Preventing and controlling COVID-19 in child care settings poses unique challenges due to the nature of caring for infants and young children, which necessarily involves close contact between children and their caregivers.
The Wisconsin Department of Children and Families (DCF) is coordinating information and guidance on child care programs, Head Start, and 3- and 4-year-old kindergarten programs and related child care programs.
At this time, child care programs are encouraged to remain open during the COVID-19 outbreak.
Outbreak guidance for child care settings
The Wisconsin Department of Health Services (DHS), in consultation with DCF, recommends that all child care providers follow the Center for Disease Control and Prevention’s (CDC) COVID-19 Guidance for Operating Early Care and Education/Child Care Programs, which includes comprehensive recommendations for preventing and responding to COVID-19 in child care settings. Updated COVID-19 outbreak guidance specific for Wisconsin child care settings from DHS is forthcoming and will be made available to child care providers throughout the state when it is published.
Testing support for child care programs
The DHS is pleased to support COVID-19 testing in child care programs. This testing support is subject to the availability of testing supplies and is intended to complement other COVID-19 prevention efforts. Participation in the program is voluntary.
Close contact: being within 6 feet of another person for at least 15 minutes or more.
Asymptomatic: a person who does not report or appear to have any symptoms or signs of illness.
Symptomatic: a person exhibiting symptoms.
Quarantine: is used to keep someone who might have been exposed to the virus away from others.
Isolation: is used to separate people infected with COVID-19 from those who are not infected.
Molecular test: is a type of highly accurate diagnostic test than can detect if you have an active COVID-19 infection. Samples for diagnostic tests are typically collected with a nasal swab, or saliva collected by spitting into a tube. Samples are usually sent out to a lab for processing.
Antigen test: is a type of diagnostic test than can detect if you have an active COVID-19 infection. Samples for diagnostic tests are typically collected with a nasal swab. Results are available in 15-30 minutes. If individual is symptomatic and tests negative, they will require a follow up molecular test.
Licensed Family Child Care providers: May care for 4 or more children under age 7. No more than 8 children may be in care at one time, including the providers’ children under age 7 and any additional children above age 7. Licensed providers must have 40 hours of Early Childhood training and complete 15 additional training hours annually. Licensed through the Department of Children and Families.
Licensed Child Care Centers: Programs that serve 9 or more children. Each center must meet specific regulations of ratios of caregivers to children and group size. Staff must meet training requirements including annual continuing education. Licensed through the Department of Children and Families.
Certified Family Child Care providers: May care for up to three children under the age of seven unrelated to the provider with a group maximum of six children. Certified providers must complete pre-service child care training and annual continuing education.
Key reasons to test in child care programs
- Testing symptomatic individuals is recommended by the CDC.
- Testing helps reduce community spread and keeps child care programs operating safely. Testing individuals who are symptomatic and close contacts helps enable rapid detection of cases in child care programs to reduce or prevent outbreaks. A routine screening testing program, which regularly tests people without symptoms or known exposures, is a tool to reduce “silent” spread of the virus and can help children and staff. According to the CDC, at least 50% of infections are likely contracted from someone that is asymptomatic (showing no symptoms) or pre-symptomatic (not currently showing symptoms but may develop them in the future).
- Testing in child care programs helps ensure equitable access. Having testing available at child care programs makes testing available as a trusted, convenient, safe part of the community on a schedule that works for children, staff and their families without requiring extra appointments or transportation.
Who should be tested?
Staff, volunteers, and children are able to be tested.
When to test?
Child care providers should consult with public health to determine the best testing model(s) to meet their needs and may consider following the CDC’s guidance for testing in K-12 schools.
Through this program, COVID-19 testing can be performed to:
- Test symptomatic individuals. The CDC lists possible symptoms of COVID-19 as fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, and/or sore throat.
- Test close contacts of someone who has tested positive for COVID-19.
- Provide screening testing. This may include testing children and staff each week. Individuals who are fully vaccinated do not need to complete routine screening testing.
- In the event of an outbreak at the child care program, test all close contacts of the person who tested positive for COVID-19, at a minimum. Ideally, testing would be conducted facility-wide. Please make sure to coordinate with the appropriate local or tribal health department.
Preparing for COVID-19 testing: step-by-step instructions
1. Determine the right testing supplies for your child care program.
Testing supplies are available through the DHS COVID-19 testing supplies website. Child care programs have the option to order and use testing supplies that best meet their needs for children and staff, including rapid point of care tests and highly accurate lab-based tests.
