Back to ECE Safely With SAGE: Reducing COVID-19 Transmission in Hispanic and Low-income Preschoolers

Study Overview
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Brief Summary
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This study aims to get children safely back to school by (1) Child and Family Testing, (2) ECE Personnel Testing, and (3) Outdoor Learning via Garden Education.

Detailed Description
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This study aims to get children safely back to school with a three strategy approach. Child and Family Testing. Investigators will determine acceptability, feasibility, efficacy and scalability of testing children and families as a pre-screening strategy for re-entry to 40 CACFP-eligible ECE sites for fall 2021. Our trained bilingual ASU team (vaccinated staff and nursing students) will provide onsite testing ECE sites. Investigators will assess acceptability and feasibility via brief parent surveys and developmentally appropriate icon ratings for children, and assess efficacy as the proportion of viable samples obtained, coaching time needed to obtain one sample, and proportion of successfully obtained samples. Investigators will document costs of delivering the screening strategy (e.g., personnel, time, materials) to determine scalability. For participants testing positive for COVID-19, community health workers from Equality Health Services will provide follow-up care. ECE Personnel Testing. Investigators will determine the acceptability, feasibility, efficacy and scalability of routine ECE screening of ECE personnel (teachers and aides) who have direct contact with children. Investigators will determine the acceptability of screening by 6-8 focus groups with teachers (N=80) from the 40 ECE sites above in July. Investigators will measure feasibility and efficacy (agree to test, proportion of viable samples obtained) of bi-weekly ECE site-based testing with school personnel from half (20) of the sites for fall 2021. Investigators will survey teachers to determine how acceptability toward testing relates to importance for back to ECE safety changes as vaccine uptake increases and vaccine hesitancy decreases over time. Investigators will record costs (e.g., personnel, time, materials) to determine scalability. Investigators will determine the additive efficacy of both child testing (see #1) and ECE personnel testing on attendance and enrollment. For participants testing positive for COVID-19, community health workers from Equality Health Services will provide follow-up care. Outdoor Learning via Garden Education. Investigators will determine the efficacy of enhanced outdoor learning opportunities for closing the gap from the lack of in person based ECE on motor development and eating in the absence of hunger in 4 and 5 year olds. Investigators will randomize participating sites to engage in an adapted Sustainability via Active Garden Education (SAGE) garden curriculum in Spring of 2022 or wait list. Wait list sites will receive the garden and curriculum in Fall 2022. Investigators will install or enhance existing gardens in ECE sites to promote outdoor learning opportunities linked to NAEYC guidelines, and expect children in those sites to gain more rapid improvements following the learning gap. Using established protocols Investigators will test children on motor behavior and eating in the absence of hunger in Fall of 2021 (T1, baseline), prior to implementing SAGE, in Spring 2022, following SAGE implementation, and then a follow up in Fall of 2022 to determine ongoing effects.

Official Title
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Back to ECE Safely With SAGE: Reducing COVID-19 Transmission in Hispanic and Low-income Preschoolers

Conditions
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COVID-19 Testing, Children, Preschool, Parents, Child Development, Self-Control, Exercise, Diet, Healthy

Intervention / Treatment
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* Behavioral: CHILD back-to-ECE COVID-19 saliva testing
* Behavioral: ECE personnel back-to-ECE COVID-19 saliva screening
* Behavioral: SAGE garden programming


Participation Criteria
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Eligibility Criteria
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Inclusion Adult parents and their minor children (age 3-5) Children and their parents who are attending eligible early care and education (ECE) sites ECE site personnel (adults 18 and older) with direct contact of children attending ECE sites. Exclusion -Children with health-compromising conditions (e.g., food allergies) that study activities might aggravate.

