It’s 6:30 p.m. on a Friday night in Boone, North Carolina, and a hush falls over the East Boone Listening Room.

“We spent many years trying to find a space like this in town,” says artist and songwriter Sarah DeShields. 

Boone, which is home to Appalachian State University, has plenty of small to mid-sized venues, but they tend to cater to the college crowd or tourists. Because these hot spots are designed more for drinking and socializing, the performers often end up getting drowned out by the noise. 

What DeShields says Boone was missing was a space for singer-songwriters to showcase their songs to an audience intent to listen. 

“So, we decided to just make it ourselves!” DeShields laughs.

All the chairs in the East Boone Listening Room are taken, and I’m not surprised. Every time I come to these listening events, the place is packed wall to wall. So, I find a little spot on the floor and settle in to listen to the other songwriters before it’s time to play my own set of three songs.

The listening room hosts concerts on the second Friday of each month and is housed in the Boone Studio Collective – a space typically used by photographers and other artistic professionals. On listening nights, the studio is transformed into a small, cozy venue. The events are free, but attendees are encouraged to donate directly to the artists via Venmo or PayPal.

“I think it’s actually a need. People need connection,” says Meris Gantt, another songwriter and creative consultant who helps curate the evenings along with DeShields and fellow artists Will Willis and Simon and Sydney Everett. 

After the pandemic, Gantt felt people were hungry for that human connection they couldn’t get online. In a way, the Listening Room has become a place where people can heal from both the vitriol and the isolation of the pandemic. It’s a space for an artist to share their deepest emotions free of judgment and free of noise.

When I think about the greatest challenge to my own artistic work, it is indeed noise, and I don’t just mean singing over the racket of a crowded bar – though I’ve done that more times than I care to count. Artists are increasingly competing with the noise of a global music marketplace. 

Online streaming platforms, while they have their advantages, have saturated the market with endless content. It’s hard for a songwriter to cut through the noise, much less get paid a fair wage for their creative labor.

But that’s another beautiful thing about the Listening Room. Songwriters from all over have played here, but for the most part, “we try to make it hyper-local,” Gantt says, thereby instilling the value of not only an in-person, embodied musical experience but also a local one.

Becoming “hyperlocal” is a concept that’s increasingly appealing to me, especially in a world that every day becomes more and more oriented towards the compelling but somewhat artificial connections and consumption that the internet provides. These days, I – and I believe many others – are less interested in what’s cutting edge globally and more interested in what my own community has to offer me.

This is what I’ve found at the East Boone Listening Room. I’ve found Appalachian folks singing songs about what it means to live and love and work and grow here in Boone, in Appalachia. 

I’ve heard songs about what it means for your religious beliefs to change when you live in a highly religious context. 

I’ve heard songs that wrestle with being a descendant of settlers on a land that once belonged to the Cherokee. 

I’ve heard songs about watching people die of addiction and about the experience of incarceration. 

I’ve heard songs about local floods and mountaineer ghosts who haunt the hills.

These are deeply Appalachian songs about deeply Appalachian struggles. But the genre is not limited to what people typically think of when they imagine Appalachian music. Certainly, some artists incorporate traditional Old Time musical instruments like a banjo or mandolin. But the diversity of sound is something the curators of the East Boone Listening Room take great pride in. If a tourist from “off the mountain” were to wander into the East Boone Listening Room in hopes of simply experiencing a stereotypical “down home” sound, they’d have to go elsewhere to get their hillbilly trope fix.

DeShields, who sometimes plays ambient electric guitar and sometimes plays a folksier acoustic guitar, writes music that is indeed genre-bending. She was born in Scotland and her songs are often inspired by her connection to the land, both in Scotland and her new home in North Carolina. These songs of Scottish migration evoke the rich and decidedly Appalachian tradition of mourning and celebrating the exchange of one unique topography for other. 

About her performance at the East Boone Listening Room, DeShields says, “People are still talking to me about what happened in them when they were listening to me sing. It felt very sacred to me. I felt known and seen in my community in a new way.”

When my time to play arrives, I approach the microphone feeling a bit intimidated. The room is absolutely quiet. All heads are up, no one is looking down at their phones. While you may see a few folks take quick photos of the performers, for the most part, devices are put away and people are fully present.

But as much as I feel unnerved, I feel emboldened, buoyed by the earnest attentiveness and eager reception of the listeners. Like DeShields, I too feel seen. There are my people. This is my community. It is a place where I can express my most complex thoughts and feelings and be understood. I can present myself rather than a perfect performance without having to shout over the noise or cut through the excesses of our modern-day world.

“We just want people to be humans here,” says Gantt. 

And be human is exactly what I am able to do at the East Boone Listening Room.

Amanda Held Opelt is a singer-songwriter and the author of A Hole in the World: Finding Hope in Rituals of Grief and Healing and the forthcoming Holy Unhappiness: God, Goodness, and the Myth of the Blessed Life. She writes about faith, grief, rituals and life in Southern Appalachia. She lives with her husband and two daughters in Boone, North Carolina.

The post In North Carolina, A Sanctuary for Local Songwriters Emerges: The East Boone Listening Room appeared first on 100 Days in Appalachia.

By Taylor Knopf

North Carolinians in need of mental health support now have more places to call — and soon will have more places to go — for help. The state health department is investing more money in a greater array of mental health crisis services, including those run by peer support specialists. 

In addition to 988 — the rebranded nationwide suicide prevention help line — North Carolina recently added a statewide Peer Warmline. 

A Warmline is a noncrisis mental health support line staffed by peer support specialists — people living in recovery from mental health problems who may have also experienced substance use, psychiatric hospitalization, homelessness, incarceration or a combination of these. 

