are (Ex. in the mall)
-Everyone has equal insurance
-Everyone has access to the same health services
-Mental, dental, and vision included in health plans (one stop shop)
-Resources/center for mental heal ad substance use
-Transportation access
-Focus on prevention not just treatment
What are barriers to having access to healthcare?
-Accessible transportation
-Lack of information or knowledge from primary care providers about health services
-Language/mental capacity (unable to understand what’s being told/explained)
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-Lack of family support
-Unaffordable healthcare
-Discrimination (ex. mental health and substance use issues/lack of voice)
-Services unaffordable
-Lack of knowledge (prevalence, basic info, cost, etc.) not addressing interconnectedness of issues
-Transportation to all locations (satellite location)
-Long waiting periods
-Deductibles
-Referrals delay treatment
-No point person/easy system to identify resources
-Lack of respect from doctors
-No patient centered care, all business oriented
-Health and human services has more responsibility such as home visits for seniors
-More exercise programs in housing facilities
-More health education in housing facilities
-Pairing retired doctors/healthcare workers with seniors to help individuals navigate the health system
-More remote health visits, group visits, and health programs
-Using private money more effectively
-Universal healthcare
-Integrate mental health and physical health services
-More primary care providers to increase access to walk in/mobile clinics with stable hours
-More screening services/prevention
-Money, grants
Poverty
-Peace of mind
-Less stress
-Vocational training for people leaving prison
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What are barriers to having the money and resources needed to live?
-Not having politicians that work to address these issues
-Lack of training and education which leads to lower paying jobs
-Lack of teaching about financial issues, such as budgeting
-Lack of jobs
-Unable to afford adequate housing
-Unaffordable healthcare or lack of access to necessary health services
-Unemployment
-Lack of caring people in charge
-Lack of respect by employers and employees
-Money
-No affordable housing
-No transportation
-Insufficient social programs/benefits
-Affordable daycare and adult daycare
-Healthcare is motivated by profit
-Raising the minimum wage
-Knowing what resources are available
-Financial education
-More family support
-Electing officials that care about poverty and working to address the issue
-Budgeting classes and vocational and employment training in high schools
-Increase public transportation, need lines/routes that connect (comprehensive county wide)
-Free accessible county buses
-Timely transportation and supplemental
-Affordable housing
Mental health
What would it look like for you to be mentally well?
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-Durham would be a peaceful place
-More mental health education to reduce stigma and eliminate fear
-More mental health services
-Less crime
-Additional/adequate care for substance abuse
-Access to integrated physical health services (one stop shop)
-Transparent communication between doctors and patients
-Knowing what is in the range of “normal”/mentally well
-Access to affordable services (sliding scale)
-Access to social support and physical activity
-Broad understanding of the brain to empower people to make their own informed decisions
What are barriers to mental health?
-Not enough resources for substance abuse and mental health
-Lack of adequate facilities
-Lack of education related to mental health issues
-Individuals being sent to prison when what they really need is healthcare
-Stigma
-Expensive
-Dirty air/pollution
-Fear for your safety
-Community/police relationships
-Safe syringe program (lack of)
-Lack of free, accessible condoms
-Lack of integrated care that’s accessible
-Lack of support groups
-Transportation
-No anonymous ways to access care
-No early intervention programs for dementia
-No mental health in schools
28
-Electing officials that care about mental health issues
-Making sure that mental health remains covered under health insurance
-Pass more laws that allows family members to have other family members committed for mental health
and substance abuse health care
-Eliminate the stigma of mental health
-Online support groups
-Integrated treatment
-Free/comprehensive public transportation
-Trained counselors in schools to health with mental health
-Training for the sheriff and police departments on mental health and dementia
Obesity, diabetes and food access

