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Assessment for and Provision of Essential Services Needs for Individuals in Isolation and Quarantine

State: MN Type: Promising Practice Year: 2019

www.hennepin.us

Hennepin County serves Minneapolis, MN and surrounding communities. 

  • 1.2 million residents
  • 22% of the State's population
  • Median age: 36.2
  • 17.5% speak language other than English at home
  • 13.4% foreign-born
  • Hennepin County Government ~ 10,000 staff
  • Human Services and Public Health Departments ~ 3,800 staff
  • 45 municipalities
  • 22 independent school districts

Hennepin County Public Health Department works to improve and protect the health of children, adolescents and adults who live, learn, work or play in Hennepin County.  Our ultimate purpose is to promote physical and mental health, prevent illness and injury associated with communicable diseases and environmental conditions, reduce chronic diseases, and enhance the well-being of individuals affected by mental illnesses and serious emotional disturbances.  We do this when we:

  • Prevent or reduce the impact of chronic diseases;
  • Improve mental health and well-being of people at all stages of life;
  • Promote optimal health and development outcomes from the prenatal period through infancy, early childhood, adolescence and young adulthood; 
  • Prevent and control infectious diseases;
  • Reduce illness, injury and unintended death;
  • Ensure an effective response to all public health emergencies;
  • Assure access to healthcare and public health services, and referrals to human services; and
  • Deploy changes in policy, program and practice to advance health equity.

Hennepin County Human Services mission is to strengthen individuals, families and communities by:

  • Increasing safety and stability,
  • Promoting self-reliance and livable income, and
  • Improving the health of our communities.

Human Services delivers a variety of services that assist with basic needs or encourage client change:

  • safety net services such as food support, emergency shelter and cash assistance;
  • help for people who are developmentally disabled;
  • services for seniors;
  • services for veterans;
  • behavioral and chemical health services;
  • protective services for children and adults;
  • child support; and
  • Medical Assistance.

This proposed model practice is titled Assessment for and Provision of Essential Services Needs for Individuals in Isolation and Quarantine.”

This practice required coordination between human services and public health departments, to develop a process to address the challenges of keeping people in isolation and quarantine, while meeting (or exceeding) requirements put forth by Minnesota State Statutes 144.419.  Specifically, this model addresses the requirements that:

  • Isolation and quarantine must be by the least restrictive means necessary to prevent the spread of a communicable or potentially communicable disease;
  • The needs of persons isolated and quarantined shall be addressed in a systematic and competent fashion, including, but not limited to, providing adequate food, clothing, shelter, means of communication between those in isolation or quarantine and those outside these settings, medication, and competent medical care. Hereafter referred to as essential services needs.

A multi-disciplinary team of subject matter experts developed a procedure that met these objectives:

  1. Assure isolation of active cases during their infectious period;
  2. Assure compliance with social exclusion (voluntary quarantine) among non-immune contacts of actively infectious cases;
  3. Ensure a systematic and inclusive assessment of cases in isolation and contacts in voluntary exclusion for essential service needs;
  4. Leverage the unique partnership between public health and human services emergency preparedness and response in Hennepin County.

This procedure was first developed in 2005, but has evolved significantly due to changes in technology and service provision, as well as outcomes and lessons learned when it was used in the following incidents:

  • Katrina 2005
  • H1N1 2009-2010
  • Ebola 2014
  • Measles 2017

Factors leading to the success of this practice include:

  • Engagement of Subject Matter Experts in Epidemiology and Human Services;
  • Coordination of human services and public health in preparedness and response;
  • Opportunities to implement the procedure in real life incidents;
  • Expanding the scope of what Hennepin County considers an essential service;
  • Managing the process using the Incident Command System (ICS);
  • Support and buy-in of leadership for this planning and response;
  • Having an Emergency Response Line (phone) and testing this line regularly;
  • Training of staff- on-going and just in time;
  • Staff are ready in the field to respond to requests, especially those that may be specific to a cultural group;
  • Technology and commerce has changed to make it easier to coordinate and access essential services.

The impact of the Assessment for and Provision of Essential Services Needs for Individuals in Isolation and Quarantine” practice is that it has incorporated human services into an infectious disease response, which reduces the spread of disease.

This proposed model practice is titled Assessment for and Provision of Essential Services Needs for Individuals in Isolation and Quarantine.”

This practice required coordination between human services and public health departments, to develop a process to address the challenges of keeping people in isolation and quarantine, while meeting (or exceeding) requirements put forth by Minnesota State Statutes 144.419.  Specifically, this model addresses the requirements that:

  • Isolation and quarantine must be by the least restrictive means necessary to prevent the spread of a communicable or potentially communicable disease;
  • The needs of persons isolated and quarantined shall be addressed in a systematic and competent fashion, including, but not limited to, providing adequate food, clothing, shelter, means of communication between those in isolation or quarantine and those outside these settings, medication, and competent medical care.

