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 is designed to support county and federal emergency response plans. This document 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).

In addition to the statewide KRP, the KDHE Emergency Readiness Initiative Plan outlines the various roles and responsibilities of staff within the Incident Command System (ICS). Given the breadth of services, supports, and programming provided through the Bureau of Family Health, the Bureau Director, also the Title V MCH Director, serves as “Deputy KDHE Commander” and the System of Supports Section Director, also the Title V CSHCN 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 recent 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.

Additionally, 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, 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

When KDHE’s ICS is activated, the KDHE Commander is the ultimate authority on anything and 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 at the Commanders direction. 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. Other supporting units like human resources and legal are typically called in for brief periods of time, usually in the Logistics/Administration Section, to provide specific subject matter activities for that Section Chief and the KDHE Commander. All agency staff participate in agency planning and preparedness in some way, more extensive at times depending on the type and duration of an emergency, to enhance statewide preparedness for addressing potential short- and long-term impacts of disasters and emerging threats on the MCH population.

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. The Bureau of Family Health routinely works with the surveillance programs to identify needs and respond (dangerous exposures for pregnant women, birth defects/patterns that could be attributed to investigations, high blood lead levels in young children, etc.). 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. In the past, the KS Special Health Care Needs Program 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 in Kansas.

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

The COVID-19 pandemic specifically 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 Kansas 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 (CDC), 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. Title V stayed abreast of evolving recommendations related to maternal and child health and created resource guides for providers inclusive of these frequent updates. 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/benefits 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).