People with a history of mental illness sometimes prefer talking with people they feel they can relate to, who may have had similar experiences. And unlike 988, the North Carolina Warmline will not call for law enforcement or EMS unless the caller requests it. Though emergency responders are rarely dispatched after calls to 988, it occasionally happens — and the possibility does deter some people from calling.

Callers can reach the 24/7 Peer Warmline at 1-855-PEERS-NC (1-855-733-7762). The 988 call center also connects callers to the Warmline by request.

The state Department of Health and Human Services recently partnered with Promise Resource Network, a Charlotte-based peer-run mental health organization, to launch the statewide Peer Warmline. Promise Resource Network has been operating a Warmline for several years for Mecklenburg County residents, and it briefly scaled up to answer statewide calls during the early months of the pandemic. Then funding constraints led them to cut back to local calls.  

Historically, North Carolina has not always invited peers to crucial mental health service meetings or invested much in the types of peer-led services that some advocates have requested. Now, there seems to be a shift in this trend.

In addition to the Warmline, the state health department is investing $22 million in community crisis centers, including a new peer-run center that will open in Wake County. The facility will be in Raleigh, operated by Promise Resource Network and mirror the services at its peer respite center in Charlotte. 

A peer-run respite is designed to be a voluntary alternative to hospitalization for people in mental health distress, allowing them space and time to de-escalate their emotional crises without the hospital. Completely staffed by peer support specialists, respites are peaceful, home-like settings where people can stay and receive help from trained peers who are on their own recovery journeys. 

In response to the droves of people showing up at emergency rooms and psychiatric hospitals for help during their mental health crises, North Carolina is investing more in crisis alternatives such as the Warmline and peer respite, as well as new community crisis centers. DHHS recently announced financial support for five new centers for adults in Alamance, Forsyth, New Hanover, Pitt and Vance counties and three new centers for children in Gaston, Pitt and Vance counties. 

The funding for many of these new initiatives comes from state lawmakers’ $835 million investment in mental health services last year. The money comes as a result of a federal bonus that came to North Carolina when the state expanded the Medicaid program.

“We got money to invest in the crisis system,” said Kelly Crosbie, director of the NCDHHS Division of Mental Health, Developmental Disabilities, and Substance Use Services. ”We’re going to invest in some of the more traditional things that make up a good crisis continuum — everything from 988 to crisis teams to crisis receiving facilities, which are a much better and appropriate alternative to the emergency room for a lot of people that need that level of care instead.”

Peer support in demand

With the launch of the national crisis line 988, state-level data showed that 45 percent of more than 90,000 calls a month were from repeat callers, according to the 988 data dashboard.

“They are calling for someone to talk to, so we wanted to offer them an opportunity to talk to somebody with lived experience — someone who can share their experience of recovery and their experience of the system in North Carolina,” Crosbie said of the Warmline. “We just know it’s a valuable resource.”

Warmlines have been shown to reduce loneliness and participants’ use of mental health crisis services. Additionally, a review of several studies found that digital forms of peer support improve the lives of people with serious mental illness by “enhancing participants’ functioning, reducing symptoms and improving program utilization.”

Even before the Warmline expanded statewide, Cherene Caraco, chief executive officer of Promise Resource Network, said that the 988 call center was transferring people to her organization’s Warmline, especially during the pandemic when the Mecklenburg Warmline tried to scale up and answer statewide calls. She believes that when the 988 call center started referring callers to the Warmline, a nontraditional mental health resource, that gave it “a level of validation within the system that didn’t otherwise exist.”

“[The 988 call center] saw the value of it before we were funded statewide. Their endorsement is a big deal,” Caraco said. 

The statewide Warmline continues to gain traction. Noah Swabe, chief operations officer at Promise Resource Network, said the state’s financial support allowed the Warmline to double its number of full-time peers who answer the phones, which he said is necessary as call volume continues to increase. The Warmline recently received more than 4,000 calls in a one-month period, he said. 

In addition to the Warmline, Promise Resource Network’s peer respite has been in high demand. The Charlotte respite, which opened in 2021, is always full. Swabe said there is about a monthlong waitlist to get in. People with mental illness appreciate the nonjudgmental environment where they can stay in an unlocked facility for up to seven days while receiving support from peer support specialists. Promise Resource Network also has what the organization calls a “recovery hub” nearby, which has classes, groups and programs to support people.

Swabe said the plan for Wake County is to open a recovery hub and respite care to provide wrap-around services for those looking for alternative mental health support. Funding will come from DHHS, Wake County and Alliance Behavioral Health.

Buy-in from state and national leaders

During the Warmline ribbon-cutting ceremony, Crosbie visited the peer respite in Charlotte for the first time and said it was beautiful. 

“It is a peaceful setting. It offers dignity and offers a safe space. It offers harm reduction for folks who are using [drugs]. It’s very comprehensive,” she said. “We want to build more of those. Those are the kinds of places we need.”

In addition to the respite DHHS is helping to fund in Raleigh, Crosbie said she wants to see more peer-run spaces, like peer living rooms or day programs, and supportive places for those with mental health issues who are stepping down from hospitalizations, like the one operated by GreenTree in Winston-Salem. 

“We think peer services are wonderful evidence-based, great outcomes, resources for people. So we just know that, and so we’ve been looking at really refreshing our peer portfolio because it’s effective,” Crosbie said. “And we also are in the midst of a [health care] workforce crisis, and we’ve got lots of peers, and peer supports are effective treatment resources.”

Historically, peer-run organizations have struggled to scrape together funding to keep their programs going. The new outspoken support from Crosbie and the new waves of funding could be huge for the peer movement in North Carolina. 

Caraco, who has been a leader in the peer-led recovery movement for nearly two decades, said the support from the federal government and other national groups has also helped those in the more traditional mental health system recognize peer support as essential.

“The Biden administration has created a unity agenda and is naming peer support as a necessary component of a healthy array to prevent suicide, to support people, to create access, to [help with] workforce shortages,” she said. “They have been […] endorsing peer support for a variety of different reasons where our system is either struggling, has gaps or just not well equipped to do.”

