Health Department MCH Capacity in Emergency Preparedness and Response Survey

Question Title

* 1. Where do you work?

State Health Department

County Health Department

City Health Department

Question Title

* 2. How many staff conduct MCH activities in your health department, including full time and part time?

Work on MCH activities at least 50% (2-1/2 days/week) of their time or more

Work on MCH activities less than 50% (<2-1/2 days/week) of their time

Question Title

* 3. How many MCH staff have received training in emergency preparedness and response?

Question Title

* 4. How many MCH staff have participated in an emergency response to support MCH needs?

Question Title

* 5. What lessons has your health department learned from previous emergencies?

Question Title

* 6. Does your health department have emergency preparedness plans and protocols for supporting MCH during an emergency?

Yes

Unknown

Question Title

* 7. Does your health department have guidance for women of reproductive age, including pregnant, postpartum, or lactating women for emergency preparedness or during emergencies?

Yes

Unknown

Question Title

* 8. Are there emergency preparedness and response staff or resources within your health department?

Yes

Unknown

Question Title

* 9. Which of the following best characterizes the current frequency of collaboration between MCH staff and emergency preparedness and response staff or resources in your health department?

Routinely

Frequently, but not on a routine basis

Occasionally/Infrequently

Rarely

Never

Question Title

* 10. Which of the following best characterizes the current frequency of collaboration between MCH staff and local or state emergency preparedness and response resources?

Routinely

Frequently, but not on a routine basis

Occasionally/Infrequently

Rarely

Never

Question Title

* 11. How many formal or informal partnerships does your health department have with external MCH agencies (e.g. March of Dimes, Healthy Start, PRAMS partners, AAP, ACOG, hospitals)?

Formal

Informal

Question Title

* 12. Which of the following best characterizes the current frequency of collaboration between health department MCH staff and partner agencies to support emergency preparedness and response activities?

Routinely

Frequently, but not on a routine basis

Occasionally/Infrequently

Rarely

Never

Question Title

* 13. For formal partnerships, does your agency know how these MCH agencies can provide support during an emergency response?

Yes

Unknown

Question Title

* 14. Do MCH staff within your health department generally have ready access (0 to 3 days return, electronic or hard-copy) to current medical, epidemiologic, and public health full-text articles and journals?

Unlimited, full access

Almost full access (i.e. access to most of the scientific journals needed in a MCH position)

Partial access (i.e. access to only a portion of scientific journals needed in a MCH position)

No access

Question Title

* 15. What state and/or local surveillance systems does your health department use that may include relevant information on women of reproductive age and may include pregnant and postpartum women?

Question Title

* 16. How much assistance would your health department need to perform the following emergency preparedness and response activities?

	Great Deal of Assistance		Some Assistance Needed		No Assistance Needed
Estimating the number of pregnant/postpartum women in an affected area	Estimating the number of pregnant/postpartum women in an affected area Great Deal of Assistance	Estimating the number of pregnant/postpartum women in an affected area	Estimating the number of pregnant/postpartum women in an affected area Some Assistance Needed	Estimating the number of pregnant/postpartum women in an affected area	Estimating the number of pregnant/postpartum women in an affected area No Assistance Needed
Developing surveys to assess impact on affected populations	Developing surveys to assess impact on affected populations Great Deal of Assistance	Developing surveys to assess impact on affected populations	Developing surveys to assess impact on affected populations Some Assistance Needed	Developing surveys to assess impact on affected populations	Developing surveys to assess impact on affected populations No Assistance Needed
Developing communication materials for a broad audience including medical professionals, politicians, and general public about the unique needs of women of reproductive age and pregnant/postpartum women during emergencies	Developing communication materials for a broad audience including medical professionals, politicians, and general public about the unique needs of women of reproductive age and pregnant/postpartum women during emergencies Great Deal of Assistance	Developing communication materials for a broad audience including medical professionals, politicians, and general public about the unique needs of women of reproductive age and pregnant/postpartum women during emergencies	Developing communication materials for a broad audience including medical professionals, politicians, and general public about the unique needs of women of reproductive age and pregnant/postpartum women during emergencies Some Assistance Needed	Developing communication materials for a broad audience including medical professionals, politicians, and general public about the unique needs of women of reproductive age and pregnant/postpartum women during emergencies	Developing communication materials for a broad audience including medical professionals, politicians, and general public about the unique needs of women of reproductive age and pregnant/postpartum women during emergencies No Assistance Needed
Administering prophylaxis to affected populations	Administering prophylaxis to affected populations Great Deal of Assistance	Administering prophylaxis to affected populations	Administering prophylaxis to affected populations Some Assistance Needed	Administering prophylaxis to affected populations	Administering prophylaxis to affected populations No Assistance Needed
Setting up quarantine and special needs shelters	Setting up quarantine and special needs shelters Great Deal of Assistance	Setting up quarantine and special needs shelters	Setting up quarantine and special needs shelters Some Assistance Needed	Setting up quarantine and special needs shelters	Setting up quarantine and special needs shelters No Assistance Needed
Providing needed services for families affected by an emergency	Providing needed services for families affected by an emergency Great Deal of Assistance	Providing needed services for families affected by an emergency	Providing needed services for families affected by an emergency Some Assistance Needed	Providing needed services for families affected by an emergency	Providing needed services for families affected by an emergency No Assistance Needed
Conducting trainings related to emergency preparedness/response	Conducting trainings related to emergency preparedness/response Great Deal of Assistance	Conducting trainings related to emergency preparedness/response	Conducting trainings related to emergency preparedness/response Some Assistance Needed	Conducting trainings related to emergency preparedness/response	Conducting trainings related to emergency preparedness/response No Assistance Needed
Creating budgets and estimating costs of emergency preparedness/response activities	Creating budgets and estimating costs of emergency preparedness/response activities Great Deal of Assistance	Creating budgets and estimating costs of emergency preparedness/response activities	Creating budgets and estimating costs of emergency preparedness/response activities Some Assistance Needed	Creating budgets and estimating costs of emergency preparedness/response activities	Creating budgets and estimating costs of emergency preparedness/response activities No Assistance Needed
Conducting after-action investigations to determine lessons learned	Conducting after-action investigations to determine lessons learned Great Deal of Assistance	Conducting after-action investigations to determine lessons learned	Conducting after-action investigations to determine lessons learned Some Assistance Needed	Conducting after-action investigations to determine lessons learned	Conducting after-action investigations to determine lessons learned No Assistance Needed

Question Title

* 17. Please indicate which level of emergency preparedness and response training would be beneficial for your health department?

No Training Needed

Basic Training Needed

Advanced Training Needed

Basic and Advanced Training Needed

No Training Needed

Basic Training Needed

Advanced Training Needed

Basic and Advanced Training Needed

Question Title

* 18. How confident are you in your health department's ability to prepare for an emergency response?

Not At All

Somewhat

Extremely

Not At All

Somewhat

Extremely