Please provide an overview of goals and objectives of the practice.
Goal(s) and objectives of practice.
Goal: Re-opening schools (K-12) and keeping them safe for in-person learning through COVID-19 Pandemic
Objectives:
1. To provide free and accessible COVID-19 testing to schools
2. To promptly detect cases of COVID-19 in schools especially among the vulnerable
3. To rapidly respond to COVID-19 outbreak in schools
What did you do to achieve the goals and objectives?
Which steps were taken to implement the program?
Planning phase:
Stakeholders' engagement - school district management team, schoolteachers and nurses, parents' community, social media influencers, student community, CDC Foundation
Laboratory assessment and selection – laboratory capable of a turn-key process with local presence, and 24-hour turnaround time (specimen collection to sharing of result to schools and parents
School assessment for existing COVID-19 infection prevention and control strategies
School testing pattern determination – frequency, date and ZIP location cataloging
Parental consent – content and deployment strategy development
Implementation phase:
Training of field staff – coordination, specimen collection among children, specimen transportation in optimal condition
School nurses' training on student coordination for testing, resulting checking and sharing with parents
Development and distribution COVID-19 mitigation strategies information, education and communication (IEC) tools
Regular school visits for nasal sample collection, kit shipping, PCR testing and result sharing
Case investigation and contact tracing – 24-hour epi hot lines
Outbreak investigation and implementation of control strategies
Technical support for infection prevention with deployment of epidemiologists to schools to support nurses in implementing mitigation strategies.
What was the timeframe for the practice? Were other stakeholders involved? If so, what type and how?
Time frame: October 2021 -Date
The HHD School Testing Program involved active participation of relevant stakeholders to ensure a successful school COVID-19 testing/surveillance. The engaged stakeholders are classified into internal (within HHD) and external stakeholders (outside HHD)
Internal Stakeholders: include various units within HHD like the directorate of Laboratory services, call centers, school health units, outbreak units,
External stakeholders include Texas Education Agency, Department of State Health and Human Services, Centers for Disease Control and Prevention (CDC), school district management teams. Others include non-governmental agencies like Parents teachers' organizations, private laboratory, communities in which students reside and schools are located.
The stakeholders were engaged through all the phases of the program – planning and design, implementation and evaluation. The stakeholders were engaged through various media from individuals to groups, in-person, and virtual engagements.
What was the LHD's role in the planning and implementation of the process?
What did the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s).
The Local Health Department took leadership role in the planning and implementation of the School Testing Program by identifying and bringing together all relevant stakeholders (listed in section above) from the design phase through implementation and evaluation.
The health department also identified internal resources with school health experience, epidemic response expertise - epidemiology and laboratory, community engagement and communication experts. These various individuals had the one objective of ensuring a safe reopening of schools for in-person learning through the COVID-19 pandemic.
The HHD at the design phase elicited and addressed possible threats such as unconducive political terrain for COVID-19 testing at the State level, unfavorable school board perception of in-school testing, and possible parental refusal in the face of miscommunication and rumor mongering.
The HHD School Testing Program team consisted of physicians, nurses, epidemiologists, biostatisticians, laboratorians, community engagement leads, school liaisons to mention a few. These individuals served cross-cutting supportive roles to one another.
The School Health COVID-19 Chief Nurse Consultant engaged specifically for the program liaised with the ISDs and the school nurses. Being a highly experienced professional colleague, an effective engagement with the ISDs and the school nurses was achieved. Also, a team of highly motivated school liaisons engaged by HHD played a key role in initiating and maintaining collaboration with the schools and key community stakeholders e.g., wrap-around service providers who conducted health fairs, scheduled vaccine clinics and obtained parental consents for COVID-19 testing and uptake of vaccines.
The HHD School Testing Program conducted assessment of various laboratories and selected one with localized laboratory within the CoH capable of a turn-key process from digital consenting platform, field staff capacity to comb all schools based on the testing schedule, obtain and ship samples in optimal condition to the lab, and resulting of tests to school nurses and parents as indicated.
What steps were taken to ensure equitable, meaningful, and representative collaboration with target populations?
I.The HHD School Testing Program engaged with school principals to learn about the school community specific needs, and the most effective way to communicate with parent coummnity.
II.Regular meeting with school nurse managers to obtain their feedbacks and experienced challenges for quality improvemen
III.ISD management teams' visit to the testing laboratory for site seeing and quality reassurance.
IV. ISD ownership of the program and
V.Engagement with Parent Teacher Organization at school levels
VI.Providing in-school testing provided students and parents that depend on public transportations with easy/ convenient/assessable testing.
VII. Prioritized areas with high positivity rates and low vaccine up take for drive-thru testing.
VIII. Provided in-school testing for a private school with special needs/fragile student population and staff.
IX.Testing promotions and consent forms were done in multiple languages.
Any start-up or in-kind costs and funding services associated with this practice? Please provide actual data, if possible. Otherwise, provide an estimate of start-up costs/ budget breakdown.
The HHD through the CDC Reopening School Grants funded the following start-up activities:
ISDs in recruiting testing coordinators, testing supporting staff and purchase of office materials for testing with a sum of $1,300,000 allocated directly to the school districts.
Funds were provided for the purchase of antigen test kits through the Texas Department of State for Health and Human Services - ~$4,900,000
PCR testing though contracted laboratory – (10,000,000)
Enter the local health department and community collaboration related to your practice.
The HHD School Testing Program had an active collaboration with some community stakeholders such as .
Texas Education Agency (TEA) and Texas Department of State Health and Human Services (DSHS): - the HHD partnered with the TEA and DSHS to ensure all schools are carried along the testing program. The three agencies (state/local health and education) conducted joint webinars with school principals, nurses and administrators to provide guidelines on existing testing types, approaches reporting pathway.
CDC foundation: With the supportive collaboration between HHD and CDCF, school liaisons were recruited and deployed to schools within underserved communities to provide assistance to school nurses and wrap around services.
School Principals: The school principals serve as the point of contact for each school with effective support from the school nurses
School Nurses/ISD Wrap around service providers: - The school nurses receive the daily test results from the screening testing conducted at their individual schools. They alongside the HHD Contact Tracing Team provide a follow up call to parents with child(ren) who test positive.
School district management teams: The HHD School Testing Program collaborated with the school district management teams to develop and agree on the Memorandum of Understanding that goes through the School District, Health Department and City Governing Council.
Parents teachers' organizations: The Parents-Teachers Organization served as an effective platform to hear from parents – concerns and apprehension. The HHD epidemiologists attend the meeting fora to address the raised concerns and questions.
Private laboratory: With the engagement of a laboratory with local presence and capacity for a turn-key process from consent through sample collection, specimen shipping, testing and resulting, and a turnaround time of 24 hours, parents and teachers were assured of testing with efficient result-sharing.