Rapid asymptomatic testing in specialist settings

Table of Contents

Main changes to the previous version

This guidance has been updated to reflect:

the rollout of home testing of staff in specialist settings
the introduction of twice weekly testing of secondary aged pupils and students
changes to requirements for on-site testing via Asymptomatic Test Sites (ATS)

Introduction

This guidance is for leaders and others involved in the asymptomatic testing programme in:

special academies
maintained special schools
alternative provision (AP) academies, including hospital schools
registered independent AP, including hospital schools
pupil referral units (PRUs)
special post-16 institutions
non-maintained special schools
independent special schools

This guidance may also be useful for:

local authorities
clinical commissioning groups
community health staff working with children and young people with special educational needs and disabilities (SEND)

Parents and carers of children and young people in the settings in this list may also find this guidance helpful. Guidance and resources will be made available for parents and carers on how to support their child taking a lateral flow device (LFD) test at home.

This guidance supplements the guidance on mass asymptomatic testing for schools and colleges, recognising that there are distinct issues for settings in the special school, specialist college and AP sectors. It is part of guidance and resources for schools and colleges to support preparations for coronavirus (COVID-19) asymptomatic testing in education settings.

Importance of testing secondary age pupils and students

It is crucial that action continues to be taken to break the chains of transmission of the virus and help safeguard the health of the staff of education settings and their pupils and students.

Up to one-third of people who have coronavirus are asymptomatic. By rapidly identifying and containing any asymptomatic cases, we can reduce the spread of transmission. Testing does not replace existing protective measures such as handwashing, and settings should continue to follow the system of controls.

Settings should not make it a requirement for a child or young person to have been tested in order to attend their setting.

Testing is voluntary and no child or young person should be tested unless informed consent has been given by the appropriate person such as a parent or legal guardian and the child and young person is willing to be tested. If assisted swabbing is required, the willingness and feasibility to swab should be reviewed and risk-assessed every time before swabbing. Further guidance is available in the informed consent to testing section.

However, we strongly encourage all children and young people to participate in testing, wherever it is possible to do so, to help identify asymptomatic positive cases and support appropriate self-isolation to break the chain of transmission.

Testing is similarly voluntary for members of staff and they are encouraged to participate.

Background

The coronavirus (COVID-19) pandemic has been extremely challenging for many families of children and young people with SEND. Supporting them is a priority for this government and their wellbeing remains central to our response.

We recognise that special and AP settings are diverse and there will be a wide range of challenges in delivering effective testing to their pupils and students. This guidance, which has been drawn up with the help of representatives of these sectors, is intended to give leaders in these settings a framework within which they can devise and deliver an approach that is effective in their particular context.

The asymptomatic testing programme does not replace the current testing policy for those with symptoms. Anyone with symptoms (even if they recently had a negative LFD test result) should still self-isolate immediately according to government guidelines.

Those with symptoms should follow guidance for households with possible or confirmed coronavirus (COVID-19) infection and book a test. They can order a test online or visit a test site to take a lab-based polymerase chain reaction (PCR) test to check if they have the virus.

It remains imperative that the system of controls continues to be rigorously applied to enable the safest possible environment. The testing programme is an important addition to supporting leaders to maintain the continuity of education through the pandemic.

What is the testing offer?

Specialist settings are encouraged to:

offer all staff home test kits to be taken on a twice weekly basis
upon wider reopening from 8 March 2021, where it is appropriate to do so offer pupils and students aged 11 and above (including those who have been attending during the lockdown period, including vulnerable children and the children of critical workers) 3 supervised tests 3 to 5 days apart on-site before moving to home testing
work with pupils and students of secondary school age who are in attendance and their families to agree the most appropriate way for them to access twice weekly testing from 8 March 2021

Wider reopening from 8 March 2021

Upon wider reopening from 8 March 2021, special schools, special post-16 institutions and AP should continue to remain open to allow vulnerable children to attend, whether or not they have had a test. Those with a positive LFD test result will need to self-isolate in line with the stay at home guidance for households.

Schools and colleges have flexibility to consider how best to deliver testing on a phased basis from 8 March 2021 as pupils and students return. Vulnerable children and children of critical workers should be prioritised.

For the majority of pupils and students, having their first 3 tests on-site via the setting’s Asymptomatic Testing Site (ATS) will help them get used to the tests before they begin doing them at home. Settings should aim for pupils to take 3 tests (taken 3 to 5 days apart), starting from 8 March 2021. The pupil and student’s fourth test and regular testing after this can then be done at home using a home testing kit if this is appropriate.

