FUND FOR JOURNALISM ON CHILD, YOUTH AND FAMILY WELLBEING Grantees
Cristina Caron, New York Times
Over the past generation, a mental health crisis has been brewing among Black youths, one that very few people — including Black families — have spoken about publicly. Self-reported suicide attempts rose nearly 80 percent among Black adolescents from 1991 to 2019, far outpacing other races and ethnicities. For her Fellowship project, New York Times reporter Christina Caron explored the same question that legislators and researchers are racing to answer: why? Her reporting found that Black children may have unique risk factors for self-harm. One government study found, for example, that Black children and adolescents who died by suicide were more likely than white youths to have had a crisis in the two weeks before they died. Denise, a 19-year-old high school senior living in Cleveland is one example. She lives with her mother and six siblings, and struggles with depression and anxiety, largely driven by conflict at home and the lingering trauma of a sexual assault.“When I told Mom how I was feeling, she didn’t seem to care,” Denise said, adding: “She said I had nothing to stress about because I’m a kid.” Suicidal behavior is a well-known problem in Denise’s school district, which is about two-thirds Black. Roughly 18 percent of Cleveland high school students had attempted suicide in the previous 12 months, compared with about 9 percent nationally, according to CDC data. Many students in Cleveland face chronic stressors, including neighborhood violence and food insecurity.
Kassie McClung, Frontier
Kassie reported on maternal and child health outcomes for Blacks in Oklahoma for The Frontier, an online investigative outlet. In her project, “In Oklahoma, Black families turn to doulas for better births,” she reported on the increasing role that doulas (non-medical birth workers) are playing in helping Black pregnant women in Oklahoma avoid the birth complications that have contributed to a disproportionately high rate of infant and maternal deaths. It’s the kind of smart framing that can advance solutions – rather than delving first into well-known concerns. The state reported the fourth highest rate of maternal mortality in the country in 2018, with Black women dying of pregnancy-related complications at a rate more than 60 percent higher than that of White Oklahomans. In addition, Black infants in Oklahoma are more than twice as likely as White infants to die before their first birthdays. Oklahoma has just begun to take steps to expand access to doula services to Black women, and there’s pressure on state legislators to provide Medicaid coverage for doula services, as some other states do. Doulas say that the emotional, educational and physical support they provide during pregnancy, labor and delivery and the postpartum period can help women avoid complications. Kassie received a supplemental community engagement grant and specialized mentoring. As part of her community engagement strategy for her first article, Kassie convened an online panel discussion on racist practices within the reproductive health system on December 10, a few weeks after her first Fellowship story ran. The panel discussion, which was moderated by Jacqueline Blocker, data & policy director at the Take Control Initiative, featured LaBrisa Williams, executive director of the Tulsa Birth Equity Initiative; Marnie Jackson, a mother and maternal health advocate; and Dr. Syeachia Dennis, assistant dean for equity and community engagement and associate professor at OU-TU School of Community Medicine. For her second story, she and a colleague, Brianna Bailey, reported on a disturbing trend: an increase in criminal charges against women who had miscarriages or infants born exposed to drugs with crimes. Her interest in that topic was sparked when a prosecutor charged a 21-year-old Indigenous woman with first-degree manslaughter conviction because she used drugs while she was pregnant and suffered a miscarriage. Jurors found her guilty, and she was sentenced to four years in prison. Kassie and Brianna looked into how many women in Oklahoma had been charged with crimes related to drug use while pregnant and found 45 cases of women across the state who were charged with felony child abuse, child neglect or manslaughter in connection with substance use during pregnancy since 2017. In 2020, the Oklahoma Court of Criminal Appeals ruled that such charges were constitutional. Kassie reported that the number of infants exposed to drugs in the womb had almost quadrupled between fiscal years 2015 and 2021, but that most exposures were to marijuana (more than 75 percent of cases in 2021, with 11 percent attributed to methamphetamines). Health care providers and policy experts say that fear of criminal prosecution can lead to worse health outcomes for women and babies by preventing mothers from seeking prenatal care or substance use treatment. In late December, 37 Oklahoma doctors signed a letter denouncing the practice, she reported.
