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California Department of Public Health Updates Guidance Related to Cohorts
CDPH Cohorting Guidance and Governor’s Supplemental FAQ
On Friday, September 4, 2020, the California Department of Public Health (“CDPH”) revised its Guidance Related to Cohorts (“Cohorting Guidance”), which it originally released on August 25, 2020.
The Cohorting Guidance is intended to provide guidance for the use of small “cohorts” and groups of children and youth in order to deliver necessary in-person child supervision and limited instruction, targeted support services, and facilitation of distance learning in small group environments for a specified subset of children and youth. This “Cohorting Guidance,” applies to children and youth who attend or participate in controlled, supervised and indoor environments that are operated by local educational agencies, nonprofit organizations or other authorized providers, including public and private schools, child-care facilities, organized and supervised care, recreational programs, youth groups, before and after school programs, and day camps.
Also, on September 4, 2020, the Governor’s Office revised its supplemental FAQ specific to the provision of school-based targeted, specialized support, which it originally released on August 25, 2020. The most significant modification made by the September 4, 2020 updates to the CDPH Cohorting Guidance and the Governor’s FAQs allows cohorts to include different configurations of children/youth and adults than previously required (i.e., no more than 12 children/youth and no more than 2 adults), provided that the total number of individuals in a cohort does not exceed 16 individuals.
The Governor’s FAQ should be read together with CDPH Cohorting Guidance, which reiterates many of the same directives for safe services. One helpful way to navigate and apply these documents is to refer to the CDPH Cohorting Guidance with regard to “how” you may safely provide limited instruction or supervised care to youth and children, and the Governor’s FAQ, for “when” you are permitted to deliver these services or programming.
CDPH noted that, “Guidance and directives related to schools, child care, day camps, youth sports, and institutions of higher education are not superseded by this document and still apply to those specified settings.” Presumably, this means that the CDPH Cohorting Guidance does not supersede CDPH’s July 17, 2020 COVID-19 and Reopening In-Person Learning Framework for K-12 Schools in California, 2020-2021 School Year (“July 17 Framework”). The Governor’s FAQ reiterated that schools should refer to local and county health orders to ensure compliance with those guidelines, which may be stricter. If you have questions whether or not your particular school may use face-to-face instruction as authorized in this Guidance, contact your legal counsel.
Cohorting Guidance from the California Department Public Health
Considerations for Cohorts
A “cohort” is defined as a stable group of no more than 14 children or youth and no more than two supervising adults (or a configuration of no more than 16 individuals total in a cohort), in which all individuals stay together and avoid contact with others outside of their group in the setting. In order to limit the opportunities of COVID-19 transmission and efficiently respond in the instance of a positive case, CDPH recommends that groups of youth and adults in these environments should be in cohorts as small as possible. Children and adults should not physically interact with the staff, children and parents of other cohorts. All children and adults must use face coverings at all times.
CDPH provided the following specific guidelines with regard to cohort size and cohort mixing:
- Cohorts must be limited to no more than 14 children and youth and no more than two supervising adults, or a configuration of no more than 16 individuals total (children and youth or adults) in the cohort.
- Requirements for adult to child ratios continue to apply for licensed childcare programs.
- Cohorts can be divided, as needed, into subgroups of children and youth from the same cohort, as long as the 14-to-2 ratio is not exceeded.
- The maximum cohort size applies to all children and youth in the cohort, even when not all children are participating at the same time.
- Prevent interactions between cohorts, including interactions between staff assigned to different cohorts.
- Assign children and youth who live together or carpool together to the same cohort, if possible.
- Avoid moving children and youth from one cohort to another, unless needed for a child’s overall safety and wellness.
- Cohorts must be kept separate from one another for special activities such as art, music, and exercise. Stagger playground time and other activities so that no two cohorts are in the same place at the same time.
- The requirement to prevent interaction between cohorts can be met either by having each cohort in a separate room or space created by partitions.