What would it look like for you to be able to maintain a healthy weight/manage diabetes or other
-Proper medication and knowledge of its use
-More exercise opportunities for people/more access
-Able to afford healthy foods
-More home health visits for obese people for medical services
-Knowledge of how to prevent or manage chronic conditions and support by physicians and case
managers
-Healthy restaurants/on the go options that are affordable
-Reasonable serving sizes
-Eat organic foods that are affordable
-Eat green bananas (knowledge)
-Reliable, non-biased info on food and nutrition
What are barriers to being able to maintain a healthy weight/manage diabetes or other chronic
health condition?
-Lack of nutrition education/cooking education classes
-People can’t afford healthy foods/healthcare
-Lack of access to grocery stores in some neighborhoods
-Different neighborhoods have different quality foods
29
-Lack of funds
-Food deserts
-Junk food cost is less/cheaper than healthier food
-Mistrust of the food industry
-Lack of knowledge on what is healthy, food preparation, spices, etc.
-Transportation
-Social network may negatively affect decisions and temptations
-No places to exercise
-Social norms for kids-exercise is not appealing
-More nutrition/cooking education in people’s homes or where people already are
-More places for people to exercise that is affordable and convenient
-Better education/information about where individuals can exercise and available physical activity
resources
-Educate people about the importance of taking their medications
-Mobile clinics
-Transportation to bridge gaps in food deserts---location of bus stations-locations should be closer
together with more frequent pick up times and buses on each line with hours after 6pm
-Soda tax
-Trainings in community on dementia
-Home economics in high schools
-Warning labels on food packages
-More diabetes screenings
-Pre diabetes prevention education
-Screening options that don’t involve sticking finger
-Affordable medications
-Realistic education/tips and accessible treatment
30
Listening Session Notes from East Regional Library
Notetaker 1
Affordable housing
-Building lasting structures
-Maintaining a variety of different levels of affordability
-Rent curves
-Planned community-food, transportation, recreation
-Elimination of sanctuary city
-Emergency assistance for home repairs
-Protection in policies for residents
-Being able to pay for where you want to live
-Meeting families where they are
-Equality for housing (equal opportunities for housing)
-Taxation- lowering taxes for homeowners in areas where they were once low
-Evictions/credit history
-Gentrification
-Capitalism
-Unoccupied housing
-Zoning policies
-Not enough affordable housing
-Cost
-Spike in taxes
-Income
-education for outreach on how to own a home
31
-Community impact bonds
-Intentional city planning
-Creative construction- combining housing and parking
-Increase awareness of existing resources
-Address zoning policies
-More education sessions for homeownership
-Invite people with stories that have been affected
-More housing built that are affordable in the county
-More funding programs
-Upgrade facilities
-Shorter wait hours
-Service driven
-More specialized attention
-Community health worker-bridge
-Healthy city and environment
-Health grocery store access
-Increased competition in healthcare
-Repeal Affordable Care Act
-Universal health care
-Support for caregivers and resources for caregivers
-List of agencies of available resources
-Transportation that’s easy, safe, and affordable
-Including mental health when talking about healthcare
-More affordable health services
-Easy, convenient accessibility to medications and disposal
-Holding physicians accountable for malpractices
What are barriers to having access to the healthcare you need?
32
-Lack of communication about resources
-Lack of paid positions
-Systemic/historical racism
-Financial resources- lack of access to sufficient insurance
-Capitalism
-Lack of access of services for mental health
-Financial disparity (have money=live, no money=die)
-Not expanding Medicaid
-Language barriers
-Health literacy
-Understaffed health clinics
-Silos
-Cost
- Convenient and direct transportation to health care services
-Language and culture
-Lack of cultural competency
-Tap into existing resources
-More staff in health providers offices and hiring diverse staff
-More patient navigators
-More transportation services
-Keep social workers in the loop
-Training grandmothers on park bench or just lay health leaders on/in mental health services (Just
thinking outside the box)
-Increasing premium help
-Higher tobacco tax
