Los Angeles County is one of the largest and most populous counties in the United States, with approximately 10 million residents and spanning approximately 4,000 square miles. Not only is it one of the largest counties, but it is also among the most ethnically, economically, and linguistically diverse jurisdictions in the United States.  The Los Angeles County Department of Public Health (LACDPH) serves 86 out of the 88 cities within Los Angeles County, and all unincorporated areas.  

Schools in Los Angeles County serve over 1.5 million children between ages 5-17 through 3,200 public, charter, and private schools spread over 80 school districts. The COVID-19 pandemic severely disrupted daily life, including closures of K-12 schools in Los Angeles County and across the nation for the better part of the 2020-2021 academic year. These school closures severely impacted these children, resulting in academic regression and significant socioemotional consequences for many. As the County prepared for reopening of schools for the first time in many months, schools, administrators, students and parents needed a great deal of assistance to interpret and implement the myriad of complex COVID-19 requirements, recommendations and guidance filtered down from government officials.  

Reopening schools safely requires addressing the varying needs of the diverse communities in LA County, as: 

-Maximizing safety of students and school staff, 

-Preventing the spread of COVID-19 in the K-12 School setting, 

-Educating schools on ever-changing local, state and national requirements and best practices for preventing the spread of COVID-19 in school settings, and 

-Ensuring that schools implemented the LACDPH K-12 School Reopening Protocols with a high degree of fidelity 

LACDPH used federal funding in September 2020 to onboard and train a team of health educators, forming the School Technical Assistance Team (STAT) to implement the overarching mission of helping schools bring students and staff back safely and to prevent the spread of COVID-19 in the classroom. STAT accomplished the vision of accessible, public health expertise and assistance through multiple innovative strategies: 1) Providing an in-person site visit and technical assistance at K-12 schools within Los Angeles County within 14 days of notification of re-opening; 2) Providing prompt technical assistance with K-12 School re-opening documentation requirements and general requests for assistance; 3) Collaborating with other LAC COVID response teams to support consistent health education messaging and guidance throughout the response.  

 STAT provided technical assistance through detailed, in-person site visits to assess school safety and compliance, and answered questions submitted by schools via email and phone in an effort to mitigate COVID-19 transmission on K-12 campuses. By the end of June 2021, the majority of schools in Los Angeles County had at least partially re-opened for in-person learning, including those served by Los Angeles Unified School District, and the vast majority of school districts. 

The economic, emotional, and public health impacts of the COVID-19 pandemic have been acutely realized in Los Angeles County. The effects have been disproportionately felt by Black and Latinx communities, and communities in low socioeconomic status communities. The American Academy of Pediatrics reports that school closures not only severely impact families and children by negatively affecting learning and emotional growth, but they also exacerbate educational, racial and economic disparities. Moreover, schools are an essential source of nutrition, safety, and medical and mental health services, particularly for disadvantaged families. In December 2020, Los Angeles County was the global epicenter of the pandemic, with some of the highest case rates per capita in the world. Schools were effectively closed to all students for several months during the 2020-2021 winter surge, except for students considered most at-risk and those needing specialized services and support. 

Los Angeles County public and charter schools serve a large number of students who rely on schools for essential services. According to the Los Angeles County Department of Education, 70%, or over 1 million, of the children served by Los Angeles County public and charter schools are economically disadvantaged. Schools serve nearly 170,000 students with disabilities, 63,000 students experiencing homelessness, 258,000 English Language Learners, and 26,000 foster youth. Los Angeles County also serves a racially diverse population of students. Of the 1.4 million students served by Los Angeles County, 65% are Latino or Hispanic (940,000), 14% are white (196,500), 7% are African-American (103,000), and 2% are Filipino, including students of Pacific Island and Indigenous American descent.   

Schools, districts, parents, and administrators made very clear that there was an immense and urgent demand for public health assistance, to safely re-open schools for these students in need. In order to meet these demands, the Department of Public Health (DPH) needed to create a program that would effectively and appropriately serve all schools in the County, and the populations they serve. Communication, flexibility and sustainability were key to the implementation and efficacy of the STAT program. In addition, a strong evaluation component was integral to assess the effectiveness of the program at mitigating COVID-19 transmission, STAT’s ability to meet diverse community needs equitably, and to establish critical relationships with district officials/school administrations to ensure they are informed of changes and improvements throughout its duration. 

