In 2019, Maine’s Title V Director and Lead MCH Epidemiologist met with staff from Maine’s Public Health Emergency Preparedness Program (PHEP) to complete the CSTE MCH Emergency Preparedness Capacity Assessment. It was the first time Maine’s Title V program met with PHEP program staff in recent years. This initial meeting established a relationship between MCH and PHEP staff and an acknowledgement that more collaboration was needed to address MCH populations in Maine’s Emergency Preparedness Plans.

In Summer 2020, Maine was given the opportunity to host a Council of State and Territorial Epidemiologists (CSTE) Fellow with a focus on MCH and PHEP. Andrea Lenartz received her Master’s Degree in Public Health from the University of Iowa and started working with the Maine CDC in August 2020. In Fall 2020, a team from Maine applied for and was accepted into an Action Learning Collaborative (ALC) on MCH and PHEP sponsored by CDC’s Division of Reproductive Health and coordinated by AMCHP. The team was led by Ms. Lenartz and also included Maine’s Title V Director, Lead MCH Epidemiologist, Maine DHHS Child Health Officer, a member of Maine CDC’s PHEP staff, and representatives from Maine’s Emergency Medical Services. The ALC was active from October 2020-July 2021. During this time, States were provided with AMCHP’s Public Health Emergency Preparedness and Response Checklist for Maternal and Infant Health. Using this checklist, we identified strategies and activities to focus on.

Maine’s relationship with PHEP increased exponentially over the past year due to our increased epidemiology capacity and our participation in the ALC. We will continue to foster partnerships that will help further MCH-EPR (Emergency Preparedness and Response) work in the state. We plan to hold meetings with PHEP staff and Title V staff at least quarterly to maintain the momentum of our work and collaboration.

Maine has a written emergency operations plan (EOP) that is reviewed annually. The current plan is available at: https://www.maine.gov/mema/sites/maine.gov.mema/files/inline-files/maine_emergency_operations_plan.pdf

As part of our efforts through the ALC, the Maine team identified the various emergency preparedness plans across the state and reviewed them to ensure MCH considerations were documented. After completing what we called an “environmental scan” to locate the various EPR plans across the state, we reviewed them to ascertain their level of comprehensiveness regarding maternal and child health populations. Neither the state base plan for all hazards emergency operations or the mass care (shelter support) annex mentioned emergency preparedness as it relates to maternal and child health; they both took a more general approach to reach as many populations as possible. The Pediatric Surge Annex (developed by the Healthcare Coalition of Maine), however, provided a thorough detailing of strategies that should be used in case of an incident leading to a large number of pediatric patients needing hospital care.

Maine’s EOP includes annexes for some specific MCH-related programs such as WIC program, Maine Family Planning, Maine Newborn Bloodspot Screening Program, and Data, Research, and Vital Statistics (DRVS). We compiled all of the plans into a document, “Considerations for MCH Emergency Preparedness and Response.”

Currently the State’s EOP does not specifically consider the needs of the MCH population as a whole, but as a result of our collaboration with PHEP through the ALC, we are planning on conducting a hazard vulnerability analysis of the MCH population and develop an annex to the State EOP specifically focused on MCH populations.

Maine Title V leadership has not been traditionally involved in Maine’s emergency preparedness before a disaster. However, due to the work during the ALC, Maine’s Title V Director has been invited to participate in an emergency preparedness working group with PHEP, which we hope will allow for increased representation and advocacy for MCH populations in the emergency preparedness space. Title V leadership is not currently part of Maine’s Incident Management Structure.

Our ALC team evaluated the MCH role in the last state response, which was the EXPO Response in 2019 where over 450 asylum seekers from several African nations travelled from Southern Texas to be housed at the EXPO in Portland, Maine. PHEP was activated because of a potential exposure to infectious or vaccine preventable diseases. With the support of many organizations including Public Health Nursing (PHN), Immunizations (IMM), Maine Emergency Management Agency (MEMA), and American Red Cross (ARC), the EXPO provided sheltering operations, health screenings, disease surveillance, and vaccinations. As some of the asylees were mothers with infants or toddlers, Women, Infants, and Children (WIC) was activated to provide family assessments and guidance as well as assist with feeding. MCH staff were activated to provide cribettes and safe sleep education. An After-Action Report/Improvement Plan (AAR/IP) was completed to document the efforts of this response. WIC’s coordination of services and resources were marked as a strength in the report. Our ALC team, however, felt there could have been more input from MCH staff when completing the AAR/IP. We recommend that MCH staff members (including our Title V Director) attend after-action report meetings following a response involving maternal and child health populations and review the report to ensure accuracy and thoroughness.

As noted previously, Maine’s Title V program completed the CSTE MCH Emergency Preparedness Capacity Assessment in collaboration with PHEP staff. This assessment identified multiple gaps in how PHEP addresses MCH populations. Having a CSTE fellow dedicated to MCH and PHEP allowed us to fill in some of the gaps related to surveillance during a public health emergency. Our CSTE fellow currently has access to Maine’s National Electronic Disease Surveillance System (NEDSS) Base System, which houses data on notifiable diseases including COVID-19. This is the first time MCH epidemiologists accessed this system. We are currently working on a data linkage between birth certificates and COVID-19 case data that will allow us to evaluate how well NEDSS captures pregnancy status in COVID-19 cases and in other diseases or emergencies that use this system for tracking data. Over the course of the pandemic, we have also been creating data visualizations to show how COVID-19 impacts children, birth outcomes, and pregnancy-related behaviors. The birth outcomes dashboard is currently monitoring health indicators such as access to prenatal care, WIC use, tobacco use, breastfeeding, and others to identify any possible impact due to COVID-19. These types of visualizations could be replicated in other emergencies to monitor their effects.

Using the CDC’s tool for estimating the number of pregnant women in a geographic area as well as 2019 birth counts, infant death counts, and abortion counts from the Data, Research, and Vital Statistics (DRVS) program, we estimated and mapped the number of pregnant women by county. We also mapped the CDC’s social vulnerability index (SVI) at the census tract level to begin to better visualize vulnerable communities in the state. We plan to build upon the maps to more clearly identify vulnerable MCH populations in the state. We may do this by adding population rates to our SVI maps or creating a StoryMap displaying other MCH considerations such as drive time to the nearest hospital or analyzing access to other service providers. We will continue to monitor birth outcomes on a monthly basis to determine whether there are changes in trends that require attention.

MCH staff have not participated in the development of training and planning tools, but our first step is to increase the number of staff trained in emergency preparedness. In the most recent MCH needs assessment, MCH program leads and other partners identified workforce development as a need. To help fill this need related to PHEP, we compiled training resources, which are in a document sent to all MCH staff across the agency as part of this new workforce development initiative. Staff will be encouraged to attend training on emergency preparedness.

As our Title V director participates in the emergency preparedness response workgroup, there will be more opportunities for her to provide input into trainings and communication.

Title V staff are involved in the development of emergency preparedness plans related to newborn screening and newborn hearing, as well as family planning.