III.E.2.b.iv. MCH Emergency Planning and Preparedness

As an accredited health department, IDOH has an Emergency Operations Plan that is reviewed every two years. It is located on the Department’s intranet site. The last time this plan was updated was in March 2019. As it is currently written, the MOMs Helpline is listed as an essential service within the EOP with an understanding that women and families will have an even more acute need to get connected to services during times of emergencies.

MCH’s previous director was involved in the authorship of IDOH’s previous EOP but Title V is not currently a part of the incident command structure. Gaps in emergency response were not explicitly identified throughout the needs assessment; however, what did become apparent as the COVID response went on is the inconsistent surveillance of pregnant people on case report forms as well as the lack of capacity of data analysts to match that data with other birth and death records. Inconsistent data and expertise engaged in other parts of the response made it difficult to assess the impacts COVID had, and continue to have, on pregnant people and their babies here in Indiana. In addition, we know there was a large need for resources for families and many were struggling with a shortage of essential supplies for their families.

COVID has also illustrated the lack of coordination and integration of the MCH division and infectious disease programs. While the division promotes best practices, advisories, guidance, and other late breaking news to external partners, staff were not involved clinical strategies nor surveillance. The MCH Director relied heavily on the expertise of the state health commissioner who is an OBGYN. In the future, however, we recognize that IDOH needs a more systemic and sustainable approach to include the voices of mothers, infants, children, adolescents, and families.

During the heaviest months of the COVID-19 outbreak in 2020 and early 2021, some members of the MCH team stepped up and dedicated vast amounts of hours to aid in delivering the state’s response to combat the pandemic. From supervising the state of Indiana’s COVID-19 Call Center to working in the field managing public and long-term care testing and vaccination sites, the IDOH MCH team was well-represented and showed a commitment to their constituents.

In the first quarter of 2021 when positive COVID-19 cases decreased across the state, MCH staff returned to their “normal” Indiana Department of Health duties. After spending 15 months in the field addressing the emergent needs of the population, the MCH staff returned to their work with a new perspective and lessons learned from their emergency preparedness experiences. To make the most of these exciting experiences and better prepare for what is to come, the MCH Division was accepted to participate in the Association of Maternal and Child Health Programs (AMCHP) Emergency Preparedness and Response Action Learning Collaborative in late 2020. This learning collaborative was based on the four strategies of the 2021 AMCHP Public Health Emergency Preparedness and Response Checklist for Maternal and Infant Health. This checklist serves as roadmap to help the IDOH MCH team establish expectations regarding emergency planning and response for their populations.

Through our participation in the cohort, MCH created a list of priorities for IDOH Emergency Preparedness surrounding emergency preparedness and response to guarantee women, children and their families are considered in the plans, policies, and exercises. For example, within the next three to six months, the MCH Division Director has committed herself to setting up a meeting the EPR Division Director to touch base, share best practices and create a new partnership and guarantee that MCH is represented in all state plans and policies. In tandem with setting up a meeting time between the two divisions, other emergency preparedness and response activities include: researching a training for staff and setting an expectation for the percent of staff who will participate, updating a list of key MCH stakeholders with current contact information, and collecting data on the COVID-19 experiences of women shortly before, during and after pregnancy with the Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Long term, the MCH team plans work with key partners to establish annual reviews of hospital discharge protocols for postpartum care and newborns, plans for contraceptive use during and after emergency events, and participate in future workgroups to include MCH within the IDOH Continuity of Operations plan (COOP).