-sugar, sweet beverage tax increase
-Providing translation services- telehealth, online health
-Treat people with respect
33
-Limit healthcare to what it most efficacious
-Accountable health communities
-Increase health staff in clinics
Poverty
-Working people making enough to live
-Not having to sacrifice and choose between necessities
-Trained workforce/meaningful work example Germany
-Opportunities for formally incarcerated to rejoin workforce and obtain housing
-Work/life balance (get paid enough from 1 job)
-Realistic expectations
-Food security
-Constantly growing and improving economy
-Educated workforce
-Equal opportunity for advancement
-Pay equity
-Quality transportation (Extending bus routes, light rail)
-Better leadership in the workplace
What are barriers to having the money and resources you need to live?
-Incarceration/felony (housing, jobs, education)
- -isms (racism, sexism)
-Victim mentality
-Access to affordable education
-Lack of publicizing services such as criminal record expungement
-Treatment of immigrants
-Dehumanization
-A historical perspective on country history
-Lack of adequate leadership
-Lack of recognition in the work place
34
-Pay inequity
-Understaffed schools/lack of supplies in schools
-Racism
-Trainings for professional development
-Income
-Better jobs/lack of jobs
-Lack of quality employment
-Lack of affordable childcare
-Stress
-Prison reform- see people as contributing citizens
-Education that would deter participation in human trafficking and illegal immigration
-Restorative justice- rights back for formally incarcerated, compensation for work while in prison,
acknowledgment degree
-Raising minimum wage
-Apprenticeship opportunities
-Hope scholarship type programs example. Georgia, community colleges
-Better trained leaders
-Supporting laws and polices relative to pay inequities
-Universal pre-k
-Strategic auditing on racism
-Raising the minimum wage
-Funding to support trades
-Onsite daycare at workplace
Mental health
-Recovery-being able to live, be productive and function with a mental illness
-Adequate social support (Threshold made available-expand services of the New York model)
-Access to culturally appropriate mental health services with or without insurance
35
-Basic needs met
-Reasonable treatment for addictions
-Naloxone by police
-Wellness city organization
-Reduction in adverse events (sexual abuse, spousal abuse)
-Safe communities
-Integrated mental and physical health
-Mental well-being across the lifespan (birth to death)
-Affordable services for uninsured
-Having employers honor mental health days
-Employer provided mental health training
-Stigma of mental illness
-Not seeking help
-Stigma of mental illness from employer’s perspective
-Lack of resources
-Lack of positive self esteem
-Lack of positive environment
-Funding to support people without insurance
-Lack of long term mental healthcare facilities, staff, community support and policies
-Pharmaceutical companies
-Limited resources, fewer providers
-Being uninsured
-Access to emerging services
-Untrained first responders no recognizing the signs
-Lack of knowledge around mental health
-Stigma
-Lack of caseworkers/power of attorney
-Culture
36
-Fear
-Longer vacations
-Increasing the amount of green spaces
-More work/life balance
-Required vacation
-Family leave
-Community education on trauma, conflict resolution, mindfulness, meditation
-Increase in financial resources
-Policy change
-Cultural competency/understanding of others cultures, especially in schools
-Getting away from “me” generation mentality
-Increase care providers and resources
-Prevention and intervention programs
-Tie government support (social security, food stamps) to inflation/cost of living
-Training first responders to understand mental health conditions
-Access to foods/healthcare/exercise facilities
-Education in community on proper things to eat and diet/nutrition
-Exposure to corrupt food system
-More people with dogs or other animals to increase emotional/physical health and decrease the
population of animals in animal shelters
-Time/energy to do things needed
-More examples in community of healthy lifestyles
-Reduction of food dependence (fast foods)
-More dog friendly places and physical activity opportunities
-Access to affordable nutritious foods
37
-Fresh, healthy foods in schools
-Overall consistent educational messages on nutrition, prevention, and maintenance
-Holistic/integrated health services for disease management
What are barriers to maintaining a healthy weight/managing diabetes or other health condition?
-Too many screens (Tvs, computers, phones)
-Lack of access to proper healthcare
-Lack of safe exercise spaces
-Food costs
