COVID-19 Testing Innovation Series

NRHI, with support from The Rockefeller Foundation, offers opportunities for ongoing collaboration and resource sharing through our Innovation Series. The Innovation Series brings testing site leaders together to learn from one another and share successes and challenges.

From February through August 2021, the series will focus on use of COVID testing to support reopening of schools. Past events focused on preparing for inclement weather, testing vulnerable populations, and ensuring a positive patient experience.

COVID-19 Testing to Support Reopening of Schools:
A National Forum for Regional Leaders

According to the US Census Bureau, close to 93% of households with school-aged children are participating in distance learning due to the Covid-19 pandemic. Disparities are emerging as low-income families have less access to online resources and having children home from school has had a negative economic impact as many parents have been forced to leave their jobs to be home with children.

Schools, public health departments, and healthcare providers are coming together to determine how to reopen schools safely. To aid these efforts, the Network for Regional Healthcare Improvement (NRHI), with support from The Rockefeller Foundation, is hosting a bi-weekly Innovation Series focused on COVID-19 testing to support the reopening of schools. We will hear from leaders in education, public health, and healthcare sharing successes, plans, and needs for successful implementation.

Access key takeaways and recordings:

July 20, 2021

Operation Expanded Testing

Key Takeaways: 

 

On July 20, 2021 the Network for Regional Healthcare Improvement (NRHI), with support from The Rockefeller Foundation, held the event “Operation Expanded Testing.”

Jessica Little kicked off this last session in the K-12 Covid-19 Innovation Series by providing a high-level overview of the Operation Expanded Testing (ET) Program funded by the Department of Health and Human Services (HHS) and Department of Defense (DoD),

Operation ET offers free testing for K-12 schools, vulnerable populations and congregate settings like correctional facilities and shelters. Three coordinating hubs across the country work with schools and other organizations to stand up testing. The hubs do not provide staff to help with the logistics of testing at schools (e.g., collecting samples), but the hope is that schools can use ELC funding to support hiring staff or providing existing staff with additional compensation for their time.

Elizabeth Winterbauer, representing Affinity, the group that runs the hub serving the Northeast and South, discussed the services these hubs provide. These include:

  • Pooled PCR Covid-19 testing with reflex testing using a CLIA-certified, CAP accredited lab.
  • 18-24 hour turnaround time.
  • Testing 1-2 times per week, depending on the needs of your school/organization.
  • Test is approved for self-collection.
  • Test does not require a prescription per FDA EUA.
  • Schools/organizations are paired with a logistics coordinator to coordinate training and supplies.
  • Schools/organizations have access to a portal to view and track results.

Jessica Lin from the Affinity team also explained how they handle consent to test children: it involves a great deal of education on testing and on how the patient information is used.

Beverly Roberts, representing Batelle, the group that runs the hub serving the Midwest, which covers 16 states, shared that this hub provides a similar set of services. 

The West hub was not available for today’s program and contact information was provided for PerkinElmer: https://letsendthistogether.com/

Leah Perkinson from The Rockefeller Foundation shared that because of decreasing positivity rates, and increasing vaccination rates, the demand for testing is lagging. To address this and increase participation in testing, some schools have used an opt-out method for consent.  Baltimore City Schools uses this approach and they include consent forms on their website.

There was discussion regarding the alignment of state and federal funded programs noting that not all funder requirements line up;  some sources cover staffing, while others don’t. Schools should consider looking at all available funding sources as they design and administer their testing programs (). The regional hubs can help localities navigate some of these challenges.

This event is being co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation. The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors.

 

Additional Resources:

Operation Expanded Testing: https://perkinelmer-appliedgenomics.com/wp-content/uploads/2021/06/Federal-Resources-Supporting-School-Screening-Testing-Update-22-June_v2_header_2.pdf

 Rand Survey referred to during discussion: https://www.rand.org/pubs/research_reports/RRA1393-1.html

The Rockefeller Foundation K-12 Testing Playbook:

https://www.rockefellerfoundation.org/report/covid-19-testing-in-k-12-settings-a-playbook-for-educators-and-leaders

 Access to free testing program: https://simplereport.gov

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June 22, 2021

COVID-19 Antigen Testing to Support Reopening of K-12 Schools

Key Takeaways

On June 22, 2021 the Network for Regional Healthcare Improvement (NRHI), with support from The Rockefeller Foundation, held the event COVID-19 Antigen Testing to Support Reopening of K-12 Schools hearing from an expert panel with speakers from Utah, California, and Pennsylvania.

Kendra Babitz, Covid-19 Testing Coordinator from the Utah Dept of Health described the testing approach deployed in Utah focused on keeping their schools open. They found BinaxNow tests to be very helpful to support their strategy. Kendra shared some strategies that they used including “Test to Play” to keep football teams on the field and to ensure other student activities, like theater and arts programs continue.  Later in 2020, they moved to a new phase, “Test to Stay” which was successfully piloted in December and implemented broadly in January 2021. Test to Stay involves providing regular antigen testing for surveillance at participating schools.