“So we have not only more recognition at the federal and national level, but more push into states and to communities to make it a sustainable, healthy part of their community,” Caraco said.

Crosbie said she couldn’t speak to culture at the North Carolina division of mental health before she took the position, but said for her, peer services are “non-negotiable.” She has seen the power of peer support in her own family.

“For my father in particular, who had a serious mental illness, for so many reasons did not get traditional treatments,” she said. “But he was always helped significantly by peers. That was the only type of help really that made any difference to him, and therefore to me and my family.”

The post North Carolina to expand peer-led crisis services in push for more mental health support appeared first on North Carolina Health News.

Innovative Construction Group pointed to community college and workforce training programs as factors in the decision to pick Siler City.

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By Jaymie Baxley

Small purple boxes have become a promising tool in Wilson County’s fight to lessen the deadly toll of the opioid epidemic. 

ONEbox is a first aid-like kit that contains doses of naloxone, a nasal spray that can rapidly reverse the effects of opioid overdose. When the kit is opened, a screen embedded in the lid plays a video of a paramedic giving step-by-step instructions for administering the drug.

“Let’s take a deep breath,” says the woman in the video, speaking in either English or Spanish, depending on the language selected. “Step No. 1 is to check to see if somebody really is unresponsive. You can do that by gently shaking them or shouting, or you can use your knuckles against the sternum to see if you get a reaction.”

Dozens of the kits have been placed in strategic locations throughout Wilson County in recent weeks. Jeff Hill, executive director of the Wilson County Substance Prevention Coalition, said he wants the boxes to become so ubiquitous that “any layman will know what it is, know how to identify it and know how to use it.”

“At the end of the day, we understand that anybody in the right place, right time and right scenario can become, or needs to become, a first responder,” he said. “Wherever I can’t be, a ONEbox can — and that could be the difference between life and death.”

‘Community of first responders’

Hill first encountered ONEbox at a conference last year in Washington, D.C. Impressed with the kit’s lifesaving potential, he brought back a sample to show county officials.

“My initial reaction was, ‘Wow, it is so compact and it gives you everything that you need — all the tools that you need — to help save a life,’” said Lori Winstead, deputy manager for Wilson County. “With this system, you kind of avoid that fear of not knowing what step comes next. It puts you at ease, and that’s important in an emergency situation.”

At the time, Winstead was working on a spending plan for Wilson County’s first tranche of funding from a landmark settlement with the pharmaceutical companies that stoked the national opioid epidemic. Money from the settlement, which brings $7.5 million to the county over the next 18 years, can only be spent on services and strategies that address the crisis. 

ONEbox fit the bill. In April 2023, the Wilson County Board of Commissioners agreed to buy 200 kits for $40,000. Hill’s coalition received the kits in February and began distributing them to local nonprofits, government agencies and businesses such as Casita Brewing Co. and Thomas Drug Store. 

He said the demand was “greater than we expected.” The coalition ran through its initial supply within three weeks, prompting the county to order another shipment of 200 kits.

“I think it caught on so fast because the community bought into being a resource,” said Hill, adding that Wilson is the first county to deploy the kits in North Carolina. “Our quote here in Wilson County is ‘we’re a community of first responders, not a community dependent on them.’” 

Unlike many of the state’s rural counties, Wilson has seen a decrease in fatal overdoses. The latest available data from the N.C. Department of Health and Human Services shows that Wilson County had 30 overdose deaths in 2022, down from 37 deaths a year earlier. 

The use of naloxone rose over the same period. The Wilson Times reported that local paramedics administered naloxone to 105 patients in 2022, a 34 percent increase from the previous year. That number does not include doses administered by other public safety agencies and civilians. 

Hill said the kits are part of a larger effort to improve community access to lifesaving interventions. He noted that Wilson County’s Board of Education approved a policy last May requiring every school in the district to keep a supply of naloxone. 

“That’s very rare because most people would view that as, ‘Oh, no, we have a drug problem,’” he said. “That’s not what our school system is saying. What they’re saying is the same way we have an AED and a first aid kit on site, God forbid, in case of emergency, we want to make sure that we have naloxone to protect the sanctity […] and the livelihood of our students.”

Another example, he said, is Wilson Professional Services, a local medication-assisted addiction treatment center that offers free naloxone to anyone who requests it. The facility also provides training so people know how to properly administer the drug. 

Naloxone has been readily available for years at community hubs like the Wilson County Public Library, where a staff member used it to save the life of a man who overdosed in 2022. 

Creating a model  

The county’s swift adoption of ONEbox has not gone unnoticed by the kits’ distributor, the West Virginia Drug Intervention Institute. 

“Wilson has certainly been one of the more comprehensive approaches that we’ve seen,” said Susan Bissett, president of the institute. “They’re using the libraries. They have them in bars and restaurants. They’re working with the schools and the local higher education facilities.”

Bissett traveled to Wilson County with a film crew last month to record testimonials from local leaders. The recordings, she said, are meant to show other communities how to successfully implement the kits.

“To see another Appalachian community embrace this has been incredible,” she said. “The fact that it is a more rural community — and how they’re making sure that boxes are in locations strategically placed throughout the community so that bystanders can respond — is incredible.”

Her comments were echoed by Joe Murphy, creator of ONEbox. Murphy said he came up with the idea after seeing his small West Virginia hometown “ravaged by drugs.”

“The way that every single organization we’ve talked to in this community has embraced it, from law enforcement to the public sector, is unbelievable,” he said. “You just don’t see this anywhere in the country.”

Hill believes Wilson County could be a bellwether for other communities in North Carolina. He said officials from neighboring counties have already expressed interest in deploying ONEbox kits based on the successful rollout in Wilson.

