Goldilocks and the 4 Tiers of Student Integration

A reaction to the ruling on Governor DeSantis’ Executive Order prohibiting school face mask mandates that do not allow parental opt-out.

BY MEGAN MANSELL

Many Florida parents are in an uproar over the initial ruling on Governor DeSantis’ executive order relying on HB 241, the Parental Bill of Rights (PBOR). The order, which banned school districts from mandating face coverings unless parental opt-out is permitted, was challenged by a group of Florida parents on behalf of their children. I believe far more focus should have been given to a very simple sentence in the quoted segment repeated by the judge:

“Section 1014.03 Infringement of parental rights.—The state, any of its political subdivisions, any other governmental entity, or any other institution may not infringe on the fundamental rights of a parent to direct the upbringing, education, health care, and mental health of his or her minor child without demonstrating that such action is reasonable and necessary to achieve a compelling state interest and that such action is narrowly tailored and is not otherwise served by a less restrictive means.”

Read that last segment again: “and is not otherwise served by a less restrictive means.” The mitigation steps in the hierarchy of controls do not become invasive and negatively physiologically impacting till we get to Personal Protective Equipment (PPE) – real PPE, not the make-believe kind made of fabric with a fun print, sewn by a co-worker’s cousin’s grandma – I mean regulated PPE under OSHA and NIOSH standards for the relevant size of the particles. Students most certainly can be served by less restrictive means.

Source: https://www.cdc.gov/niosh/topics/hierarchy/default.html

There are established practices that follow the hierarchy of controls (more on that to follow) that are far less restrictive than requiring all children in a school system to wear expressly non-mitigating, unregulated, untested masks with no efficacy standards for the particle size range of concern (as is the case for child masks). Furthermore, a focus solely on medical exemptions while ignoring religious exemptions goes against the freedoms this country was founded upon, in addition to the other parental provisions set forth by the PBOR. 

But before stepping into the realm of what to actually do to improve our mitigation strategies in a meaningful measure that follows current law, have we considered how strange it is that it has suddenly become commonplace to drop children off every day at buildings the parent is barred from entering? Several school board members have recently brought up the concept of in loco parentis, or how schools serve in the place of parents during a school day. But despite their assertions, in loco parentis does not mean that school personnel get to make complex medical decisions for a child once the school bell rings. When superintendents, teachers, and staff  overstep their boundaries into the medical decision-making realm during school hours, does that mean high school football coaches will soon have the authority to sign off on a minor child’s abortion in absence of the parent? It’s an already slippery slope that is getting more slippery by the day.

We have already seen frightening medical interference by omnipotent superintendents who have challenged and encouraged the reversal of medical exemption forms when provided as required by state law. We have also seen school districts preemptively attempt to get all local pediatricians to speak out in support of these non-mitigating apparatuses; pediatricians who sign mask exemption forms are faced with firing and being “canceled” for making medical decisions as qualified medical professionals in conjunction with consenting legal guardians (whom virtually none of the tyrant superintendents or school board members are ever qualified to challenge or refute). 

Accommodations and Meaningful Modifications

Looking at a class photo of 24 kids, we cannot tell who among them has asthma, was a kidnapping victim, has autism, or is hearing impaired. We cannot tell who speaks our language, who is in the foster system, who is a follower of a given religion or is sick with a transmissible pathogen. We do not know who among them is medically vulnerable or has a peanut allergy— unless we allow them to identify themselves, in which case we can then provide meaningful accommodations with Individualized Education Plans (IEPs), 504 plans for students with disabilities, English Language Learner (ELL) plans, behavior contracts, or social system supports, etc., all of which require legal guardian consent as a critical element in forming a plan that becomes a legal contract between the home and school. 

These students are required to be placed in what’s called the Least Restrictive Educational Environment (LRE). This means that a student’s environment must be as close as possible to what is considered the most normal and least interfering environment for the child, while considering the impact of a given child’s needs on a classroom setting and peers. This requires navigating a laundry list of qualifying exceptionalities to create an educational environment that complies with federal IDEA Least Restrictive Environment designations in segments 300.114-300.120 of subpart B. Florida statutes regarding how students can be physically restrained in school, when necessary, state that “School personnel may not use a mechanical restraint or a manual or physical restraint that restricts a student’s breathing.” This makes it clear that forced masking is neither legal practice nor a condition of a Least Restrictive Environment. 