Nina Shapiro, Seattle Times
Nina reported a long-form piece on how the digital divide affected children and their families on Indian reservations and in other rural areas of Washington when the COVID pandemic forced school to be held virtually. The piece was published on December 19. Nina and photographer Amanda Snyder journeyed to the Colville Reservation in eastern Washington to capture the experiences of people who live on the other side of the digital divide. The reservation is home to about 7,000 members of 12 Bands of the Confederated Tribes, and internet service ranges from non-existent to spotty, as it does in many other remote areas of Washington populated largely by residents with low incomes. “When the pandemic largely turned the online world into the world for many urbanites, hundreds of thousands of people in Washington were shut out,” Nina wrote. “Kids couldn’t attend Zoom classes or do assignments online. Seniors and others needing medical care couldn’t switch to telehealth appointments. The unemployed struggled to fill out online job applications, and the employed looked for places to log on. Pandemic tedium was unbroken by streaming TV and movies, and forget about online grocery and restaurant delivery orders.” Colville reservation officials got so frustrated with the gaps in service that they used COVID relief funds to erect towers for wireless broadband and handed out devices to residents to receive signals at home. The tribes are also seeking tens of millions of federal dollars to complete a fiber optic network with the goal of enabling all reservation residents to be online by 2026. Nina’s story was co-published in Native News Online, The Columbian, the Yakima Herald-Republic, Forbes Japan and Government Technology.
Early Impacts: The Washington State Bar Association’s committee overseeing family law cited Shapiro's project in a letter it submitted to the state Supreme Court, raising concerns about a rule allowing video trials because of the lack of broadband access in many places. This impacts a tremendous number of cases regarding dependency, divorce, parenting and child support. The committee asked to use the graphic we created after getting raw survey data from the state Broadband Office showing how many respondents in each county had speed test results that fell below the FCC’s already very low standard for broadband
Sushma Subramanian, Washington Post
Subramanian explored an emerging model for child custody — "shared custody," in which each parent is awarded equal time -- in a long-form article in The Washington Post Sunday Magazine. Family courts historically gave mothers physical and legal custody and fathers visitation rights. In the last 25 years, shared legal custody has become the norm, with courts giving divorced and separated fathers more time with their children. But shared custody -- with a true 50-50 split in time -- is rare. Kentucky became the first state to mandate it in July 2018, and Arkansas followed in 2021, with other states now considering it. Her story focused on a Kentucky couple that she described as a "test case" for the concept, which has been touted mainly by fathers who felt that the courts often short changed them. Teenage sweethearts Jordan Pyles and Ashlyn Harrell split up soon after Ashlyn, then 17, discovered she was pregnant. Ashlyn wanted to raise their daughter, "Ann," by herself, but Jordan wanted to be a fully involved father, and he sought full custody when Ann was 4. While awaiting trial on his custody suit, Jordan learned of a bill in the Kentucky Legislature that would mandate a 50-50 parenting time split as the presumptive arrangement for permanent custody orders, except in certain situations. Jordan broached the idea to Ashlyn, who agreed, mostly out of fear of losing full custody to Jordan. Ann is now 7, and shared parenting has worked out well for Jordan and Ashlyn. “I think 50-50 is great in situations where both parents are good parents and don’t have major problems,” Ashlyn told Subramanian. “I would say I support it, but for those situations only.” Child therapists disagree about whether shared custody is in the best interests of children, with some arguing that it can contribute to them feeling rootless. And some are concerned about courts disregarding allegations of child or intimate partner abuse in favor of shared parenting.
Jessica Washington, Fuller Project
Jessica reported a long-form piece on the disproportionate involvement of Indigenous children in the foster care system in Minnesota. Her story ran both on The Fuller Project’s website and in Mother Jones. (The Fuller Project is an online outlet that focuses on women's and girls' issues.) She reported that Native children in Minnesota are 17 times more likely to spend part of their childhoods in the foster care system than non-Native children. As of 2019, Minnesota had the highest disproportionality of Native children in the foster care system. The most common reasons cited for removing a Native child from his or her parents are parental drug abuse and neglect. Many parents who have had children removed from their custody and some child welfare experts see the foster care system as a modern-day version of the boarding schools that many Native children were forcibly sent to, beginning in the 18th Century, with the explicit goal of forcing assimilation. The National Native American Boarding Schools Coalition estimates that by 1926, nearly 83% or all Native children were in boarding schools. The practice ended in the 1970s, and an increasing amount of research has chronicled the harm it caused to Native family structure and childrearing practices through generations. Through sensitivity training and other reforms, child protection agencies in Minnesota have been trying to reduce the disproportionate removal of Native children from their families, with little success. In an interactive timeline, Jessica illustrated the history of large-scale Native family separations ending with the current era. Washington's stories were co-published in the Star Tribune and Mother Jones.
