Reopening and keeping open the nation’s 130,000+ K-12 schools has been a challenge over the course of the COVID-19 pandemic. With the shift to virtual learning for most in the spring of 2020, the shift to hybrid learning in spring of 2021 and fully in-person learning in fall of 2021, school staff not only had to create more agile instruction models to address the unique needs of students during the pandemic but also implement a comprehensive set of health and safety measures to limit spread of the SARS-CoV-2 virus.
Healthy Davis Together (HDT), a joint project between the University of California Davis (UCD) and the City of Davis, supported K-12 schools throughout Yolo County, California, with quick, painless, and free saliva-based COVID-19 testing, among other health and safety measures. This was made possible using a high-throughput, low-cost testing platform developed by the UC Davis Genome Center to process its samples and designating leads to collect and transport samples. Schools either hired their own staff, or used one of HDT’s mobile testing teams, to collect the samples. HDT’s courier service or hired school testing staff transported those samples to the Genome Center for analysis.
HDT began school-based testing at Davis Joint Unified School District (DJUSD) in April of 2021 and by August 2021 expanded to all five public districts across Yolo County and two private schools in Davis. All ran weekly testing programs through December. This represented nearly 29,000 students across 51 schools (and 3 administrative buildings) that had access to COVID-19 testing. Over this time period, HDT administered nearly 175,000 tests to students and staff, and community members at select sites, and provided results within 24 hours on average, allowing for immediate contact tracing and implementation of quarantine and isolation procedures if needed.
Details on what HDT did and how we did it can be found in our Safer School Reopenings and COVID-19 Testing in K-12 Schools guides. Since publishing these guides, HDT has identified six additional best practices in communicating and operating school-based testing. These can help schools enhance existing testing operations or serve as additional considerations as schools begin testing on-site.
- Make Registration Easy: Too many or unclear steps to register for testing may limit the number of students and staff who get tested. Because most students are minors, it was critical that parents/guardians register their students directly. HDT tried the following methods to increase registrations with school partners:
- Posted a step-by-step video to walk-through the registration process and any FAQs on the school district and individual school websites. Alternatively, one-page flyers with brief registration steps and/or paper registration forms (for those with limited technology access) can be mailed to families ahead of school reopening or provided to students as they exit school or to parents at drop-off and pick-up times.
- Hosted tables at school events, such as sports games or back-to-school nights/orientations, to enable on-the-spot registration. This also built trust with families as it allowed them to learn more about the testing process and meet the testing staff
- Included registration information and medical waivers in multiple languages. Bilingual staff members were especially helpful in a specific school district where 40% of the families spoke a language other than English at-home
- Called parents of unregistered students directly to remind them to register. During these calls, HDT heard from multiple parents that they had stopped registration altogether due to outstanding questions or issues (which were then quickly resolved live)
- Provided gift cards to families as part of registration. The impact of net new registrations as a result of this measure was unclear, however, it did create a positive culture around testing.
- Customize health and safety messaging: Standard health and safety messaging from the CDC or your state and public health departments may not resonate with all community populations and subpopulations. In its efforts to encourage testing, HDT found that specific messaging, such as “keeping kids in school” appealed more than “keeping your kids and community safe” to populations that were hesitant toward health and safety measures. These same communities required extra education around the importance of weekly testing, especially when not showing symptoms and post-vaccination. For one such school district, HDT launched an inter-school competition to reward the school with the highest monthly testing rate at the elementary, junior school, and high school level with access to a food truck for a day. Competition provided added motivation to test for that district but was not as appealing to another district that was more collaborative in nature and already compliant with health and safety measures. Additionally, it’s valuable to have a contact at the district who is solely responsible for communications to ensure that communications materials are distributed in a timely and effective way via school and district channels. This person’s knowledge of how to communicate with a given school or district’s population will help ensure messages are tailored to resonate with the audience.