To meet statutory requirements and to provide the best service to county residents in isolation and quarantine, a multi-disciplinary team of subject matter experts developed a standard operating procedure that met these objectives:

  • Assure isolation of active cases during their infectious period;
  • Assure compliance with social exclusion (voluntary quarantine) among non-immune contacts of actively infectious cases;
  • Ensure a systematic and inclusive assessment of cases in isolation and contacts in voluntary exclusion for essential service needs;
  • Leverage the unique partnership between public health and human services emergency preparedness and response in Hennepin County.

The procedure, resource guide, and tracking is as follows, and can be used to assess for and provide essential services to residents in isolation or quarantine/exclusion:

Note: workflow process was developed for the 2014 Ebola response, but can be generalized to any infectious disease incident that requires assessment and provision of essential services for individuals in isolation or quarantine.

Workflow from Epidemiology to Human Services for Essential Services

  • Epidemiology makes call to traveler and determines if client in quarantine has essential services needs.
  • If they do have essential service needs, Epidemiology completes Essential Services tab in Excel database.
  • For clients with essential services needs, Epidemiology will call 612-596-1540 to connect client with screener between 8am and 4pm or supervisor between 4pm and 8am.
    • Epidemiology will complete their portion of the Excel spreadsheet on O drive for screener/supervisor to access under the traveler's name.
  • Screener or supervisor will find out from the Epidemiology staff, the traveler's essential service needs.
    • For each essential service need, screener or supervisor will help client problem solve solutions for getting those needs met within their own support system or community.
  • If there is a financial barrier to meeting their essential needs and the request is reasonable, you will help the client determine how/where the item will be purchased and then contact Amy Hansen or Salome Muthiani, who will use a Pcard (county credit card) to help purchase those items. 
  • If there are essential services that are unable to be met within client's own support system or community, and for which something is required to be delivered to a client's home, a referral will be made to the pre-identified, Ebola trained service planner pool or to their current Hennepin County worker.
  • Service planner or existing social worker will help develop plan for essential service needs with client and note all contacts and outcomes in essential services tab of Excel spreadsheet on O-drive (shared network drive).
  • If there is a financial barrier to meeting their essential needs and the request is reasonable, you will then contact Amy Hansen or Salome Muthiani, who will use a Pcard (county credit card) to help purchase those items. 


Emergency Response Line

During this planning process, it was determined that it would also be necessary to have a dedicated Emergency Response Line that could be activated during a response.  This phone number would only be active during an emergency. 

The best staff to answer this line is those who have experience in assessing needs and providing resources.  The Front Door” staff were determined to be the best fit and able to work in this role as this is their day to day work.  They have the capacity to take on the extra calls and are professionally trained as social workers and public health nurses.  They also already work in a call center environment which would require no new set-up for them to be able to answer the calls, other than adding in the emergency response line.

During an infectious disease emergency where essential services are needed for individuals in isolation or quarantine, Front Door Service Planners and/or Office of Multicultural Services workers were called upon to fill this role as their work is already in the field and the workers are social workers and case management assistants.

The emergency response line (612-596-1540) is a dedicated line, set up with 3 different answering options:

  1. A combined line with the Front Door Call Center, with the emergency response line taking priority;
  2. Just the emergency response line between 8am-4pm; and
  3. The emergency response line 24/7. 

The emergency response line is tested twice every year to make sure the programing remains functional.  Additionally, the staff answering the line are trained twice every year to ensure their readiness for an emergency.


Just in Time Training (JITT)

Just-In-Time Training (JITT) for Ebola screening and provision of essential services was developed during Ebola (but not used), and then modified for measles.

Ebola Just-In-Time Training for Screeners

Important Phone Numbers

  • Ebola Hotline MDH:  651-201-3920
  • ICA Emergency Response Line (only to be used by HC Epi Unit):  612-596-1540
  • HC Epi Emergency Response Line (for people being monitored or in quarantine): 612-543-1446
  • PCard Contacts (for purchasing of Essential Needs/Services for people in quarantine who are unable to fund their own purchases)

Ebola Response Basics

All travelers from the affected areas of Africa (Guinea, Sierra Leone and Liberia) are being directed to 5 US airports to gain access back into the country.  They will be assessed at those airports before they are allowed to continue to their home airports.  These 5 airports are providing a unified list to the states so that each state can monitor each of these travelers for 21 days.  Hennepin County Epidemiology unit will be calling identified Hennepin County travelers to complete a Day Zero assessment and begin monitoring them for fevers and symptoms.

If at some point a traveler becomes symptomatic, they will be placed in quarantine.  Because they will be unable to leave their home and we want to encourage their cooperation with quarantine, Epi will be asking them if they have essential needs that will need to be taken care of.  If they do, they will then pass those callers onto you with a warm hand off phone call to the 612-596-1540 line.