- One-to-one specialized services can be provided to a child or youth by a support service provider that is not part of the child or youth’s cohort.
- Specialized service includes but is not limited to occupational therapy services, speech and language services, and other medical, behavioral services, or educational support services as part of a targeted intervention strategy.
- Services must be provided consistent with the industry guidance for Limited Services.
Considerations for Staff
Supervising adults and staff should be assigned to one cohort, and staffing assignments should not change to the extent practicable. Using substitute staff is permitted but individuals should only work with one cohort of children per day. Meetings that include staff from different cohorts must occur remotely, outdoors, or in a large room where all service providers wear masks and remain at least a six-foot distance from others. Physical distance between staff must be observed as much as possible.
Governor’s Office FAQ on Providing Targeted, Specialized Support and Services at School
The Governor’s guidance supplements and elaborates on the CDPH Cohorting Guidance with regard to the school setting. The FAQ provides that the CDPH Cohorting Guidance authorizes small-group, in-person services, such as those operated by schools, and applies to schools that are not permitted to reopen based on the July 17 Framework or those that have not received an elementary school waiver through the local public health office. The FAQ states that schools “that have been authorized to reopen for in-person instruction under the July 17 Framework, including elementary schools operating pursuant to a waiver, must adhere to the Industry Guidance for K-12 Schools and any applicable order or directive of the local public health office.”
Develop a Plan
School administrators should develop and implement plans in collaboration with local health officials and school-based staff, though they are not required to receive express approval from their local health departments. Schools are required to adhere to any applicable, more restrictive local public health directives. As noted above, schools that have reopened under the July 17 Framework, including elementary schools operating through the waiver process, must adhere to Industry Guidance for K-12 Schools.
Applying the Cohorting Guidance in School Setting
The guidance does not allow for in-person instruction for all students. The guidance is intended to provide minimum health and safety parameters for providing specialized services, target services, and support for students while schools are otherwise closed for in-person instruction. The guidance permits schools that are otherwise closed for in-person instruction to provide targeted, specialized support and services in stable cohorts that follow the CDPH Cohorting Guidance. It does not compel schools to provide the small-group services; rather, it enables them to provide supervision and care for particular at-risk and high-need students.
Who May Receive In-Person Services and Support
Schools may determine which students the school serves in-person. The FAQ states that students with disabilities, English learners, students at higher risk of further learning loss or non-participation in distance learning, students at risk of abuse or neglect, foster youth, and students experiencing homelessness should be prioritized.
What Services May Be Provided
Schools also determine what specialized and targeted support services to provide, but may include occupational therapy services, speech and language services, medical services, behavior services, educational support services as part of targeted intervention strategy, or assessments such as those related to English learner status.
Students may receive one-on-one specialized services or targeted support from other qualified adults that are not in their cohort. These services cannot be done with other students. Staff providing these supports or services (e.g., speech or occupational therapy) should be assigned to work with students in as few cohorts as possible, and must observe appropriate precautions to prevent transmission, including wearing personal protective equipment (“PPE”) as required by the Industry Guidance for Limited Services.
Cohorts are limited to no more than 14 students and no more than two supervising adults, or a configuration of no more than 16 individuals total (children and youth or adults). The number of children/youth and adults who make up a cohort should be based on student needs (e.g., the inclusion of a student or students in a cohort who requires continuous assistance from an instructional aide). While the number of adults assigned to a cohort should be minimized and is ideally two, cohorts may include more than two adults, provided the total size of the cohort does not exceed 16 individuals (students and adults together).
Different cohorts of students should not interact with each other in-person, and should maintain separation in the physical environment (e.g., in different classrooms). Schools may assign cohorts of students who only participate on certain days or part of the days, but must properly clean the physical space between cohorts, consistent with health and safety guidelines. The number of cohorts at any given school will depend on its enrollment size and building capacity as determined by the school, but generally should not exceed 25% of the school’s enrollment size or space capacity.