Title V Involvement in State-Level Emergency Preparedness & Response

The emergency operations plan is referred to as the Kansas Response Plan (KRP), revised 2017. The KRP establishes a unified, cross-agency approach to incident management to support coordination, efficacy, and efficiency in the state’s capacity to prevent, protect against, mitigate, respond to, and recover from terrorism, major natural disasters, and other emergencies. The KRP provides guidance and policy direction on interfacing with county emergency operations plans and the Federal Interagency Operational Plans and is based on the fundamentals within the National Incident Management System. The KRP is comprised of fifteen emergency support functions (ESF), of which Public Health and Medical Services is ESF 8 and is led by the Bureau of Community Health Systems at the Kansas Department of Health and Environment (KDHE). ESF 8 provides information to support coordinated health and medical activities conducted in response to disasters or emergencies, specifically MCH-related needs such as the behavioral health needs of survivors and responders, medical needs of “at risk” populations (e.g., pediatrics, pregnant women, children with special health care needs, individuals from diverse cultures).

The agency’s Continuity of Operations Plan (COOP) ensures the provision of critical public health services to the MCH population during an emergency or disaster event and timely and efficient coordination of MCH personnel and resources before, during, and after an event. Within the Bureau of Family Health (BFH), the COOP outlines the specific maternal and child health emergency response needs as related to the primary functions of the Bureau (including critical public health infrastructure and programming); key personnel and required training/certification for each function; plans for accessing records and equipment; staff contacts and an order of succession; and the key stakeholders in which communication must be established.

Participation in Emergency Preparedness Planning Activities

The KDHE Emergency Readiness Initiative Plan outlines the various roles and responsibilities of staff within the Incident Command System (ICS). When KDHE’s ICS is activated, the KDHE Commander is the ultimate authority on everything related to that incident and serves with guidance from the KDHE Secretary. Underneath the KDHE Commander are Officers (Public Information/Political Liaison Officer, Safety Officer, Department Liaison Officer) who provide subject matter expert support to the KDHE Commander. Under the KDHE Commander and taking care of functional areas are the Operations, Planning, and Logistics/Administration Sections which are led by Chiefs. These sections perform functional tasks related to the incident in the achievement of operational objectives, goals, and implementing direction from the KDHE Commander. Given the breadth of services, supports, and programming provided through BFH, the Bureau Director serves as “Deputy KDHE Commander” and the System of Supports Section Director, also the Title V MCH Director, serves as a “Behavioral Health Branch Director” during ICS response activities to assist and support day-to-day responsibilities and various functions within the ICS depending on the situation. It is also not unlikely that other Title V subject matter experts could be added to the formal ICS staffing list, as was the case in the Zika public health emergency. BFH/Title V staff are involved in the review and revision of the state emergency operation plans, including the KDHE Emergency Operations Guide. Staff also participate in tabletop “readiness” exercises internal to the agency.

Data Assessment & Surveillance

Training: All employees at the agency have the following outlined in their position descriptions: “Perform other duties as assigned including serving as a member of the KDHE Disaster Response Team as needed to assure the agency's public and environmental health response is adequately staffed during and immediately following natural and/or manmade disasters, infectious disease outbreaks, and/or acts of terrorism.” As such, all employees are required to complete the ICS trainings within the first 90 days of hire. In recent years, the agency has provided other preparedness trainings around topics such as self-defense and situational awareness, active shooter response, and CPR/First Aid.

Communication Plans: The COOP outlines internal and stakeholder communication plans associated with activation and response of the plan. Individual Bureaus are required to complete Annex B to the plan, which outlines five sections (1) Functions (includes key personnel and required training or certification for each function), (2) Records and Equipment, (3) Bureau Order of Succession, (4) Staff Contact Sheet, and (5) Stakeholders. Internal protocols are established to determine communication plans for each program related to staff and stakeholder contacts.