Epi staff will identify what Essential Needs they need help with.   You will be helping them to identify resources within their family, community, church, etc.  If the only barrier to meeting their essential needs is financial and the request is reasonable, you will then contact Amy Hansen or Salome Muthiani, who will use a Pcard to help purchase those items.  If there are absolutely no viable people resources to be able to help them get their essential needs met, you will then be referring the case on to Access workers or their existing worker, if there is one. 

Phone Instructions

  • Only ONE person, who is not taking calls can be logged into the Emergency Response Line, and they have to remain logged in all day in Not Ready mode.
  • Everyone else will log into their phone shift using their normal log in ID.
  • Effective immediately, we will have the electronic coverage person log in everyday at 8:00 a.m. and log out at 4:00 p.m.
  • The electronic coverage person will not put themselves in ready mode or take any calls. They must remain in Not Ready mode all day for the rest of the group to take calls from Emergency Response Line, 4500 and 4111.
  • Once electronic coverage is logged in, Emergency Response Line calls will be prioritized and queued to the top of the waiting list.
  • When your phone rings, if you look to the top left corner of the screen print, there is a section that says Field and Data.
  • When a call is being queued to you from the Emergency Response Line, it will say ERL in this top left corner.
  • When you see this, please DO NOT answer the phone Front Door how may I help you”. Instead, please answer the phone by saying Emergency Response Line, how can I help you?”
  • The other numbers are provided in the event that they are needed later in the Ebola response.
    • 9901542 – Front Door and Emergency Response Line 8 a.m. to 4 p.m.
    • 9901540 – Emergency Response Line, 596-1540 (ERL) only 24X7
    • 9901541 – Emergency Response Line only 8 a.m. to 4 p.m.

 I&Q Emergency Screening Questions (asked by epidemiologist and/or human services screener)

Language

  • Interpreter needed?
  • Use of telecommunications device for the deaf (TDD)?
  • Other Special Instructions

Medications/Medical Equipment or Supplies

  • Medication
    • From where do you normally get your prescriptions?  Do they deliver? If not, would you be willing to have your prescriptions filled by a pharmacy that does deliver?
    • Do you have money to purchase your prescriptions?
  • Medical Conditions, Equipment or Supplies
    • Do you have any medical conditions that you need to be seen for?
    • Where are you normally seen?  Clinic and doctor's name and number.
    • Where do you normally get these supplies from? Do they deliver?  If not, would you be willing to have the equipment delivered from another company?
  • Medical Insurance Info
    • Medical Insurance type
    • Medical Insurance Policy number
    • If none, complete Medical Assistance app for client and fax to EA.

Shelter Needs

  • Do you or any of your family members need temporary shelter during this I & Q?
  • Do you have any friends or family that would be able to house this person temporarily?
  • Do you have financial means to secure lodging at a hotel/motel?

Food Needs

  • Do you or any of your family members need food during this I&Q?
  • Do you have friends or family that would be able to purchase and/or prepare food for this individual (and deliver to them)?
  • Do you have financial means to secure food through on line sources like Simon Delivers?
  • Do you have access to a computer?

Transportation Needs

  • Do you or any of your family members need transportation during this I&Q?
  • Do you have friends or family that would be able to provide this transportation?
  • Do you have financial means to secure transportation through the bus, light rail, cab, etc?

Clothing Needs

  • Do you or any of your family members need clothing during this I&Q?
  • Do you have friends or family that would be able to provide clothing?
  • Do you have financial means to secure clothing using the internet?  Do you have access to the internet?

Psychological/Mental Health Needs

  • Do you or any of your family members need psychological or mental health counseling during this I&Q?
  • What are the barriers to obtaining these services?

Utilities

  • Do you or any of your family members help with maintaining your utilities during this I&Q?
  • What are the barriers in maintaining them?
    • Financial?
      • If yes, do you have friends or family that would be able to provide assistance with this?

Access to Legal Representation

  • Do you or any of your family members need legal representation during this I&Q?
    • Do you have financial means to secure legal representation?
      • If no, refer to legal aid.

Social Amenities

  • Do you or any of your family members need TV, books, radio, games during this I&Q?
  • Do you have friends or family that would be able to provide these items?
  • Do you have financial means to secure these items using the internet?  Do you have access to the internet?

Employment Needs

  • Do you or any of your family members need assistance around their employment during this I&Q?
    • If yes, transportation?  Letter to employer?

Communications

  • Do you or any of your family members need access to a phone during this I&Q?
  • Do you have friends or family that would be able to provide a phone for your use?
  • Do you have financial means to secure a phone for your use?  Would someone be able to get that to you?

Child care/Adult care

  • Do any of your family members need child care or adult care during this I&Q?
  • Do you have friends or family that would be able to provide that care?
  • Do you have financial means to secure that care through alternative means?