In circumstances where a pupil or student would not be able to be tested through an ATS but who could be tested at home by (or with support from) a suitably competent adult. Settings can provide home testing kits to them from the outset (without the pupil being tested at an ATS first), where this is appropriate for the pupil or student.

This may, for example, be suitable for pupils or students where a parent or carer would be able to support with testing at home whereas the setting is unable to.

This approach should be agreed with the parent or carer and, wherever possible, the young person themselves. This would follow a guided conversation with the school on what is best for the child, whilst ensuring the accuracy of the results.

As a minimum, the first 3 tests done at home (if not initially done via ATS) should be administered by the pupil or student’s parent or carer (meaning the parent or carer should do the swab as well as the other steps).

If the pupil or student feels confident enough in doing so and can do it effectively, they can self-swab from the fourth test onwards as long as they are supervised by an adult. Further information can be found in the ‘Ongoing twice-weekly testing: Home testing of pupils or students’ section.

Ahead of testing the parent or carer should ensure they have undertaken appropriate training, including watching the approved video package which demonstrates how physical tests are conducted. If a carer is assisting with a test in a residential setting, then they must wear appropriate PPE in line with testing guidance. A parent or other member of the child’s support bubble assisting with the test at home does not need to wear PPE, though appropriate precautions should be taken, such as washing hands.

Ongoing twice weekly testing: Home testing of pupils and students

Ahead of moving to twice weekly home testing of staff and secondary aged pupils, where appropriate pupils and students should be offered testing on-site via ATS for their first 3 tests (3 to 5 days apart) from 8 March 2021. This should help them to get used to the LFD tests in a supervised environment.

For their fourth test onwards, pupils and students should be offered home testing kits and should be supervised by an adult at home when taking the tests (unless they are aged 18 or above).

The LFD test will give a result in around 30 minutes. Staff and students must report their result (whether positive, negative or void) to NHS Test and Trace as soon as the test is completed either online or by telephone as per the instructions in the home test kit. Staff and pupils and students should also share their result with their setting to help with contact tracing. Ideally tests should be taken in the morning, if this is not possible tests can be taken at a different time of the day.

Students aged 18 and over can self-test if this is possible and report the result (whether positive, negative or void), with assistance if needed. Adolescents aged 12 to 17 are able to self-test and report with adult supervision.

The adult may conduct the test if necessary. Children aged 11 attending a special school should be tested by an adult, those under the age of 11 should not be tested.

Staff or students with a positive LFD test result will need to self-isolate in line with the stay-at-home guidance.
They will also need to arrange a lab-based PCR test to confirm the result if the test was done at home. Those with a negative LFD test result can continue to attend school or college and use protective measures in line with the systems of control.

We recognise home testing may not be appropriate for some pupils and students. In these instances, on-site testing should be offered if that is a viable alternative. If a pupil or student is unable to tolerate a swab-based test at all no testing should take place. Settings should not make it a requirement for a child or young person to have been tested in order to attend their setting.

Ongoing twice weekly testing: On-site testing

Settings should maintain on-site ATS testing facilities where possible. Even if it is appropriate for the majority of pupils or students to test at home we recommend settings retain a small ATS so that they can offer testing to pupils or students unable to test at home. In some settings the asymptomatic test site may need to maintain more capacity if a large number of pupils or students cannot take advantage of the home testing offer.

We recognise that some settings may not have rooms that meet the requirements set out in the ‘how to guide’ on the secure digital platform, for example, because otherwise suitable rooms have a carpet or other porous floor covering. Settings are encouraged to be pragmatic.

Guidance on managing the testing process is available on the secure digital platform, including how to register the tests. A setting may additionally wish to record when a child or young person has required assistance with swabbing and a parent, carer or member of staff has assisted or performed the swabbing, in order to comply with any school and college insurance requirements.

Due to the high prevalence of coronavirus (COVID-19) infections in England, the government has temporarily removed confirmatory PCR testing for LFD tests taken at test sites, such as those in education settings. This follows advice from Public Health England (PHE) that, when coronavirus (COVID-19) prevalence rates are high, the performance of LFDs and PCRs are broadly comparable when used at testing sites with systematic operating procedures, significantly reducing the need for routine confirmatory testing. This policy will be kept under constant review in line with rates of infection.

