We asked AMCHP Members: How is your Title V/MCH department incorporating reproductive emergency preparedness and response into its work?
By Juanita Graham, DNP, RN, FRSPH
Mississippi State Department of Health
On Aug. 29, 2015, Mississippi (MS) will recognize the 10th anniversary of Hurricane Katrina. I use the term "recognize" because it will certainly be no celebration – merely an opportunity to remember lives lost and lessons learned through the single greatest natural disaster ever experienced by our state. Damages exceeding $125 billion encompassed all 82 Mississippi counties. A 30-foot storm surge wiped out 90 percent of the buildings along the MS Gulf Coast, 238 people died, and 67 went missing. Public health nurses from all over MS were deployed for the disaster response efforts. On Sept. 1, 2005, just two days post-storm, my nurse buddy and I abandoned my car and walked/climbed through nearly a mile of debris to get to the beach and see for ourselves the seemingly endless line of bare foundations where stately and historic coastal homes had stood just a few days before. Ten years later, many of those slabs remain bare.
Mississippians are no strangers to challenges. We employed our humor and strength to get us through the trying times to follow – well-illustrated by this photo I took of a Rolls Royce and fern pillar parked next to the FEMA trailer that replaced a once stately home. We have trudged along seeking partners and resources to rebuild. One partnership was sought with the CDC DRH to help assess the needs of the Gulf Coast maternal and child health population. We were delighted to help DRH pilot a survey tool designed for just that purpose.
Utilizing a group of nursing students from the University of Mississippi as data collectors, we interviewed more than 100 coastal women in waiting rooms of the six Coastal Family Health Center locations. The women were eager to tell their stories and many stood in line waiting to speak to a student, even after all of the small incentives had been disbursed. There were weaknesses and limitations to the pilot project but we did the best we could, given the sparse resources in the region. But, those weaknesses and limitations provided valuable insight as to what challenges a researcher might anticipate in a significant post-disaster setting.
As expected, many women described long waiting periods for appointments and low availability of services. Most notably, about 40 percent of the women said they usually got their family planning services at a hospital emergency room, certainly not the best setting for quality reproductive health care. Given the state history of high rates of infant mortality, that finding was a grave concern. As it turned out, MS recorded a statewide infant mortality rate (IMR) of 11.4 per 1,000 live births for the calendar year 2005, the highest rate during the 20-year span of 1994 to 2013. There are insufficient data to confirm any correlation between the high 2005 IMR and Hurricane Katrina. But, the limited findings derived through the DRH pilot study suggest that risks for infant and maternal health were present on the coast, long after that dreadful day of Aug. 29, 2005.
By Emily K. Roberson, PhD, MPH
Hawaii Pregnancy Risk Assessment Monitoring System (PRAMS) Program Coordinator
Bryan Vidrine, MPH
Public Health Preparedness (PHP) Planner
Judy K. Kern
Education and Training Coordinator, Acting PHP Branch Co-chief
The Hawaii Pregnancy Risk Assessment Monitoring System (PRAMS), housed within the Hawaii State Department of Health (DOH), Family Health Services Division and funded by the CDC, is a population-based surveillance system designed to identify and monitor maternal experiences, attitudes, and behaviors from preconception, through pregnancy and into the postpartum period. Every three to five years, the survey that forms the basis of the program is revised through a collaborative process involving many local, state and national stakeholders. The revision process that will eventually result in the 2016-2020 version of the Hawaii PRAMS survey version began in earnest in 2014.
In late 2014, CDC introduced a new potential survey question to PRAMS states related to family and household disaster preparedness. Hawaii PRAMS contacted the Hawaii DOH Public Health Preparedness Branch (PHPB) to see if they had any interest in working with Hawaii PRAMS to add this question to the revised survey. PHPB was very interested, as MCH populations are often among the most vulnerable in disasters. Hawaii PRAMS and PHPB worked together to modify the disaster preparedness question slightly (with the CDC blessing) to make it more relevant to the unique needs of Hawaii as a geographically remote island state. The modified version of this question will appear in the Hawaii PRAMS 2016-2020 survey, and PHPB is providing funding support to the Hawaii PRAMS program in order to assist with data collection activities.
PHPB seeks to use this data to increase state capacity to ensure the needs of MCH populations are adequately addressed during emergencies or disasters and identify any gaps that may exist. In addition to collecting important new information about disaster preparedness among a high priority population in Hawaii, this experience also established a mutually beneficial new partnership between Hawaii PRAMS and PHPB that did not exist before.
By Jennifer Fiddner, MPH
Epidemiology Research Associate, Allegheny County Health Department
Recognizing that pregnant women, infants and children are especially vulnerable during public health emergencies, the Allegheny County Health Department (ACHD) Emergency Preparedness, Bureau of Assessment, Statistics and Epidemiology (BASE) and MCH program staff launched an innovative collaboration. The ACHD MCH home visiting program offers prenatal, postpartum, and pediatric visits to promote healthy pregnancies and positive birth outcomes in an at-risk populations. In order to deliver preparedness information to this population, the ACHD incorporated curriculum enhancements into its MCH home visiting program. Topics included making an emergency kit and plan, keeping extra food and water, infant safe sleep during an evacuation and awareness about infectious disease emergencies. The brief messages were designed to complement curriculum lessons, which home visitors use to develop visit plans for their clients. For example, a lesson on infant nutrition could include messaging about storing extra formula for emergency situations. Understanding that clients enter the program at different points, messages were repeated when topic areas recurred.
ACHD preparedness staff trained the home visitors to incorporate the enhancements into their lessons. The MCH preparedness initiative was well-received and supported by the home visitors. Three months after implementation, home visiting clients were asked to recall key preparedness topics. These questions were delivered as part of a routine client satisfaction survey. Fifty-two percent of the surveyed clients reported that preparedness information was addressed during a visit.
The project initiated conversation about emergency planning with a vulnerable population. The enhancements aligned well with essential home visiting lessons; thus, the structure of the curriculum was preserved. When developing preparedness goals for an at-risk population, access to resources must be considered. MCH home visitors, who work with the same clients throughout their enrollment, develop a unique perspective on a family's ability to plan for an emergency, including needs and access to resources.