State MCH Capacity to Advance Effective Public Health Systems

MCH Emergency Planning and Preparedness

The Idaho Office of Emergency Management is directed by Governor Executive Order to establish and maintain the Idaho Emergency Operations Center for “directing the coordination of emergency and disaster operations.”[1] The State of Idaho, in accordance with Title 46, Chapter 10, “State Disaster Preparedness Act of 1975, as amended by the Idaho Homeland Security Act of 2004,” is required to plan and prepare for disasters and emergencies that are natural or human-caused to include enemy attack, sabotage, or other hostile actions including terrorism and the use of weapons of mass destruction[2]. The most recent Idaho Emergency Operations Plan (IDEOP) was published in 2019. The IDEOP is reviewed and updated regularly and applies to all state agencies.

The following describes where and how the IDEOP specifically considers the needs of MCH populations:

• There are two Emergency Support Functions (ESFs) where MCH populations are mentioned. ESFs provide the structure for coordinating a response to an incident by grouping capabilities into a structure to provide support, resources and services that are needed to save lives, protect property, and restore essential services and critical infrastructure[3]. Within ESF 6 (Mass Care, Emergency Assistance, Housing, and Human Services) and ESF 8 (Public Health and Medical Services) the Women, Infants, Children (WIC) Program is mentioned as a concurrent program with the Idaho public health districts providing a WIC coordinator to perform administration supervisory and professional work necessary to the planning, implementation, and evaluation of local WIC program activities.

• The Women, Infants, Children (WIC) Program - WIC provides federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. WIC Disaster Response - Although the WIC Program is not designed to be a disaster assistance program, and therefore is not considered a first line of defense, WIC policies are designed to allow State agencies flexibility in program design and administration to support continuation of benefits to participants during times of natural or other disasters.

Medical sheltering is the responsibility of IDHW in coordination with the seven Idaho public health districts. Together, they will provide health services in medical needs shelters, however, the IDEOP does not specifically call out medically vulnerable women, infants, and children. As part of ESF 8, the plan does mention that IDHW “may consult with public health and medical subject-matter expert representatives about access and functions needs populations such as the aging, populations with disabilities, limited English proficiency, and those with temporary or chronic medical conditions.”

Within the IDEOP, the IDHW Public Health Emergency Preparedness (PHEP) Program is the primary agency for the following ESF annexes:

• ESF 2: Communications
• ESF 6: Mass Care, Emergency Assistance, Housing, and Human Services
• ESF 7: Resource and Logistic Support
• ESF 8: Public Health and Medical Services (primary and coordinating agency)
• ESF 10: Hazardous Materials
• ESF 11: Agriculture and Food

During an emergency, the IDHW PHEP operates out of the IDHW Operations Center (IDHWOC) and has a set of plans that are followed to carry out their specific ESF annexes.

Prior to COVID-19, the IDHW PHEP plans were reviewed annually and the MCH Program was not involved in the development. The plans did not include specific populations, but subject matter experts were identified when those populations needed to be addressed. MCH leadership were included in some trainings and exercises. However, COVID-19 caused the PHEP program to analyze how their plans and response were organized. As a result of the pandemic, the PHEP program will look at how local public health district plans align with IDHW plans with the goal of reducing the total number of plans from 19 to 8. Going forward, the PHEP program plans to be intentional about involving multiple programs across the Division of Behavioral Health and the Division of Public Health such as Environmental Health and the MCH Program. Subject matter experts will be identified for each program and continuously involved in training and plan development. MCH staff are specifically included in the IDHWOC Incident Management Structure as part of the logistics team. The current MCH representative in the IDHWOC has training in Incident Command System (ICS) courses and has previous disaster response experience at the county level.

The Association for Maternal and Child Health Programs (AMCHP) has created a checklist to support emergency preparedness and response capacity building for state and territory MCH programs with action item cards to elaborate on each activity. The MCH Program has shared those items with the PHEP Program, and the PHEP Program is considering how to include MCH priorities in local-level objectives as a way to integrate MCH considerations into the state emergency preparedness and response plan. The MCH Program is also hopeful that by working more closely with the PHEP Program, a greater ability to identify programs, interventions, and policies that can assist MCH populations during emergencies will emerge. This could result in increased coordination between programs like newborn screening, immunizations, home visiting, and other MCH population-serving programs.

Between March and June of 2021, the MCH Health Program Manager was involved in the AMCHP Public Health Emergency Preparedness Work Group. This work group consisted of representatives from other states and professional organizations. The purpose of the work group was to enhance the capabilities of agencies that intersect with MCH populations to actively engage in public health emergency responses. The project will result in a comprehensive toolkit that identifies characteristics of systems that are prepared to deliver an equity-centered and evidence-based emergency response. At the state level, the MCH Program has been limited in their involvement in the development of materials, communication plans, or tools and strategies to enhance Idaho’s preparedness to respond to disasters involving MCH populations. The MCH Program has a role in the IDHWOC, however, this role has not been utilized during the COVID-19 pandemic. 

The current MCH representative participates on the Idaho Emergency Medical Services for Children (EMS-C) Advisory Council with the purpose of providing the perspective of EMS needs for the MCH and CSHCN populations. To date, the MCH Program has not participated in the development of coordination plans with other public health programs to enhance statewide preparedness to address impacts of disasters and threats on MCH populations.

[1] Idaho Emergency Operations Center, https://ioem.idaho.gov/operations/ideoc/

[2] Idaho Office of Emergency Management, Idaho Emergency Operations Plan, https://ioem.idaho.gov/wp-content/uploads/sites/57/2018/12/2017-IDEOP.pdf

[3] U.S. Department of Health & Human Services, Office of the Assistant Secretary for Preparedness and Response, https://www.phe.gov/Preparedness/support/esf8/Pages/default.aspx#:~:text=Emergency%20Support%20Functions%20(ESFs)%20is,environment%2C%20restore%20essential%20services%20and