New Hampshire has a State Emergency Operations Plan (SEOP) found at State Emergency Operations Plan (nh.gov). The steward of the SEOP, which is updated every five years (last published in 2019) but reviewed on an annual basis, is Homeland Security and Emergency Management, which is located within the Department of Safety. Although the Department of Safety is the lead organization, all of the State agencies’ Commissioners (including DHHS) and several large charitable organizations sign off on the SEOP. The State’s Incident Management Structure/Team is also led by the Department of Safety, on which both the Commissioner of DHHS and the Director of DPHS sit.

DHHS, within which lies Title V, leads the implementation of several of the emergency service functions, or ESFs. One is ESF 6, which focuses on mass care, housing and human services. Another is ESF 8, which specifically focuses on health and medical support, and is led by the Bureau of Emergency Response, Preparedness and Recovery (BERPR), which is within the Division of Public Health Services (DPHS), within DHHS, as is MCH.

BERPR works to build and strengthen the State’s ability to effectively respond to a range of public health threats, including infectious disease, natural disasters and biological, chemical, nuclear and radiological events using an all hazards approach. BERPR also works to increase the ability of public health (through the public health emergency preparedness program-PHEP) and health care partners (through the hospital preparedness program-HPP) across NH to plan for and respond to large-scale emergencies and disasters.

There is no specific language relating to the Title V populations identified in the SEOP. In fact, there are no subsets of the NH population identified at all throughout the SEOP. There is language regarding people with access and functional needs as well as the term “whole community” which is to include all populations. Title V staff were not involved in the 2019 update of the SEOP, but will be in 2024, when the next updates for ESF 6 and ESF 8 will be due. That does not mean that Title V staff are not consulted in the case of a statewide emergency or help in the preparation for one. In fact, they are. It is just not documented as such within the SEOP. MCH and BFCS leadership are on the Incident Command Structure of DHHS as a whole and their respective Divisions’ Continuity of Operation Plans in particular. NH’s Title V programs were called upon, particularly with the COVID‑19 pandemic response, but also for the recent dearth of infant formula and the systemic health care workforce shortage, to deliver critical MCH services and assist local communities in responding. NH’s Title V is proactive in its emergency preparedness planning and coordinates with partners at the state and local levels to develop emergency preparedness and response plans that include the needs of the MCH and CYSHCN population.

Also in 2021, the CSHCN Director arranged for the Council for Youth with Chronic Conditions (CYCC) to meet with NH's Chief Medical Officer and Director of Division of Long Term Supports and Services, to discuss COVID-19 Vaccine distribution phases and inform DHHS of the complex challenges faced by high-risk families. The CYCC’s Representative from the NH legislature contacted the Director of NH Homeland Security to identify the CYCC as a resource for future emergency preparedness planning. Following this outreach, the Director of DPHS met with the Council and encouraged them to monitor legislation related to their concerns and to share their families’ stories and experiences as another way of providing important input to the processes. 

DHHS staff all are trained annually (virtually) in emergency response protocol and systems. Throughout the pandemic, but particularly this past year, Title V staff from both MCH and BFCS who are registered nurses (RNs) were asked to staff the COVID‑19 vaccine clinics and testing sites held across the state. RNs make up a significant part of the totality of Title V staff, thus delaying or preventing routine work responsibilities. This has eased off within the last few months, with the last public vaccination clinic being held in May of 2022. Staff skilled in data entry also helped with the enormous volume of information from COVID‑19 testing and vaccination efforts.

MCH staff do work with the BERPR on developing any pertinent NH Health Alert Network (HAN) releases. The HAN is the primary method of sharing around the clock information about urgent public health incidents with healthcare partners. The HAN can also permit the exchange of information between sender and receiver. Messages are sent out via telephone, text message, fax, email and pager with recipients being a wide variety of stakeholder including health care providers of all sorts and well as hospital emergency departments and NH’s network of local health officers.

MCH’s Injury Prevention Program oversees the implementation of the DHHS contract with the Northern New England Poison Center (NNEPC) at Maine Medical, the State’s 24/7 call center and resource for all health care providers, particularly hospital emergency departments. The NNEPC is also a steward of hotline data and can often act as the “canary in the coal mine” for public health emergencies. The BERPR contributes funding from the federal hospital preparedness grant and collaborates with MCH in work with the NNEPC.