Highly accurate, lab-based molecular tests
Laboratory-based molecular tests (for example, RT-PCR) are the gold standard for COVID-19 testing. Conducted in a specialized environment by trained professionals, these molecular tests are the most accurate tests available. These test supplies are shelf-stable, but specimens collected for a molecular test must be return-shipped or couriered to the laboratory for processing. Test results are usually available in 24-48 hours. The laboratory conducts all required certificates and reporting for the child care program.
Rapid, point of care antigen tests
Abbott BinaxNOW rapid antigen tests are available for use in child care programs and provide results in 15 minutes. These instrument-less, shelf-stable supplies are shipped in boxes of 40 tests. BinaxNOW tests are the most accurate for individuals with symptoms and sometimes require a follow-up test to confirm the test result.
To use BinaxNOW tests child care programs must:
Obtain a Clinical Laboratory Improvement Amendment (CLIA) Certificate of Waiver. The CLIA certificate process is fast and easy.
Report results to state and federal authorities within 24 hours of receiving the result.
Facilitate access to confirmatory testing when needed. DHS will provide lab-based molecular testing supplies to child care programs for confirmatory testing.
- Negative BinaxNOW test results occurring in individuals with COVID-19-like symptoms should be confirmed by a lab-based molecular test, because of the risk of false negative results.
- Positive BinaxNOW test results occurring in asymptomatic individuals (e.g. tests conducted as part of a routine screening program) should be confirmed by a lab-based molecular test, because of the risk of false positive results.
2. Obtain a CLIA Certificate of Waiver (only for rapid point of care tests).
When ordering rapid antigen tests from DHS, you will need to submit your CLIA Certificate of Waiver number.
To obtain a CLIA Certificate of Waiver, you will need to submit a completed application to firstname.lastname@example.org.
3. Partner with a clinician.
All COVID-19 testing sponsored by this program needs to occur under the authority of a clinician with prescribing authority (MD, DO, PA, or NP). If you do not have a local clinician who manages your child care program’s health services, you can complete the attestation form and submit to WICovidTest@Wisconsin.gov. This will allow you to conduct testing under the statewide standing order for COVID-19 tests prescribed by the Wisconsin DHS Chief Medical Officer.
4. Submit a request for testing supplies.
- To receive rapid point of care antigen tests, complete all fields under BinaxNOW Testing Supplies.
- To receive lab-based molecular tests, in the PCR Testing Supplies field, type “Exact” for the Clinical Laboratory, click “Add Item,” and select “Collection Supplies and Laboratory Services.” Complete fields in form.
- To order both rapid point of care and lab-based molecular tests, complete both PCR Testing Supplies and BinaxNOW Testing Supplies fields.
5. Complete training.
Any staff who will administer COVID-19 testing at your child care program must complete training to assure they are using the tests safely and effectively.
Performing and Reporting the BinaxNOW test (Rapid Antigen) in Child Care Programs
BinaxNOW antigen testing does not allow for a self collection option.
- How to do a nasal swab video
- How to use BinaxNOW test video
- How to interpret BinaxNOW test video
- BinaxNOW package insert
- Reporting antigen results to public health
Performing and Reporting PCR test in Child Care Programs
6. Set up an account with the Wisconsin State Lab of Hygiene to report results.
COVID-19 is a Category I reportable condition in Wisconsin. As such, test results must be reported to the State of Wisconsin and to federal authorities (HHS). To report results, set up an account.
If you have questions about ordering testing supplies or the child care program testing in general, please email email@example.com.
Frequently asked questions by category
- What support is the Department of Health Services providing child care programs to conduct COVID-19 testing? The Department of Health Services is offering free Abbott BinaxNOW point of care antigen tests with optional confirmatory PCR supplies and comprehensive testing services through approved vendors. Tests may be used for staff and children who are symptomatic and close contacts, to conduct surveillance testing and outbreak response.
- Where can I find additional information about testing in child care programs? If child care programs have specific questions on the testing program, email WICovidTest@Wisconsin.gov.
- Is it mandatory for child care programs to test children and staff? No, participation in the testing program is voluntary.
- Will the program offer child care programs funding for additional staff in order to conduct testing? No. Direct funding to pay staff is currently not covered under this program.
- How do I order Abbott BinaxNOW tests under this program? Free Abbott BinaxNOW tests under this testing program may be ordered through the Wisconsin COVID-19 Collection Supply Request website. Child care programs conducting testing must provide a valid CLIA Certificate of Waiver number during the ordering process.
