In the hallways of New Orleans schools, students talk about the headphones, video games, or Christmas presents they’re saving up for with an unusual new source of income: cash incentives for the COVID-19 tests they take.
The money they’re budgeting has accrued gradually in their online accounts, $10 a week for every COVID-19 test they take at school. For students who’ve participated since the beginning of the school year, those accounts could soon hold a few hundred dollars.
“Once kids realized this incentive existed, we saw a lot of our kids really pushing their parents to sign the consent form,” said Tiffany Delcour, the chief operating officer of New Orleans schools.
Like many other districts, New Orleans has made routine mass virus testing a key part of its COVID-19 precautions. Weekly PCR molecular tests allow administrators to detect sometimes asymptomatic cases, isolating students before they infect their peers. This has helped to cut down on some of the churn of disruptions caused by constant quarantines and classroom closures in schools around the country, Delcour said.
Around the country, schools with such broad testing programs have seen a major hurdle to their efforts: low student participation rates that can weaken their ability to detect the virus and slow its spread.
In some cases, parents don’t consent to have their children tested, fearing the interruption to their family life if they test positive. In others, students themselves opt out because of concerns about inconvenience or even the discomfort of sticking a swab in their nostrils to collect a sample.
That’s why some districts—and some state school testing initiatives—have experimented by rewarding students with gift cards, extra recess time, and even cash to encourage more participation.
“What we’ve heard from districts and schools is that COVID fatigue is real,” said Leah Perkinson, the manager of the pandemics health team at the Rockefeller Foundation, which has worked with schools, states, and the federal government to grow testing efforts. “People are tired, they are frustrated, they are exasperated ... I think incentives are a way to inject some new energy into this space.”
While many large school districts have launched some form of virus testing program, Rockefeller does not track how many offer incentives, though Perkinson said the number is likely quite small.
The pandemic has proven how difficult it can be to change human behavior, and public health officials agree that it’s too early to determine whether incentives for COVID-19 testing will work in every school.
Schools that have embraced the strategy say anything that gets more students on board is worth it, even if participation is still far from universal.
Continued calls for testing in schools
Even as the emergency approval of vaccines for children as young as 5 has brightened the light at the end of the pandemic tunnel, advocates for school testing say it’s too early to discontinue those efforts.
Many children are not yet vaccinated, precautions like masking are unpopular in many communities, and scientists remain concerned about the emergence of possible more-contagious strains, like the recently detected Omicron variant, which they are still evaluating.
In states like Michigan and New York, governors have called for additional funding for school-based testing as numbers start to rise.
The Biden administration has encouraged broader school testing efforts by setting aside $10 billion in federal aid for such work and by providing additional guidance on how schools can use money from the American Rescue Plan to carry out such work, but such efforts are rare in many parts of the country. That’s in part due to varying state approaches to the pandemic and in part because of the logistical challenges schools face in purchasing testing materials, interrupting class time, and coordinating and tracking regular swabs. In Texas, for example, millions of dollars of money for testing in schools has largely gone untouched, the Dallas Morning News reported.
Some districts, like Los Angeles and New York City, have made participation in regular COVID-19 testing mandatory for in-person learning. But there is not an appetite for such a requirement in many areas, where precautions have become politically divisive.
The Rockefeller Foundation has teamed with the Centers for Disease Control and Prevention to offer education leaders resources about launching and strengthening school-based COVID-19 testing efforts. Learn more here.
In October, after President Joe Biden urged more school testing as part of a fresh wave of federal efforts, the U.S. Department of Education said in a memo that school districts could use their relief aid to reward families with “reasonable incentives,” like “nominal gift cards,” if their students agree to regular screening tests. Schools should also be sure to provide information in languages parents can understand to encourage broad participation and consent, the memo said.
Some states have already introduced incentives into their voluntary plans, which rely on a variety of types of COVID-19 tests . School districts in Colorado and Louisiana can opt into weekly programs, which require separate consent from parents for students to participate and to receive incentives. In exchange for their first test, students in both states get $25 loaded onto an online debit card, and they get $10 for each subsequent weekly test.
But, even with that extra nudge, participation is far from universal in many schools.