Pet care

  • Do you need pet care during this I&Q?
  • Do you have friends or family that would be able to provide that care?
  •  Do you have financial means to secure that care through alternative means?

Laundry

  • Do you or any of your family members need assistance with laundry during this I&Q?
  • Do you have friends or family that would be able to provide this assistance?
  • Do you have financial means to secure someone to provide this assistance?

Banking

  • Do you or any of your family members need assistance with banking during this I&Q?
  • Do you have friends or family that would be able to provide this assistance?


Just-In-Time Training for Screeners for Essential Services (modified for use during the measles response)

6/7/2017

Measles Response Basics

Hennepin County currently has 70 identified cases of measles. Anything over 2 cases is considered an outbreak due to the virus being so infectious.  98% of these individuals were not immunized. Because the outbreak began in the Somali community and because their MMR immunization rates are very low, the Somali community is at a high risk.  All people who are not immunized or have not had measles in the past are at risk of contracting the measles virus if exposed.

Hennepin County Epidemiology unit will be calling identified Hennepin County residents who have confirmed measles exposures to complete a Day Zero assessment and begin monitoring them for 21 days. They are in voluntary isolation meaning that the exposed family members cannot leave their homes.  They are called every 3 days to check for symptoms and to check for any essential services needs. There are currently several hundred exclusions.

MDH is calling all known exposed individuals from daycare centers and clinics. They are placing all non-immune individuals into voluntary exclusion and monitoring them for 21 days with weekly phone calls.

DHS has made an exclusion for those who receive childcare assistance to allow for them to not lose their assistance due to excessive absences and for the providers to be paid.  However, if they choose to not get immunized, they will not get this exclusion again in the future.

Jillian's navigators are making monitoring phone calls and may also be sending referrals. Additionally, there are mobile outreach teams who will be going out to people homes who also may be sending you people with Essential Services Needs.

Epi staff, DHS, monitoring and mobile outreach will ask if they have Essential Needs that are barriers to maintaining isolation or exclusion.  If they do, they will call the Front Door phone number to alert you of this need.  Front Door will be helping them to identify resources within their family, cultural community, faith community, etc.  If the only barrier to meeting their essential needs is financial and the request is reasonable, you will contact Sarah Tjernagel to get the debit card information and proceed with making the purchases online to be delivered to the family.  Once that is complete, you will email Sarah and Anne Semenak the receipt from the online order. Sarah will log the purchase to the debit card log.  Anne will report monthly to Youa Lee.  If there are absolutely no viable people resources to be able to help them get their essential needs met, you will then be referring the case to Anne Semenak. 


Resource Guide

People in quarantine are required to use their own financial and personal (friends, family, and community) resources first before the county's resources would be used.  It is important to help clients think through their own resources first.


Essential Service

Provider

Contact Information

Notes

Banking

For any banking needs that cannot be met by personal supports, please refer to Service Planning to assess and weigh needs and risk factors.



Child/Adult Care

For children requiring day care while person is in quarantine in which financial resources are available to family, family would seek out day cares in their community to which another family member would transport the child to and from.




For children requiring day care while person is in quarantine in which financial resources are NOT available to family, family would seek out day cares in their community to which another family member would transport the child to and from and services would be paid for by the county using the P Card.




For children, for whom their only provider is in quarantine and for whom there are no friends/family/community supports to take the child in, a call to the Essential Services Unit Lead will be made to help coordinate shelter with the Child Services/Protection area of the department. 




For adults requiring day care while person is in quarantine in which financial resources are available to family, family would seek out adult day cares in their community to which another family member would transport the adult to and from.




For adults requiring day care while person is in quarantine in which financial resources are NOT available to family, family would seek out  adult day cares in their community to which another family member would transport the adult to and from and services would be paid for by the county using the P Card.




For adults, for whom their only provider is in quarantine and for whom there are no friends/family/community supports to take the adult in, a call to the Essential Services Unit Lead will be made to help coordinate temporary nursing home placement. 



Clothing

-Clothes could be bought on-line and delivered to their home by most sites online

-Clothing can be purchased online at www.Target.com, either by the client or using the P Card, picked up by staff at the closest location and dropped off at client's home.



Employment Needs:


-If a client needs a letter to an employer, Epi unit can provide.

-If transportation is needed for someone in the home to work, Metro Transit information can be provided. 

-If a bus card or cab voucher is needed, contact Jillian Kyles. 



Financial Assistance

For people unable to fund their essential needs during quarantine, a contact person will be designated by the Finance area who will be able to pay for these needs using a P Card. 