A major advantage of antigen testing was not needing to have trained medical personnel to perform the tests. And while antigen tests don’t have the highest sensitivity, Babitz and others agreed that some testing (where indicated) is better than no testing and that having a testing program supports overall focus on adherence to safety measures.

Adam Hersh, MD, Professor – Pediatric Infectious Diseases, University of Utah shared the data on the incidence rates for school age children in conjunction with the strategy that they had in place at the time.

  • 66% of high schools participated in Test to Play program. The positivity rate stayed below 1% during these programs and 95% of scheduled events were able to go on as planned.
  • 70% of eligible students participated in the Test to Stay program and Hersh estimated that 109,7532 in person days were saved due to this program.

Dr. Hersh also shared a MMWR article which further describes the program.  

Maggie Eisen and Susan Coffin, MD from Children’s Hospital of Philadelphia provided an overview of their Project ACE-IT. Their team provided support to 576 school sites in partnership with public health officials in Pennsylvania. HHS allocated 900,000 BinaxNow tests in the fall. The team described their approaches for targeted testing (symptomatic) and surveillance testing.

Naomi Bardach, MD, Associate Professor, Pediatrics and Health Policy from University of California San Francisco described the state-based testing program including antigen testing that started in January 2021 with BinaxNow . She explained that the antigen testing was a desirable option because results are received at the point of care, although she also pointed out that antigen testing requires more resources on site. She explained that a key advantage to their model is that they have a CLIA waiver at the state level which enables schools to participate without going thorugh the process of obtaining a CLIA waiver. She shared that currently they are looking at use of at home testing to support screening as well as incentives to participate in testing.

Resources and training materials developed to support the program in California can be found here

Each of the panelists shared that the approach for the Fall is still uncertain. Dr. Hersh commented on the desire for policy to support vaccination requirements, testing requirements, and quarantine requirements. He sees testing as a strategy to motivate vaccination.

Dr. Coffin views antigen testing as a good method for public health surveillance, not as much as an individual diagnostic tool.

Dr. Bardach commented on recent concern with the rise of the Delta variant and should be a motivator for schools to commit to testing for the Fall.

Maggie Eisen shared that in discussions with their education partners, there did not seem to be much of an appetite to continue testing in the fall.

In summary, the panel shared a variety of ways antigen testing can successfully support schools to reopen. While there is no one size fits all approach, schools are successfully adapting to meet the needs of their communities and pivoting as prevalence rates decrease and vaccines become more readily available. Given concerns around highly contagious variants, and the uncertain timeline for vaccination in younger children, it is important that schools are prepared to implement testing programs as needs arise.

This event is being co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation. The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors.

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June 8, 2021

Maine DHHS: Lessons from Early COVID-19 Testing Implementation

Key Takeaways

 On June 8, 2021 the Network for Regional Healthcare Improvement (NRHI), with support from The Rockefeller Foundation, held the event COVID-19 Testing to Support Reopening of Schools: A National Forum for Regional Leaders hearing from Sally Weiss of the Maine Department of Health and Human Services on Maine’s lessons from Covid-19 testing implementation.

Sally leads testing strategies for Maine’s DHHS and shared that Maine’s testing strategy for K-12 schools started with the use of BinaxNOW for symptomatic testing last fall. She explained that this experience led to the launch of a pooled PCR program for surveillance testing which starting in late April 2021. The pooled PCR testing program is funded through an ELC grant and Sally noted that this funding has been especially valuable for providing additional staffing support necessary for testing.

The program, led by Ginko Bioworks, supports once per week testing for students and staff in districts/schools that opt-in to the program. Upon positive pool result, all members in the pool are tested individually with BinaxNOW test.

Sally highlighted benefits to individuals and districts participating in the program. Individual students and staff participating in weekly testing are not required to quarantine when part of a positive pool. Additionally, schools with 30% or more participation in the weekly testing are allowed to remove the 3ft spacing requirement.

While thirty-one school districts and private schools are participating, parents and staff have asked why the program wasn’t available sooner. Sally commented that the timing of the rollout was in large part due to the timing of funding and indicated rollout has been a challenge with falling case rates and availability of vaccinations. She also noted that the future of the testing program for the fall is unknown – schools may see it as another safety measure given that many other safety measure requirements have been removed, or they may not be interested in committing to testing because other safety measures have been removed.

Sally shared that feedback indicates that testing helps the community feel safer. Leah Perkinson from The Rockefeller Foundation added that preliminary results from a recent RAND survey of parents indicates that mitigation strategies in schools are even more important to parents of color.

During the discussion with participants, the use of wastewater testing was suggested, and Sally shared that the current funding cannot be used for this type of surveillance. However, she anticipates that it could be used as a tool in the future for monitoring specific communities.

