Component 3A: Responsive Testing

Responsive COVID-19 diagnostic testing is deployed at the school or childcare site after receiving notification of a positive wastewater or surface sample finding and determination that testing is warranted.

How does it work?

As quickly as possible after an environmental positive, all students and staff members who could have contributed to the positive environmental sample (i.e., people who were on campus or in a room when the positive sample was collected) should be tested. The site will need a contract with a COVID-19 testing partner to execute this component. The tests themselves, either PCR or antigen, can be administered by site personnel or by a contracted team. The key feature of testing in the SASEA system is that it is on demand/as needed. 

Consent to test

Parents and staff will need to consent to testing ahead of time. While individual level consent is not necessary for wastewater and surface monitoring, parental consent will be needed for onsite screening or diagnostic testing to identify people infected with COVID-19. The SASEA system hinges on high testing consent rates. 

There are a wide variety of reasons why parents may choose not to consent to testing in schools. These reasons range from fear that the test will be painful, to data privacy concerns, to worries about the financial implications if a positive test means the loss of up to 14 days of income.

In our school community survey, 1 in 5 respondents reported that an inability to afford 14 days of isolation presented a serious burden to COVID-19 testing, and 22% reported they were afraid they would lose their job if forced to isolate. However, messaging that emphasizes the following  can go a long way to mitigating these issues:

  1. Testing is an important component of protecting one’s family and school community, and
  2. Social and financial support resources are available to support quarantine

Proactive engagement

We strongly encourage frequent, transparent, and respectful communication with all members of the school community to allow parents and staff to voice these fears and to proactively address them to the degree possible. 

The precise nature of consent will depend on a school’s diagnostic testing partner and/or data management system. Many health systems or laboratories will likely require that either parents consent directly via an app, or that schools certify they have received parent consent and enter student data directly into an online platform themselves. These consent forms can often be dense, with a large amount of biomedical language related to HIPAA, lab processes, and other information that (while important) can be difficult to decipher.

Best practices for testing consent

  • Consent forms can be written in accessible and easy-to-understand language and to reduce redundancies in questions.
  • Ensure that consent forms are translated into multiple languages. Make sure translated consent forms are reviewed by parent volunteers to ensure translation is correct and easy to understand.
  • Reduce the use of legalese and complicated explanations of the testing process as it may deter families from participating (to the degree possible).
  • While testing partners will prefer electronic consent forms, some families will need to consent on paper, so make sure that is an option.
  • Families will undoubtedly have questions like: What happens to my data? Who gets my test results? Is this procedure painful? Consent forms that answer questions like these are more likely to be signed and returned.
  • Principals and teachers are trusted authorities that can also be used in face to face conversations or phone calls with parents who are hesitant about having their children be tested. For more information about building trust with hesitant families

Requirements

  • Contract with an entity to conduct the testing, analyze the samples, and notify tested people and site leadership of results. 
  • Child-friendly and trauma-informed approach to sample collection. Individuals involved with sample collection must be trained in how to work with children. We have found that a trauma-informed approach to nasal swab sampling is essential: Testing personnel are careful to describe the procedure to children before collecting samples and ask for the child’s consent. Children are told that they can ask the sample collector to slow down or stop at any time and are free to ask any questions.
  • Outdoor or well-ventilated indoor space for collecting the samples.
  • Campaign to promote consent to testing, or a requirement to participate in testing.

Limitations

  • In the absence of a testing requirement, 100% consent from families is difficult to attain.
  • On-demand testing requires flexibility.

Costs

  • Testing management system, sample collection, testing materials, transportation from site to lab, sample analysis – may be in one contract or may be in separate cost centers.

Communication resources


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