-Research fraud-diet, lifestyle living, butter/high fat foods
-Lack of evidence based and practical information about nutrition and food preparation
-Advertising
-Screwed up economics (bad food=cheap food and vice versa)
-Time/balanced schedule
-Lack of employment support
-Operation hours
-Safety (lights, sidewalks)
-Inadequate playgroup structures for kids
-Cost
-Lack of medication resources to manage health conditions
-Food desert
-More education and community centers
-Policy changes
-“Will pay for drugs/medication before nutritionists”
-How food is shipped
-Changes in farm bill
-Changes in school (what they serve)
-Bento box in each school
-More walkable city- sidewalks, crossing signals, stoplights near schools
38
-Better transportation- more frequent and efficient
-Increased incarceration/longer sentencing
-Garden at every bus stop
-Healthy and safe playgrounds/play spaces
-City needs to communicate better about existing resources
-Evaluate hours of rec centers and adjust as needed
-Cross collaborative approach to existing trails (safety issues)
-Renew the bike program
-Connect with groups that work with kids to address playgrounds
-Tax breaks to address food swaps or food deserts
-Allocate land for community gardens
39
Listening Session Notes from LGBTQ Center
Notetaker 1
Affordable housing
-Affordable across all classes
-Intention by government officials
-Community input
-Desirable, affordable housing, mixed income
-Stable rent
-Ability to stay in neighborhood
-Mixed types of housing
-Income
-Debt
-Gentrification
-Family size
-Lack of investment for affordable housing
-Access- transportation, etc.
-Lack of barriers to greedy investors
-“Ground water” (structural racism)
-Big business call major industry
-Land trusts
-Rent control
-Regulations for developers
-Subsidizing small land lords
40
-Affordable insurance independent of job
-Access to healthcare for all
-No penalties for not having health insurance
-Time availability
-Broader range of covered services
-No limit of yearly visits
-Cost transparency
-Cheaper cost
-Accessibility of healthcare centers
-Interpretation services
-Cultural competency
-Cost
-Type of insurance
-Access
-Surprise hospital fees
-Lack of free clinics
-Control of primary care providers of patient care
-Wait time in ER and scheduling
-Medication cost
-Past experiences
-Provider bias
-Historical trauma
-Mistrust
-Sliding scale based on income
-Free healthcare
-Mobile clinics
41
-Legislation regarding medical cost
-More patient control over referrals
-Cultural competency trainings
-Mystery shoppers
-Local government involvement
-Free preventive care
-Affordable education to become a provider
Mental health
-More services
-Insurance covering continued mental health care
-Holistic approach to mental health
-Time off/ work life balance
-Less stigma
-Less self-blame
-Less stress due to poverty and housing
-Feeling in control
-Prioritizing self-care in work settings
-More mental health awareness
-More EAP programs
-Financial stress
-Lack of facilities and providers
-Stigma
-Silence
-Lack of good responses to crisis situations
-Providers not trained on full spectrum of mental illness
-Misdiagnosis of mental illness
-Focus on diagnosis
42
-Lack of proactive screening and challenges identifying those in need
-Disenfranchisement/historical trauma
-Certain communities left out of conversation
-Toxic masculinity
-Free mental health care
-Raising national awareness-visibility matters
-Changes in insurance ESB to increase access
-Mobile screening clinics especially in rural areas
-Better labor laws
-More sick leave/time off
Poverty
-Affordable transportation
-Lower interest rates on debts
-Ability to get a job
-Reduce income disparities
-Access/affordable daycare
-Lower taxes
-Affordable education
-Money and resources to live, work, and play
-Non livable minimum wage
-Increased cost of living
-A lot of student debt
-High interest rates
-Income disparities across gender, race, etc.
-Gentrification
-Transportation and parking
43
-Health
-Minimum wage aligned with the cost of living
-Stricter policies on loans and debt
-Strengthen union worker and labor rights
-Job training programs
-Free public transportation with broader reach
-Paid, mandatory maternal leave
-Early career path training
-Redistribution of wealth
-Reparations
-Access to jobs for people without degrees
-Reentry programs
-Community shared resources
-Affordable diabetes medication
-Less fast food access and more affordable, healthy food
-More time to prepare healthy food (work/life balance)
-Education about healthy food
-Healthy food within walking distance
-Decolonizing wellness
-Peer support groups