Maine CDC and Maine DHHS and Maine Department of Education are working together to address gaps in what’s needed to provide needed assistance for schools. Sally commented that while this is an evolving process, the state remains committed to supporting schools with programs and resources to support successful reopening.

Additional early learnings include:

  • Those school districts that have been successful have started small. Schools can quickly scale up once they get started.
  • Ongoing and reinforcing communication is critical to explain the importance of testing and to build trust.
  • It is important to allocate some funding to support administrative functions necessary to support staffing and these resources can often be accessed through the testing vendor.

Resources shared by participants include:

 

This event is being co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation. The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors.

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May 25, 2021

Use of Environmental Testing to Support Reopening of Omaha Public Schools

Key Takeaways 

On May 25, 2021 the Network for Regional Healthcare Improvement (NRHI), with support from The Rockefeller Foundation, held the event, COVID-19 Testing to Support Reopening of Schools: A National Forum for Regional Leaders hearing from Omaha Public Schools and the University of Nebraska Medical Center on their Use of Environmental Monitoring to screen for Covid-19.

John Crowe, PhD from Omaha Public Schools, explained that they added wastewater monitoring as a real time monitoring strategy in conjunction with saliva-based testing. They added this testing approach in part because only a small portion of the student population was opting into the saliva-based testing.

Jana Broadhurst MD, PhD, DTM&H, from the University of Nebraska Medical Center described that when developing their school-based testing strategy quality, cost, scalability were top goals.  The approach included weekly saliva PCR testing and wastewater and in-building air/surface sampling. She explained that wastewater monitoring has a long history but has been leveraged recently in support of COVID-19 monitoring for school buildings.

Dr. Broadhurst explained the wastewater monitoring sampling techniques and shared data indicating the effectiveness of this approach. In addition, they conducted air and surface monitoring. They were also able to conduct virus sequencing with the school samples.

They intend to move to a plan where all schools are surveilled monthly. To support summer school, they have trained central staff to conduct testing if deemed necessary and for the next school year they are planning to make saliva testing accessible once a month for staff and will have wastewater monitoring in place at school buildings.

This partnership pre-dated the pandemic but the relationship has evolved under the circumstances stemming from Omaha Public Schools commitment to keep their community safe. The University was well positioned to support and was open to new approaches. Dr. Broadhurst observed that practices have moved much more quickly from academic research to implementation during this time.

Saliva-based testing with younger kids has proven to be easier than expected. This resource shared by a participant from The Silverlake Independent Jewish Community Center in Los Angeles, CA includes easily-digestible collection instructions and frequently asked questions, which schools can repurpose for their own programs.

This event is being co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation.  The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors.

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May 11, 2021

Roundtable Discussion: Addressing Frequently Asked Questions

Key Takeaways  

On May 11, 2021 the Network for Regional Healthcare Improvement (NRHI), with support from The Rockefeller Foundation, hosted a Roundtable to discuss frequently asked questions that have arisen through this series, COVID-19 Testing to Support Reopening of Schools: A National Forum for Regional Leaders.

Megan Diamond, Manager, Health Initiative, The Rockefeller Foundation kicked off the session by sharing the multi-faceted efforts in place by The Rockefeller Foundation and its partners to support K-12 reopening. These efforts include the Cross-City Learning Group, an ongoing forum of K-12 school district leaders across the U.S. To date, this group’s key takeaways include:

  • Community support is essential
  • Increased use of external vendors can reduce staff burden
  • Testing hesitancy is pervasive and opt-in testing is the main approach
  • Access to federal funding for school testing is variable across states
  • Many sites are updating testing protocols for the 2021/22 school year

Megan showcased several resources available to this community including the following developed by The Rockefeller Foundation:  

Additional resources developed by partners are listed below and can also be found in The Rockefeller Foundations Resource Repository.

Megan mentioned that in the next few weeks a resource developed by Mathematica, a dashboard for decision making around school testing, will be released.

Jessica Little from NRHI teed up the top three topics that have emerged from this learning community’s participants and were the focus for the discussion.

Topics 1 & 2: Protocols for quarantining and re-testing a positive pool & working with labs to build in reflex testing following a positive pool:

  • Anne Wyllie, PhD, Yale School of Public Health, referenced the CDC Guidelines and commented that in the case of quarantining a pool when there is a positive result, reflex testing is a valuable step in the process to prevent the need to quarantine the entire pool.
  • In the case of pooled testing, when the lab can conduct the diagnostic testing, why isn’t that automatically done when there is a positive pool? In some cases, the lab may not be authorized to or have the ability to conduct the diagnostic testing.
  • Costs are significantly lower for at-school pooled testing (e.g.; pooled nasal swabs can be done at $2-3 each, saliva in-lab pooling is often priced at $10-15 at least each).
  • Having smaller pools (5-10) is a less costly option and can have lesser impact on the need to quarantine.
  • For use of rapid antigen tests on-site, it was confirmed that the school must have a CLIA waiver. Phoebe Olhava from rapidtests.org described the rapid testing process and how it’s being successfully leveraged as a screening tool. While research shows that 1 out of 5 active infections are missed with rapid antigen tests, schools using these tests regularly have had success preventing outbreaks.  