If a 9-year-old is nonverbal, requires frequent behavioral interventions to prevent violent outbursts, and is academically unable to follow the state standards with reasonable classroom differentiated instruction, the child would likely be in a self-contained classroom or special needs school and be with the general population for special area classes, lunch, and recreation with appropriate supports found under IDEA 300.117.  

If a child is medically vulnerable or requires the use of an apparatus that puts peers or staff at an increased risk (aerosol-generating apparatuses or requiring the changing of colostomy bags during school hours, for instance), we must consider the exact risk and available mitigation standards for staff and peers when writing accommodations and integration protocol, including a separate plan called an Individual Health Plan (IHP) with school medical personnel involvement. 

All learners and school employees are seen as equals with valid needs under these standards, which take all necessary details into consideration before drafting what must be truly individualized for each learner’s rights and needs. Those who cannot be accommodated due to profound medical or other health needs are still serviced by specialized facilities, including medically vulnerable wards requiring special training before ever stepping foot inside (which clearly zero of our superintendents enforcing these mandates have undergone, or they would know better). Hospital/homebound allows children access to an individualized education while unable to physically attend school, which should be reserved as a last resort, as isolation from age peers has devastating effects in long-term application. Alternate placement specifications are found under IDEA 300.115.

Appropriately staffing out a school system following the hierarchy of controls and meaningful mitigation measures for a given element in need of control is simple if school districts follow the same tiered integration that is already in place for special education. It involves identification, consent, and treating the needs of each student and employee as equals with dignity and privacy. 

These simple surveys provide all the information necessary to staff out an entire district (plus matrix of services funding codes for those with exceptionalities requiring extensive support). 

For students:

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For teachers and staff:

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With this information, it’s quite simple. Provide accommodations for 4 levels of tiered integration for student and employee access, which provide meaningful measures of support while embracing consent and personal risk mitigation and seeing the needs of all as equals. 

Tier 1: 

  • Students and staff in Tier 1 prefer normalcy. 
  • Masking is fully optional but not enforced in any capacity, as face coverings are also a protected religious freedom, while the right to make medically impacting decisions on behalf of your children is also protected by the PBOR, including whether or not to mask them. 
  • Increased ventilation measures taken in all spaces (especially in high-risk areas like bathrooms), increased surface sanitization. 
  • Symptomatic children are sent home. School may check for fever, as has always been common practice, but that is the limit of interference. 
  • UVC, needlepoint ionization, high grade filtration, or other environs mitigation measures are additional measures that can impact aerosol transmission. 
  • Visitors allowed. 
  • Field trips allowed. 
  • Student interactions outside of school not monitored. 
  • Increased time outside encouraged for all.
     

Tier 2: 

  • Like Tier 1 but with decreased commingling with other classes on school campus.
  • Commingling limited to outdoor interaction, bus rides, and unavoidable brief encounters with others from the general population. 
  • Teachers in need of additional accommodations can teach outdoors or in large, well-ventilated spaces physically distanced from their students, such as teaching lecture-style in an auditorium.
     

Tier 3: 

  • Located on school campus but far higher limitations on non-class interactions. 
  • Students eat in their classroom, use private restrooms, and can be serviced better by a hybrid model allowing more excused absences and work sent to be completed at home during extended absences (which is an excellent option for vulnerable staff who still want to teach – they can follow the lessons of the classroom teacher and support the student virtually without added strain on classroom teacher). 
  • Appropriate for students with a truly medically vulnerable family member or staff members needing limited interaction with general school population. 
  • Focus on all environs mitigation aspects and controlled access to classroom, preferably cleaned by staff within the room.
     