What are barriers to being able to maintain a healthy weight/manage diabetes or other chronic health
condition?
-Price
-Income
44
-Weight shaming/stigma
-White narrative
-Food deserts
-Gentrification of food/ food apartheid
-GMOs/how we F up food
-Lack of education on complication of diabetes
-Providers aren’t educating around prescription options and alternatives to prescriptions
-Sedentary work place culture
-Healthcare providers educating on healthy diet
-Free nutritionist
-Recognizing people have different tastes
-Regulations around food deserts/swamps
-Exercise areas at work place
-Community gardens
-Farmers market subsidies
-Educational programs about growing own food
-Regulations around GMOs
-Raising voices of people of color (example. Art installations)
45
Listening Session Notes from CAARE
Notetaker 1
Affordable housing
-Safe neighborhoods for kids to play outside
-Close to food and activity
-Close to bus stops
-Distance from places selling alcohol
-Discounted utilities
-Close to doctors’ offices and restaurants
-Well lit
-Affordable housing close to public transportation
-Infrastructure (sidewalks, transportation, etc.)
-Access to spaces for children to play
-Knowing how to get help without retribution
-Healthy housing
-Safe and well maintained code enforcement
-“Whistle-blower” laws
-Access for a range of socio-economic classes
-Income
-Increased taxes even when house is paid off
-Predatory letters asking to sell homes
-Flipping houses and reselling for a lot of money
-Crime affects everything
-Age
-Certain services only available if you have kids
46
-High cost of meds
-Shortage of affordable housing
-Fear of eviction
-Public access (transportation)
-City/county leaning towards high end development
-Political barriers
-Increased rend due to developers
-Gentrification
-Increases in property taxes
-Police officers on foot in neighborhoods
-Security cameras in common areas (around trash areas for example)
-No property taxes if over 65 years old
-More police officers who live in Durham
-Neighborhood watch in all neighborhoods
-Get to know your neighbors
-More effectiveness/leadership in housing authorities
-Free HOAS
-School system leaders who live in Durham
-Voting for people to create positive change
-One partnership with public and private organizations to address issues holistically
-Education about affordable housing issues
-Protecting tenants through city ordinances
-Free healthcare
-Includes dental and vision
-No copays
47
-Covering preventive medical equipment (compression stockings for example) and prescriptions
-Choice of medical facility
-Transparency, knowing what you’re signing up for
-Communication/outreach to the public
-Decreasing the cost of medications
-Community health centers in neighborhoods
-Mobile clinics
-School based health centers including dental
-Improved health education
-Universal, single payer health insurance
-Expand Medicaid
-Affordability of insurance plans
-Transportation
-Government restrictions
-Not having access when retired
-Cost of medications
-Funding
-Politicians
-Transportation
-Language barriers
-Mental health services
-System based on treating illness rather than prevention and wellness
-Stigmas
-Working hours
-Employers not allowing for wellness leave
-Big pharmaceutical companies
-Insurance companies
48
-No prescription deductible (especially diabetes medications)
-Elected officials who understand the people
-Keep benefits after retirement
-Hold elected officials accountable for seniors
-Elected officials should come to listening sessions and diabetic clinics
-Voting
-Employee rights for self-care
-Organized lobbying
-Incentivize worksite health and wellness
-Free bus service
-Promote senior pharmacist and community health centers
-Expand bus routes
-More preventive care
-Mobile clinics and community health centers in neighborhoods
Poverty
-Being able to afford everything I need
-Not having to decide between food and medication
-No poverty and no children starving
-No one sleeping on the streets
-No crime
-Everyone is happy and content
-No racism
-No copays for services for those over 65 years old
-Stress free
-Fewer diseases related to stress
-Increased health of population
-Lower crime rates and more safety
-Better environment/community would look better
49
-Elimination of food deserts
-Community cohesiveness
-un- or underemployment
-Transportation
-Racism
-Prices going up not matching the cost of living (Increased cost of living and decreased paycheck)
-Community division by income
-Unable to get loans, high interest rates
-Age discrimination
-Lack of decent wages
-Lack of affordable housing
-Lack of control of cost of housing
-Price gauging in lower income neighborhoods
-Fewer, poor choices in lower income neighborhoods
