BOONE — The Watauga Compassionate Community Initiative held its weekly Wednesday Conversations webinar Dec. 9, with a focus on defining what traumas most affect Watauga County and how local businesses and the community around them can become trauma-informed.

Emily Harwood, Lindsey Sullivan and McKenzie Hellman lead the conversation, as the three work for AppHealthCare and their Resilience Catalysts project. Harwood is also a member of the WCCI’s leadership team.

AppHealthCare was first selected as a member of the Community Resilience Network and Collaborative at the time of the BCRNC’s launch in November 2019, and is one of only four Resilience Catalysts in the nation.

The BCRNC is a collaboration between the National Association of City and County Health Officials and the American Public Health Association. The other Resilience Catalyst sites are Mesa County Public Health in Mesa County, Co., Cambridge Public Health Department in Cambridge, Mass. and the city of Louisville, Ky.

“The idea of these sites is to instill resilience with the public health department and community partnerships being the force for that,” Hellman said. “These different sites have different objectives, but all looking towards things with a trauma-informed lens and all trying to decrease (adverse childhood experiences) and poor health outcomes.”

Hellman added that while AppHealthCare serves Watauga, Ashe and Alleghany County, trauma-informed efforts focus on Watauga.

“Later, one of the really important things in trying to understand our focus areas and trying to dive deeper was to try and understand the community voice,” Hellman said. “We decided that this project would be Watauga County-specific so we could really hone in and dive deep.

After key informant interviews and compiling data, the project is now looking to create a logic model for operation.

The presentation noted, “AppHealthCare is working across sectors to understand the things in our community that lead to poor health and unequal employment and housing opportunities in Watauga County.” Hellman said that while gathering data, two factors that repeatedly came up were employment and housing in Watauga, and they were able to hone in on those points.

Sullivan read a quote from one key informant interview, which provided some light on the struggles in Watauga.

“There is an enormous disparity in wealth and opportunity in Watauga County, people here with $10 million homes live a mile away from people with dirt floors,” Sullivan read. “Almost all of our economy is tourism, but the families that have lived here for generations are very poor, or a lot of them are very poor. It’s impossible for people who are local to afford to live here, it is incredibly expensive. The only places people can afford to live, if they do have some type of stability, are outside of town limits where there’s food deserts, where there’s no public transportation programs, no food programs. Then you drive into town and there’s an art museum.”

The quote went on to note that the problems people face in Watauga have been hidden away, pushed out of Boone and out of sight. It ended with “it’s a great place to vacation, but not a great place to get sober, honestly.”

Sullivan listed the five biggest issues AppHealthCare found while doing interviews: cost of living and access to resources; employment and challenges of local industry; substance use and justice-involved individuals; social cohesion, attitudes, culture and values; and the impact of COVID-19. She noted that those interviewed stated that the impact of the second home population has been negative on those who live full-time.

“We saw very different perceptions of the area,” Sullivan said. “Some described the area as very unified and tight-knit and welcoming. Others really drew attention to division, whether it’s socially, politically (or) economically.”

She noted there was mention of isolation and some resentment towards Appalachian State University alongside distrust of agencies. However, during a visioning session with those interviewed, the focus came back onto industry and housing. Mentioned was the instability and cost of housing, as well as how local businesses affect the issue. Three “action ideas” came out of the session: stickers for businesses that prioritize mental health, “living wage certified” stickers and a cost-benefit analysis for business owners to show them how impactful they can be.

Later in the conversation, Harwood noted that the Mental Health America’s Bell Seal for Workplace Mental Health can be earned by businesses who prove to be stable, supportive and less stressful for their employees.

Harwood said that after a group model building session, the two large areas of focus were income inequalities and housing inequalities. The drivers of income inequalities were seasonal jobs, lack of living wage jobs, lack of childcare options and the lack of health insurance/ability to access healthcare or mental health services. Housing inequalities were driven by high housing cost (rental or ownership), poor rental conditions and the lack of affordable rentals in general.

Harwood also discussed identified action items to focus on when it comes to businesses becoming trauma-informed. The first was providing more information on what being a trauma-informed business means, and why it is important, and a toolkit for becoming a trauma-informed business.

Harwood cited the San Francisco Department of Public Health, that developed a trauma-informed system initiative. The initiative files organizations under three categories: trauma organized (both impacted by stress and can be trauma inducing), trauma informed (which normalizes and addresses the impact of trauma on clients and the workforce) and healing organizations ( whose approaches to providing services are trauma-shielding or trauma-reducing).

The initiative also outlined six ways to become a healing organization. These points included specific training, leadership engagement, embedding trainers within the organization, policy and practice change, evaluations and having champions and catalysts for change in the workforce.

Sullivan said the desired short and medium-term impacts are an increase in knowledge or awareness of the importance of trauma-informed business policies, family-friendly policies being adopted by local businesses, an increase in knowledge of local policies that impact quality housing, an increase of productivity among employees of trauma-informed businesses, a decrease in turnover and an increase in quality rental properties.

For long-term impacts, Sullivan said the hope is the trauma-informed work being done can lead to decreases in poor mental health days among adults, child poverty and child maltreatment. Harwood said after the presentation that short-term goals would be for the next one-to-three years, while long-term goals would take three years at least.

“Because parents are better able to manage stress and handle concrete needs, the ripple effects would be that decrease in maltreatment,” Sullivan said.

Harwood ended with showing what “happily ever after” can be. Improved health and wellbeing and basic needs combined with decreases in substance abuse, crime and other negatives would lead to a more resilient and thriving Watauga, she said.

After the presentation, she added that AppHealthCare have been in contact with multiple businesses already, hoping to begin implementing actionable items in the Spring of 2021.

Hellman said the plan is to have a toolkit that is planned out and developed with the help of local partners. It can then be delivered to local businesses for implementation to benefit them. Harwood said any “best practices” that they pull from outside of Watauga needs to be localized, pointing to the area’s unique struggles that may not allow for solutions to perfectly slot in from the outside.

As they continue forward, WCCI has announced the series “Faces of ACES, Thriving Lives” which will be a part of the Wednesday Conversations. The series will be hour-long conversations with people who have been affected by adverse childhood experiences.

In an email announcing the search, WCCI Chair Denise Presnell said, “First, people with a trauma history can feel alone, ashamed, and isolated. The Center for Disease Control and Prevention says that one in four people have at least one ACE and one in 16 have four or more. So we are not alone. Sharing our stories help us feel connected and supported, and help us build community. We want the message to be loud and clear: We see you. We hear you. We are with you. Second, for people who engage or interact with people from ACEs, we want you to hear how powerful and healing it is to be a positive, consistent, caring adult for others. Relationships matter. Connections heal.”

Those who wish to join the Faces of ACES series can email Presnell at For more information about WCCI, go to

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