The Newborn Screening Program within MCH has historically always had their own contingency plan of operations to ensure program continuity, largely because timeliness is of utmost importance. This is reflected best in the contract with the State’s newborn screening laboratory, the New England Newborn Screening Program at the University of Massachusetts’ Medical School, which outlines procedures in the event of a major disaster or emergency.

MCH’s Birth Conditions Program (BCP), which Title V funds, has been working collaboratively with the Bureau of Infectious Disease Control (BIDC) within DPHS (the lead on COVID‑19 efforts) and the MCH Epidemiologist to identify and report COVID‑19 outcomes in mothers and infants for the CDC Surveillance for Emerging Threats to Mothers and Babies (SET‑NET) project. In this collective effort, BIDC provides the confirmed COVID lab data, the MCH Epidemiologist provides the link and data from Vital Records and the BCP requests mother and infant data from hospitals. The BCP staff person then compiles the hospital and vital record data for the mother and infant and adds this to the SET‑NET data entry tool for reporting. BIDC then reports this data to the CDC SET‑NET team. As a result of this effort, both BIDC and MCH collaboratively applied and were awarded CDC funding within the Epidemiology and Lab Capacity grant, Project W, “Infants with Congenital Exposure: Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats.” This has added another data analyst position to BIDC (in conjunction with MCH) who devotes a full FTE in facilitating surveillance activities related to maternal/infant COVID‑19 exposures and long-term infant follow-up.

MCH’s Quality Improvement and Clinical Services staff have been working with the Immunization Section throughout the pandemic. MCH was recently invited to the NH VaxWell Coalition VaxWell New Hampshire - Immunization, Vaccination (vaxwellnh.org) a group of stakeholders interested in increasing the state’s vaccination numbers, spearheaded by the NH Public Health Association. Of particular interest is an upcoming communications campaign for the summer entitled “Let’s Catch Up for the Summer” which emphasizes the role of adolescent well visits for immunizations, while acknowledging that these visits went down during the pandemic. This complements Title V’s work on the adolescent well visit national performance measure.

MCH’s Home Visiting Program has been a consistent provider of information to colleagues about family needs and more recently about the types of information families might be looking for when the COVID vaccine for the youngest children was approved and available. This was possible due to space being provided at meetings with local implementing agency (LIA) program staff where awardee level staff could hear how the pandemic was impacting families and communities across the State. One topic that arose early on, was the technological barriers for families that not only made virtual visits difficult, but also cut these families off from virtual medical, mental health, and other supportive services. Hearing from LIAs also inspired an American Rescue Plan grant to support getting concrete support to programs and families receiving home visiting. 

Recently, MCH and BFCS supported the Women, Infants and Children Nutrition Program (WIC) in getting out information on the infant formula shortage, best nutritional practices with infants, and solutions to current barriers. BFCS Health Care Coordinators have been working with families, Medicaid and pharmacies to ensure CSHCN needing specialty formula are able to obtain some. MCH routinely collaborates with WIC staff, particularly supporting its leadership in breastfeeding initiatives. WIC staff will be a key collaborator in helping Title V supported community health centers, many of whom have chosen breastfeeding efforts as both a quality improvement and enabling project.

Health Care and Family Support Coordinators continue to work with BFCS leadership to incorporate emergency planning into care planning. This became especially relevant during the COVID‑19 Public Health Emergency (PHE). As the scope of services is redesigned to align with the National Care Coordination Standards for CYSHCN, FY2024, additional focus will be placed on this important aspect of each shared plan of care.

It is known that public health emergencies disproportionately affect pregnant and postpartum women, infants, and children with and without special health care needs, all of Title V’s population focus. There is definitely a need for improvement for NH’s Title V staff to be a part of the preparatory work for a future disaster or public health emergency. Title V staff were definitively brought into the response as described above. However, much of this work was urgent and done ad hoc, and refined as the pandemic went on. Title V in NH now has the commitment of DPHS’s BERPR to be involved in future revisions of the State’s SEOP. Such involvement will include the dedication of time and effort on the development of emergency preparedness and response training, communication plans and tools/strategies to enhance statewide preparedness for addressing potential short- and long-term impacts of disasters and emerging threats to the MCH population. Many lessons and best practices have been learned from the COVID‑19 pandemic, which is resulting in better preparation for any upcoming public health emergencies.