- Is the cost associated with biohazard waste disposal covered under this program? No. The cost of biohazard waste disposal is not covered under this program. Child care programs are responsible for safely disposing of waste. Options include the use of biohazard bags for used Abbott BinaxNOW cards, hard-sided biohazard containers for used swabs, and/or the use of a medical biohazard disposal service. For additional information, see CDC Waste Management Guidelines for SARS-CoV-2 Point-of-Care Testing.
CLIA Certificate of Waiver
- When does a child care program need a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver? For a child care program to conduct point of care tests (like the COVID-19 Abbott BinaxNOW tests or diabetic glucose checks), the child care program must apply for and receive a CLIA Certificate of Waiver. Child care programs may not conduct testing until the certificate of waiver has been approved. A child care program does not need a certificate of waiver if they collaborate with another entity willing to conduct testing at the child care program under that entity’s CLIA Certificate of Waiver or if the child care program is not conducting point of care tests.
- What responsibilities must a child care program fulfill as an organization with a CLIA waiver? Any organization with a CLIA Certificate of Waiver is responsible for the safety and effectiveness of services they provide. For child care programs conducting COVID-19 point of care testing, this includes staff training, effective infection control practices, and reporting infectious disease test results to the State of Wisconsin and to the federal authorities (HHS). Guidance about how to set up an account and report COVID-19 point of care test results is available from the Wisconsin State Laboratory of Hygiene. If a child care program coordinates with a testing partner, or is providing lab-based molecular tests (not point of care tests), then the laboratory will assume the responsibility for the safety and effectiveness of testing – including responsibility for reporting test results on the child care program’s behalf.
- If a child care program uses another company to conduct point of care antigen testing, does the child care program still need to obtain a CLIA Certificate of Waiver? No. If the child care program partners with an entity to come to their child care program to swab and result the point of care antigen test, then the child care program does not need to obtain their own CLIA certificate of Waiver. All testing would occur under the external entity’s CLIA certificate. The child care program should verify that the external entity conducting the test has a valid CLIA Certificate of Waiver. To find out if an entity has a valid CLIA Certificate of Waiver, request the CLIA number from the testing partner and verify it by checking the CDC CLIA Laboratory Search website or emailing DHSDQACLIA@wi.gov. All entities ordering BinaxNOW supplies from DHS are required to provide their CLIA number when placing their orders.
- How does a child care program apply for a CLIA Certificate of Waiver? To apply to receive a CLIA Certificate of Waiver, the child care program must fill out the Center for Medicare and Medicaid Services (CMS) application form CMS-116 CLIA Application and submit it to the State of Wisconsin CLIA Section at DHSDQACLIA@wi.gov. Once approved, CMS will assign a CLIA number and send a letter or email of confirmation to the child care program. For more information on CLIA certification, reference the CMS Laboratory Quick Start Guide.
- How long does it take to process the CLIA Certificate of Waiver? Once a child care program submits an accurate and complete application, CMS usually processes the Certificate of Waiver in one week or less. Once approved, the child care program will be assigned a Federal CLIA number and may begin testing. Provide this CLIA number to DHS when ordering testing supplies.
- Is there a fee associated with applying for a CLIA Certificate of Waiver? Yes. An entity is required to pay $180.00 to CMS before the CLIA Certificate of Waiver is approved. CMS will send an invoice to the child care program and you may submit payment to CMS directly or pay online at www.Pay.gov.
- Does the CLIA Certificate of Waiver expire? The CLIA Certificate of Waiver is good for two years. CMS will send a renewal invoice 6 months prior to the expiration date of the certificate.
- The CLIA application asks to identify the "director" of the laboratory. Can this be anyone in the child care program? The child care program may list any employee as the director on the CLIA Application. It is recommended that the director is an individual who is or who will become knowledgeable about the requirements of maintaining the CLIA Certificate of Waiver and the child care program’s testing operations, including testing and safety protocols, staff training, and reporting of test results. Examples may include the child care program nurse, a health aide, or a child care program administrator overseeing the health or testing program.
- Would a child care program organization with multiple child care programs need to have a waiver for each child care program, or one for the whole organization? Generally, a child care organization with multiple child care programs may apply for one certificate of waiver to cover all child care programs under their organization. The child care organization must identify that the application supports multiple sites and identify each child care program and address separately on the CLIA application.
- If a child care program has multiple programs located at the same address, should the child care program fill out the application as having multiple sites? No. If all programs are located at the same address, the child care program may apply as a single location site.
- What other information will the application request? The application requires the child care program to provide their Tax ID number. The application also requires the child care program estimate the number of tests they plan to conduct. This can be a general estimate based on the number of staff and children in your program(s).
