Population Health

May 27, 2021

Initiative-funded COVID-19 population health equity grantees report final results

Image of the coronavirusThe University of Washington Population Health Initiative funded 14 COVID-19 population health equity research grants to teams of UW faculty researchers and community leaders in August 2020. These population health equity research grants supported UW researchers in partnering with communities of color – which are being disproportionately impacted by the pandemic – to develop COVID-19 research projects that address community-identified needs.

The project teams were composed of individuals representing 11 different UW schools and colleges and 26 different community-based organizations. These community-based partners include the Black Farmers Collective, Filipino Community of Seattle, El Proyecto Bienestar, Northwest African American Museum, Khmer Community of Seattle King County, Tenants Union of Washington State, Somali Health Board and the Urban Indian Health Institute. The approximate $265,000 in initiative funding was partially matched by additional school, college, departmental and external funds, bringing the total value of these awards to roughly $378,000.

Since August, the research teams have made significant impacts in identifying and supporting communities of color impacted by the COVID-19 pandemic, with many projects extending their influence beyond the period of performance. Highlights of each of the 14 projects are shared below:

Assessing COVID-19 Mental Health Impacts to Inform Filipino Community Center-Provided Services

Christopher B. Knaus, Professor, School of Education, University of Washington Tacoma;
Agnes Navarro, Executive Director, Filipino Community of Seattle;
Cyndy R. Snyder, Affiliate Faculty, Department of Family Medicine, UW School of Medicine

Project summary
This research project aimed to understand the impacts of COVID-19 on Filipinx seniors, including the mental health impacts of limiting in-person services. This project included two data collection phases to assess current mental health impacts from decreased supports and digital access for future FCC-provided services.

Surveys indicated that COVID-19 exacerbated ongoing needs amongst the senior population. A majority reported limited access to exercise, cultural programming, and food, leading to social and cultural isolation and related mental health impacts. Participants indicated a desire for more in-person activities, and most did not appear to have the technological resources to participate virtually, suggesting the need for increased technological resources and support for senior usage. Survey findings suggested interest in increased exercise and socializing opportunities to minimize mental health impacts of social isolation.

Several additional opportunities have arisen from the expressed need to expand food access (through food bank supports and food delivery services). Given the opening of senior housing in summer 2021, initial findings support grant-writing efforts to resource increased food, delivery systems, technology access and creation of COVID-19 appropriate in-person activities. Opportunities also exist in resource expansion of the programming team, including creative considerations of funding streams to support educational, food, and cultural programming staff.

Building Resilient Attitudes with Virtual Engagement (BRAVE): A Feasibility Study on Online Mental Health Webinars for Black and Asian Americans during COVID-19

Yvonne Lin, Associate Professor, Department of Pharmaceutics, School of Pharmacy
Sondrina Bullitt, Community Leader, Influential Point
Jahmil Lacey and Italo Brown, Community Leaders, Trap Medicine
Khadija Ameen and Paulah Wheeler, Community Leaders, BLKHLTH
Tammy Cho, Community Leader, Hate Is A Virus
Tamsin Lee, Postdoctoral Fellow, School of Nursing

Project summary
Building Resilient Attitudes through Virtual Engagements (BRAVE) is a mixed-methods online feasibility study for Black and Asian adults (18 – 40 years old) living with emotional distress precipitated by the COVID-19 crisis. The goals of this study were to: 1) examine whether Black and Asian adults living in the United States were willing to participate and adhere to three one-hour interactive peer-supported virtual gatherings focused on emotional wellness; 2) explore potential benefits of the interactive webinars on race-related stressors as a consequence of the COVID-19 crisis; and 3) develop an interracial webinar-based community support that can be adapted and disseminated widely.

We were able to recruit participants solely through social media with fully scheduled cohorts and waitlists. The participant adherence to attending the webinars was relatively high (i.e., 88% attended webinar #2; 95% attended webinar #3). In addition, there was a high rate of completion of post-webinar surveys and Brief Cope surveys (97-100%). Some of the perceived mental health benefits reported by the participants included connecting over shared experiences, fostering interracial solidarity, cross-cultural learning, and creating virtual human connections using technology.

We will evaluate the change in pre- and post-webinar Brief Cope surveys, post-webinar surveys and the qualitative results from the focus groups to improve the online experience and study design. We intend to apply for funding to conduct a larger study to optimize and assess online mental health community support for BIPOC.