Grocery/ Household Supplies

Lund's/Byerly's

http://lundsandbyerlys.com/shop-online/

The delivery fee for all orders, regardless of size, is $9.95

No EBT


Store to Door

651.642.1892

Must be 60+ years of age

Delivery charge of $5-$15 depending on income

Order delivered 2 days after placing

Must make order by phone

Accepts SNAP or EBT


Coburn's

http://www.cobornsdelivers.com/

Delivery fees from $5-$15 depending on size of order and same day/next day delivery

No EBT


Gopher Grocery

https://www.gophergrocery.com/

Delivery fee is $2

Next day delivery

Also has pharmacy supplies

$50 minimum order

No EBT

Language Needs

Please see attached chart for Interpreter Services



Laundry

If people in quarantine are unable to do their laundry within their own home, whether by using their own washer and dryer OR by washing by hand in a sink with soap and hanging to dry, the next best solution is buying new articles of clothing to last throughout their quarantine.



Legal Representation

Legal Aid

https://www.justice4mn.org/a2j/

Help low-income Minnesotans, seniors, and persons with disabilities with civil legal issues


If the person requires legal representation but does not meet guidelines for Legal Aid, one can google lawyers” or attorneys” and find legal representation in their area. 



Medical Care

All non-emergent medical appointments should be rescheduled or followed up by phone while person is in quarantine.




For emergent medical needs, 911 should be called and they should be alerted that the person is in quarantine so that proper PPE is worn and protocols followed.



Medical Equipment

For ongoing medical equipment needs, quarantined person would continue to use same provider/delivery service with the understanding that deliveries would be left on doorstep to be retrieved after the delivery person had left.




For a new medical equipment need for a person with health insurance, a call to member services would be made to coordinate the delivery of needed equipment.




For a new medical equipment need for a person without health insurance and without financial resources,



Medication

Most pharmacies deliver medications same day.  Use google search for pharmacy delivers with zip code to find.



Mental Health

If someone is just needing to talk through Mental Health concerns or issues they can receive telephonic MH Support through Crisis Connection at 612-379-6363.




If someone is having a Mental Health Crisis but is NOT actively suicidal or homicidal, direct their calls to COPE at 612-596-1223 and alert them that the person is in quarantine and can only get telephonic support.




If someone IS suicidal or homicidal, call 911 and alert them that the person is in quarantine so that proper PPE can be worn and precautions made.



Personal Protective Equipment (PPE)

PPE should be available through the Epi unit. 



Pet Care

Dog walking and 24/7 care for cats and dogs

Various providers

www.rover.com



Twin Cities Pets

http://www.twin-cities-pets.com/

612-222-2310



Rock Star Dogwalking

http://www.rockstardogwalking.com/

612-272-6349


Lucky Dog Pet Care

http://www.luckydogpetcare.com/

612-382-7217



Many other services can be found online by googling overnight pet care, dog walking, etc.



Phones

-For Ebola Response, contact Anne Semenak at 612-490-1088

-Otherwise, pay as you go phones can be purchased online at www.Target.com, either by the client or using the P Card, picked up by staff and the closest location and dropped off at client's home.



Shelter

If someone who is being quarantined is homeless, coordinate emergency shelter with Peg Douglass, Program Manager in Eligibility Supports, to determine appropriate placement.



Social Amenities

Most items can be ordered online and delivered to their home.  If need is more immediate, a worker can be assigned to pick up and deliver if needed.  If the need is financial, P Card can be used to purchase. 



Transportation

The only reason a person in quarantine would need transportation would be for medical care.  If medical transport is needed, 911 would be called and you would alert them that the person is in quarantine so that proper PPE would be worn and protocols would be followed.



Utilities

Utilities would be provided by the area's utility provider.  If financial assistance is needed, contact Emergency Assistance Unit Supervisor in Eligibility Supports.

This proposed model practice is titled Assessment for and Provision of Essential Services Needs for Individuals in Isolation and Quarantine.”

This practice required the coordination of effort between human services and public health departments, to develop a process in order to address the challenges of keeping people in isolation and quarantine, while meeting (or exceeding) requirements put forth by Minnesota State Statutes 144.419.  Specifically, this model addresses the requirements that:

  • Isolation and quarantine must be by the least restrictive means necessary to prevent the spread of a communicable or potentially communicable disease;
  • The needs of persons isolated and quarantined shall be addressed in a systematic and competent fashion, including, but not limited to, providing adequate food, clothing, shelter, means of communication between those in isolation or quarantine and those outside these settings, medication, and competent medical care.

To meet statutory requirements and to provide the best service to county residents in isolation and quarantine, a multi-disciplinary team of subject matter experts developed a standard operating procedure that met these objectives:

  • Assure isolation of active cases during their infectious period;
  • Assure compliance with social exclusion among non-immune contacts of actively infectious cases;
  • Ensure a systematic and inclusive assessment of cases in isolation and contacts in voluntary exclusion for essential service needs;
  • Leverage the unique partnership between public health and human services emergency preparedness and response in Hennepin County.