- Obtain buy-in from the top down: As HDT implemented school-based testing across Yolo County, a primary point-of-contact was usually assigned at each school district. This individual was usually already in a student support services role, and was critical in identifying on-the-ground operational resources, aligning decision-makers at the district and individual school levels, and providing added context and considerations around implementation within that specific school community. While a single point-of-contact at the district level is beneficial, HDT also found that this sometimes meant the school board, superintendent, and/or school principals were not as actively engaged, and their questions, comments, and concerns around the health and safety measures were not always addressed. If the school board and superintendent were publicly aligned on the importance of the outlined health and safety measures, then school principals and teachers were too. Individual families were often more receptive toward health and safety messaging from their school’s principal and teachers than those at the district-level due to closeness of relationships. HDT recommends alignment between each district’s COVID-19 response lead and superintendent on upcoming health and safety measures, followed by one-on-one conversations between the superintendent and each school board member on their related questions, comments, or concerns, and a bi-weekly all-call with school principals on progress against those measures.
- Implement a class-by-class testing model: Class-by-class testing involves teachers bringing their full classes to the on-site testing location to run through the process in roll-call fashion. One school district was able to test a minimum class size of 20 students in less than 20 minutes, one minute on average per student compared to three minutes on average per adult at HDT’s mass community testing sites (also mentioned in our blog post as a lever to increase testing capacity when facing a demand surge).Not only was this process more efficient, but it increased testing participation, and even registrations. Within this model, the school district began automatically testing all those who were registered each week so there was no longer a gap between students that had their parents’ consent to test (via registration) and students that were actually testing each week during free time or before/after school. Additionally, upon seeing other classmates getting tested, teachers noticed students going home to their parents to ask that they get registered. A diagram of this process along with the steps for replicating it are included at the end.
- Utilize parent volunteers for sample collection: Parent volunteers represent a cost-efficient opportunity to collect saliva samples on-site, especially when resources are constrained. Additionally, parents can serve as a familiar face to ease students’ anxiety around the pandemic as they guide them through the testing process. Note that this only applies to testing modalities in which you do not need a clinician to administer. As part of the implementation, the school principal sent out a survey to parents asking for specific times in which they could support.Training for volunteers included shadowing operations at a mass community testing site, reviewing training materials in advance, and a soft launch day where parents sat beside HDT testing staff as they led the process. While any parent can participate, they found that identifying at least one healthcare professional to serve on staff improved onboarding and issue resolution among other testing staff members. Following, the principal checked-in with parents on a bi-weekly basis and confirmed continued availability.
- Expand on-site testing access to families and/or community members: School-based testing is convenient for students and families alike. Many parents pick-up and drop-off their students at school already, so getting tested during this time eliminates one additional task of going and waiting at a testing site. On-site testing access to families was specifically requested among parents of elementary students who wanted to get tested with/alongside their child. It was also requested within underserved communities where testing access via existing local providers was limited.As you consider this option, identify times of day and on-site locations that are appropriate for visitors to ensure adequate school campus safety, and determine what HIPAA-related requirements exist to maintain a compliant testing process.
Example School Testing Flow
The following outlines a streamlined method of conducting class-by-class school testing*:
- Teacher brings class just outside of the testing area on-site during a defined time slot
- Greeter orders students alphabetically using roster, separates out registered vs. non-registered students, and hands each registered student a notecard with their name, date of birth and grade
- Teacher takes non-registered students aside and sits with them while registered students test
- Greeter directs students to registration/check-in station as available
- Check-in/registration personnel confirms student name, date of birth and grade (and takes notecard), provides ‘boat’ of testing materials, and assigns student to sample collection booth (if available) or waiting area (if occupied)
- [If waiting] Student stands on designated social-distancing marker in waiting area
- Sample collector calls next student in line and walks through sample collection process
- Sample collector directs student to exit and to sit with teacher and classmates
*This information is meant to be a general guideline, but it is not intended to be medical or clinical advice; the licensed Provider Partner operating the sample collection site should provide all clinical and medical standard of care decisions