Developing Planning and Implementation Strategies to Promote Community-Based Organizations as Public Health Liaisons and Critical Service Providers in the Era of COVID-19

Edmund Seto, Associate Professor, Department of Environmental & Occupational Health Sciences, School of Public Health
Deric Gruen, MPA, Co-Executive Director, Programs & Policy, Front and Centered
Aurora Martin, JD, Co-Executive Director, Capacity Building, Front and Centered
Esther Min, PhD, Research Consultant, Department of Environmental & Occupational Health Sciences, School of Public Health

Project summary
The goals of this research project were to develop statewide planning and implementation strategies to improve equity in access to COVID-19 testing and future vaccination campaigns for SARS-CoV-2. Through key informant interviews and participatory mapping, we aimed to understand the role of community-based organizations (CBOs) in serving frontline communities’ needs related to COVID-19 and evaluate potential facilitators and barriers to accessing COVID-19 related information that is critical to ongoing disease control, such as testing, and forthcoming vaccination campaigns.

Based on our interviews in these communities, we learned that existing disparities and barriers to accessing resources (such as personal protective equipment or health care) were exacerbated in the pandemic. Our findings highlighted the need for CBOs to be more engaged in the vaccination campaign to ensure equitable access and distribution of the vaccination. CBOs can continue to reduce barriers, promote equitable distribution and access to the COVID-19 vaccine, assist in sign-ups for vaccination appointments, and partner with health clinics and local health jurisdictions to provide vaccines to their communities.

We will distribute findings from this study through a joint two-part panel presentation (scheduled for the end of February and beginning of March, with 115 registrants) for CBOs and to the Washington State Department of Health, local health jurisdictions, as well as city and county planners who are continually putting efforts to improve equity in the vaccination campaign.

COVID-19 Food Access among American Indian/Alaska Native Tribes in WA State: The Value of Food Sovereignty

Jennifer Otten, Associate Professor, Department of Environment & Occupational Health Sciences and Food Systems Director, Center for Public Health Nutrition, UW School of Public Health
Victoria Warren-Mears, Director, Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board
Nora Frank-Buckner, Food Sovereignty Initiatives Director, Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board
Brinda Sivaramakrishnan, Professor, Tacoma Community College
Laura Lewis, Associate Professor, Community and Economic Development, Washington State University
Adam Drewnowski, Professor, Department of Epidemiology and Director, Center for Public Health Nutrition, UW School of Public Health

Project summary
The NW Tribal Food Sovereignty Coalition (NTFSC) staff at the Northwest Tribal Epidemiology Center (NWTEC) worked with the UW Center for Public Health Nutrition to develop unique culturally and regionally relevant instruments to define and measure constructs of food security that are of importance to the American Indian/Alaska Native population. The goal was to explore how the pandemic is shaping the existing food systems and the concepts of resilience and food sovereignty through qualitative and quantitative surveys.

As of March 2021, we have received 188 survey responses. Responses have come in from 27 of 29 federally recognized tribes. We expect to reach our goal of 300 survey responses by mid-April and commence our data analyses. Research briefs are in progress.

Once the research briefs have been finalized, the UW portion of the team will hand over control of the data to NWTEC. The goal of collecting these data was to provide NWTEC and partners with rich information that they can use to inform current COVID-19 response efforts and future policy advocacy and research endeavors.

Mitigating Exposure to Contamination in Community Gardens During COVID-19

Melanie Malone, Assistant Professor, School of Interdisciplinary Arts & Sciences, University of Washington, Bothell
Neli Jasuja, Program Manager Nature Connections, Young Women Empowered (Y-WE)
Lisa Kenny, Mycoremediation Facilitator, Y-WE
Gari Watkins, Urban Food Systems Research & Evaluation Aide, Urban Food Initiative
Ray Williams, Director, Black Farmers Collective

Project summary
The project sought to: 1) provide safe food to children of emergency frontline workers who use food in contaminated Urban Community Gardens (UCGs); 2) remediate contamination in UCGs; and 3) prevent further airborne contamination of UCGs in the Duwamish Superfund. This was done by determining if mycoremediation lowered levels of contaminants such as arsenic, lead, total petroleum products and associated polycyclic aromatic hydrocarbons (PAHs), and polychlorinated biphenyls (PCBs) in plants and soils at South Park Community Center (SPCC) and Marra Farm.