“The goal is to create a model that can be replicated,” he said.

The post Wilson County deploys overdose reversal kits to combat epidemic of opioid deaths  appeared first on North Carolina Health News.

By Jennifer Fernandez

BURLINGTON — Omira Thompson sat on the floor Wednesday feeding lunch to two of the boys in her infant classroom at First Presbyterian Child Development Center.

One made a face, then tried to wipe out his mouth with his bib, which made Thompson laugh. “Guess he doesn’t like pear,” she said.

Thompson, the lead teacher for the infant classroom, is one of 32 teachers at the five-star rated child care facility, which serves about 90 children — from infants through age 6.

Across North Carolina, child care centers such as First Presbyterian’s will be faced with some difficult decisions in the coming months as the last of federal pandemic aid dries up at the end of June. The money, which Congress first allocated in 2020 during the early, confusing days of the pandemic, helped centers pay teachers more through raises or bonuses; some were even able to provide benefits — often for the first time. The grants were renewed in 2021 and again last year. 

If centers can’t maintain that level of pay, teachers may leave to make more money at places like Target or Starbucks, child care advocates say.

A survey of child care centers released last week shows that without that extra government funding, centers expect to lose teachers, close classrooms, raise tuition and fees or a combination of those measures. More than 1,500 child care facilities in North Carolina could close, according to the survey commissioned by the North Carolina Child Care Resource & Referral Council.

“The work that we do is significant. We deserve the respect. We deserve a salary that is commensurate with what we do,” said Davina Boldin-Woods, director of First Presbyterian Child Development Center. “But more importantly, our children deserve it.”

The ‘cliff’

Pandemic aid from the 2021 American Rescue Plan Act has helped child care providers boost pay and benefits, and it has subsidized the cost of child care for many families. 

Last year, legislators approved using $150 million in discretionary funding from federal pandemic aid to continue the stabilization grants. 

The so-called funding cliff, first expected in December 2023, is now expected to happen in June when that funding ends.

Child care providers, along with legislators from both parties, state officials and the state Chamber of Commerce, unsuccessfully petitioned the General Assembly to include $300 million in the state budget last year to cover the loss of the federal pandemic aid to help providers maintain raises or bonuses for staff for another year. 

“As long as I’ve been in the business, early education professionals have wrestled with the shortage of child care workers and a marketplace competing for teachers with better pay and benefits,” Andrew H. “Sandy” Weathersbee, owner of Providence Preparatory School in Charlotte, told the N.C. General Assembly’s Joint Legislative Oversight committee on Health and Human Services on Tuesday. 

“However, we’ve not been able to find a solution for the problem because it’s bigger than we are,” he said, “and we need help.”

Effects on workforce

Child care plays a crucial role in the economy. Parents can’t work if they have nowhere to send their children.

A different survey last year of registered North Carolina voters showed that 26 percent of parents with children younger than 5 left the workforce because they couldn’t find affordable child care. 

Six in 10 of those same workers reported missing work because of a problem with child care, according to results of the phone and online survey of 500 people commissioned by the NC Chamber Foundation. 

Three in 10 did not pursue job training or continuing education due to a lack of affordable child care, and 37 percent refused a job opportunity, promotion or job change because it would increase child care expenses.

“Affordable, quality child care supports working parents on the job, allows businesses to recruit and retain talent, and helps North Carolina children develop skills for success in school and life,” Meredith Archie, president of the NC Chamber Foundation, said in a statement when their survey results were released. “The health of North Carolina’s economy is directly tied to the strength of its workforce. This survey shows that North Carolinians understand the critical role of child care and want it to be a top priority for the state.”

The chamber found that across the political spectrum, majorities of people wanted the state to increase funding to make affordable child care more accessible to workers.

A long-term study of children in Michigan who received quality early childhood care found they were more likely as adults to make a living wage and own a home compared with peers who did not receive that care.

“It’s not a child care issue. It’s not a parent issue. It’s an economic issue,” Boldin-Woods said. “So the economy, it literally doesn’t work unless early education and child care work.”

Educators, not babysitters

The first few years are a crucial time for children, whose brains are growing at nearly a million neural connections per second, according to Harvard University’s Center on the Developing Child. 

“The environment of every child’s first three years provides the foundation for the rest of their life,” Weathersbee said. “In other words, the cake is baked by the time a child turns 3 years old.”

Boldin-Woods said children spend anywhere from eight to 10 hours a day in an early education program “discovering and learning the things that are going to set them on the path to success.”

“I don’t think people see the significance of the work that is done, or understand the long-standing impact and the wide-ranging impact that early education … can have,” she said.

Researchers from across the globe have studied the effects of high-quality child care and education, according to the Buffett Early Childhood Institute at the University of Nebraska. Information from more than 150 scientific studies shows that good care can have major impacts, short term and long term, on everything from cognition and social-emotional development to school progress and earnings. It can also reduce antisocial behavior, lower welfare participation and even reduce trouble with the law.

Research also shows how important brain development is to health outcomes later in life. 
A landmark North Carolina study, the Abecedarian Project, followed for decades children from low-income families who received high-quality child care. It found that children who received better care ended up healthier as adults, with lower rates of heart disease and diabetes and better mental health.

Finding solutions

“There is creative strategy going on,” said Janet Singerman, president and chief executive officer of Child Care Resources Inc. and co-leader of the Child Care Resources & Referral Council.

Kentucky legislators passed a bill in 2022 that set aside $15 million to create a public/private partnership between employers and the state to help families pay for high-quality child care.

States from Montana to Maine are increasing eligibility for child care subsidy funding through the federal Child Care and Development Block Grant program, according to a Feb. 21 article by the Center for American Progress.

Several states are pouring money into stabilizing the child care system: California is investing $600 million and Minnesota $316 million to increase pay for child care workers.