-Exploitation of lower income neighborhoods
-Not able to afford medications
-Increased price of utilities
-Property taxes rising
-Gentrification
-Cost of healthcare
-Start with our leaders
-Training and education for employment
-No forced retirement
-Re-format job applications to remove reference to age
-Gun control-not based on race, age (same age of purchase for everyone)
-More jobs for teens after school and in the summer
-More recreation centers open at times for teens
50
-Affordable/free daycare
-Job creation programs
-More opportunities for housing and jobs
-Voting to rid of politicians
-Living wages by pressuring employers
-Rules governing the price of utilities
-Expanding food stamps
Mental health
-Physically, mentally, and emotionally well
-Not worrying about housing, crime, etc.—care free
-No bullying
-No fear
-Good self esteem
-No drugs or alcohol
-Mental health care in the language that the person speaks
-Group activities
-More outreach to house bound patients
-More community healthcare workers designated to neighborhoods
-Having a safe place to live and socialize
-Enough sleep to function
-Access to support systems
-Increased communication and advertisement
-Free medications
-Family history of mental illness
-Denial that you have a mental illness
-Do not know how to address mental health
-Stigma
51
-HIPAA-cannot get help for family for illness
-Insurance, money
-Low income
-Difficult to access
-Transportation
-Lack of information
-Language barriers
-Poor insurance coverage
-Difficulty identifying people with mental illness
Homelessness
-Lack of school based mental health services
-Lack of trained professionals in schools to recognize behavioral problems
-Family instability
-Lack of police training
-Fear
-Fear of deportation
-Include mental health checkup in well child check up
-Access to mental wellness resources in school
-Free mental health care
-More counselors in school that pay attention
-Public education of available resources
-Lower cost of prescriptions
-Incentives for teacher education on mental health issues
-Better funding for school health and social services
-Free transportation
-Specialized housing for people with mental health issues
-Sensitivity trainings for law enforcement
-Public trainings on specific mental health issues
52
-Education on benefits of taxes
-Understanding what your body needs
-Better understanding the diseases
-Early childhood education
-Community and school gardens
-Fitness trails for kids and adults
-Education on what a healthy weight is
-Keeping doctors’ appointments
What are barriers to maintaining a healthy weight/managing diabetes or other health condition?
-Income
-Inaccessibility
-Lack of finances
-Cost of food
-Availability of information regarding health issue
-Lack of interest
-Not knowing who or what to trust
-Language
-No health literacy
-Inconsistent relationship with primary care provider
-Abundance of convenient stores
-Understanding the importance of dental health
-Expanding food stamps
-Designating health food sections in convenience stores
-Mobile farmers markets
53
-More community education programs
-Healthy cooking classes in the community and schools
-Putting home economics back into the school curriculum
54
Listening Session Notes from Duke Regional
Notetaker 1
-No wait times
-Providers being paid for valued based care
-Access to providers in your community
-Community based healthcare
-Increased number of providers
-No cost urgent care clinics
-Real time discharge appointments
-No wait/reasonable wait time for appointments
-Affordable medications
-Transportation
-Child care
-Access to dental care
-Better coordination for new moms/families
-More behavioral healthcare (equal access)
-Know who to call with health questions support outside of family
-More school health providers
-Affordable health insurance
-Access to healthy foods-no deserts
-Affordable medical equipment
-No health disparities
-Lack of coordination-lots of resources but lack of communication
-Literacy
55
-Money
-Not all hospitals and providers show up in chart even though they use epic (Lincoln, health department)
-Cumbersome process of sharing med info (Example. Privacy barrier)
-Lack of primary care provider to advocate for pts (Pts not liked in to primary care provider or no shows)
-Have not expanded Medicare
-Money/models
-Transportation
-Education
-Pharmaceutical companies
-Lack of preventive healthcare
-Lack of systems and individuals coming together
-Cost/copays
-Underinsured
How can Duke address these barriers?
-Coordination via EMR (care everywhere)
-Rotations in schools (nursing, PT, PA, etc.) Students going to schools-learning opportunity and beneficial