Tier 4:

  • This is the most restrictive method that still involves students being in the same physical environment as peers, but in a very controlled manner. 
  • Any given individual present in an enclosed space should be considered exposed to a low minimum infective dose airborne pathogen, so taking extensive measures to prevent exposure is meaningful with this group. 
  • Students and staff in this tier would agree to a code of conduct severely limiting outside interaction and have protocols for returning to the group after a breach of contact. 
  • Students could be placed in portables (learning cottages) or separate buildings physically detached from other campus buildings with independent HVAC systems, as long as they also have private restrooms, as fecal/oral transmission from restroom plumes is a potential transmission hazard. 
  • Students can undergo an absolute quarantine (zero outside contact, specifics of behavior and living arrangements required) in accordance with the CDC’s current recommendation of 8-14 days and come together in the same setting with decreased risk of being contagious. 
  • Students in this grouping can also use testing strategically and can voluntarily consent to day-of testing (self-administered in isolation) before coming into contact with the rest of the controlled population. 
  • This is only appropriate for those truly isolating, for instance with parents who work from home, do not spend time in public places, and receive solely no-contact deliveries. 
  • Level of comfort with exact controls can be group-specific, dependent on vulnerability and learner need. 
  • Highest level of focus on environs mitigation strategies. 
  • Students should be transported privately or only with other students in this tier.
  • Serviced by hospital/homebound or virtual if needs unable to be met by tiered groupings, with hybrid model encouraged to allow students more time at home as needed. 

No Q for you

In the past year, our quarantine standards have been misguided and unhelpful. The hodgepodge of policies are inconsistent about requirements to quarantine masked students (in unregulated apparatuses), but they should be treated exactly the same as unmasked students. Siblings of contagious children have been permitted to attend school, while the child sitting next to the transmissible individual is forced to stay home and submit test information in order to return. Vaccinated students are allowed to keep attending, even though capable of carrying and spreading the pathogen they’re vaccinated against. Using the tiered integration model offers support where we need it and restores free will, consent, and personal risk mitigation. 

Minutiae of Mitigation

We’ve all seen spooky TV mansions with furniture covered in bedsheets, the way one would when shuttering a holiday home for the season. But why? Are invisible visitors going to get tea on the sofa, or scuff the table? Will they leave jam and cracker crumbs in bed?

Well, no, we cover furniture so extensive dusting is unnecessary upon our return. But where did it all come from in our absence, and why? 

We are part of our environment. Every step, every breath, and every time we open a blanket or sit on furniture – even small movements impact airflow patterns and contribute to matter being sent aloft. Tiny matter weighs very little. Running around with a fog machine going (and some disco lights for good measure), we can see the impact we can have on airborne matter by moving through it. When blowing bubbles both indoors and outdoors, the direction of respiratory emissions are visible (though aerosols are not visible to the naked eye). Behavior of bubbles blown indoors is impacted by HVAC system draw, ceiling fans, and physical movement. In a walk-in freezer, we can easily test exhale plume directions of different kinds of masks and see that respiratory emissions are not retained by masks or respirators; all aim the respiratory emissions in different directions, some with more concentrated plumes than others. Bit by bit, the minutiae allow us to clarify the bigger picture. 

So when it is said that an aerosol remains aloft for hours, even days, in an enclosed space depending on ventilation and can take weeks to settle, this refers to matter far smaller than the dust you see moving in a morning sunbeam coming through your window. Airborne matter consists of particles from us, our clothing, and bits of a given environment, whittled away little by little. It is impacted by movement of objects and living organisms within it. We leave little bits of ourselves everywhere and use these little bits of information to match fibers from crime scenes, test for touch DNA, and find assailants through rogue hairs left behind. 

When in an enclosed space with others, we are breathing some of their exhaled emissions, and they are breathing some of ours. When sharing a bed, we may turn in the night and breathe in one another’s faces. Larger spaces, better ventilation, and more distance between ourselves and others will have an impact. Being outside has an enormous impact, as emissions are wafted away in the breeze instead of clinging near us and remaining within respiratory range, as happens indoors with poor ventilation. Yet aerosols take the path of least resistance, which can make us breathe directly into a neighbor’s face if we’re wearing a mask that causes side plumes and sitting side by side, like this:

That’s a terrible idea if you’re trying to keep your neighbor from inhaling something you’re contagious with. 

So when it comes to trying to remove particles from an enclosed space, filtration must be based on the minimum particle size that needs to be removed from that environment in order to be considered effective.
  