In general, garden sites across Seattle that enrolled in Malone’s study showed lowered concentrations of contaminants in soils in the summer of 2020 compared to the summer of 2019. Given that both the SPCC and Marra Farm had higher concentrations of total petroleum hydrocarbons and PAHs in particular, both of which are known to be deposited after wildfires, it is likely that the increased concentrations of petroleum products are due to the 2020 wildfire events.

Dr. Melanie Malone led a demonstration of how to sample soils for contaminants. Y-WE, Urban Food Initiative and BFC assisted with sample collection and learned about sampling techniques and best data recording practices in September 2020. Additionally, in December 2020 and January 2021, greenhouse preparation began at Marra Farm instead of at the SPCC Children’s Garden, as the plot site is where mycoremediation took place, making it ideal for the new greenhouse.

Community-Driven Approaches to Identify Barriers to Food Security Due to COVID-19 and Solutions to Improve Food Security and Resilience in Agricultural Communities

June Spector, Associate Professor, Departments of Medicine and Environmental & Occupational Health Sciences, Schools of Medicine and Public Health and Director, Occupational & Environmental Medicine, UW
Elizabeth Torres, Coordinator, El Proyecto Bienestar and Northwest Communities Education Center and Radio KDNA
Jennifer Krenz, Research Coordinator, Environmental & Occupational Health Sciences, School of Public Health
Maria Blancas, Graduate Student, Environmental and Forest Sciences, College of the Environment; Outreach and Education Specialist, Pacific Northwest Agricultural Safety and Health Center (PNASH)
Jennifer Otten, Associate Professor, Environmental & Occupational Health Sciences, School of Public Health
Sarah Collier, Assistant Professor, Environmental & Occupational Health Sciences, School of Public Health
Yona Sipos, Lecturer, Environmental & Occupational Health Sciences, School of Public Health
Edward Kasner, Clinical Assistant Professor, Environmental & Occupational Health Sciences, School of Public Health and Outreach Director, PNASH

Project summary
The aims of this project were to 1) identify barriers and challenges to food security and support systems that food system workers and their families and communities are encountering due to COVID-19, and 2) identify solutions and highlight community assets to mitigate food insecurity effects resulting from the pandemic. We interviewed food system workers to learn about how they are navigating support systems, including those relevant to food security.

With input from Community-Based Organizations (CBOs) and the project team, questions were developed to learn about the four pillars of food security (availability, access, utilization, stability) with these specific goals: 1) to learn about changes in food security during transition from the work season to off-season; 2) to learn about changes in food security before and during the pandemic; 3) to learn about how people are adapting to maintain food security (short-term adaptations); and 4) to identify ways to support efforts to improve food security and food resilience. A total of 50 individuals from farmworker families were interviewed from four different CBOs.

The project team will continue to work closely with CBOs to analyze and interpret interview data collaboratively. We will also be discussing how to best organize and facilitate a workshop to translate research findings into action items. We will seek some additional support from the Pacific Northwest Agricultural Safety and Health Center, based at UW, for this effort.

Challenges, Efficacy, and Opportunities of Distance Learning for Low-Income Students of Color

Arzoo Osanloo, Associate Professor, Department of Law, Societies & Justice, College of Arts & Sciences
Taylor Harrell, Director of Learning and Evaluation, Metropolitan Area Action Committee on Anti-Poverty (MAAC)
Cristian Capotescu, Mellon Postdoctoral Scholar, UW Simpson Center for the Humanities

Project summary
Our study had three goals: 1) to describe the societal challenges that SDCS students face during the pandemic, 2) to analyze the efficacy of distance learning and scrutinize its limitations for educational attainment, and 3) to explore how the pandemic has magnified existing educational inequities centered around class and race. Our case study focused on a local charter high school in San Diego (abbreviated as SDCS), with a majority of its population being students of color who reside in low-income households.

Our study generated a descriptive framework to reveal the challenges of distance learning for marginalized students during the pandemic. We found that a host of interlocking factors, ranging from mental health issues, burdensome employment obligations, economic hardship, challenging home environments and lack of access to technology, negatively impacted student learning during COVID-19. Instructors had difficulties adequately understanding and addressing student attendance, communication and performance issues.