DENNIS A. HUNT FUND FOR HEALTH JOURNALISM Grantees
David Barer and Josh Hinkle, KXAN News
In Texas, those charged with crimes and found mentally incompetent are entitled to restoration treatment at a state hospital before returning to jail and standing trial. Mental Competency Consequences, an investigation by 2021 National Fellows David Barer and Josh Hinkle, shows the system waitlists many hundreds each year while awaiting beds. Some die before receiving treatment. It’s a growing issue — Texas has experienced a 38 percent spike in the number of people who are found incompetent to stand trial in the last 20 years, according to state data. With financial assistance from the Dennis A. Hunt Fund, Hinkle and Barer investigated how mentally ill Texans fall through the cracks of the criminal justice system, exposing crucial data the state doesn’t track, and what the agencies could do to address the issue. State agencies in Texas responsible for maintaining waitlists for individuals who are entitled to restoration treatment don’t keep track of whether those individuals die in-custody. Hinkle and Barer turned to county-level data to find out for themselves. Their review of records from Texas’ five most populous counties found that since 2015 almost a dozen people languished in jail while awaiting treatment, ultimately dying before they would ever receive it. Among them was Naquan Carter, a 23-year-old who grew up bouncing from foster families to group homes. Medical forms from a 2017 arrest suggest he was suicidal and depressed. Naquan was diagnosed with bipolar and schizoaffective disorders stemming from mental and intellectual disabilities. At 6’3” and more than 300 pounds, his large stature belied his nature. The county sheriff described him as a “gentle giant.” Naquan was awaiting transfer to a state-supported living center in 2018 when guards found him dead in his jail cell. Surveillance footage shows Naquan fell from his bed, where he remained for 2 hours and 39 minutes. Corrections officers checked his cell or walked by almost a dozen times before noticing.
Through 2022 and into 2023, Barer and Hinkle continued to document how Texas fails residents with mental illness, in particular those involved with the criminal justice system. On May 18, 2022, they reported that the number of people jailed while awaiting evaluation or treatment in a state mental hospital had reached 2,309 in March, the most ever. Several legislators told Barer and Hinkle that the problem could be solved. “We know what the solutions are: workforce, expanded Medicaid, and a diversion out of jail circumstance and into a doctor’s office,” State Sen. Sarah Eckhardt, D-Auston told them. “Currently this crisis management is ineffective. It’s inefficient. It’s unfair, and it’s exceedingly intrusive on the individual who is suffering.” The state began collecting data on the race of inmates awaiting psychiatric evaluation or treatment only after Barer's and Hinkle's project pointed out the lapse. Data released by the state in May confirm Barer's and Hinkle's calculations that Blacks wait longer to be transferred than Whites or Latinos, a disparity the state initially called "an anomaly," but later said might be explained by prolonged medical holds for conditions that can't be treated in a state hospital, or a person's specialized programming needs.In a story November 15, 2022 that ran statewide, they reported on the death in a Texas state mental hospital in September of Justin Reeder, 32, who was on the autism spectrum, developmentally delayed and mentally ill. He died strapped to a restraint chair alone in a seclusion room in a state hospital to which his family had had him committed. The story raised questions about the hospital’s failure to notify his family of multiple injuries In the previous year, when they had been unable to visit him because of the pandemic. The article also reported that 2,540 jail inmates were waiting for mental health evaluations as of October – about 600 more than when their Fellowship project was broadcast last year – and that the system’s capacity had declined by a third – 1,500 – largely because of budgetary and staffing issues. The average wait time for a maximum-security bed was 699 days – also a record – and 241 days for a non-maximum-security bed, according to state data. “This is a tragedy of epic proportion. It’s an ongoing tragedy that we have been suffering for years,” State Sen. Sarah Eckhardt, D-Austin, told KXAN. “We simply don’t have the capacity, even on a good day where we’re fully staffed.” In another development, Sonja Burns — a mental health advocate who sits on the Texas Judicial Commission on Mental Health’s Collaborative Council — nominated the late Naquan Carter, 23, to be the namesake of Travis County’s probate court building to keep a focus on reforms. In their Fellowship projects Barer and Hinkle had highlighted Carter’s death in his Travis County jail cell in July 2018 while awaiting transfer to a state-supported living center for mental health care. Meanwhile, Barer and Hinkle also reported that lawmakers are expected to author bills that could improve the situation highlighted in their reporting in the legislative session that began in January.