In the North Carolina budget passed last year, legislators addressed child care in several ways, such as $525,000 to increase the capacity of family child care homes and supporting a $900,000 pilot program that shares costs among families, the state and the provider. 

The budget also included an increase in child care subsidies, mostly federal money used to help offset the cost to parents, although the increase was based on older market data. 

The reimbursement covers 30 percent to 50 percent of the cost of a classroom slot, said Ariel Ford, who runs the Division of Child Development and Early Education for the state Department of Health and Human Services. But you can’t operate a business at 50 percent of the cost, she told lawmakers.

Ford said legislators should again look at increasing subsidies when the General Assembly reconvenes later this month.

“What we know is that the child care subsidy as we have it now is based on what our local families can afford to pay. But that’s not really what it costs,” Ford told the committee during her testimony Tuesday. “What that means … is that those wages just keep getting pushed down for child care because they can’t raise the cost anymore for families to afford it, which means they can’t pay any more for teachers to be in the classroom.”

Weathersbee suggested several ways local governments and businesses could work together to fix the problem, from employer tuition sharing and tuition discounts for early educators to a tax credit for tenured staff and tax incentives for employees offering certain benefits to child care employees.

Closures already happening

Based on response to the Child Care Resource & Referral Council survey, the expected closures would leave about 92,000 children without a child care home. That’s on top of the thousands of children who have already lost a slot as hundreds of facilities closed in the past year alone.

According to state data, the number of licensed facilities dropped from 5,500 in February 2023 to 5,166 in February this year. Enrollment during that period fell from 220,303 to 214,088. There are also 386 fewer teachers.

Many of the providers that plan to stay open said they’ll have to increase tuition and fees and expect to lose staff, forcing them to combine or close classrooms, reduce the number of children they serve or close entirely.

“There is no question we need to increase investment in child care across this nation. It is an underfinanced system,” Singerman said.

She called the survey responses “sobering.”

“If we care about what’s happening to our children, and our parents in the workforce … then child care is an issue that we should all have a stake in,” Singerman said.

The post Child care providers face difficult choices as funding cliff looms appeared first on North Carolina Health News.

Seven NC counties have lost elections directors since January. More than 50 have left in last 5 years. State worried about loss of knowledge.

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America’s “fescue belt,” named for an exotic grass called tall fescue, dominates the pastureland from Missouri and Arkansas in the west to the coast of the Carolinas in the east. Within that swath, a quarter of the nation’s cows — more than 15 million in all — graze fields that stay green through the winter while the rest of the region’s grasses turn brown and go dormant. 

But the fescue these cows are eating is toxic. The animals lose hooves. Parts of their tails and the tips of their ears slough off. For most of the year, they spend any moderately warm day standing in ponds and creeks trying to reduce fevers. They breathe heavily, fail to put on weight, and produce less milk. Some fail to conceive, and some of the calves they do conceive die. The disorder, fescue toxicosis, costs the livestock industry up to $2 billion a year in lost production. “Fescue toxicity is the most devastating livestock disorder east of the Mississippi,” said Craig Roberts, a forage specialist at the University of Missouri (MU) Extension and an expert on fescue.

By the early 20^th century, decades of timber-cutting and overgrazing had left the ranching region in southern states barren, its nutrient-rich native grasses replaced by a motley assortment of plants that made poor forage. Then, in the 1930s, a University of Kentucky professor spotted an exotic type of fescue growing in the mountains of eastern Kentucky, which seemed to thrive even on exhausted land. Unlike most native grasses, Kentucky-31, as it was called, stayed green and hearty through the winter. Ranchers found the species remarkably resilient and, if not beloved by cattle, edible enough to plant. Over the next 20 years, much of the country’s southern landscape was transformed into a lush, evergreen pasture capable of supporting a robust cattle industry. 

As early as the 1950s, however, ranchers began to notice tall fescue’s disturbing effects. One study from that time showed that cattle had to be fenced out of other grasses before they’d touch fescue. When they did eat it, the cows saw only one-sixth of their normal weight gain and lost eight pounds of milk production a day. 

Between the cells in fescue grows an endophyte, a fungus living symbiotically inside the grass. The endophyte is what makes the fescue robust against drought and overgrazing, but it’s also what makes it toxic. When scientists engineered a version of fescue without the fungal endophyte, in 1982, its hardiness disappeared and ranchers saw it die out among their winter pastures. Farmers learned to live with the health impacts of the toxic version, and today it remains the primary pasture grass across 37 million acres of farmland. 

It’s a longstanding problem, and it’s spreading. Warming temperatures from climate change are now expanding the northern limit of the fescue belt, and the grass is marching into new areas, taking root on disturbed land, such as pastures. Northern Illinois and southern Iowa could already be officially added to the fescue belt, Roberts said, introducing toxicosis to new farming regions.

“It’s becoming not just present but part of their normal pastures,” he said, noting that he increasingly gets calls from farmers in this region who are wondering what to do.

As more ranchers find themselves facing the challenges of toxic fescue, there are two strategies emerging to finally solve the decades-old problem, though in diametrically opposed ways. One involves planting a modified version of tall fescue — called “friendly fescue” — in which the toxic endophyte has been replaced by a benign one that still keeps the grass hearty and green all winter. Another would abandon fescue altogether and restore the native grasses and wildflowers that once dominated the region, helping to revitalize natural carbon sinks and fight climate change.

For a variety of reasons — some economic, some cultural — neither solution has really taken hold with most fescue belt ranchers. But the debate embodies the agricultural industry in the era of climate change: As ecosystems shift and extreme weather makes farming even more precarious, ranchers are facing tough decisions about how to adapt their land use practices. What is best for business, and will that ultimately be what’s best for the land and for the changing climate? 

Friendly fescue hit the market in 2000, developed by Pennington Seed, Inc. It looks identical to toxic fescue and behaves almost identically, thus requiring little change to the ranching habits of fescue belt farmers over the last 70 years. 