Example from a school which has implemented asymptomatic testing successfully

Castle Hill High School in Stockport is a secondary special school with 300 pupils on roll. The school caters for a range of SEN, including moderate learning difficulties, autism, social, emotional and mental health difficulties, and severe learning difficulties.

They have implemented asymptomatic testing successfully. This involved:

identifying a medium sized room to be used exclusively for testing
the head and deputy head doing the online training
a team of 4 non teaching members of staff volunteering to create a dedicated team to deliver the testing system for pupils, they received initial training from the head and deputy head followed by the online training modules
one member of the team doing the paperwork, one collecting each pupil when their time is ready to be tested and ensuring they are registered, one demonstrating to the pupil how to do the test or assisting the pupil with the test and the final member of the team doing the test analysis and recording
the deputy head overseeing the testing

When assisting pupils with swabbing, the team reports that it has been straightforward. Older, more confident, pupils tend to self-swab.

Some pupils have been nervous, but this has been easily overcome. All pupils were shown a video of the process and told what to expect prior to their first routine test.

Staff or students with a positive LFD test result will need to self-isolate in line with the stay at home guidance for households. Those with a negative LFD test result can continue to attend their setting and use protective measures.

The staff who are eligible for testing

Any staff working on a setting’s site should be offered LFD tests. This includes:

teachers
teaching assistants
clinical staff employed by the school
those providing on-site wraparound childcare
other support staff (including therapists)
those involved in cleaning testing sites

Settings can offer others testing too, for example, school nurses or drivers or escorts, liaising as appropriate with both the individuals and their employers. Some staff, particularly those employed through the NHS or Local Authority, may have separate arrangements for regular testing. Testing should be offered and undertaken in line with the standard operating procedure and the ‘how to guide on the secure digital platform.

Specialist settings should start to receive deliveries of home testing kits from 24 February 2021. Settings should offer home testing kits to all staff in line with the standard operating procedure on the secure digital platform.

The pupils and students who are eligible for testing

Pupils and students of secondary school age and those aged 19 to 25 with Education, Health and Care (EHC) plans should be offered testing.

Where a child or young person routinely attends more than one setting on a part-time basis, for example, because they are dual registered at a mainstream school and an AP setting or special school, those settings should work together to determine where the pupil should receive the testing and share the outcomes of the testing with the other settings appropriately. However, as a general guide, we would usually expect the setting where the pupil spends most of their time to take responsibility for the administration of the testing.

Schools or local authorities that commission placements in unregistered AP (any AP setting that is not a pupil referral unit, an AP academy (including an AP free school), or a registered independent school) should aim to ensure pupils accessing this provision are offered testing, for example via the mainstream school who commissioned the place or working with the local authority to identify appropriate testing if the local authority commissioned the place. They should assure themselves that any unregistered AP they commission has taken appropriate steps to ensure their institutions are following suitable coronavirus (COVID-19) protective measures.

Primary aged pupils should not be offered testing. Public Health England have advised there are currently limited public health benefits attached to testing primary pupils with lateral flow devices. The case and transmission rates amongst primary age pupils are currently lower than those in secondary age pupils. Primary age pupils may find the LFD testing process invasive and unpleasant and are unable to self-swab. For these reasons there are no plans to pilot LFD testing. We will review this approach in the light of any emerging evidence.

All-through specialist settings

Settings which are all-through should follow the guidance on testing in secondary schools and colleges on the secure digital platform.

Only secondary aged pupils and staff in all-through settings should be offered testing.

Primary specialist settings

Primary specialist settings should follow the guidance on testing their staff on the secure digital platform.

Working with children and young people and their parents

With careful and sensitive management, we are confident that the asymptomatic testing programme can be rolled out successfully to children and young people with SEND. However, testing is not mandatory, and where it has not been possible to conduct a test on a pupil or student, it is crucial that they nonetheless continue to have full access to face-to-face education.

Settings should work with their pupils and students and their families to agree the most appropriate route for testing for each individual. This may be having twice-weekly testing on-site via ATS or moving to twice-weekly home testing.

We recognise that self-swabbing may cause significant concerns for some children and young people with SEND.

Some of these concerns may be alleviated by discussing them with the child or young person and their family, agreeing strategies to help reduce anxiety and putting in place any reasonable adjustments (if the individual has a disability). There may for example be a set of simple, practical steps that the setting’s staff and parents can co-produce to smooth the testing process.

What if a pupil or student can’t self-swab?