The workgroup that developed the procedure was made up of staff from the areas of Public Health Emergency Preparedness and Human Services Front Door.  Front Door is the intake point for all voluntary social services for Hennepin County residents.

Stakeholders in this practice are:

  • Internal: staff who are developing and implementing the procedure; human services and public health leadership; Office of Multicultural Services staff;
  • External: Minnesota Department of Health; Minnesota Department of Human Services; residents of Hennepin County

The procedure was discussed in detail in the previous question (Responsiveness and Innovation).


Implementation

Ebola

Epidemiology staff partnered with staff from the Office of Multicultural Services (OMS) to conduct Ebola Active Traveler Monitoring (ATM) of travelers arriving from Guinea, Liberia, and Sierra Leone. Hennepin County has a small population of Liberian Minnesotans mostly residing in the Northwest suburbs of the county. When Public Health learned of our responsibility to monitor travelers from Ebola-affected countries, we initially partnered with OMS staff who were themselves Liberian Minnesotans or who had experience working with the West African population. Though all travelers spoke English, many expressed gratitude that they were speaking daily with members of their community who understood their needs and culture. This built trust and goodwill with the travelers and ensured a good working relationship for the 21 day monitoring period.

Measles

Staff from the Office of Multicultural Services were again utilized during the measles response, as part of the monitoring team, calling those in exclusion and during home visits. This collaboration provided culturally competent staff who spoke the contact's native language (Spanish or Somali). The Day Zero” call has a nine-page script with a great deal of information. We found the calls were best done using a native speaker, rather than having an English speaking staff person on the phone with a Language Line interpreter.

The Human Services Unit in the Department Operations Center (DOC) had several meetings with the Finance Section Chief and Operations Section staff to discuss potential options in anticipation of and preparation for a variety of circumstances in which we may need to make payments for essential services needs.  These services may be acquired either online or in the field and may be needed after business hours.

The ideal solution was to provide a county-issued credit card for use specific to this response.  This worked for online expenditures but not those made in the field (e.g., need for halal groceries after hours).  We decided to issue four prepaid debit cards to the staff who would be responsible for last-minute, after-hours and/or purchases in the field.  The final option was to use personal credit cards and submit for reimbursement, which happened on a couple of occasions.


Essential services were provided to five (5) families during the measles response.  Many other families were assessed/screened but were able to have their needs met without county involvement.

Families #1 and #2 needed to be in exclusion but were living in a homeless shelter and needed to be moved from the shelter to reduce the exposure to others.  This shelter had several measles cases living there during a previous measles outbreak in 2011 and it was known that voluntary exclusion could not be maintained in this setting (multiple families share an apartment style unit, with meals served in a communal dining hall).  For one of these families, the monitoring team identified a child who needed to be in exclusion and lived in the family homeless shelter during the Day Zero” interview. This family was referred to Epidemiology who spoke more with the family to see if they had any other housing options. After identifying no other options, the family was referred to the Essential Services Unit. 

To ensure these two families could maintain their exclusion:   

  • The Human Services Unit contacted the internal departmental partner who is responsible for vouchering people into shelter on a daily basis, to determine what options were already established as overflow options for shelter. The Human Services Unit and Shelter Team worked in collaboration to reserve a hotel room, sign the online agreement and find someone within the department who had a county-issued credit card  to pay for the hotel room and who could drive to the hotel to present the credit card (as was required for the hotel).
    • The hotel was selected based on having rooms with kitchenettes and its proximity to stores and restaurants.
    • It was also necessary to coordinate transportation using a cab voucher to get the families from the shelter to the hotel.  In one instance, it was necessary to coordinate multiple stops to gather belongings on the way to the hotel. 
    • It was also necessary to help families troubleshoot through their food and shopping needs while keeping their children in exclusion.  In both situations, the parents were able to have family or friends provide childcare for their children while they went shopping for groceries and other needs.
    • If they were unable to use their own resources, we were prepared to provide grocery delivery using a county-issued credit card to make the purchases and a service planning staff to do the shopping and delivery. If time allowed, we could have also used a grocery delivery service.  Instacart was new to the area and was being explored for grocery delivery also.

Family #3 needed help to maintain their rent.  However, during the assessment, the family decided to move rather than use emergency assistance.

Family #4 needed in-home childcare for one of her four children who was in exclusion.  The childcare hours needed were in the evenings and on the weekends. 

In-home childcare providers exist for sick children who are unable to go to childcare settings. These services were sought but none were available during the hours/days needed.  The next option was a nanny service. A service was located that was able to find a caregiver for the times needed.  A service agreement was made and paid for using the county credit card.  However, the childcare provider did not return after the first night due to feeling unsafe in the client's neighborhood and roaches present in the living space.