It would seem an ideal fit for an industry focused on maintaining the status quo amid climate challenges. But ranchers have been slow to embrace it. For one thing, friendly fescue, formally known as “novel endophyte fescue,” costs twice as much as the toxic variety — $4 for a pound of seed versus $2. And replacing one grass with another is labor-intensive; a 2004 report by the University of Georgia said it would take ranchers who made the switch about three years to break even. Matt Poore, a professor of animal science at North Carolina State University, chairs the Alliance for Grassland Renewal, a national organization dedicated to eradicating toxic fescue. Yet Poore, who also raises cattle, has only converted 30 percent of his fields, preferring to do it slowly. “The fear of failure is a big deal,” he said. “You’re sticking your neck out there when you go to kill something that looks really good.”

Many ranchers would like to avoid the risk of total pasture makeovers, if they can. Until now, they have found ways to scrape by, relying on a parade of treatments that have come out through the decades, promising relief from toxicosis. 

They can supplement their cows’ diets with grain (an expensive remedy), or cut and dry their fescue and feed it to them as hay, which reduces its toxicity somewhat. They can dilute the toxicity of their fields by planting clover among the fescue, or clip the especially toxic seed heads before cows can graze them. They can try to genetically select cows with moderate fescue tolerance, which can salvage as much as a quarter of their losses. Poore counts over 100 such remedies. “If you do enough of those things you can tell yourself you don’t really have a problem,” he said. Meanwhile, the lush ground cover that fescue displays in winter is seductive.

A lack of trust, too, is a problem. In the early 1980s, when researchers introduced endophyte-free fescue, it was hailed as the answer to toxicosis, a way to save the industry. Ranchers trusted the scientists, and they lost a lot of money when that version withered in the fields. The sting of that debacle persists as researchers try to convince ranchers to trust friendly fescue. “The sins of the past have come back to haunt us,” MU’s Roberts said. “It’s going to take a while to overcome that screwup.”

Every March, Roberts and other scientists travel around the fescue belt giving workshops on friendly fescue to anyone who will listen. He tries to assuage ranchers who are worried about the expense and labor of pasture conversion. 

There aren’t good numbers on adoption rates because seed companies are guarded about how much they sell. But Roberts says he knows it’s rising. Some states promote it more than others, by offering cost-shares, for example, and hosting workshops like those Roberts leads.

It doesn’t help that endophyte-free fescue — the one that fails in the winter — remains on the market. The state of Kentucky even provides cost-share funding for ranchers who switch from toxic fescue to endophyte-free fescue. And several Kentucky ranchers said they were still unclear on the differences among toxic fescue, endophyte-free fescue, and friendly fescue. Farm supply stores often don’t even stock friendly fescue seed, as it’s less shelf stable.

Roberts noted that toxic fescue exudes fluids that “pretty much destroy the food web,” poisoning insects that quail and other creatures feed on. A 2014 study showed that climate change could increase the endophyte’s toxicity. Friendly fescue soil, by contrast, has more microbes than toxic fescue soil. And water quality is better with friendly fescue, too, since sick cows don’t have to congregate in streams and ponds to stay cool.

Despite the confusion and slow uptake, Roberts is optimistic, noting the 30 years it took for farmers to embrace the revolution of hybrid corn in the early 20th century. And he can point to some wins. Darrel Franson, a Missouri rancher who remembers the endophyte-free fescue debacle, nevertheless decided to take the risk, converting his 126 acres to friendly fescue. He loves the results. “It’s hard to argue with the production potential of tall fescue and the length of season it gives us,” he said.

Roberts’ employer, the University of Missouri, is betting that a modified version of exotic fescue will appeal to ranchers more than the idea of converting to native grasslands. “What we’re promoting is environmentally friendly as well as economically sound,” he said. “When you seed a nontoxic endophyte and add legumes [to dilute pasture toxicity], that works as well as anything, and we have a lot of data on it. It may take another 20 years for it to catch on, but it’s not going away. It’s too good.”

For decades, Amy Hamilton and her late husband Rex fought fescue toxicosis in Texas County, Missouri, the heart of the Ozarks. They watched their and their neighbors’ cows lose tail switches, hooves, and parts of their ears to gangrene. Finally, they’d had enough. 

But the Hamiltons didn’t reach for an artificially modified version of the exotic grass. Instead, in 2012, they converted 90 acres of pasture to native warm-season grasses, using their own money and cost-share funding from the U.S. Department of Agriculture’s Natural Resources Conservation Service, or NRCS. The effects were immediate; the next year they documented increased conception and weaning rates in their cows and calves. Since then, they’ve converted another 75 acres. A former soil conservationist with a degree in agronomy, Hamilton’s mission became to annihilate fescue, on her property and across the fescue belt.

I visited Hamilton’s ranch in November 2022, where they run about 45 cows and 150 bison. She and her daughter Elizabeth Steele, who helps run the family’s native seed company, walked through a pasture where fescue grew 15 years ago. Now big bluestem, little bluestem, and sunflowers fill the main body of the pasture, and freshwater cordgrass and ironweed decorate a creek’s edge. Quail have returned for the first time in decades. 

Unlike the Hamiltons’ neighbors’ pastures, however, this field was not green; most of the plants had gone dormant for winter. Hamilton reached through a thick mass of bluestem and pointed to two diminutive, green plants: wild rye and a sedge species, cool-season grasses that provide a native analogue to fescue — and, crucially, winter forage.

“This is what would have been here pre-settlement,” said Steele, referring to the land before Europeans arrived. “A functioning grassland with different plants serving different functions. Nature’s design is not for monocultures.” 