to Durham schools
-Providing transportation (partnering with Uber health)
-Partner with primary care providers to reduce copays
-Advocate for reduce copays at state and federal level
-Partner with faith based programs (parrishner’s program)
- Leadership at the highest level
-Policies within Charity Care and Duke overall
-Focus on the social determinants of health as a cost saving measure
--Population health management-entire sections of the Durham population
-Wrap around programs
-Expanding satellite clinics
Mental health
56
-Work life balance
-More places to go for support and awareness of these places
-Functionally independent
-Access to mental health facilities (quick access, not payer dependent)
-More education on coping skills starting in grade school
-Less violence-less access to violence on TV
-Have need met (basic needs) - house, water, support)
-Everyone on needed medications
-Medication support
-No mental health stigma
-Resilience education
-Appropriate and available care for people with mental and substance abuse conditions
-Treatment instead of jail/prison
-Alternate and/or appropriate treatment instead of opioids
-Holistic way of looking at mental health
-Enough beds in mental health hospitals and enough staff
-Appropriate care and treatment for youth 18 and younger (have access to detox)
-Insurance
-Housing rates
-Adverse childhood events
-Unable to take time off from work
-Multiple jobs
-Lack of understanding crisis situations
-Stigma-prevent people from seeking care
-Domestic violence
-Not seeking help because it will be in EMR -fear of negative effect on insurance, life insurance (become
high risk)
57
-Lack of providers
-Not receiving the right care- going to the emergency department instead of psych
-Lack of early intervention
-Lack of mental health providers and facilities
-Lack of reimbursement
-Stigma
-Lack of research money for mental health conditions
-Jail/prison/over criminalization
-Insurance not covering mental health, payment model
-Lack of pediatric care for youth with mental conditions
-Lack of family support
How can Duke address these barriers?
-Expand Project Access
-Start funding psychiatric care
-Working to reduce stigma (example. Changing printed materials)
-Redefining mental health
-Make mental health a part of regular checkups/ more mental health assessments
-More clinical case managers
-Supporting ACCESS committee
-Project Access for psych care-need providers, volunteers, and money
-Fighting homelessness
-Add awareness of mental health
-Decrease stigma
-Public figure to talk about it and public campaigns
-Mobile clinics for mental health and all health needs
-Expand behavioral health campuses
-Increase living minimum wage to address poverty
58
-Less junk food
-Junk food would cost more than healthy food
-More/better transportation, walking, active transportation
-Sustainable farming and teaching farm skill
-Community access to healthcare
-More community access/support for physical activities for youth
-Educating kids early on health
-Simplified education everywhere
-More education (not just in clinics)
-Improved health literacy
-Affordable health food, especially in schools
-Affordable gym memberships
-Safe places to be active
-Cultural change
-Safe bike paths-more accessible bike rental programs (alternative pay other than credit card)
-Access to medications
What are barriers to being able to maintain a healthy weight/manage diabetes or other health
condition?
-Disparities in quality of food in inner city
-Cost of everything
-Lack of education
Cost of healthy food
-Stronger support organizations for diabetes and other chronic conditions
-Toxic stress
-Food deserts
-Lack of access to healthy foods
59
Lack of insufficient food regulations
-Affordability of junk food, easy access to fast food
-Limited time to prepare healthy food
-Vending machines in schools
-Lack of health education in schools
-Increased cost of club sports
-Lack of safe places to be active
How can duke address these barriers?
-Education on toxic stress and resilience
-Trainings such as the one coming on March 23rd
-Mobile farmers markets
-Integrated healthcare
-System framework on healthcare
-Limit TV/media exposure
-Schools should allow community to use track, fields, etc.
-Experts to help with promoting health and health literacy
-Fresh fruits and veggies in convenience stores
-Limit food waste (grocery stores throw away food)
-Drive-through with healthy food
-Provide places for group activity (example. Zumba at mall)
60
Qualitative Data Analysis
I am currently in the process of conducting data analysis for each of the listening sessions.
This is the process I am using.
Qualitative Analysis Guide