Ages Eligible for Study
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Minimum Age: 3 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Participating ECE sites (N=40) will be block randomized to receive child and family back-to-ECE testing OR child and family testing plus ECE personnel biweekly testing. Of this same group of sites, half will be block randomized to complete an outdoor learning garden condition (SAGE) and have will receive waitlist. Waitlist sites will receive the garden condition delayed by one year.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CHILD testing<br>One child and parent dyad will be tested for COVID-19 using the ASU saliva test as part of back-to-ECE safely programming. All sites will receive this condition. | Behavioral: CHILD back-to-ECE COVID-19 saliva testing<br>* Preschool children and their parent will complete saliva COVID-19 tests at the start of the school year and after winter break as part of a back-to-ECE safely intervention. Tests may be completed during pick up, at drop off, or during school, depending on local on-campus regulations.<br>|
| Experimental: CHILD+ personnel testing<br>This arm receives the CHILD condition plus ECE site personnel are screened biweekly for COVID-19 using the ASU saliva test. | Behavioral: CHILD back-to-ECE COVID-19 saliva testing<br>* Preschool children and their parent will complete saliva COVID-19 tests at the start of the school year and after winter break as part of a back-to-ECE safely intervention. Tests may be completed during pick up, at drop off, or during school, depending on local on-campus regulations.<br>Behavioral: ECE personnel back-to-ECE COVID-19 saliva screening<br>* ECE personnel will complete saliva COVID-19 tests biweekly through the school year as part of a back-to-ECE safely intervention. Tests may be completed on the ECE campus or in the parking lot, depending on local on-campus regulations<br>|
| Experimental: SAGE garden<br>The SAGE arm is a garden-based curriculum that emphasizes outdoor learning opportunities such as active games, songs, and garden-activities. About half of the original 40 sites (roughly evenly divided by CHILD and CHILD+) will receive this in year one, and the remaining sites will receive this condition in year two. | Behavioral: CHILD back-to-ECE COVID-19 saliva testing<br>* Preschool children and their parent will complete saliva COVID-19 tests at the start of the school year and after winter break as part of a back-to-ECE safely intervention. Tests may be completed during pick up, at drop off, or during school, depending on local on-campus regulations.<br>Behavioral: ECE personnel back-to-ECE COVID-19 saliva screening<br>* ECE personnel will complete saliva COVID-19 tests biweekly through the school year as part of a back-to-ECE safely intervention. Tests may be completed on the ECE campus or in the parking lot, depending on local on-campus regulations<br>Behavioral: SAGE garden programming<br>* The SAGE garden programming includes installation of a garden; teacher training via Zoom and/or short videos, a binder and website support along with other accompanying materials and teacher technical support (email, text, phone); gardening supplies and gear (e.g., hats, watering cans, gloves); and delivers active songs, games, science experiments and other outdoor learning opportunities.<br>|
| Sham Comparator: Wait list<br>Those in the wait list condition will receive SAGE in year two. | Behavioral: CHILD back-to-ECE COVID-19 saliva testing<br>* Preschool children and their parent will complete saliva COVID-19 tests at the start of the school year and after winter break as part of a back-to-ECE safely intervention. Tests may be completed during pick up, at drop off, or during school, depending on local on-campus regulations.<br>Behavioral: ECE personnel back-to-ECE COVID-19 saliva screening<br>* ECE personnel will complete saliva COVID-19 tests biweekly through the school year as part of a back-to-ECE safely intervention. Tests may be completed on the ECE campus or in the parking lot, depending on local on-campus regulations<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Viable sample | Proportion of viable saliva samples obtained from children | Within six weeks from the start of school (varies by site and semester) | 
| Proportion of Children Attending ECE | Aggregated weekly attendance of children in ECE sites and comparison (non-participating) sites. | within four weeks of the end of school (varies by site and semester) | 
| Progressive Aerobic Cardiovascular Endurance Run (PACER) | Product-based quantitative, locomotor skills test | Baseline pre-intervention | 
| Progressive Aerobic Cardiovascular Endurance Run (PACER) | Product-based quantitative, locomotor skills test | Post-test up to four weeks after intervention | 
| Children's Activity and Movement in Preschool Study (CHAMPS) motor skill protocol | Process-based quantitative, locomotor skills test that tests skills of running, broad jumping, sliding, galloping, leaping, and hopping | Baseline pre-intervention | 
| Children's Activity and Movement in Preschool Study (CHAMPS) motor skill protocol | Process-based quantitative, locomotor skills test that tests skills of running, broad jumping, sliding, galloping, leaping, and hopping | Posttest up to four week post-intervention | 
| Eating in the absence of hunger | Behavioral, quantitative test of eating when one is not hungry | Baseline pre-intervention | 
| Eating in the absence of hunger | Behavioral, quantitative test of eating when one is not hungry | Posttest up to four weeks post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acceptability and feasibility of saliva COVID-19 test | Self-report survey scale that measures difficulty, satisfaction and repeatability of COVID-19 test. | At time of COVID-19 test within six weeks from the start of school (varies by site and semester) | 
| Cost to obtain a sample | Cost including personnel, time, materials, space to obtain a sample | Time 1 at the time of COVID-19 test, Within six weeks from the start of school (varies by site and semester) | 
| Parent reports of COVID-19 household incidence | Brief questionnaire that measures self-report of COVID-19 cases in households enrolled in the project completed by parents approximately once per month | Approximately once per month following time 1, up to 10 months following time 1 (varies by site and semester) |