If the goal is to protect schoolchildren from an airborne pathogen, we must be specific about the size of that pathogen. If you are trying to keep a neighbor’s dog out of the yard but build a fence with openings big enough for the dog to easily get through, you have failed at filtering that dog. If a person is working in an environment with asbestos but not wearing a respirator that filters asbestos-size particles and is properly fitted, that person will be exposed to asbestos. If the exposure element is, for instance, a 0.06-micron low-minimum-infective-dose pathogen, sewing something up and hoping for the best is irresponsible and encourages a false sense of security for the truly vulnerable. Again, if a child is in an environment containing SARS-CoV-2 and is wearing such a mask, that child will be exposed. SARS-Cov-2 is such a low-minimum-infective-dose pathogen that one exhale from a transmissible individual can have enough viral matter to infect 5 or more people, at the most conservative of estimates. Playing make-believe with PPE can expose medically vulnerable students and employees to the pathogen of concern and result in serious illness or death. The law requires both protection for the at-risk and the least restrictive environment for those who do not consider themselves to be at-risk.

Think of aerosol accumulation in an enclosed space like smoking a cigarette in an elevator all the way up 18 floors. When you get off, if ventilation is poor, some smoke remains in the elevator, and some escapes when the doors open. Pathogens with the minimum infective dose of SARS-CoV-2 can infect someone even when nobody else is present, if the infectious person was in a small space long enough to leave a sufficient viral load contribution.

The medically vulnerable deserve the dignity of honest, specific information regarding truly meaningful measures of protection that treat us all like Goldilocks, following the hierarchy of controls (see above,) which places PPE at the very bottom as a mitigation measure. 

Goldilocks

Masks, respirators, and more complex personal protective equipment are not all created equal. They are not interchangeable. If a person operating a motor vehicle wears a deoxygenating apparatus that also interferes with the lower field of vision, that is a danger to the wearer, who may be further impacted by underlying health conditions. The driver in turn becomes a danger to others, and a masked bus driver with 50 or so child passengers, without seatbelts, is a tragedy waiting to happen. 

Just as PPE is not interchangeable, neither are their wearers. I can’t go into a random house on my street and expect the person’s clothes to fit, their bed to be my level of comfort, their home temperature to be my preference, the food in their refrigerator to fit my dietary restrictions, or their books of worship to fit my personal beliefs. What fits my face properly will not fit a 2-year-old. What fits my face properly would not be the same PPE recommended for a 350 lb man with a beard. A marathon runner is not interchangeable with an 80-year-old smoker with a sedentary lifestyle. Medical clearance, medical consent, and a certified fit test are workplace requirements with repercussions for noncompliance. If an employee is exposed to noxious substances in the workplace and an employer requires an employee to sew something up instead of providing the effective protective kit for the relevant particle grade, that is a reportable offense with stiff fines for breaking OSHA mitigation standards. Direct exposure to pathogens has to follow these same protective measures to ensure worker safety. 

Over time (hours), a mask becomes a living medium of accumulated pathogens undergoing biological amplification in ideal conditions, such as the moist, warm, porous environment directly in front of the mouth and nose. This is one of several reasons why reusing these already worthless apparatuses can be a real danger. Even washing a cloth mask that is worn day after day may not be sufficient due to biological amplification, which is when that accumulated microbial matter builds and replicates.

Conclusion
Now that it looks like many families will want to designate their children as at-risk from COVID-19 for many more months or even years, attention must be paid to both proper mitigation and least restrictive environment for all children. School districts must identify students and staff who consider themselves at-risk and desire accommodations, while simultaneously maintaining a normal environment for those who do not desire to be treated as if they are at-risk. The tier system accomplishes this and should be incorporated into school district pandemic plans.

Lastly, please remember –
If you’re breathing fine and it doesn’t properly seal and fit, you aren’t in effectively mitigating kit for airborne particulate.

Megan Mansell is a former district education director over special populations integration, serving students who are profoundly disabled, immunocompromised, undocumented, autistic, and behaviorally challenged; she also has a background in hazardous environs PPE applications. She is experienced in writing and monitoring protocol implementation for immunocompromised public sector access under full ADA/OSHA/IDEA compliance. She can be reached at [email protected]

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