We intend to disseminate the research findings in a detailed summary to the Metropolitan Area Action Committee on Anti-Poverty (MAAC) and SDCS’s leadership teams. We also plan to collaborate with the SDCS administrative staff to determine the best channel to share key insights to staff, community partners, funders and other external stakeholders. By circulating these findings and inviting discussion, we encourage continuous learning and the evolution of educational practices that best support students’ success.

Life Events and Difficulties of Khmer American Elders and Youth Affected by COVID-19

Jenna Grant, Assistant Professor, Department of Anthropology, College of Arts & Sciences
Thyda Ros, Director, Khmer Community of Seattle King County

Project summary
This project sought to understand and mitigate the impact of COVID-19 on the daily lives of Khmer elders and youth in King County and to collect exploratory data on the interrelated problems of isolation, neglect, and intergenerational conflict. Our specific aims were to assess: 1) elders’ needs for COVID-19-related and non-COVID-19-related emergency planning, and 2) life events and difficulties of elders living alone and elders and youth living in multi-generational households.

Khmer elders found social and physical resonance between the pandemic and prior experiences during the Pol Pot era and time in refugee camps. Many elders compared COVID-19 to the Khmer Rouge period in terms of how fear and anxiety impacted their well-being. Young people acknowledged their own experiences with intergenerational trauma and expressed a desire to heal from it. Youth described financial issues or job loss for themselves, their parents and grandparents due to the pandemic. In addition, Khmer young people reported negative mental and health impacts related to social isolation, familial and intergenerational conflict from long-term quarantine with family, socio-political strife in the nation and fear of themselves or a family member contracting COVID-19 as essential workers.

We will share findings with our research participants, inviting youth and elders to come up with different avenues for sharing this information. We will present findings through a stakeholder forum, bringing together community partners invested in serving Khmer and refugee/immigrant communities to facilitate dialogue, build community power and strengthen the network of support for the Khmer community. Haskins will complete a report and presentation for students, faculty, and guests at UW’s Community-Oriented Public Health Practice MPH program’s Capstone event in June 2021.

Understanding and Addressing Barriers to COVID-19 Testing in the Somali Community in King County, WA: A Community-Driven Strategy

Keshet Ronen, Clinical Assistant Professor, Department of Global Health, Schools of Public Health and Medicine
Ahmed Ali, Executive Director, Somali Health Board
Farah Mohamed, Board Vice-President, Somali Health Board
Anisa Ibrahim, Board President, Somali Health Board; Clinical Assistant Professor of Pediatrics, School of Medicine and Harborview Pediatric Clinic Medical Director
Asiya Ahmed, Undergraduate student, Medical Anthropology and Global Health, College of Arts & Sciences
Kathleen West, Clinical Assistant Professor, Department of Global Health, Schools of Public Health and Medicine, and Research Scientist, Department of Bioethics & Humanities, School of Medicine

Project summary
Leveraging the Somali Health Board’s deep community roots and planned testing fairs, our mixed-methods and community-driven proposal sought to (1) quantitatively determine the prevalence and correlates of access to timely COVID-19 testing in the King County Somali community; and (2) gather perspectives of multiple stakeholders (community members, healthcare workers and policymakers) on community testing needs and how they may be integrated into King County’s testing strategy.

We conducted a community survey between October 10 and December 18, 2020, recruiting: (1) individuals seeking testing at COVID-19 testing events and Public Health – Seattle & King County testing sites in South King County (2) members of the Somali community purposively recruited through social media and word of mouth. Somali respondents were less fluent in English, less likely to have been tested and less aware of free COVID-testing compared to non-Somali respondents. Barriers to testing included system distrust, transportation and misinformation.

Participants outlined the following strategies to promote access to testing: mitigating medical distrust by having Somali-led testing, representation at other testing sites and community outreach to help with breaking down the stigma. For the team, the next steps are to prepare a report on the findings for dissemination to policymakers to guide their future community engagement efforts and seek additional funding and analysis for this work.