Topic 3: Impact to testing programs now that more are vaccinated including adolescents.

  • Regardless of vaccination status, the need for testing persists and will allow us to continue to evaluate the transmission of the virus. The group commented on the risk of stopping our testing too soon and not being able to prevent outbreaks. Risks include waning immunity, variants, and active infections in those both vaccinated / not vaccinated.
  • It was also discussed that school testing is of critical importance to not only keeping the school community safe but also in monitoring overall community status.

This event is being co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation.  The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors.

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April 27, 2021

Supporting K-12 Reopening Through
Customized Approaches to Meet Diverse Needs

Key Takeaways 

On April 27, 2021 the Network for Regional Healthcare Improvement (NRHI), with support from The Rockefeller Foundation, hosted the event Supporting K-12 Re-Opening Through Customized Approaches to Meet Diverse Needs

A conversation with:

  • Laura Clancy, Chief Talent and Strategy Officer, Mastery Charter Schools in Philadelphia, PA and Camden, NJ. 61% of students are currently in person, and more than 40,000 tests have been conducted with a low positivity rate.
  • Allison Perkin-Cohen, Chief of Staff, Baltimore City Public Schools (168 schools). Symptomatic testing services have been in place since December and asymptomatic testing has been in place since March. Testing includes pooled testing and the district is seeing positivity rates well below the community rate.

How have you managed parental consent for testing?

Laura: Informational forums are held for parents with ongoing opportunities to discuss testing with school representatives. Early on, parents were included in discussions regarding which types of testing to offer to support higher levels of comfort and consent.

Laura: Communications were framed to position testing as a way to be informed about your child’s health and a way to keep your child, and the community, safer.

Alison: Focus groups are held for parents to understand concerns and distill fear. Consent forms are structured as an opt-out “social agreement” outlining responsibility for all parties to keep student and staff safe.  Responsibilities include masking, reporting symptoms, and participating in testing program.

Alison: Videos have been used to show self-administration of tests which helped make it less scary for students, parents, faculty, and staff.

What have you learned / would do differently?

Alison: When starting a program, you need to be very thoughtful about adequate levels of staffing and training. For example, leaders did not anticipate how much central support is necessary and in response have needed to provide additional training and resources to support the required processes. Health and safety coordinators have also been hired through a temp agency for additional support.

Laura: While pooled testing has been a success, Laura wished they had spent more time thinking through the options for re-testing and selecting a vendor that could do re-testing from the original sample to support the parent experience. They also would have built household testing into their model from the beginning so parents and caregivers did not have to take on the responsibility of finding testing sites and scheduling appointments following a positive pool.

 What are your funding sources for testing?

Laura: Testing programs are supported by allocation of Cares Act Funds. However, there is currently confusion on what will be available and required with next round of federal funds.

Alison: Funding from The Rockefeller Foundation has support some of the high school testing. ESSER funds have also been used and grant funds awarded to University of Maryland have supported a testing van which brings testing to schools.

What are your considerations for the Summer?

Alison: Given summer school has expanded under the current plan, testing will continue throughout the summer, and likely into the fall. Efforts are underway to be able to conduct onsite testing and not rely on the van to provide testing.

Laura: For summer programs they are thinking about how to best align partners to support testing needs. They are also looking forward to learning more about regional testing hubs as a potential means of support. Changes in guidance are anticipated given more students will be fully vaccinated and more students will have access to vaccines in the coming months.

Some tips for pooled testing:  

  • Anyone who has had COVID should be excluded from pooled testing for 90 days.
  • Consider the size of your pool to strike balance between keeping cost low (which would have you put as many people as possible in a pool) and the need to be able to have in person schooling function with as little disruption as possible. Having too many people in the pool can place a lot of critical people in quarantine when a pool is positive.
  • If you do re-testing from original sample, make sure your vendor is fully approved to do individual diagnostic testing in your state(s).

Resources and tips shared by presenters and attendees:

Relationship with local public health departments and health advisory committees are critical to successful testing efforts.

Merv 13 Filters are used in Baltimore City Schools HVAC systems (older systems can’t function with that level of filter and they don’t work in buildings without AC).

Self-collection saliva tests could be sent home with the students that test positive in their pool.  Results take less than 48 hours and it has been very well received by the parents.

(ex: www.edpbiotech.com)

Reflex testing can be easy and affordable added to pooled testing strategies and ensures that kids are not left behind.

This event is being co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation.  The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors.

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April 15, 2021

Navigating a Complex Landscape to Support School Reopening- Special Event with Mara Aspinall

Key Takeaways

On April 15, 2021 the Network for Regional Healthcare Improvement (NRHI), with support from The Rockefeller Foundation, hosted the event Navigating a Complex Landscape to Support School Reopening- Special Event with Mara Aspinall.