- How can a child care program verify whether they already hold a CLIA certificate? To verify whether an entity has a valid CLIA Certificate of Waiver, check the CDC CLIA Laboratory Search website or email DHSDQACLIA@wi.gov.
- Who do I contact if I have additional questions about the CLIA Certificate of Waiver process? For any questions about the CLIA Certificate of Waiver and process, email the State of Wisconsin Department of Health Services, Division of Quality Assurance at DHSDQACLIA@wi.gov.
- Who at my child care program is allowed to collect the specimen for a COVID-19 test? Does it have to be a nurse? Any staff member who is properly trained is allowed to collect the specimen and result the point-of-care antigen test. Training may be accessed through many venues, including from a trained clinician (a healthcare provider) or through the test manufacturer’s materials. If you need assistance finding these vendor materials, email WICovidTest@Wisconsin.gov(link sends e-mail).
- Does a child care program need to have access to lab-based molecular tests? All child care programs conducting point of care testing under Dr. Westergaard's statewide standing order (including Abbott BinaxNOW tests) must assure compliance with the DHS and CDC recommendation for providing follow-up testing to confirm some antigen results. Lab-based molecular tests are recommended for this follow-up testing. Child care programs can order and provide these follow-up, confirmatory tests(link is external), or refer children and staff to follow-up:
- at a free community testing site that conducts molecular testing
- using a free at-home saliva collection kit
- at the individual’s health care provider or a free or low cost health clinic for those who do not have a health care home (verify if they are conducting COVID-19 molecular testing prior to referral).
- How should child care programs prepare to test children and staff on site? Child care programs interested in offering onsite testing will need to assure the following:
- that the testing program works for their child care program community’s needs.
- that staff and children (and their guardians) know about and understand the testing program and processes, including:
- obtaining guardian consent
- developing a process for notifying individuals of their results,
- and providing the staff and supplies necessary to conduct testing, including personal protective equipment, tables, and cleaning supplies.
Child care programs will also need to provide space to isolate children with symptoms and who test positive while they wait for pick-up, develop processes for sending them home as soon as possible, and offer instructions to access follow-up testing when needed.
- Should child care programs require a negative test result for children or staff before returning to child care programs after they have been sick? No. It is not recommended to require a negative test before returning to the program or work. There have been reports that an individual can continue to test positive long after they are considered to be contagious. Children and staff who test positive should observe a 10-day isolation period from the date their symptoms first appeared. Additionally, they need to be fever-free for 24-hours and have improved symptoms before they end their isolation period. An asymptomatic person should observe a 10-day isolation period starting on the date the positive specimen was collected.
If a fully vaccinated person is exposed to COVID-19 they should be tested within 3-5 days of exposure and wear a mask in public indoor settings for 14 days starting with the date of last contact with the infected person or until they receive a negative test result. Close contacts who are not fully vaccinated should be tested and will need to quarantine for a 14-day period starting with the date of last contact with the infected person. Any child or staff member who experiences COVID 19 symptoms should get a COVID 19 test and stay home and away from others. If they test is positive, they should complete a minimum 10-day isolation period.
For additional guidance on this topic:
- Learn about isolation and quarantine.
- Contact your local health department.
- See CDC guidance for operating child care programs.
- When should an individual be referred for follow-up lab-based molecular testing? Follow-up confirmatory molecular testing is recommended for individuals who are symptomatic and test negative using the Abbott BinaxNOW, and for people who are asymptomatic and test positive using the Abbott BinaxNOW. Confirmatory testing should be conducted as soon as possible and within 48 hours. For a simple guide on when to retest, see COVID-19 Antigen Testing: When is it Best to Retest?. Additional guidance for the use of antigen testing is located in the COVID-19 Health Alert #17: Important Considerations for Use of COVID-19 Antigen Tests.
Does a child care program participating in this state-sponsored program need an order signed by a medical provider to do testing? Yes, COVID-19 testing sponsored by this program needs to occur under the authority of a medical provider. A child care program may obtain a written order through a clinician with prescribing authority (MD, DO, PA, or NP), or opt to use a standing order issued by Dr. Ryan Westergaard, Chief Medical Officer for the Wisconsin Department of Health Services. If a child care program chooses to use Dr. Westergaard’s standing order, they must sign an attestation form agreeing to follow the requirements of the order.
Do you have a standard testing consent form we can utilize? A consent form should be signed prior to testing children and staff. Template consent forms are available on the DPI COVID-19 School Health Services webpage. Testing in school consent forms can be modified for the purpose of testing in child care programs.
Wisconsin Department of Children and Families
The Wisconsin Department of Children and Families' (DCF) COVID-19 webpage features a variety of resources including: