UDHHS has a defined disaster response role to protect public health and support the local public health and healthcare systems during a disaster. To manage this responsibility, UDHHS has emergency plans in place to address natural and man-made disasters. Response plans are developed by response function or hazard-specific. The Population Health Division houses the Office of Emergency Medical Services and Preparedness (EMSP) who is the lead regulatory agency for Utah’s emergency medical services (EMS) system and coordinates public health and medical preparedness and response planning for the department and local stakeholders. EMSP's mission is to promote an effective and resilient public health, trauma, and emergency health care system to respond to emergencies and disasters through professional development, preparedness, regulation, quality assurance, and partner coordination.

The Utah Department of Public Safety, Division of Emergency Management manages the state of Utah’s Emergency Operations Plan (EOP) in coordination with all state agencies, including the UDHHS. This plan is reviewed and updated every five years or updated as a result of lessons learned during responses.

The current EOP includes an overarching planning assumption that individuals with disabilities and others with access and functional needs may require more assistance before, during, and after an incident in functional areas such as maintaining health, independence, communication, transportation, services, and medical care. They may also be more adversely affected during an incident. This includes, but is not limited to, individuals with a mental or physical impairment, individuals who live in an institutionalized setting, are older adults, are children, are from diverse cultures, have limited English proficiency, are transportation disadvantaged, are homeless, or low-income.

However, Utah is in the process of expanding planning considerations for vulnerable populations in all aspects of the EOP. This includes an expanded understanding of at-risk and functional need populations and collaborating with representatives of these populations when developing emergency plans and responding, including the Offices of MCH and CSHCN.

MCH/CSHCN staff were not involved or consulted in the planning and development of the current state EOP. Leadership of MCH, CSHCN and EMSP are in communication to better address the needs of the MCH/CSHCN populations in the Emergency Support Function 8 (health and medical) annex/addendum to the state emergency operations plan. In addition, lessons learned from the COVID-19 response and the merger of the Utah Department of Health with the Utah Department of Human Services will result in improved processes and stakeholders will be integrated into the new functions.

UDHHS has critical operations that must be performed, or rapidly and efficiently resumed, in an emergency and has a developed Continuity of Operations Planning (COOP) document. The COOP plan helps to establish guidance to begin the response and recovery of department-wide critical functions in the event of a major incident.

Title V leadership (MCH/CSHCN) is included in the COOP for UDHHS. COOP planning enables agencies to continue their essential functions across a broad spectrum of hazards and emergencies. The plan outlines essential functions, essential positions/personnel, vital records/critical program applications, alternate facility or recovery location, determination of priority functions/recovery time, defines lines of succession and delegation of authority, and reconstitution (return to “normal”) planning. The emergency planning effort ensures more involvement with Title V leadership with other emergency operations planning efforts, including revisions to the state EOP.

The Office of CSHCN has developed COOP and department plans to address being able to continue services during an emergency. We have individuals identified for the response as well as duties and data systems which will require immediate attention. All the newborn screening programs (blood, heart and hearing screenings) and direct care services are involved in this plan. The plans have worked during the pandemic and we have been able to provide continued services to the children, youth and families we serve. Additionally, we have continued to educate providers on screening and maintain compliance with the timeframes of the screeners during the pandemic.

To date, Title V leadership has not been involved in the Incident Command System (ICS). The scope, scale, and nature of the response is determined by UDHHS leadership and they activate various UDHHS programs depending on the incidents. MCH/CSHCN could easily be integrated into the department operations center or ICS structure as needed in the future and this will be reviewed and updated depending on response needs.

The COVID-19 pandemic had an impact on Title V populations. Many programs serving the MCH/CSHCN populations experience delayed or disrupted services due to fear and social distancing requirements resulting in fewer interventions for communicable diseases, injury prevention, and preventive screenings; decreased WIC participation; fewer families seeking direct care and care coordination for CSHCN; enrollment and participation in Early Intervention services for the up to age three population; a decrease in families benefiting from home visiting; and fewer children receiving recommended immunizations. Programmatic eligibility systems required programming changes to override several complex eligibility rules that resulted in case closure. Additionally, in some areas of the state, rural communities did not have the internet bandwidth to support increased telehealth services exacerbated by the pandemic.

The COVID pandemic has highlighted systemic issues and gaps in Utah’s public health and healthcare systems. UDHHS is currently in the process of collecting and analyzing lessons learned and best practices from the response to be incorporated into ongoing programmatic activities and future emergency preparedness efforts.

Moving forward, plans are in place for the Offices of MCH and CSHCN to meet with staff in EMSP to engage the Offices in sharing needs and resources and how MCH/CSHCN population considerations will be integrated into emergency preparedness plans.