Heritage Sites as Healing and Health Promotion Spaces for Black Communities During and Beyond COVID-19

Ralina Joseph, Professor, Department of Communication, College of Arts & Sciences, and Director, Center for Communication, Difference, and Equity
LaNesha DeBardelaben, Executive Director, Northwest African American Museum
Jody Early, Associate Professor, School of Nursing & Health Studies, University of Washington, Bothell
Carmen Gonzalez, Assistant Professor, Department of Communication, College of Arts & Sciences and Associate Director, Center for Communication, Difference, and Equity

Project summary
This project centered on the mental health of Black Seattle residents during the COVID-19 pandemic and explored how healing spaces can mitigate the compounding impacts of racism and racial health disparities. Our aims were thus twofold: 1) to understand the disproportionate mental health impacts of COVID-19 on Black communities in Seattle in the current moment; and 2) to identify how cultural heritage sites (e.g., museums and community organizations) can serve as spaces of healing and health promotion.

We hosted 11 semi-structured dialogues between 22 Black community members in Seattle and beyond about their mental health experiences and challenges during the dual pandemics of COVID-19 and racism and what measures they are taking to find support. Participants’ stress and feelings of fear, isolation and past traumas were found to have been augmented by the events and media coverage of the 2020 murders of innocent Black Americans, subsequent racial awakening and calls for police reform. A common theme that stood out in our research was that participants wanted more opportunities to gather in interracial settings, whether for learning, dialogue or simply socializing, both in-person or in a digital environment.

Our assessment of the Northwest African American Museum (NAAM) highlights the important role that community organizations play in community well-being and will inform further work on examining how heritage sites can provide public health support for marginalized communities. In addition to academic publications, the recorded dialogues are currently being edited and produced as podcasts for dissemination by NAAM and CCDE.

Healing Heart and Soul: Decreasing COVID-19 Perinatal Racial/Ethnic Health Disparities through Home-Based Maternal Self-Monitoring and Self-Reporting of Blood Pressure, Stress and Depression

James Pfeiffer, Professor, Department of Global Health, Schools of Public Health and Medicine
Yvonne Griffin, Director of Midwifery, Neighborcare Health
Rachel Chapman, Associate Professor, Department of Anthropology, College of Arts & Sciences
Amelia Gavin, Associate Professor, School of Social Work

Project summary
This project tested the feasibility of technology transfer to prenatal care clients for use in reduced prenatal care settings, including telemedicine visits, under COVID-19 quarantine restrictions. Technologies of interest included blood pressure monitoring kits (BP kit) and a stress, depression, and safety self-monitoring screener tool. Pilot study objectives included: 1) increasing perinatal clinic/patient points of contact for critical health monitoring, treatment and referrals; 2) decreasing barriers to reporting and treating maternal hypertension and debilitating sequelae of stress and depression; and 3) normalizing social and emotional health-seeking alongside biological health monitoring as the best perinatal care practice during COVID-19.

Our findings to date confirm that this is a viable model for technology transfer. Patients and providers are using the tools in ways that improve antenatal screening, not only under COVID quarantine restrictions but more broadly, as a means to enhance antenatal telehealth communication, patient self-efficacy and provider diagnostics, referral and treatment. A majority of providers rate the BP cuff (70.6%) and screening tool (42.9%) home use as “great” (6 on a scale of 1-6).

Given the positive experience and findings, the team is eager to pursue further opportunities to test and measure the impact of the model in a regional trial. The team anticipates that this feasibility study will demonstrate the feasibility of core components. We will continue to collect data on fine-tuning the screening tool and scaling up this approach to reducing perinatal disparities in the region. Additional funding has been received for the Mama Amaan (Safe Motherhood) project approach and conference opportunities, as well as funding from the Washington State Department of Health.

Assessing the Nature, Extent of, and Variation in the Housing Insecurity of Low-Income Tenants of Color During the COVID-19 Pandemic

Rachel Fyall, Assistant Professor, Evans School of Public Policy & Governance
Violet Lavatai, Co-Executive Director, Tenants Union of Washington State
Matthew Fowle, PhD Student, Evans School of Public Policy & Governance

Project summary
This study examined the research question: How have the COVID-19 pandemic and housing policies designed to mitigate its effects shaped the housing security of low-income tenants, in particular low-income tenants of color? The study comprised both a qualitative and a quantitative component. Semi-structured interviews with low-income tenants were conducted to obtain insight into the strategies they used to maintain their housing and the relationship with their landlord since the pandemic began.