Additional stories published in 2022:
Additional stories published in 2023:
Thousands waiting in jail for hospital beds. Is help coming?
Early Impacts: Prison policy researchers and members of the state agency responsible for the restoration treatment waitlists suggested that Hinkle and Barer’s findings should lead to policy changes, including tracking of data related to demographics, race, ethnicity, homelessness and in-custody deaths. Just weeks after publication, the state began tracking data related to race and ethnicity of people in-custody who were waitlisted for restoration treatment — a key piece of data that Barer and Hinkle’s investigation found was not being tracked. In addition, the Joint Committee on Access and Forensic Services is looking into the causes of a potential solutions to the lengthy waitlist. “Our goal for this committee right now is to keep analyzing the data to see what it tells us in terms of hopefully we will be able to have some data driven recommendations for policy actions or legislative action,” Stephen Glazier, a member of the committee, told Barer and Hinkle in April.
The project has received 14 local, region or national awards: two awards from the Texas Association of Broadcasters in the investigative and multimedia/digital storytelling categories (and two awards in those same categories from the Headliners Foundation of Texas' Charles E. Green Awards); four regional Emmys; and the First Amendment Award from Society of Professional Journalists (SPJ) Fort Worth Professional Chapter.
Jorge Carrasco and Juan Cooper, Noticias Telemundo
Noticias Telemundo, a national news show that reaches almost 1.2 million Spanish-speaking households nightly, began broadcasting Jorge Carrasco’s and Juan Cooper’s Fellowship project, a five-part video and text series, on June 14. Headlined Salud de Alquiler (“Health for Hire”), the program investigated why many Latinos -- more than 15,000 between 2015 and 2019—enroll in clinical trials of drugs -- many over and over again -- and found that the root cause was poverty. "The clinics want the participants and the participants want the money,” Dr. Olveen Carrasquillo, chief of general medicine at the University of Miami, told the reporters. “So that creates a system that is ripe for abuse."
In Part One, “Risk Health for Money,” they told the story of the late María Elisa Rangel, a 38-year-old undocumented immigrant who in 2015 signed up for a Phase 1 clinical trial of a potential epilepsy drug at the Celerion research center in east Phoenix. (Phase 1 trials assess the toxicity of an investigative drug.) She was paid $8,300 for taking the drug, spending a month hospitalized under observation and having more than 30 blood draws. Experts told Carrasco and Cooper that Rangel wasn’t adequately informed of the risk of DRESS Syndrome, a serious drug reaction. Nearly three months after she began taking the drug, Rangel died of “an adverse reaction to an experimental drug,” according to an autopsy. Rangel’s husband sued and in March received a confidential settlement.
In Part Two, “Recruiting the Desperate,” Carrasco and Cooper reported an apparent anomaly: Latinos are underrepresented in clinical trials of drugs on patients who are sick (Phase 2 and 3 trials), but are apparently overrepresented in Phase 1 trials, which require participants to be healthy. The lure for the Phase 1 trials: payments that average up to $250 a day (more if hospitalization is required) and no requirement for legal immigration status. Nahara Candelaria, a Cuban immigrant who has taken part in numerous studies, told the reporters she does it to pay for legalizing her and her daughter’s immigration statuses. “More than 100 people call me every day,” Marylean Camacho, a recruiter at the CenExel RCA clinic in Hollywood, Florida, said. The long-term effects of serial participation in studies is unknown, but the government allows it. Almost 30,000 clinical trials are currently underway in the United States.
Part Three, “The Price of Silence,” described the pressure participants feel to stay in trials, even if they’re experiencing side effects, so that they receive full compensation. Some also withhold side effects for fear of being terminated from a study, which can jeopardize public health, since the Food and Drug Administration assesses side effects when deciding whether to approve a new drug. One trial participant, Roberto Lamelo, a Cuban immigrant, told the reporters that he failed to report 18 straight days of diarrhea because he didn’t want to jeopardize his $6,000 payment. The reporters informed Senator Sherrod Brown, D-Ohio, of their findings, and he told them: "By participating in a trial, no one should be afraid that they will take advantage of them, harm them, or worse.” Brown has advocated for stepped-up efforts to include diverse participants in drug trials.
Part Four, “A Dangerous Lack of Regulation,” profiled Blue Fronteraz, 36, a Mexican immigrant who makes her living as a serial trial participant. To maximize her income, she once took part in three trials at once, but got scared when her hair fell out, and she didn’t know which investigational drug had caused it (nor did she report the side effect to the clinic). Medical ethicists want the government to build a national database in which clinics would have to track participants’ histories and what drugs they ingested. Some commercial registries have been developed, but participation by clinics is voluntary; most of the 25 clinics that responded to a Telemundo survey said that they use them only if the study’s sponsor requires it.
Part Five, “Clinical Trials that Give Life,” explored the reasons that drug companies actively recruit Latinos for clinical trials: to meet the FDA’s diversity goals, designed to ensure that drugs benefit all takers, since some drugs behave differently in people of different racial and ethnic backgrounds. Because Phase 2 and 3 trials are limited to people with the disease the drug is meant to address, financial incentives aren’t as important to participants. Rather, people sign up with hopes that the investigative drug will cure them. To assure sufficient representation of Latinos, many drug trials are held in Puerto Rico. In addition, clinic owners have formed Latinos in Clinical Research with a goal of diversifying the clinical trial workforce.
Laura Garcia, San Antonio Express-News
Laura Garcia's first article in her project, Access Denied. ran April 20 in the San Antonio Express-News. Headlined "A Broken System Got Worse: How COVID Ravaged San Antonio's Southside," the project analyzed the historical and systemic contributions to the disproportionate impact of COVID-19 on San Antonio's Latino population. By analyzing 50 years of census data, redlining data from the University of Richmond and information from the city's COVID-19, the paper showed that COVID-19 infections have been more prevalent and more deadly among residents of the southern parts of the city, which is 81 percent Hispanic. The data showed that the southern neighborhoods have COVID-19 mortality rates more than double that of Bexar County overall, the state of Texas and the nation. Laura's article also revealed that the incidence of chronic conditions is also higher in Bexar County's poorer, largely Latino neighborhoods. Experts told her that the disparities started with decades-old racially-biased government policies that pushed Hispanic residents into less desirable parts of the city with weaker infrastructure and less public investment, which stunted their prospects for getting ahead. Generations later, residents of the southern third of the city still have less access to medical care, healthy food and opportunities for advancement. “COVID-19 shined a harsh light on and further exacerbated systemic inequities, especially for Latinos,” Amelie Ramirez, chair of the department of population health sciences and director of the Institute for Health Promotion Research at UT Health San Antonio, told Laura.
In her next piece, Garcia analyzed 50 years of census data, redlining data from the University of Richmond and information from the city's COVID-19 Dashboard to show how the pandemic disproportionately affected the mostly Latino residents of the city's South Side, from vaccination rates to confirmed infection rates to death rates. The 78224 ZIP code on the South Side, had a death rate of 677 per 100,000 people from the start of the pandemic through March 2022 --16 times higher than in the more affluent (and more non-Latino) 78256 ZIP code. Experts told her that the reasons were "cumulative and complex, starting with racially-biased government policies decades ago that intentionally pushed Hispanic, primarily Mexican American, residents into less desirable parts of the city with weaker infrastructure and less public investment — stunting the economic prospects of thousands of San Antonio families for generations." For her next piece, she mapped the nearly 50 emergency care facilities in San Antonio and found that the majority were on the more affluent North Side, with eight emergency rooms for every one on the South Side. The limited access to health care is one reason that South Side residents are more likely to lose limbs to diabetes and have shorter life spans. “This is the most segregated city for health in the world," Linda Hook, former director of the Metropolitan Health District’s public health nursing department, told her.
In another project follow-up, Garcia reported June 22 on plans by Bexar County Hospital District’s board of managers to build two new hospitals in medically underserved areas — one on the Southwest Side, a neighborhood on which she focused in her project, and one on the Northeast Side. Her investigation had found that options for hospitals, medical specialists and surgical centers are limited in the southern part of the city, where 81 percent of all residents are Hispanic, and 21 percent of patients are uninsured. Garcia's final story profiled the people in an informal network of Spanish-speaking health care navigators in San Antonio who help residents overcome the cultural complexities and socioeconomic barriers that prevent many from getting the care they need. The story focused on Maria Lee, an independent insurance broker and Medicare adviser, who helps clients find the healthcare coverage that best suits their needs, but also guides them to providers who provide culturally competent care.
Garcia received a supplemental community engagement grant from the Center to experiment with new ways of engaging the public with her reporting. On May 28, 2022, the Express-News hosted a health fair at the Wesley Health and Wellness Center on San Antonio’s South Side, the neighborhood on which Garcia focused in her project, in partnership with Methodist Healthcare Ministries of South Texas, HealthTexas Primary Care Doctors and the Center for Health Journalism. More than 150 people visited 21 booths, got COVID-19 vaccinations and picked up free bags of produce. The paper’s editor interviewed Garcia and photographer Josie Norris about their findings, and Garcia then moderated a panel discussion featuring six experts on health disparities who had been sources for her project: Dr. Lyssa Ochoa, CEO and vascular surgeon at San Antonio Vascular and Endovascular Clinic; Dr. Carolina González Schlenker, UT Health San Antonio’s Department of Family and Community Medicine promotores program; Dr. Adriana Rocha Garcia, San Antonio City Councilwoman of District 4; George B. Hernández, Jr., president and CEO of University Health (Bexar County Hospital District); and Dr. Jason Miller, Psychiatrist at Texas Vista Medical Center (formerly Southwest General Hospital).
Early Impacts: Bexar County Manager David Smith cited Garcia's reporting in announcing his plans to hire a county public health director and other core staff to revamp health care in some areas of the community. He held up two maps from Garcia's project that highlighted health care inequities and disparities in largely Latino neighborhoodsas he told the county commissions: “To me, these two maps are a sort of visual mission statement for this new department that I’m forming. It is to try and make these health care outcomes more evenly distributed throughout our community.” Garcia and a colleague, Scott Huddleston, reported June 10 on the Bexar County Commission’s plans to address some of the health disparities she had reported in her Fellowship project, Access Denied. Using funds from the American Rescue Plan Act, the commission approved $30 million for a University Health medical office building on the South Side; another $20 million to be split between a University Health satellite medical clinic and a new public health school that will be run by UT Health San Antonio and the University of Texas at San Antonio; $3.5 million for upgrades at the Texas Biomedical Research Institute; and $1 million will pay for five “VillageMD” clinics inside Walgreens stores.
Allison Herrera, KOSU Public Radio, Oklahoma
Herrera is exploring the impact on criminal justice and mental health services in Oklahoma as a result of the Supreme Court decision in McGirt vs. Oklahoma, which stripped state courts of the authority to prosecute crimes committed by or against Oklahomans who are also tribal members. Because they must scale up their criminal justice systems, tribal authorities have the opportunity to devote more resources to prevention, treatment for addiction and mental issues that are the root causes for criminal behavior.
I want to help my people': Tribal nations in Oklahoma focus on mental health treatment
Moreno investigated missteps in the handling of the COVID-19 pandemic by public health officials in Virginia. Her five-month investigation found state leaders allowed the health department to wither and shrink for more than 20 years. A series of budget cuts and underfunding led to “a severely undermanned and underfunded public health system, incapable of fulfilling its core promise to protect the health of all Virginians,” Moreno wrote in the first part of her series. She found that the state’s health department’s budget for public health totaled about $85 per person — less than it was spending in 2000, after adjusting for inflation. The disinvestment disproportionately impacted Latino communities. In at least two separate assessments, community members identified language barriers as a cause of poor health. The department faced a lawsuit in 2021 when it used Google Translate to relay COVID-19 vaccine information to Spanish speakers. That software offered shoddy translation, falsely telling Spanish readers on a state website that "the vaccine is not necessary" instead of "not required,” Moreno wrote. To inform her reporting on this pandemic, Moreno looked back to the department’s response to H1N1 in 2009, finding that language barriers and distrust of public health officials among Latino communities hampered their response. Virginia faced those same problems during the COVID-19 pandemic, something one public health historian Moreno interviewed blamed on public health officials being “engineers to these problems” but relying upon politicians to deliver funding and resources to address them. Oftentimes, politicians don’t want those types of problems being measured, and don’t provide adequate resources to track the data needed to solve the problem, Moreno reported.