Subsequently, the client was able to find a neighbor willing to provide childcare.  The Human Services Unit worked with the Finance Section Chief on approval to pay for the neighbor's childcare services at $15 per hour.  The neighbor was given a template to record the number of hours she provided childcare each day.  Both she and the client signed the document attesting to the number of hours worked.  The neighbor/childcare provider was able to bring this into a Hennepin County site convenient for her and a weekly check was issued to her.

Family #5 remained home during the exclusion but was now unable to pay their monthly bills. Because the parents had multiple children with overlapping exclusion periods, they were out of work for several weeks.  Copies of bills were requested so that checks could be issued for those unpaid bills. The Human Services Lead worked with the Finance Section Chief to get approval to pay for client's overdue bills and a procedure to use a county-issued credit card to make those payments.   

This was an unfortunate situation in which the childcare needs were not addressed as the children went into exclusion.  The intent of the Essential Services SOP was to catch families with needs at the beginning, to allow parents to continue to work and earn income so that loss of wages or employment never became an issue. 


Partnership with the MN Department of Human Services

A few weeks into the measles outbreak, Hennepin County Public Health and the state health department learned that some of the non-immune contacts excluded from childcare were enrolling in a different childcare facility during their exclusion period (daycare hopping”). In one instance a child that should have been in exclusion developed measles and exposed children in a new childcare facility. In an attempt to prevent this from happening again, the state health department worked with the Department of Human Services (DHS) so as to not allow children receiving childcare assistance from DHS to change their enrollment to a different childcare center until the end of the measles outbreak.

Another issue we became aware of was that children who received childcare assistance from DHS would be losing their spot if they were absent from childcare for 25 days per calendar year (the exclusion period for measles was 21 days per exposure). In turn, the childcare facility would not be paid for the days the child was absent. DHS was able to suspend the absence policy and paid the childcare facility during the days of the exclusion period. This ensured children did not lose their spot in the childcare assistance program and the facility did not incur a financial burden. Even though this variance only applied to families receiving childcare assistance from DHS, the majority of families were receiving childcare assistance.

Many human services essential services needs were identified during the measles response that had not been anticipated, specifically the procedure that it would take to quickly acquire and pay for services.  Hennepin County was able to meet the essential services needs of all clients during the measles response, and was able to update both our Essential Services Plan as well as our Incident Management/Emergency Response and Recovery Plan.

Our experience with Ebola and measles monitoring highlighted the importance of offering basic and creative essential services to maintain voluntary exclusion and prevent further disease transmission. While this practice was not evaluated, the county did find that by working with families in exclusion and providing a wide variety of supportive services, exclusion could be maintained.

After each incident that the Essential Services for Isolation and Quarantine plan is used, gaps are identified and corrective actions are made to the process.

Standard practice after an emergency response is to review the incident to determine successes and areas for improvement.  Based on that evaluation, we create an improvement plan with corrective actions.  In the measles response, emergency preparedness staff worked with a facilitator (from an area of the department called Integrated Planning and Analysis”) to conduct a very comprehensive after action review (AAR) that included all staff (almost 100 total) who were involved in the response over a 19-week period (April August).


Evaluation Methodology

Timeline:

  • Integrated Planning and Analysis staff (facilitators) initially met with emergency preparedness staff on July 12 to begin planning the AAR data collection process
  • Several all-staff meetings were held to solidify plans during July and August
  • Initial debriefing discussion with emergency preparedness staff on August 17
  • Online survey (launched August 31 and closed September 29)
  • Debriefing discussions with other response staff (September 1 September 26)
  • Emergency Preparedness staff met to review the summarized data on October 16

Methods used:

1. Debriefing discussions with human services and public health staff

Ten debriefing discussions were scheduled with non-emergency preparedness staff who participated in the measles response. (An eleventh session was scheduled but had no attendees.) Debriefing sessions lasted 90 minutes.

Staff who served similar positions during the response attended debriefing sessions together as a group. Sessions ranged in size from three participants to ten. Fifty-five out of the 82 people who were invited to participate attended a session for a participation rate of 67%.

The debriefing sessions were formatted as semi-structured group interviews and used the following questions as a rough guide.