Coordination with Other PH Programs: Ongoing planning and coordination is necessary across public health programs and BFH routinely works with the surveillance programs to identify needs (e.g., dangerous exposures for pregnant women, birth defects/patterns, high blood lead levels in young children). The child care program has emergency disaster guidelines which go into effect during any local or state declaration of emergency and cooperation with other programs, including but not limited to Immunizations, is necessary. The KS Special Health Care Needs Program (KS-SHCN) has participated in the agency’s Extreme Weather Work Group to assure the needs of people with disabilities were considered during extreme heat and cold seasons.

COVID-19 Pandemic Response (Jan. 2020 to present)

The COVID-19 pandemic elevated the need for agency staff to monitor and engage in emergency planning and preparedness at all levels, beyond the agency’s COOP planning activities. Throughout the pandemic response, the Title V MCH Director was instrumental in emergency operations and support to the agency, the Governor’s Office, and the Federal Emergency Management Agency (FEMA).

Kansas enacted many executive orders during the pandemic, including: temporarily prohibiting evictions and foreclosures; expanding telemedicine and addressing licensing requirements; conditional and temporary relief from certain motor vehicle carrier rules and regulations; requiring continuation of waste removal and recycling services; temporarily suspending driver’s license and vehicle registration expirations; allowing certain deferred tax deadlines and payments; extending unemployment benefits to help ensure the protection of families; relief for child care facilities continuing operation; and more.

Title V staff proactively monitored all guidance provided by the Centers for Disease Control and Prevention, national experts, and epidemiologists and infectious disease subject matter experts at KDHE. Based on these sources, Title V staff developed guidance for providers and staff as well as the MCH population. Content/guidance was developed for topics including but not limited to service provision for pregnant and perinatal populations (exposure, testing, vaccines, etc.), delivering home visiting services via telehealth, crisis/behavioral health, and safe operation of child care facilities. The guidance is updated episodically based on evolving recommendations and made available on the KDHE COVID-19 Resource Center. These efforts alleviate the burden on local providers to regularly search for updated recommendations during the pandemic and ensure best practice recommendations are being operationalized related to Title V services.

Title V worked closely with the other KDHE Bureaus and the Kansas Department of Emergency Management (KDEM) to make sure families have access to supports such as the Emergency Food Assistance Program, the Supplemental Nutritional Assistance Program, Temporary Assistance for Needy Families, and Child Care Assistance. Resources for how to connect to crisis centers, including mental health and substance use treatment facilities, were developed. A community resilience toolkit and scripts for public health contact tracers to utilize provided suicide prevention resources. Additionally, the Title V program worked closely with our local MCH agencies to use funding in innovative ways to help support families in their communities during the pandemic, such as using MCH funds to purchase technology and minutes for family cell phones so they could participate in telehealth activities and the purchase of “quarantine kits” for families in need (e.g., activities for families to enjoy together, coloring books, jump ropes, sidewalk chalk).

In addition to providing support, technical guidance, and flexibility for our local MCH grantees, individual members of the Title V team were integral to specific COVID-19 response activities outlined below.