Mara Aspinall, advisor to The Rockefeller Foundation, walked through the K-12 National Testing Action Program (NTAP) resources starting with a high level overview of the 4 federal options for schools to fund school testing:  

  • NTAP –$10 billion through CDC; funds have already been allocated for K-12 schools and testing the focus of the program.
  • CDC Coordination Hubs – Program for underserved K-8 schools currently out to bid and sites will be announced later this month.
  • ESSER – Funds already allocated to districts and K-12 schools through Congress via the Coronavirus Aid, Relief, and Economic Security (CARES) Act to districts and K-12 schools.

Mara stressed the importance of getting and keeping schools open for the health of the economy overall, not just to benefit kids and schools.  She also noted that at this time, all tests are effective at detecting variants.

  • Research shows that weekly testing reduces in school infections by an estimated 50%
  • School prevalence rates are 10x lower than community rates
  • After implementing a testing program, the confidence of teachers increased greatly

Testing programs needs to be:  

  • Free and easy
  • Reliable and predictable
  • Fast with a maximum of 24-hour turnaround time

Strong testing protocol includes these 3 steps:

  • Step 0: Initiation testing: Test everyone before regular testing begins
  • Step 1: Asymptomatic screening
  • Step 2: Positive pool follow-up testing

Consideration for testing now that we have vaccines:

  • No vaccine is 100% effective, testing will continue to be needed to control spread
  • Not all have been or will be vaccinated
  • Important for program integrity to test everyone (regardless of vaccination status)

Mara shared information on the labs available to support school testing and notes, that the next update of the NTAP resource will indicate the experience of each of the labs with schools. A vendor checklist is also included. These resources will be updated on a monthly basis.

Mara shared that fund are available to schools for the administration of a variety of tests, and while many have focused on pooled testing, this is not a requirement. She explained that each state is establishing their own requirements for use of funds and that overall, these funds are allocated to be used now through June 2022.

Mara wrapped up stressing the importance of communication regarding the ongoing value of testing to safely reopen schools.

Our presenters included:

  • Mara G. Aspinall, Managing Director, Health Catalysts Group; Professor of Practice, Biomedical Diagnostics, Arizona State University

This event is being co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation.  The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors.

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April 13, 2021

Supporting Schools on Navigating the American Rescue Plan

Key Takeaways

On April 13, 2021 the Network for Regional Healthcare Improvement (NRHI), with support from The Rockefeller Foundation, hosted the event Supporting Schools on Navigating the American Rescue Plan

Dr. Mike Magee, CEO, Chiefs for Change, presented their newly released resource: How Schools Should Use Funding from the American Rescue Plan to Support Students. He spoke to the recently approved American Rescue Plan and explained that 90% of the funds will flow to local school districts with 10% to states. The “Day in the Life” tools developed by Chiefs for Change in partnership with The Rockefeller Foundation are aimed to assist schools in developing their plans for re-opening, acceleration of learning, closing the digital divide, post-secondary pathways, and redesigning assessments and accountability systems. The American Rescue Plan provides much needed funding to address systemic needs that have increased due to impacts of the pandemic.  

Dr. Magee challenged us to think about building a plan that assumes 100% students in person five days a week and to start there to develop your blueprint. He views testing as a necessary element of every school’s plan. He encouraged the group to revisit their testing plans as experience and options have evolved. Dr. Magee also commented on the importance of framing testing in way that does not stigmatize positive test results and in effect, dissuade testing. 

Dr. Magee provided additional rationale for walking your plans through the process from the perspective of students and staff to pressure test them and identify where there are possible failures / gaps and build mitigation into your plans. He recommended messaging that focuses on prevention and not fear.

Dr. Magee spoke to the concern of space in schools for appropriate distancing, especially for charter schools that tend to be located in smaller facilities.  He spoke to studies underway by public school districts to assess for feasibility of 3 feet distancing and there is confidence that this standard can be met and that hopefully in the near future, increased vaccination will eliminate the need for the 3ft standard overall.

Dr. Magee responded to questions regarding how American Rescue Plan funds could be used to support infrastructure and commented on the importance of looking at all fund sources and work to “braid” funding sources together to maximize their use and impact.

Resources shared by participants include:

Our presenters included:

  • Mike Magee, CEO, Chiefs for Change

This event is being co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation.  The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors.

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March 30, 2021

State Supported Pooled Testing Approaches to Support K-12 Reopening

Key Takeaways

On March 30, 2021 the Network for Regional Healthcare Improvement (NRHI), with support from The Rockefeller Foundation, hosted the event State Supported Pooled Testing Approaches to Support K-12 Reopening.

We heard from leaders in Massachusetts which is the first state in the country to launch a state-wide pooled testing program – a program which offers a free, weekly COVID-19 test to every public-school student and staff member.