To understand the fescue-native debate requires an understanding of the ecological tradeoff between warm- and cool-season grasses. Simply put, warm-season grasses grow in the summer, harnessing the strong sunshine to grow tall and robust; then they go dormant in the winter. Cool-season grasses do the opposite, putting their evolutionary resources into frost-tolerance. As a result, they tend to be smaller than their warm-season counterparts, providing less biomass and less food per plant for the cows that graze them. 

Hamilton and Steele have decided to bet on biodiversity. Instead of a year-round monoculture of fescue, they have a biodiverse mix of warm- and cool-season grasses, along with wildflowers. It’s not as visibly lush as a fescue field, but the benefits to cattle health, soil health, and climate resistance make it worth it. “It is a kind of faith that these prairies evolved for the good of the native species that were here,” Hamilton said.

Even with the leaner cool-season grasses, their native fields produce twice as much forage as the old fescue fields and generate a much higher amount of organic matter, enriching the soil and allowing the pasture to hold more water. A soil-health specialist from NRCS tested their soil’s organic matter content before the 2012 restoration, then again five years later. The result was pastureland that holds up to a half gallon more water than a typical fescue field. 

In a warming climate with more extreme droughts — much of the Ozarks was in severe drought last year — that extra water storage can make a critical difference for cattle and soil health. The southeastern U.S., the heart of the fescue belt, faces a future of more intense drought and floods. The Hamiltons’ biodiverse style of ranching helps address both extremes, and they expect their native ecosystems will be more resilient to climate change.

“[The extra water] trickles into our stream through the year, as opposed to running off in a flood,” said Steele.

The roots of native grasses also reach three times deeper than fescue roots, making them drought-resistant as well as efficient carbon sinks. Grasslands are uniquely good at carbon sequestration. Unlike forests, they store more than 80 percent of their carbon underground, where it’s more safely sequestered than in aboveground trees where the carbon can potentially volatilize and return to the atmosphere. What’s more, intensive grazing of monocultures makes it hard to sequester carbon. A 2019 study, published in the journal Nature, showed that native, biodiverse, restored grasslands hold more than twice as much carbon as monocultures. The deep roots of the Hamiltons’ native species lock carbon deep underground, where it can take hundreds or even thousands of years to return to the atmosphere.

In the years since the Hamiltons converted their fields, the use of native warm-season grasses has gained momentum in the ranching industry. The University of Tennessee — firmly in the fescue belt — opened a Center for Native Grasslands Management in 2006 aimed at getting ranchers to incorporate native warm-season grasses (known as NWSGs) into pastureland. The Missouri Department of Conservation conducts workshops to familiarize ranchers with NWSGs. Research by the native grasslands center found that pastures of native switchgrass financially outperform fescue pastures. 

And Patrick D. Keyser, the center’s director, said native grasses significantly outperform fescue in climate resiliency. Fescue, he says, wants it to be 73 degrees and rainy every other day. “Think Oregon or Scotland,” he said. Native warm-season grasses in the fescue belt, on the other hand, can go weeks with blistering heat and drought without a problem. “To them, the worst climate projections that we’re getting really aren’t a big deal. From a resiliency standpoint, they absolutely win.” 

If replacing fescue with natives is moving slowly in general, replacing it with native cool-season grasses, to get year-round forage, remains nearly unheard of. As with friendly fescue, cost is partly to blame. Elizabeth Steele’s “cowboy math” estimates that a native conversion today would cost around $365 per acre, a scary number for ranchers. Proponents of native conversion also face a more complicated obstacle than cost as they seek buy-in from ranchers. The debate over how beef cattle are raised is caught up in the culture war over climate change. By some estimates, meat production accounts for nearly 60 percent of the greenhouse gasses generated by the food system, with beef as the leading culprit. Even as the concept of “regenerative ranching,” a method of cattle farming that tries to restore degraded soil and reduce emissions, has secured a toehold in the industry, “climate change” remains a political term in farm country, one that is largely avoided.

Ranchers like Amy Hamilton risk getting marginalized as “progressives.” So while she believes diverse native grasslands will make pastures more resilient to climate change, she doesn’t mention that when proselytizing to fellow ranchers. Instead she talks about increased water infiltration, more abundant wildlife, and improved soil health — things that matter to ranchers no matter their thoughts on climate change. 

She also tells them that native conversion pencils out. Hamilton doesn’t fertilize her pastures, and she rarely uses hay, as most ranchers do to supplement their cows’ fescue diet. And Steele estimates that, because native pastures produce more forage than fescue monocultures, increased forage and resulting weight gain makes up for the initial conversion costs in less than two years. “The more you emulate natural systems, the less money you have to spend on stuff like baling machines, herbicides, toxicosis effects, and fertilizer,” she said. That extra forage also allows ranchers to feed more cows. So if a rancher wants to expand their herd size, they can either expand their fescue acreage, for $3,000 an acre, or spend $365 an acre to convert the land they already have to natives. 

Saving money matters in the fescue belt. According to U.S. Department of Agriculture data, 60 percent of farms in Texas County, Missouri, run a deficit, and every state in the fescue belt loses money on agriculture, except for Illinois, which is largely a crop state. 

“Agriculture is so hard that if you don’t do it with your pocketbook in mind, you can cause people to go broke. I don’t want to do that,” Hamilton said. Hamilton estimates that more than 100 other fescue belt ranchers she’s in touch with are in the process of converting some or all of their pasture to native grasses. One of them, Steve Freeman, co-owns Woods Fork Cattle Company with his wife, Judy, in Hartville, Missouri. Freeman has converted 80 acres of fescue to natives, with plans to convert 180 more in three years. In total, that will make a third of his pasture diverse native grasslands.

“Almost all my inspiration has come from going to [the Hamiltons’] field days every year and seeing what this land could be,” Freeman said. For him it’s not just about eradicating fescue toxicosis, it’s about the whole suite of benefits for biodiversity, soil health, and water retention. “I realized we’re not going to get there with the grasses we have.”