• KDHE Incident Command and Response. The former BFH/Title V MCH Director was part of the agency response team since Incident Command was established and the statewide emergency was declared by the Governor in March 2020. Activities include/have included but are not limited to:
  • participating in briefings, local public health updates/webinars, and calls with providers;
  • providing updates to the Governor, State Health Officer/Secretary, and/or response team related to all aspects affecting the MCH populations;
  • coordinating the drafting, updating, approving, and posting of COVID-19 guidance for all BFH programs and public health priority areas of work and COVID-19 response (e.g., exposure, testing, vaccine) for a variety of audiences including other state agencies, public health workforce, providers, families, and the public;
  • monitoring the impact on pregnancy health and birth outcomes (internally and with MCH partners including members of the perinatal quality collaborative executive team);
  • initiating and maintaining collaboration and communication across state agencies as it pertains to developing guidance, proposals/plans, response, accommodations, and more;
  • serving as member of the workgroup focused on developing guidance for schools to safely operate during the pandemic using a variety of methods (in person, virtual/remote, hybrid); and
  • participating in ongoing conversations related to allocating/investing federal relief funds originating from a variety of sources and federal legislation focused on public health, child care, and behavioral health.
• Kansas: Stronger Together. At the onset of the pandemic, an overwhelming amount of information related to COVID-19 was available in every media outlet. As part of the initial state response, a collaborative effort began across state agencies such as the Kansas Department for Aging and Disability Services, KDHE, Kansas Department of Agriculture, and KDEM to create the Kansas Resource Guide for COVID-19 that was shared widely with state, local, and community partners to increase both knowledge and availability of resources and services during COVID-19. Title V staff were involved in this effort to share accurate and timely information and resources, specifically information and resources for the physical, mental, and emotional well-being of citizens. A primary goal was to alleviate stress and anxiety and reduce the spread of misinformation. The guide included information and resources related to topics such as: COVID-19, Mental Health, Substance Use, Anti-Violence, Parenting, Household, Agriculture, Information, and Business and Legal. The guide, and later a website, phone number, social media campaign, and broader outreach program emerged – all together known as Kansas: Stronger Together crisis counseling program. The program is authorized under the Robert T. Stafford Disaster Relief and Emergency Assistance Act Crisis Counseling Regular Services Program, funded by the FEMA. 
• Coronavirus Relief Fund (CARES Act) Programs. The Title V MCH Director was assigned to a cross-agency workgroup established by the Governor’s Office in July 2020 to make recommendations about how to allocate/invest relief dollars. The focus was on identifying immediate and ongoing needs of MCH populations and families, with emphasis on the early childhood workforce and young children. Three projects were assigned to the Title V MCH Director and implemented with BFH staff and partners.
  • The Child Care Health Consultant Network, implemented in partnership with Child Care Aware of KS, assisted licensed child care providers with mitigating the spread of COVID-19 and continue safe operation. Between September and December 2020, approximately $2.5M in funding was awarded to 440 home and center-based facilities across the state, reaching nearly 12,000 children. The program continues with alternate funding.
  • KS-SHCN administered the COVID-19 Essential Worker Health Fund between August 2020 and January 2021. The fund was established to provide assistance for essential workers (e.g., first responders, medical personnel, teachers, grocery workers, maintenance workers, military, childcare providers) who contracted COVID-19. The program’s existing infrastructure was positioned to implement/oversee the program. Once an individual was eligible, they were linked to a care coordinator who provided the appropriate referrals/linkages/reimbursement. Kansas workers received financial support for medical expenses, lost wages, and miscellaneous expenses incurred due to COVID-19. The program processed 704 applications. Approximately 500 Kansans qualified and received payments totaling $1.7M.
  • The Technology for Families program was implemented in partnership with the Children’s Cabinet and the University of Kansas Center for Public Partnerships and Research. Existing home visiting programs funded by state agencies were engaged to identify families across the state who were vulnerable for health and social hardships due to a lack of digital connectivity. The local programs then applied for funding to purchase and distribute devices (tablets, laptop computers and mobile phones) as well as internet connection via internet service plans, hot spots, and data cards. A total of 49 programs received more than $750,000 and delivered 1,567 devices and 1,621 instances of connectivity to 1,584 households with 3,280 young children in 71 of 105 counties (35% rural).
• Infant Toddler Medicaid COVID-19 Policies: With support and guidance from the Title V Director and the Children and Families Unit Director, the team worked closely with the Medicaid program to reimburse early intervention services provided via telemedicine. This collaboration was critical to supporting sustainability of services during the pandemic. In addition, during spring of 2021, BFH and Medicaid partnered to update the Kansas Medical Assistance Program Manual for Early Childhood Intervention to support correct billing procedures and enhance systems alignment.