Our presenters included:

  • Melea Atkins, Health, Economic, & COVID-19 Policy Consultant with COVID-19 Response Advisors
  • Eliza Novik, Project Manager with Shah Family Foundation
  • Lyn A. Snow, Director of Pupil Personnel Service with Littleton Public Schools
  • Kim Janssen, K-12+ educational Technology Coordinator with Attleboro Public Schools

Melea kicked-off the session describing the state-wide, state-funded program in Massachusetts which currently has participation from over 1,000 schools.  The primary method used is pooled testing which is conducted on site at the schools. As of March 29th, the pool positivity rate is .76% (individual rate is much lower as there are ~7 individuals per pool).

Melea also outlined the features of the Massachusetts program that have been key to its success, taking into consideration that schools have a great deal to manage during this time and don’t have all the resources and expertise in place to support testing.

Lastly, she walked through the covidededtesting.com website launched in partnership with the Shah Foundation. This site provides a multitude of resources to support testing in Massachusetts schools including communications resources. The site also includes information on different types of tests and how frequently they should be used. While these tools were launched for the state, there is opportunity for other regions to leverage the robust templates and resources.

Lyn and Kim spoke to how their respective schools got involved with pooled testing. They commented on how quickly the program has become routinized throughout K-12. The vendors that are used in Massachusetts made it as easy as possible to get the testing up and running. A challenge has been the consent for testing which is currently at ~60%. They spoke to considerations regarding mandated testing and at this time have determined not to mandate testing for in person learning.

Key takeaways include:

  • Having contingency plans, ensuring good collaboration across roles, and having plans tailored for each individual school
  • Have resources in place to support the process which is quite consuming the beginning however becomes streamlined over time
  • Be flexible with your process, staying solution orientation to overcome hiccups along the way
  • Engage staff and students in the process in fun and educational ways such as creating roles and curriculum focused on becoming “scientists” throughout the process
  • Provide information sessions to meet the rising interest of the community to learn more about the importance of testing especially with vaccination rates on the rise.
  • Evaluate shipping and courier service to find the most expeditious transfer of samples

This event is being co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation.  The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors.

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March 16th, 2021

Return to School: Lessons Learned from the Classroom

Key Takeaways

On March 16, 2021 the Network for Regional Healthcare Improvement (NRHI), with support from The Rockefeller Foundation, hosted the event “Return to School Testing:​ Lessons Learned from the Classroom.”

Many schools across the country have demonstrated the ability to safely get kids back in classrooms. To do this requires both insight from continuously improving science, public health and clinical recommendations, as well as flexibility and innovative approaches to how we accommodate teachers, staff, and families. The innovation series aims to highlight expert perspectives and data-driven solutions offering leaders tested approaches to support their tailored reopening plans.

Phillip D. Levy, Professor and Associate Chair for Research – Department of Emergency Medicine, Assistant Vice President for Translational Science and Clinical Research Innovation, and Wayne State University Chief Innovation Officer at Wayne Health spoke to how Wayne Health is partnering with schools to support reopening throughout Greater Detroit.

Dr. Levy named partnerships as the number one lesson learned to date, stressing the importance of identifying willing partners to support testing. He shared criteria for when to open and when to close schools and explained how screening can be used in schools to detect presence of the virus to prevent transmission.  

Dr. Levy outlined the following steps to determine how to establish a screening testing plan:

  • Understand prevalence in the community and use statistical modeling to determine an appropriate level of testing in schools
  • Determine whether to use individual or pooled testing and keeping the goal of screen testing in mind, determine the type of test
  • Decide where testing will be held taking into consideration the willingness of the school community to be tested
  • Determine how the consenting process will be handled and how to best obtain results from students and staff

Other critical insight is that there is the potential stigma associated with testing in the school setting. Leaders need to decide how to manage the process at the school to take into consideration sensitivities regarding getting tested. Messaging is a critical component to engaging parents and students, and Dr. Levy shared this brief video showing the process of testing to help prepare students and alleviate concerns.

Dr. Levy recommended that communities work to understand what is in the new relief bill to determine how funding will be made available to support testing. He also shared concern about the decrease in support for testing in schools and expressed apprehensions that this has become very political. He expressed the need to stop focusing on politics and focus on science and on “getting things done.”

This event is being co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation.  The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors.

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March 2nd, 2021

Multi-Sector Collaboration to Support Reopening

Key take-aways

On March 2, 2021, the Network for Regional Healthcare Improvement (NRHI), with support from The Rockefeller Foundation, hosted the event Multi-Sector Collaboration to Support Reopening.

Dina Faticone, Director of Community Health and Engagement from Common Ground Health in Rochester, New York presented on its work to implement the Reopening Finger Lakes Schools Safely Task Force which represents 13 counties in New York state aimed to create some consistency across the region for school reopening activities. The Task Force is working to take guidance from the state and federal government to support planning and to serve as bridge across school districts.

Acknowledging that reopening would require multi-sector collaboration, the group requires representation from parents, public health, healthcare, mental health, education, and caregivers.