There are a number of options that settings and families have if a pupil or student is unable to self-swab. These are detailed in the section and can be summarised as:

having a parent, carer or suitably trained member of staff assist with swabbing on-site
having a parent or carer assist with swabbing at home
whether at home or on-site, doing a nasal only or throat only swab if a combined nasal and throat swab is not possible

Testing technology is developing all the time. We are continuing to work proactively on other approaches to testing for children and young people who are unable to self administer a throat or nasal swab.

Settings may want to consider updating risk assessments to understand which of their pupils or students are unlikely to be able to self-swab and therefore are likely to require additional support or reasonable adjustments, if they are disabled, to be put in place. The standard operating procedure available on the secure digital platform provides guidance on ensuring risks are identified, recorded and managed.

Whether done on site or at home, self-swabbing should be supervised.

When testing on-site, the individual may wish to have a particular trusted adult from the setting to supervise the self-swab of the test. The setting may also wish to consider whether it would agree in exceptional circumstances to a parent or carer coming into the setting to support the child to self-swab or to swab their child in a supervised environment ahead of moving to home testing. This might be a reasonable adjustment for the testing of a child or young person with a disability, for example.

Settings will need to put in place suitable measures in line with the system of controls to manage any infection risk to staff and other children and young people of a parent or carer being present.

We recognise that self-swabbing may not be possible for a wide range of children and young people with SEND, for example, because:

they lack the fine motor skills to do so
the process of their inserting the swab into the mouth and nostrils would cause great anxiety (because, for example, they have an aversion to such touch or they are not comfortable with a gagging reflex)
their level of learning difficulty affects their ability to fully understand, and therefore co-operate with, the testing process
the child or young person has medical needs such that this process would present a disproportionate risk given the benefit

Assisted swabbing (such as performing the swab for someone who is unable to self-swab) does not need to be done by a clinician. Special schools and special post-16 institutions already have a range of staff to meet the health needs of children and young people.

These staff members have undertaken a variety of training to support health needs and it might be appropriate for them to swab individuals who cannot self-swab, once they are confident in doing so and familiarised with how to perform assisted swabbing via the training detailed in the training guide on the secure digital platform.

Those assisting with swabs on-site should wear appropriate personal protective equipment (PPE) and read the PPE guidance on the secure digital platform.

Some settings may not have enough staff to undertake assisted swabbing, for example, due to staff absence. In these instances, further support may be available from Medacs Healthcare. Contact us for more information.

Where possible a combined nose and throat swab should be taken. However, a ‘person centred approach’ should be used to assess which sample to take from each child or young person. A child or young person may find it difficult to take a throat swab due, for example, to their having difficulty in understanding instructions, needing to keep their mouth open during the period of swabbing or they are having a strong gag reflex. In such cases, where a combined nose and throat swab is not possible, a nose swab from both nostrils can be taken. Similarly, if for some reason a nasal swab is not feasible, a throat swab alone will suffice.

Swabbing should be carried out in line with the standard operating procedure available on the secure digital platform.

Testing is voluntary, but those who are eligible for tests are strongly encouraged to participate to reduce the risk of transmission within education settings.

The person giving the consent (parent or legal guardian or the young person) needs to have a sound understanding of the risks and benefits of testing. The setting is responsible for communicating the purpose of the testing.

Even if the child or young person or the parent or legal guardian has given consent, if the individual at any point is not willing to participate in testing then that choice should be respected.

Young people aged 16 or over do not need parental or legal guardian consent provided that they are able to make the decision for themselves. However, the setting will need to decide whether the young person can reasonably provide informed consent themselves and may exceptionally need to consider undertaking a mental capacity assessment (MCA). Young people themselves should be given the opportunity to express their views and preferences to the extent that they are able. Settings should keep a record of how the decision on consent was made. There is further guidance on the Mental Capacity Act 2005 and deprivation of liberty safeguards (DoLS) during the coronavirus (COVID-19) outbreak.

It is important that the willingness of the child or young person and the risk posed to them and the staff or parent assisting the test is always considered. The setting should exercise due care and judgement and, in appropriate circumstances, may choose not to test a child or young person, even when consent has been given. Settings should not make it a requirement to have been tested in order to attend.

For a looked after child or young person in local authority care, such as those from children’s homes, including secure settings, or some pupils in residential special schools, individuals would need to agree to be tested, where age-appropriate. Where parental consent is required this would need to be secured through the child’s or young person’s social worker unless existing arrangements are in place which covers this.

