In 2020, the COVID-19 pandemic occurred throughout the world and appeared in Utah in March. On March 18, 2020, Utah experienced a 5.7 magnitude earthquake. The epicenter of the quake was located in Magna, Utah, a suburb of Salt Lake City. Utah citizens lost power, heat, dwelling structures and much more. The earthquake on top of the pandemic created more anxiety, fear and other emotions. We then experienced over 500 aftershocks in total over a week-long period and then a second 4.2 quake on April 14. Then Mother Nature continued to show her strength and on September 8, 2020, Utah had a major windstorm with winds up to 100 mph that tore through towns and communities uprooting trees, electrical and water lines and homes. Nearly 200,000 homes lost electrical power, with nearly 50,000 of these losing power for a week. Additionally, as many parts of the country experienced a variety of riots and damage to structures, Utah also experienced protests and civil unrest. The Utah Department of Health (UDOH) was targeted by community members who disagreed with implementing COVID-19 safety measures. Specifically, the UDOH Highland building had windows broken by a pellet gun. Luckily, no staff were at work when this incident occurred, but staff had concerns for their safety. There were also protests at the UDOH and individual employees' homes.

The UDOH has emergency plans in place to address natural and man-made disasters. Each bureau and program have building and program emergency plans to ensure that during a disaster, business can continue as normal as possible. The Family Health and Preparedness (FHP) Division houses the Bureau of Emergency Medical Services and Preparedness (BEMSP) who is the lead agency for Utah’s Emergency Medical Services (EMS) system and public health and medical preparedness and response. The BEMSP was available and provided statewide support during the pandemic response, two earthquakes, aftershocks and the windstorms. To ensure constituent input, the BEMSP has three statutory committees, three subcommittees, and various task forces. BEMSP'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 UDOH. This plan is reviewed and updated every five years or updated as a result of lessons learned during responses.

The current EOP addresses vulnerable populations defined as individuals in need of additional response assistance and may include those who have disabilities, live in institutionalized settings, are elderly, are children, are from diverse cultures, have limited English proficiency or are non-English speaking, or are transportation disadvantaged. 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 MCH/CSHCN.

For the current State EOP, MCH/CSHCN staff were not involved or consulted in the planning and development of the state EOP. Leadership of MCH, CSHCN and BEMSP are in communication to better address the needs of the MCH population in the Emergency Support Function 8 (health and medical) annex/addendum to the state emergency operations plan.

UDOH 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 Continuity of Operations Planning (COOP) for the Utah Department of Health. 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 CSHCN Bureau has developed COOP and department plans for years 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 did work during the pandemic and we were able to provide continued services to the children, youth and families we serve. Additionally, we 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 UDOH leadership and they activate various UDOH 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 ICS needs.

The COVID-19 pandemic had an impact on Title V populations. Many programs serving the MCH population 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 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 (such as eREP) 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 BEMSP applied for the National Emergency Medical Services for Children (EMSC) Resources Centers Demonstration CA U01MC37471. After receiving the grant, the CSHCN Bureau Director was made aware of the opportunity. Contact was made to collaborate as UDOH has the CSHCN Bureau who serves the population statewide and has knowledge, data and services offerings to serve this population. This opened a door for an internal and community partnership to work together to improve the opportunity, access and health of a rural area of Utah.

Activities of their demonstration grant include completion of an environmental scan of telehealth capabilities and need and development and implementation of a strategic plan to address the needs of either CSHCN or behavioral health emergencies. Over the years it has been found that silos have increased for a variety of reasons including overload of responsibilities, but the pandemic has opened the door as agencies/partners are realizing that working together will further our collective missions. This is a positive example of that growth. Our current plan is for the demonstration group to perform their environmental scan, then meet to evaluate the data compared to the Title V CSHCN Needs Assessment data. We will include knowledge from the Bureau of telehealth sites, access and needs and determine a service plan and expansion of collaborations moving forward. Additionally, the BEMSP Director is considering incorporating the CSHCN Bureau team members in emergency outreach planning for the future, as to date, each entity had siloed approaches.

The Utah Legislature conducted COVID-19 impact studies during the past 18 months which illustrated that areas with a high health improvement index score, a composite measure of social determinants of health, tend to be disproportionately impacted by disasters or crises. In order to be prepared for future crises, including pandemics and natural disasters, the reports recommended increasing capacity for the system to respond quickly with rental and utility assistance and affordable housing; food assistance; paid sick leave; and childcare subsidies. It was also determined that the ability to quickly recruit, train, and mobilize community health workers; staff at community-based organizations, and within emergency response programs is essential in providing services to an affected public as soon as possible. Recommendations also include improving cellular infrastructure to allow for increased internet access and increased availability of telehealth services, particularly in rural and frontier parts of the state, accompanied by expanded digital literacy training for those who are less comfortable with this technology. Additionally, language and cultural barriers and mistrust of the system in general may limit the impact of public health initiatives, and even more so in times of crisis. This information will be reviewed and emergency plans will be updated accordingly. Title V leadership will continue to work with stakeholders and internal emergency preparedness staff to improve outcomes.

Work on this section of the Title V Block Grant has renewed conversations between programs related to emergency preparedness. Moving forward, plans are in place for the MCH and CSHCN Bureaus to meet with staff in BEMSP to engage the Bureaus in sharing needs and resources and how MCH/CSHCN population considerations will be integrated into emergency preparedness plans.