Seventy-five Durango, Colo., students signed up to participate when their district began piloting a regular testing program Nov. 1, spokeswoman Julie Popp said. With the help of state-administered incentives, that number grew to 352 students by the end of the month. That’s only about a seventh of the elementary, middle, and high schools’ combined enrollment, which totals about 2,500 students.
Still, the district has seen value in the program, and it expects participation to continue to grow. Administrators recently decided to roll it out district-wide, Popp said.
Adding serial testing to other efforts, like improved ventilation and universal masking, offers “an extra layer of protection, supporting the goal of keeping our schools open and providing a safe and healthy environment for students and staff,” she said.
When New Orleans launched its state-administered testing program in August, about 11,000 of the school system’s 45,000 students opted in. With the help of incentives and other efforts, that number has grown to about 16,000, Delcour said.
“I think there was a fear that if we were testing kids for COVID that we would find more COVID and that would that mean putting more kids in quarantine,” she said.
In reality, fewer than 0.05 percent of tests come back positive each week, and schools are able to act quickly to isolate those students and limit disruption.
Educators there also found mass testing particularly helpful after schools closed for two weeks in September in response to Hurricane Ida, leading many students to travel to other states and regions for safety. That testing identified 225 cases, preventing potential classroom outbreaks that could have further disrupted students’ lives, Delcour said.
Beyond the persuasive power of cash, New Orleans leaders attribute growing testing rates to the hard work of school leaders. In the all-charter school system, some have seen participation rates as high as 80 percent. After consulting principals at the most successful schools, the district made a playbook that recommended verbal communication with parents—on calls home, in parent-teacher conferences, and in the school pick-up line—as the most effective tool for building support for testing.
“That hard, boots-on-the-ground work is paying off,” Delcour said.
Varying responses to the incentives
Changing human behavior through small actions, known by researchers as “nudges,” and larger incentives can be more complicated that it seems on the surface, and there can be unforeseen consequences, said Tom Chang an associate professor of finance and business economics at the University of Southern California.
Chang has studied the effectiveness of vaccine incentives and state lotteries, which rewarded millions of dollars to randomly selected recipients of the inoculations to encourage residents to get the jab. His research showed such efforts worked for people who were reluctant but open to getting the shot, but they have had little effect on the most stubborn holdouts, who said they were concerned about unproven claims that the vaccines are not safe.
“They are not on the fence thinking about whether they should get vaccinated or not. That’s why incentives and messaging and nudging don’t work for them,” Chang said. “When it comes to testing, I would imagine there are far more people on the fence.”
For incentives to be effective, school leaders should make sure they will be received positively and that they won’t be viewed as coercive to resistant parents, he said.
Perkinson, of the Rockefeller Foundation, said schools should also ensure they have the capacity to distribute rewards on top of the work of administering tests.
“There are a lot of practical challenges in managing an incentive program just like there is in managing a testing program,” she said. “We are talking about all of these systems changes happening in schools at once.”
School leaders should also ensure they are addressing all barriers to testing and ensuring that their approach fits the attitudes of their community, Perkinson said.
In the Hillside, Ill., district, which consists of one school that educates 425 early-childhood through 8th grade children, about 88 percent of students have opted into weekly testing, said Superintendent Kevin Suchinski. He attributes the community buy-in in part to demographics: The vast majority of students are Black and Latino, two communities that have been disproportionately affected by the pandemic.
On Mondays, cohorts of students start lining up in the gym by 8:45 a.m. to spit into tubes used for saliva-based molecular tests, and the whole process wraps up by 10. Athletes and participants in higher-exposure extracurricular activities, like choir, take an additional test on Thursdays, Suchinski said.
The school does not provide financial rewards for testing. Rather, it has incorporated COVID-19 precautions like proper mask wearing and participating in testing into its positive behavior interventions and support system, through which students earn points for good behaviors, like helping a classmate, that can later be traded for small toys, lunch with a teacher, or extra recess time.
That has made testing feel like a part of the school’s culture and a way for students to support each other, Suchinski said.
“We wanted to teach why it was important to test, we wanted to reinforce it, and we wanted to reward it,” he said. “We are all in this together.”