1. Assign each listening session an ID (done)
2. Type up all written notes by session, question, and topic (in progress)
3. For all three questions, categorize by theme (3-5 per question) within overarching topic
a. E.g., affordable housing responses may fall within three themes: taxes, set-asides, and
landlord accountability
4. Then, further categorize Question 3 responses by their intervention level (i.e.,
individual/program, PSE, or Other).
5. Repeat this process for each listening session.
61

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Durham County Department of Public Health

Integrated Learning Experience Product

Potential Evidence-Based Strategies………………………………………....4-6

Listening Session Schedule…………………………………………………..7

Community Health Assessment Listening Session Facilitator’s Guide……...8-17

Listening Session Results from Durham County South Regional Library….18-23

Listening Session Results from Durham Center for Senior Life…………….24-30

Listening Session Results from Durham County East Regional Library……31-39

Listening Session Results from LGBTQ Center…………………………….40-45

Listening Session Results from CAARE……………………………………46-54

Listening Session Results from Duke Regional Hospital…………………...55-60

Qualitative Data Analysis……………………………………………………61

Durham County Health Priorities

 Healthy home environment assessments

 Affordable housing tax increment financing (TIF)

 School based health centers

 Behavioral health primary care integration

 Mental Health First Aid

 Mental health benefits legislation

 Telemental health services

Obesity, diabetes, and food access

The goals of the sessions were to:

Listening Session Ground Rules for Small Groups:

OBESITY and DIABETES

Listening Session Logistics:

Listening Session Items:

Facilitator and Notetaker Guidelines:

Time Agenda Item Process Notes On Projector Screen

Facilitators and Notetakers

Select top idea for each question based

Access to healthcare/health insurance

Access to healthcare/health insurance

Obesity, diabetes and food access

-Building lasting structures

-Maintaining a variety of different levels of affordability

-Planned community-food, transportation, recreation

-Elimination of sanctuary city

-Emergency assistance for home repairs

-Protection in policies for residents

-Being able to pay for where you want to live

-Meeting families where they are

-Equality for housing (equal opportunities for housing)

What are barriers to affordable housing in Durham?

-Not enough affordable housing

-education for outreach on how to own a home

What ideas do you have to address these barriers?

-Intentional city planning

-Creative construction- combining housing and parking

-Increase awareness of existing resources

-Address zoning policies

-More education sessions for homeownership

-Invite people with stories that have been affected

-More housing built that are affordable in the county

-More funding programs

Access to healthcare/health insurance

-Shorter wait hours

-More specialized attention

-Community health worker-bridge

-Healthy city and environment

-Health grocery store access

-Increased competition in healthcare

-Repeal Affordable Care Act

-Universal health care