Freeman notes the power imbalance between the informal effort to promote native grasses and the universities and beef industry groups that are pushing modified fescue. “There’s no money that backs this,” he said of native restoration. “The novel endophytes and those kinds of things, there’s a lot of money to be made. They’ve helped the universities. I think [Hamilton] is starting to change people’s minds, but it’s been 15 years of doing this.”

For his part, MU’s Roberts hears the subtle dig at his work. “Friends of mine in conservation groups think the university professors are hooked on fescue,” he said. “They’re not. What they’re hooked on is a long grazing season, good yield, and good quality. They’re hooked on criteria, not on a species.”

Either way, change on this scale takes time. The University of Missouri claims that 98 percent of pastures in the state are still toxic, with ranchers slowly opening up to either friendly fescue or native forage. “I’m sure there are ranchers out there that think we’re absolutely nuts,” Hamilton said. “But some of them are interested in thinking about new ways of doing things.”

As we drove out to visit her cows, we passed some of her neighbors’ fields. In one, a herd of emaciated cattle had grazed a fescue field down to stubble. In another, all but a few cows stood in the middle of a pond, trying to cool themselves on a mild, cloudy day. 

“These are good people,” Hamilton said. “They’re just trying to make a living.”

By Jaymie Baxley 

In North Carolina, first-time public schoolchildren and students who have moved here from other states are required to have a physical health assessment within 30 days of their enrollment. Those who don’t run the risk of suspension, which could make them fall behind academically. 

The risk is heightened in rural, economically distressed areas like Duplin County, where many residents lack health insurance and providers are scarce. More than a quarter of the county’s children live in poverty, according to a 2022 study of health needs.

Duplin County has about 49,000 residents, a quarter of them under 18 years old, and only four pediatricians. Several surrounding counties have even fewer providers. 

Over the past three years, medical students from East Carolina University have provided free physicals for hundreds of schoolchildren in Duplin. The effort is part of Healthier Lives at School and Beyond, an initiative launched by the university in 2016 with funding from the U.S. Department of Health and Human Services. 

Originally a telemedicine program, Healthier Lives was expanded to offer in-person health screenings after the university converted a Wi-Fi-enabled transit bus into a mobile clinic in 2020. The bus now makes regular visits to K-12 campuses in Duplin, Jones and Sampson counties.

Lauren Nuriddin, a third year M.D. candidate at ECU’s Brody School of Medicine, gave an overview of the program during last month’s Rural Health Symposium in Greenville. The at-school physicals, she said, have “been successful in addressing barriers to care that the children in our rural communities face.”

Some of those barriers include “medical mistrust,” immigration status and limited access to transportation, according to Nuriddin. She said many parents are unable to take their children to a medical provider because they can’t afford to miss work. 

“All children deserve the right to education and should not have to forfeit this right based on reasons beyond their control, such as not having a school health assessment,” Nuriddin said, adding that she and her classmates “know the negative impact of suspension on school-aged children, and we are committed to doing something about it.”

Effects of suspension

Nuriddin said suspension can cause several “research-proven, negative long-term side effects,” especially in older children. They may fail to graduate on time, she said, and could face difficulty “obtaining employment with a living wage” after they do. 

A 2021 study by the American Institutes for Research found that suspensions had a “consistent negative effect on […] long-run educational outcomes for students.” The study was based on a decade’s worth of suspension data for middle and high school students in New York City. 

Another study, published in 2022 by the nonprofit Learning Policy Institute, found students were “less likely to earn a high school or college degree” after being suspended. An analysis of national data showed that suspensions were “meted out disproportionately to Black students, Native American students, and students with disabilities,” according to the study.

North Carolina has seen a similar disparity. A 2020 report by the N.C. Institute of Medicine  revealed that Black students were more likely to be suspended than their white peers. 

“In the education system, children of color are disproportionately punished through mechanisms like short-term suspension from school,” authors of the report wrote. “These punishments inhibit academic achievement and open a gateway that can, in time, lead to subsequent involvement with the justice system.

“Lower educational attainment and incarceration both have long-term negative impacts on health and well-being by decreasing employment opportunities and income potential.” 

While the bus physicals currently make up a small percentage of the Healthier Lives program’s encounters with students, Nuriddin said the share is growing. She hopes the service will contribute to the institute’s goal of lowering the state’s short-term suspension rate by 2030. 

Seeing the impact

Nuriddin and her fellow medical students have helped more than 300 schoolchildren avoid suspension since ECU began offering mobile health assessments. 

She said the effort has saved parents an estimated 330,000 miles worth of travel. It has also “increased instructional time for students who otherwise would have had to miss school” to attend doctor’s appointments.

Kristen Hall, chief officer for district effectiveness and student support services for Duplin County Schools, called the program an “invaluable service.”

“Beyond the students’ enjoyment of the unique experience of having their assessments conducted on an ECU athletic bus, our school system reaps significant benefits from this service,” Hall wrote in an email to NC Health News. “The seamless integration of the mobile health assessment bus contributes to the overall efficiency and effectiveness of our school system, ensuring the well-being and accessibility of healthcare services for all enrolled students.”

The bus physicals aren’t just helping schoolchildren, they’re “benefiting students at all levels,” according to Nuriddin.

“For public school students, reducing school suspension by completing required health assessments [results in] improved academic engagement and performance,” she said. “For medical students, providing school-based outreach opportunities in the curriculum enhances learning and engagement.”

Nuriddin described her time in the program as a career-affirming experience. She said she feels “blessed” for the opportunity to make a difference in the lives of children.

“Gaining this direct experience with children in their schools was invaluable and inspired me to see the impact I can make as a future physician beyond the clinic walls,” she said.

The post Medical students help rural schoolchildren avoid suspension with mobile physicals appeared first on North Carolina Health News.

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