From its inception, STAT used multiple innovative strategies to develop a model for the safe reopening of schools. STAT developed a checklist based on the Reopening Protocols for K-12 Schools that personalized on-campus school visits. The site visits allowed for specific, flexible visualization and implementation of LA County protocols and guidance documents in real-time, based on a school’s individual capacity, physical space and financial resources.  The School Technical Assistance Team offered recommendations to strengthen the school’s mitigation strategies and then followed up via email to make certain they were able to implement those recommendations, and to offer additional assistance and support as needed.  

The in-person site visits and ongoing technical assistance at each K-12 school created strong partnerships and bonds between LAC DPH and the school communities on a level that had not previously existed. The STAT was organized to accommodate the enormous geographic size of Los Angeles County, and teams of health educators worked with schools within the communities assigned to them, engaging school district personnel, administrators, teachers, parents, and students. Training and working with school nurses helped to established them as exposure management liaisons at their campuses. In addition, the STAT collaborated innovatively with other LACDPH COVID-19 response teams including Acute Communicable Disease Control, Outbreak Management Branch, Environmental Health, Vaccine Operations, Emergency Preparedness and Response Division, and the Community Liaison Branch. These collaborations not only provided support to one another but also ensured consistent health education messaging and guidance. 

With respect to data and evaluation, the COVID-19 Education Prevention Data and Evaluation Team created a multi-layered data universe, where STAT members could document site visit concerns on live forms in real time, with information uploading instantly to shared databases. This allowed for prompt evaluation and was highly adaptable and informed the evolution of the STAT procedures and practices. Additionally, call center staff instantly uploaded questions, categorized by sector and question type, into an online database, while staff was required to document responses provided to constituents. These databases were accessible by several critical response teams, and constantly and consistently evaluated. These data collection systems permitted LACDPH to rapidly identify and address key, emergent topics of concern within the school communities, often within a matter of days.  

As with many aspects of pandemic response, STAT was created and implemented extremely quickly by LACDPH. A Liaison team of Subject Matter Experts from across the department had been assembled and activated to respond to constituents and businesses seeking guidance via centralized support email and call centers.  

When the need for in-person assessment and guidance became acutely clear, LACDPH staff were reassigned from their home programs to focus exclusively on the education sector, and a team of over 60 health educators were trained in COVID-19 safety protocols, constituent outreach and communication, prior to being deployed into the field. The immediate goals of the program were to prevent the spread of COVID-19 in schools by establishing partnerships with schools and providing technical assistance so that schools 1) understand state and local COVID-19 guidance and 2) are able to implement the LACDPH K-12 School Protocols with a high degree of fidelity.  

Every effort was made to engage individual school administrators, district officials, and school nurse partners to collect and implement feedback both on the feasibility and impact of the Los Angeles County K-12 protocols and guidance documents themselves, as well as on the implementation of technical support for compliance via STAT. Schools provided individual feedback on technical assistance needs through the Liaison Call Center, but other channels were used to connect with schools and administrators as well:  

-Weekly telebriefings with K-12 leaders to inform leaders on the overall status of the pandemic, any potential changes in guidance. A Q&A is always available so leaders can collect information on what might be beneficial.  

-Weekly calls with the Los Angeles County of Education and 80 school district superintendents and school leadership to review COVID-19 safety requirements, recommendations, and to address concerns. Leaders are able to submit questions to Public Health in advance of these meetings.  

-Periodic key stakeholder meetings with district, public health, and labor leadership to navigate difficult issues. 

-Periodic trainings for school nurses on contact tracing, exposure management and COVID-19 transmission mitigation best practices. 

-Ambassador Program was established to train parents and students as local community public health ambassadors to promote COVID-19 best practices and combat misinformation. 

In addition to this regular engagement, Public Health Education Sector Response staff meet frequently to assess feedback from school constituents and make adjustments to guidance, protocols, and public health response operations to better meet sector needs.  