  • It's been quite a while since most of you have been in emergency response mode. To get us started out, I'm just going to ask you to think back to your time serving on the measles response. Think about what you saw, heard, maybe even touched or smelled during your time on the response. What are one or two words or phrases that comes to mind to describe what you saw, heard or remember happening during your time on this response? [Round robin.]
  • Thinking about what you did in your role in this response, how did it compare to what you expected to do? What surprised you?
  • What was something that happened during your time serving on the measles response that made you feel the most proud?
  • Thinking about your own section and role, what are some other things that worked particularly well on the measles response? [Probe for specific examples; we will post the following topics on easel paper as a reminder of what to discuss, but won't ask explicitly about each one]
    1. Deployment
    2. Training and orientation
    3. Chain of command/role clarity
    4. Communication and briefing
    5. Collaboration within and across sections
    6. Collaboration with external response partners
    7. Materials, resources, tools, technology provided to support you in your role
    8. Worksite locations
    9. Role of emergency preparedness staff
  • Thinking again about your own section and role in the response, what are some things that didn't work as well? [Same topics as above] (OR: what did you struggle with? What should could be improved? What was challenging, confusing, frustrating?)
  • When something wasn't working as well as you'd hoped, what changes did you make? (Or what new documents, plans, or procedures did you develop during your time serving on the response?)
  • OPTIONAL: All things considered, what would you say are the most important issues that need to be addressed before the next response?
  • What specific changes do you think should be made to improve future responses? What kinds of tools, resources, or procedures should be developed to support response staff in the future?
  • What advice would you give to someone serving in your role in the future? [One at a time]
  • Any final comments/anything we didn't ask about yet?


2. Debriefing discussion with emergency preparedness staff

A two-hour debriefing discussion was held with emergency preparedness staff. The following questions guided the discussion:

  • How would you describe the ways the Public Health response was different from past responses? What was new this time that had never been done before? What parts of previous responses weren't relevant in this response? (10 min)

  • What did you see as successes and areas for improvement in terms of… (5-8 minutes each)
    1. Deployment and activation of staff?
    2. Assigning staff to appropriate ICS roles?
    3. Training, handoff, orientation, onboarding? (including Just-In-Time Training, training on measles, emergency preparedness coaches)
    4. Chain of command? (ICS structure, org chart)
    5. Internal communication and collaboration? (Including weekly briefings, communication across sections)
    6. External communication and collaboration?
    7. Resources and tools provided to response team? (including existing resources and things that were developed just for this response Org chart, Planning P, ICS forms, role checklists)
    8. Section meetings, section work products and accomplishments?
    9. Optional discussion: Technology (including shared network drive, SharePoint, OneNote, conference calls, virtual meetings)
    10. Optional discussion: Worksite locations [you said you want to minimize this discussion]
    11. Role of emergency preparedness staff in the response?
    12. Demobilization?
  • What additional documents, plans, Standard Operations Procedures did you develop in your Section as part of measles response?  (10 min)
  • All things considered, what would you say are the biggest successes of the measles response? And what were the biggest areas for improvement? (10 min)

  • What lessons learned apply to short-term responses? Which apply to longer-term responses? (10 min)
  • Any additional topics not previously addressed?  (5 min)
  • Any final comments? (5 min)


3. Survey

A link to an online survey was sent to all 90 people who participated in the measles response. Seventy people responded to the survey, for a response rate of 78%.

The link to the survey was sent out by email on August 31 and stayed open until September 29. Three reminders were sent to people who had not yet responded to the survey.

The survey included open-ended and closed-ended questions about deployment, training and orientation, communication, technology, the role of emergency preparedness staff, and respondent characteristics. 


The Assessment for and Provision of Essential Services Needs for Individuals in Isolation and Quarantine” practice is sustainable in a number of ways.

Public Health Emergency Preparedness work has a cyclical review process built into it. The Minnesota Department of Health requires local public health departments to have a multi-year training and exercise plan.  This is a 5-year schedule of trainings and exercises that will test our plans, train staff on how to use plans, and make updates and improvements to them. Plans are reviewed internally every year to assess for edits needed. For example, the Emergency Response Line is tested twice per year and staff practice using it for purposed described herein.

The Public Health Emergency Preparedness program at Hennepin County has strong support from leadership within both the human services and public health departments. The intentional collaboration is ongoing and fosters successful responses to public health emergencies and after action improvement plans. The improvement plan assignments are completed after an emergency incident to ensure plans and procedures are updated to be most effective for the next emergency response.  This was true in the case of the procedures involving our Provision of Essential Services for Individuals in Isolation and Quarantine. Updated plans are regularly reviewed with public health and human services leadership to ensure understanding of their necessity and function during an emergency response. This also contributes to the sustainability of this particular practice.

Because of the commitment to integration of emergency preparedness planning and response activities across our human services and public health departments, we have a permanent 0.5 FTE staff person dedicated to work on emergency preparedness within the human services department, including plans for Provision of Essential Services for Individuals in Isolation and Quarantine.  Human Services staff who are responsible for conducting the assessments of plans are trained annually.

Sustainability of our plans is evident in that we have over 250 staff within our public health and human services departments who are trained to respond to any incident with a public health or human services consequence, using our Public Health Emergency Response and Recovery Plan (master plan).  Staff are trained to administer a Department Operations Center and manage several types of response sites. These staff have responded to over 15 different public health emergencies within Hennepin County over the past 10 years. The plan for Provision of Essential Services Needs for Individuals in Isolation and Quarantine will be sustained within our master emergency response plan and improved upon annually or after using during an emergency response.

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