The Task Force established 4 workgroups:

  • Communication workgroup – with a primary focus on parent communications
  • School reopening resource hub – with focus on resources needed by the professionals supporting re-opening, e.g.; mental health
  • Health and medical advisory – medical experts charged to translate federal and state guidance into local guidance
  • Childcare intersections – in partnership with United Way to consider school reopening in relation to childcare

The Task force helped schools to understand the school testing requirements established by the state of New York and is supporting schools with implementation of testing. Dina noted many important factors for successful implementation, including:

  • Fostering alignment between healthcare and education was key to successful roll out of testing
  • Reducing fear and anxiety was a critical part of the process
  • Creating communications in multiple languages and appropriate literacy levels was integral to successfully communicating across regions
  • Gaining agreement early on how consent will be obtained is imperative
  • Having a plan that accommodates multiple models for testing and lab resources will allow for more efficient roll out
  • Having the right people on your team to plan testing: school health professional, school leaders, staff members, legal team, clerical support is critical

Overall lessons learned include:

  • Private and charter schools have less capacity for testing than publics and varying needs
  • Local health departments are critical partners for schools to conduct testing
  • Clear, consistent communications across schools and districts is important
  • Need to communicate positivity rates and transmission rates in schools to reduce fear and anxiety

This event is being co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation. The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors.

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February 26, 2021

Image from The Rockefeller Foundation “Covid-19 Testing in K-12 Settings: A Playbook for Educators and Leaders.” Click on image to access.

Kickstart event: Covid-19 Testing in K-12 Settings

On February 26, 2021, the Network for Regional Healthcare Improvement (NRHI), with support from The Rockefeller Foundation, hosted the Kickstart Event for COVID-19 Testing to Support Reopening of Schools: A National Forum for Regional Leaders series. 

We need to re-open our schools and to do so safely, Covid-19 testing is a critical element of a re-opening plan.

To support schools and those working with schools on these efforts, The Rockefeller Foundation, in partnership with the Skoll Foundation and Testing for America, recently released the Covid-19 Testing in K-12 Settings: A Playbook for Educators and Leaders. The kickstart event focused on two important components of the Playbook, risk assessment and testing strategies.

Risk assessment is an important tool to share your re-opening plan. The risk assessment includes understanding prevalence of Covid-19 in your school’s community and the risk and consequences of transmission in the school setting.

Choosing a testing strategy starts with understanding the types of tests that are available. The Playbook provides important information on options available.

Friday’s event also highlighted additional resources and regional success stories.
Two school districts highlighted how they are using the Playbook as well as Chiefs for Change Reopening Resources to safely keep schools open.

Leaders from Rhode Island and Texas shared their approaches for testing and the successes realized in keeping their schools open.

These leaders emphasized the importance of information and education to support the communication required for successful implementation of testing; the necessity of a phased in approach that recognizes and addresses fears; importance of having and sharing data on positivity rates; and inclusion of the school community in developing the plan.

While there is no one approach that it is best for all schools, there are approaches that are working that will continue to be shared throughout the NRHI and The Rockefeller Foundations Innovation Series. It is important that the approach taken is aligned with the factors for each particular school and that schools receive the necessary resources and support to get children, teachers, and administrators back to school safely.

This event is co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation. The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors.

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December 1st, 2020

Return to School and Work – Scaling Rapid Testing

Key take-aways

 First presenter presenter during the final session of the three-part Innovation Series was Jennifer Unger, Ph.D., Assistant Professor of Preventive Medicine at the University of California Keck School of Medicine and Principal Investigator on a study with The Rockefeller Foundation to develop a testing protocol for K-12 schools, Dr. Unger focus is on the Los Angeles County, one of the most diverse and largest school systems in the Country. Qualitative research including interviews are being conducted to inform what will work in the real world. Interviews will help identify what to expect regarding receptivity of children to be tested and who will be willing to administer the tests. They are anticipating multiple challenges including limited availability of tests, how to handle the transport to lab and resulting processes, and staff to conduct the testing. Her team expects to have a report to help guide others early in 2021.

Second presenter was Tommy Thompson, former Wisconsin Governor and HHS Secretary and Interim President of the University of Wisconsin, spoke to strategies used across the university system to keep students and staff safe while keeping the University open. Regular rapid antigen testing has resulted in a dramatic improvement in positivity rates- from 22% to less than 3% across all campuses. With this improvement, the current focus to combat the spread of the virus is to ramp up testing even more. The success at the University has attracted attention of the current administration as well as the Biden team providing the opportunity to showcase the effectiveness of widespread and frequent rapid testing and the need for resources to support this approach.