The level of direct engagement and hand-in-hand coordination with school-based partners, particularly with the Los Angeles County Office of Education and the Los Angeles County Archdiocese has proved to be an invaluable resource for quickly leveraging established networks and disseminating essential COVID-19 information to schools, districts, staff and students. Schools, districts, and parents rely on these institutions as their primary source of trusted information and have proven receptive to COVID-19 safety guidance received directly from these institutions via partnership. STAT has worked hard to engage with these trusted partners to seek access to school campuses and enhanced communication with administrators.  

The myriad, constant communication between LACDPH and K-12 schools, administrators, staff and parents helped to ensure that the overall public health response, including the STAT model, remained flexible and adaptive to community needs. In the 2020-2021 school year, STAT was responsible for engaging and visiting all schools within Los Angeles County. As schools all gradually re-opened, STAT moved to a risk-based model, prioritizing schools in communities at increased risk from negative COVID-19 outcomes. These were quantified as schools within geographic regions with the lowest community vaccination rates and highest community case rates per capita.  

Schools in underserved communities frequently had fewer financial resources to mitigate COVID-19 transmission, and therefore had significantly higher disease burdens within their communities. These schools also broadly had fewer staff to conduct essential COVID-19 safety screening and contact tracing and less physical space to provide distance to students or separate students by cohort. Many did not have a school nursing staff to oversee compliance with LACDPH COVID- 19 safety requirements and recommendations.  STAT prioritized proactively reaching out to these schools to offer technical assistance in the 2021-2022 school year, even if they’d had previous interaction with LACDPH or prior site visits. STAT assisted with providing guidance on ventilation in classrooms as well as providing opportunities for school improvement e.g., drafting concise directions for the CalSHAPE grant application, a State of California grant that provides funding to over 1,000 schools across LA County to update their HVAC system and non-compliant plumbing fixtures. STAT also provided guidance on maximizing physical space for safe mealtimes and the classroom and coordinated with district officials to provide guidance to schools serving students with specific, challenging medical needs.  

Since September 2020, STAT has conducted an enormous volume of work supporting Los Angeles County K-12 schools, including 3,261 individual school site visits.  STAT has also provided verbal or written technical support to 5,385 individual requests for assistance. The benefits of the STAT program are also reflected in the very low COVID-19 outbreak rates at TK-12 Schools within Los Angeles County. Between October 2020 and December 2021, there were only 257 outbreaks in all of the more than 3,200 K-12 schools. Remarkably, these outbreaks (defined as 3 or more epidemiologically linked cases within a 14-day period) resulted in only 644 total staff cases, and 1,797 student cases on K-12 campuses. This is an extraordinarily low rate of transmission, particularly compared to the rate of transmission occurring in other sectors and within surrounding communities. 

In response to the success of these endeavors, Public Health is continuing to use federal grant dollars to fund the STAT health educator model to continue to disseminate COVID-19 prevention strategies toward continued transmission mitigation during the current Omicron surge. Moreover, LACDPH is working to establish a permanent team responsible for maintaining these crucial partnerships and engaging with schools and administrators to collaborate on public health needs beyond COVID. As the existing team of health educators will be significantly scaled down over time, Public Health clinical staff and analysts will be assigned to coordinate with schools on a regional basis. These regional teams will then coordinate with a central management, administrative, and data team, housed in the Maternal, Child and Adolescent Health Division of LACDPH. This team will be responsible for ongoing collaboration with the K-12 community, identifying key public health issues, furthering existing safety initiatives, continued development of innovative, equitable programs and associated evaluation measures.  

Partnership, patience, empathy, and direct engagement with our community are among the most valuable tools health departments can use to further health and safety. Building and maintaining relationships with constituents and key stakeholders are critical to ensure that the needs of our most vulnerable community members are clearly seen and their voices are clearly heard. STAT addressed this head on, and engaged directly, face to face, with thousands of administrators, parents, staff, and students to listen to their fears, address their concerns, and provide essential COVID-19 safety guidance based on each individual school’s resources, space and capacity so that K-12 students could return and remain in school.  

LA County Department of Public Health, TK-12 Schools COVID-19 Toolkit: http://ph.lacounty.gov/acd/ncorona2019/EducationToolkit/tk12/