Despite unprecedented levels of unemployment, which have left many low-income households unable to pay their rent on time, the eviction moratorium appears to have prevented a noticeable increase in formal evictions and increased prevalence of informal evictions. However, the perceived health consequences of housing insecurity appear to be more common and more severe. As tenants have spent more time in low-quality housing with mold, pest infestations, old carpets and poor ventilation, they report an increased exposure to toxic substances and conditions. In addition, people who identify as Black, Hispanic or Latinx, and multiracial are more likely to be behind on rent, owe more in unpaid rent and are less confident about their ability to pay the next month’s rent.

We are drafting a policy brief to publicize findings from the study. In coordination with the Tenants Union of Washington State (TU-WA), the policy brief will be disseminated widely to relevant organizations and policymakers. Discussions regarding how the study’s findings will inform TU-WA’s programming and advocacy strategy are ongoing. Study findings will be presented at the American Society for Public Administration in April 2021 and Society for the Study of Social Problems in August 2021.

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COVID-19 and Civil Domestic Violence Protection Orders in King County: Implications for Population Health and Justice Equity

Ali Rowhani-Rahbar, Associate Professor, Department of Epidemiology, School of Public Health
Kimberly A. Morrill, Lead Legal Advocate, New Beginnings
Deirdre Bowen, Associate Professor of Law, Seattle University
David Martin, Domestic Violence Unit Supervisor, King County Prosecuting Attorney’s Office
Alexandra Burton, Domestic Violence Staff Attorney, Eastside Legal Assistance Program
Judy Lin, Senior Managing Attorney, Family Law Pro Bono Programs, King County Bar Association
Adrian Dominguez, Director of Research and Epidemiology, Urban Indian Health Institute
Avanti Adhia, Senior Postdoctoral Fellow, Department of Pediatrics, School of Medicine
Megan Moore, Associate Professor, School of Social Work
Kimberly Dalve, Doctoral Student, Department of Epidemiology, School of Public Health

Project summary
We conducted a study in King County to compare the rate of civil domestic violence legal filings and their adjudication trajectory before and during the pandemic, stratified by survivor’s race/ethnicity, gender, age and socioeconomic status. We also characterized programmatic and systemic adaptations implemented during the pandemic intended to increase access to civil legal services among domestic violence survivors of color.

Overall, the trend found while these strategies were impactful and successful for survivors, it was not a shared experience by BIPOC populations. The new methodology of electronic filing had a devastating impact on pro se petitioners (i.e., without attorneys), which overwhelmingly tend to be BIPOC. In addition, there was a dramatic drop in legal submissions. Language barriers were also a common reason for not receiving legal help, as many were unable to find services in their preferred language. However, there were benefits also, such as survivors no longer bearing the burden of finding childcare, taking time off from work and locating transportation to the court, which were barriers carried particularly by BIPOC female survivors.

The next steps for the current project include further data collection, sharing findings of the project with our community partners and preparing abstracts and manuscripts for conferences and publications. For data collection, we are continuing to recruit participants for the survivor survey.

Health and Human Rights in Immigrant Detention: A Case Study of the Northwest Detention Center

Angelina Godoy, Helen H. Jackson Chair in Human Rights, Jackson School of International Studies, College of Arts & Sciences and Director, UW Center for Human Rights
Maru Mora Villalpando, Founder, La Resistencia

Project summary
The study examined human rights conditions in the Northwest Detention Center in Tacoma (NWDC), specifically focusing on concerns arising in the context of the COVID-19 pandemic and the health inequities it magnifies. The research draws on detainee accounts, as well as records obtained through FOIA and local public record requests, in keeping with UWCHR’s established area of expertise.

The project found that it is clear that there are endemic health and safety concerns at the Northwest Detention Center, although the full dimension of their gravity remains unknown due to a lack of transparency on the part of Immigration and Customs Enforcement (ICE) and GEO. Additionally, it is clear that the Department of Homeland Security’s and ICE’s oversight mechanisms have failed to correct abuses and that local and state authorities have chosen not to exercise their regulatory authority to ensure the health and safety of all Washingtonians.

The research culminated in the December 2020 publication of a report, “COVID-19 and Health Standards at the Northwest Detention Center,” which was shared with the public through UWCHR’s website, social media and other communications. The report was also presented to Rep. Lilian Ortiz-Self of the Washington State Legislature, whose longstanding concerns about the NWDC led her to request the analysis of the research team.

Media coverage of several of these projects can be found by visiting our News page.