Key take-aways include:

1.“Testing Works,” and when combined with mask wearing, distancing, and quarantining can effectively reduce the spread of COVID-19

  • Initial antigen tests, or rapid point of care testing, combined with confirmatory PCR tests as necessary, can help identify cases among both symptomatic and asymptomatic individuals
  • Testing is only the first step and must be combined with diligent masking, quarantining if positive, and distancing
  • Frequent testing is necessary to effectively identify cases
  • Availability of tests continues to be a major barrier for effective testing at schools, universities, and in communities

2.Testing to re-open K-12 schools is extremely complex and will require insight from school administrators, staff, and community partners

  • Interviews with school administrators, teachers, parents, and children will help inform potential solutions and barriers to K-12 testing
  • Given the likely hesitance of some parents to have children tested due to potential of missing work if a child tests positive, it is imperative that supports are in place for families needing to quarantine
  • Mathematical models are needed to understand who to test and how often
  • Pilots at a variety of different schools can help shaped the most effective approaches; however, choosing pilot locations will be difficult given limitations in tests and supplies

This session highlighted the ongoing need for frequent, mass testing as the critical first step to containing spread of the virus. With resources and supplies greatly limited, test site leaders in a variety of settings are having to make difficult choices of who to test and at what frequency. Pilots at Universities are showing promising results and with better defined protocols and ample resources, could help influence reopening of K-12 schools.

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This event is co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation. The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors

November 24th, 2020

Promoting a Positive Patient Experience

Key take-aways

During the second part of the Innovation series, Phillip D. Levy, MD, MPH, FACEP, FAHA, FACC Professor of Emergency Medicine and Assistant Vice President for Research at Wayne State University and Chief Innovation Officer at Wayne Health
shared how they are engaging community members and providing screenings and services beyond COVID testing to meet the needs of community members and to provide a positive patient experience.

Key take-aways include:

1.Work with trusted community partners

  • Identify which communities you want to target and then identify community partners trusted by that population to help build trust and reduce fear
  • Community partners can help provide services beyond COVID-19 testing (e.g., HIV testing, blood pressure screening, mental health referrals)
  • Prioritizing the patient experience can have a cumulative effect when patients share that positive experience with others

2.Use data to drive prioritization and services provided

  • Leverage data to understand risk distribution and inform response
  • Use data on language and disabilities to understand translation and accessibility modifications necessary
  • Utilize patient registration data and community-level data about both social needs and medical comorbidities to inform the types of services offered beyond COVID-19 testing.
  • Understand not only the pockets of risk, but why that risk exists

This session highlighted the value of building services with communities and not for them and to how understanding the needs, fears and desires of community residents supports effective response. This approach can create lasting infrastructure needed for response to the current pandemic and more importantly for long term community engagement to support population health management.

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This event is co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation. The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors

November 17th, 2020

Choosing the Right Type of Testing Site & Managing Through Changes in Weather

Key take-aways

During the first part of the Innovation Series, Ashley Johnson, Continuous Improvement Specialist at Providence St. Joseph Health, Alaska Region, and Brittney Hahn, BSW, CDCA, Early Intervention Program Coordinator at the UC College of Medicine in Cincinnati, OH shared how they are selecting testing sites and managing through changes in weather.

They shared innovative practices as well as ongoing challenges and received insight from other leaders across the country.

Key take-aways include:

1.Approaches to keeping staff warm

  • Use hand and foot warmers
  • Create heated spaces for staff breaks using space heaters inside tents
  • Use ice fishing huts designed to withstand the elements to protect staff from the elements
  • Use heated storage units with collapsible awnings as hubs for testing Select plastic gowns (vs. paper) to provide more insulation
  • Move testing to indoor locations when proper ventilation and infection prevention protocols can be established
  • Consider indoor/outdoor facilities with open walls such as parking garages
  • Consider using refurbished shipping containers

2.Staff and patient safety and patient trust

  • Provide ice cleats to staff in icy conditions
  • Rotate staff often
  • Implement signs and cones and barriers at drive through sites to keep vehicles at safe distance when conditions are icy or snowy
  • Create testing spaces that are thoughtful, clear, and reassuring

3.Ongoing barriers include

  • Access to heaters and tents that withstand conditions
  • Ability to keep cleaning supplies from freezing
  • Keeping the hands of staff warm given need to frequently change gloves
  • Financial barriers to maintaining site operations and concerns of upcoming funding cliff with CARES ACT funds only available through the end of 2020

We also heard from Caitlin Taylor, RA, Architect and Design Director at MASS Design. Caitlin shared how MASS is supporting pandemic response working with multiple industries to build spaces and processes to reduce the spread of infectious disease and support trust building with patients. Caitlin provided an overview of Design Considerations for Off-Site COVID-19 Testing Centers, a tool designed in partnership with NRHI and Senior Epidemiologist Liz Winterbauer, MPH. Additional resources shared by presenters and participants and can be accessed here.

This session highlighted the need for ongoing support and financial assistance for COVID-19 testing as cases surge across the country. Let’s continue to learn from each other and accelerate progress by coming together, sharing resources, and advocating for the ongoing support needed for effective and safe testing.

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This event is co-sponsored by the Network for Regional Healthcare Improvement and The Rockefeller Foundation. The views expressed by the speakers and moderators do not necessarily reflect the views of the sponsors