In Part Two, Virginia’s COVID Response: for some Latinos, help came too late, Moreno reported that a disproportionate number of Latinos contracted COVID between March and September 2020 because they were in essential jobs and working despite the risk of exposure. The Virginia Department of Health reported that Latinos ages 35 to 44 were then dying at 11 times the rate of than Whites in the same age group. (All told, 1,022 of the 19,000 Virginians who have died from COVID were Latino.) The Virginia Department of Health received $1.4 billion in federal COVID grants, but it wasn’t enough to meet the needs of uninsured essential workers living in multigenerational households without access to quality health care or paid sick leave, so many went to work sick, Moreno reported. To put a human face on the policy issues, Moreno profiled Maria Fuentes, whose husband, Yuki Mendez, a construction worker, died of COVID on July 28, 2020, a day after the state mandated workplace protections that might have prevented him from contracting the virus. Fuentes had lost her housekeeping job early in the pandemic, but Mendez kept working to pay their bills. It wasn’t clear who caught COVID first, but Fuentes survived, and Mendez didn’t. When Fuentes tried to get assistance with rent, the information was only available in English, which she can’t read.
Yereth Rosen, Arctic Today
In rural Native Villages across the Alaskan arctic, it’s not uncommon to see children hauling buckets of human waste to dump it in a lagoon. In these indigneous communities, there’s no infrastructure for fresh water or waste. Such conditions lead to a host of challenges for residents, the most dire of which involves a litany of well-documented chronic health conditions. Yereth Rosen, a grantee of the Dennis A. Hunt Fund for Health Journalism, reported on the impacts the lack of water and sanitation infrastructure has on indigenous communities in Alaska, and the hope they have for the future. That hope, Rosen writes, could come from the federal Infrastructure Investment and Jobs Act, which allocates more than $3.7 billion for construction projects in villages for sanitation and wastewater management. The aid is needed. Respiratory syncytial virus, or RSV, plagues infants and children in rural parts of Alaska, a result of the poor water quality. “We expect that one out of every three of our infants every year in one of those communities will be hospitalized simply because they don’t have running water,” said Valerie Davidson, president of the Alaska Native Tribal Health Consortium. Illustrating the problem, Rosen headed to the village of Teller, an Iñupiat community home to about 250 people. Residents there leave bags of human waste in plastic bags outside their homes to be picked up by sanitation workers at a cost of $35 per week, unless they choose to haul it to the dumpsite by foot. They have no running water, so they must travel to a community storage tank to fill buckets at a cost between 50 and 63 cents per gallon. It’s so cost-restrictive that residents use water sparingly and often reuse water to the point of contamination. A survey of 21 rural households found an average use of 2.4 gallons per household per day, well below the 156 gallon daily average water use in the United States. Rural residents have been clamoring for improvements for years, which seem within grasp now with an infusion of federal funding. But progress over the decades to address infrastructural issues has been slow-going. “I was hoping we’d have water and sewer by now. It’s always been out of reach,” one tribal government leader said. She pointed to the mayor. “I can remember her grandma talking about it,” she said. In her second piece, “In-home water and sanitation systems offer alternatives to serve remote Alaska villages,” she reported on efforts by the Alaska Native Tribal Health Consortium to equip some individual homes in parts of rural Alaska with water and sewage microsystems that produce safe drinking water and reduce the possibility of residents developing infectious diseases because of contact with human waste. Her third story described the innovative ventilation systems installed in the homes of a four-house living laboratory at the Cold Climate Housing Research Center on the edge of the University of Alaska Fairbanks. They provide a way to balance the need for energy conservation, a perennial issue in cold climates of high latitudes, with the need for fresh indoor air, which is essential to people’s health. Native residents are advising designers of attributes needed to accommodate their lifestyles, which include multigenerational living arrangements and long-term storage of hunted and fished prey. (This story was co-published in Nunatsiaq News, the newspaper of record for the Nunavut and the Nunavik territory of Quebec.) Her fourth story reviewed the devastating impact of the 1918 Spanish Flu pandemic on Alaskans and what lessons learned from it are applicable to the COVID-19 pandemic and whatever other pandemics lie ahead. Natives accounted for 82 of the documented deaths from the 1918 pandemic, even though they made up 48 percent of the then-territory’s population at the time. More recent waves of avian flu also disproportionately affected Natives. And Natives accounted for 28 percent of COVID-19 deaths through October 2021, though they comprise just 16 percent of the population now, according to state data. Because Alaska’s large waterfowl population makes avian flu a constant concern, epidemiologists are hoping that the infection control methods developed to control COVID can be quickly reinstated if other viruses threaten.