For a looked after child or young person from a fostering or kinship care household, in most circumstances local authority (via a social worker) or birth family consent would be required to allow foster or kinship carers or settings to assist swabbing.

Safeguarding

Schools and colleges must comply with their legal duties as appropriate regarding pre-appointment checks when utilising agency staff, contractors and volunteers to support testing schools and colleges, including having regard to the statutory safeguarding guidance on keeping children safe in education and safeguarding in colleges.

Managing the anxiety of pupils and students

School and college staff know the children and young people in their settings well and will be able to put in place an approach that helps reduce any anxiety as much as possible. They will also need to consider whether there are reasonable adjustments that they would need to make to the context in which the tests were conducted for disabled children and young people while maintaining the integrity of the testing process.

Where a setting has concerns about the anxiety levels of a child or young person, it will often be helpful to talk the issues through with them and their parents.

Areas staff may wish to consider

These questions are based on feedback from the sector.

How can staff help ensure that the child or young person knows what is involved and the reasons for it? What methods of communication work best for them?
How can parents help their child know what testing will involve and what advice can they provide to the setting as to what might work best?
Would it be helpful by exception for a parent, with appropriate measures in place to manage infection risk, to accompany the pupil or student as they self-swab when taking the test, or to assist their swabbing during the test? For more information, see What if a pupil or student can’t self-swab
Would it be helpful to have someone on the staff who has a good relationship with the child or young person present during the testing?
Would it be helpful for the child or young person to be familiarised with the site to be used for testing and how it will be set up?
How can the site being used for testing be made as calm an environment as possible?
Will it help to offer the child or young person a relaxing activity after testing or refreshments to help make it as positive an experience as possible?
If the child or young person stims to relieve their anxiety, then will it help to allow them to have their stimming toy with them throughout the test?
If the child or young person would be more comfortable with testing being done at home, would that be the better approach from the outset?

Resources for parents will be made available to help them support their children testing at home.

Financial and workforce support

We will continue to fund schools and colleges to support with the delivery of testing on-site in line with departmental policy.

In Special Schools, Alternative Provision and Special Post-16 institutions we anticipate that on-site testing may be more appropriate for a greater proportion of children and young people; these settings should carefully consider the specific needs of their pupils, to establish the right level of on-site testing they continue to deliver.

We have accounted for different staffing levels needed in special schools, APs and specialist colleges to deliver testing. Non-maintained special schools and independent special schools will also receive funding to support them with testing costs.

Where specialist settings may not have the capacity to deliver assisted swabbing (due to, for example, staff sickness) then further support may be available from Medacs Healthcare. Contact us for more information.

Settings should note that staff available through Medacs will have had the similar levels of training to those in specialist settings (they are not medically trained) as assisted swabbing does not need to be done by a clinician.

For institutions receiving Medacs support for assisted testing requirements, the cost of this Medacs support will be deducted from that institution’s allocation or payment.

Residential special schools and special post-16 institutions

The guidance on safe working in education, childcare and children’s social care settings includes the actions to be taken in the event of a child or young person being tested positive for coronavirus (COVID-19) in a residential setting.

Further information on what to do if a child or young person tests positive for coronavirus (COVID-19) using a lateral flow device (LFD) can be found within the ‘how to guide’ on the secure digital platform.

Transport

Where a child or young person has tested positive for coronavirus (COVID-19) on-site, they need to be sent home. The setting should contact the parent or carer who should make arrangements for the child or young person to journey home as soon as possible. They may walk or cycle if it is possible for them to do so and they are able to wear a face covering and keep a safe distance from others. They must not travel on public transport. In exceptional circumstances, where it is not possible for the parent or carer to make arrangements for the child’s or young person’s journey home, home to school transport may be provided.

Further information on what to do if a pupil or student tests positive for coronavirus (COVID-19) using a LFD can be found in the ‘how to guide on the secure digital platform. Those affected should self-isolate immediately and follow the guidance for households with possible or confirmed coronavirus (COVID-19) infection.

Support available from local health services

Settings are encouraged to liaise with local health bodies and services where they need advice or support in relation to testing for specific individual children and young people with complex needs.

Resources

Schools and colleges can access more resources on the secure digital platform.

Contact

Schools and colleges should complete our asymptomatic testing contact form or call 0800 046 8687 (Mon-Fri 8am to 6pm, Sat-Sun 10am to 6pm) if they have further questions.

Tags: asymptomatic, Rapid, settings, specialist, testing