Stephen Simpson, Arkansas Democrat-Gazette
Stephen Simpson, a Capitol reporter for the Arkansas Democrat-Gazette, reported “The Great Delta Divide,” a four-story package on health disparities in the state’s rural Delta region, where economic disinvestment and out-migration of young people have left communities lacking needed services, including health care. In his first story, he reported on the barriers to health care in Arkansas’ Delta region, where many people live long distances from hospitals and specialists are few and far between. Residents are also more likely to have low incomes and chronic conditions, such as obesity, which have contributed to shorter lifespans. In his second story, he documented the population decline in most towns in the Delta over the past decade, while the Central and Northwest metropolitan areas of Arkansas were growing. His third story delved further into the reasons for the population decline, including the closure of the Blytheville Air Force Base in 1992, which led to an almost 50% decline in population, His fourth story reported on the high rates of depression in the Delta’s poorest counties, which are predominantly Black. “You see this trauma and depression just getting passed down from generation to generation, and I believe it’s affecting their health,” Dr. Valencia Andrew-Pirtle, a family medicine specialist in Blytheville told him. In a sidebar with that piece, a banker, George Makris Jr. expressed the view that declining infrastructure – health care, school systems and broadband – are holding back economic growth in Little Rock. For his final story, he interviewed community leaders about what the state government could do to help reverse the decline of the Delta. His project included a series of interactive graphs documenting lagging population growth in the Delta; health care shortages in the state; poverty in the Delta; food insecurity in the Delta; life expectancy in the Delta; and the high rate of COVID deaths in the Delta.
Center for Health Journalism Fund Grantees
Donnell Alexander, Capital & Main
The lucrative legal cannabis industry is projected to sell $64 billion worth of product by 2030 in the United States, but there’s intense jockeying over who will be part of the industry’s ownership class. For his National Fellowship project published in Capital & Main, Donnell Alexander explored troubling equity issues in the cannabis industry, and questioned whether enough is being done to ensure historically disenfranchised communities get a fair chance at becoming a part of the now-legal multi-billion dollar industry. Just 1.2%-1.7% of legal ownership is Black, Alexander notes. Alexander’s first story (written in the Gonzo journalism style synonymous with Hunter S. Thompson), ‘Legal Cannabis Opens a Pandora’s Box of Equity Issues,’ explores how the ‘Green Rush’ has consistently failed Black farmers across the United States, particularly in Florida. “Until recently the $1 billion Florida medical marijuana market has been in the clutches of a half-dozen companies, essentially an oligopoly,” Alexander writes. He tells the story through the eyes of Howard Gunn, a Black farmer who has been promised a license to grow cannabis in Florida more than five years ago, but still hasn’t received it. In his second piece, “Is Weed Equity in Florida a Pipe Dream,” which was co-published in Salon, Alexander focuses on corporate dispensaries and cannabis farmers, including Trulieve, a Canadian company that has become the United State’s largest medical marijuana company. The stark contrast between corporate dispensaries advertising exploiting Black culture and the lack of ownership representation is problematic, Alexander points out. “Black people in legal cannabis flirt with ubiquity in cannabis adverts, and have high visibility in both dispensary storefronts and delivery missions. Or, like the rappers who act as company faces, they’re fronting for a brand and receiving a licensing fee, not ownership.” In the third installment of his series, “Who Are We Talking About When We Talk About Black-Market Marijuana?” Alexander explores the financial challenges for obtaining licenses to sell cannabis legally, and the various state laws and onerous taxes that keep many legacy dealers operating underground, fueling an unabatting illegal cannabis market. In his fourth and final installment, “The Rocky Road for Black Cannabis Entrepreneurs, Past and Present,” Alexander tells the stories of unlicensed cannabis operators, many of whom are victims of a racist War on Drugs that has led to generational consequences. They face the irony of being locked out of building generational wealth by entering a licensed cannabis industry that they helped create. Less than two weeks after publication, Gov. Gavin Newsom’s Office of Business and Economic Development awarded $35 million in grant funding to local jurisdictions to support equity in California’s cannabis industry.
Krebs’ three-part series on the long-term effects of COVID-19 outbreaks at meat-packing plants on their largely immigrant workers, their families, communities and the industry ran December 15-17 on Iowa Public Radio and on the Side Effects Public Media Network, a Midwestern radio health collaboration. The stories were published in English, Spanish and Karen, a language spoken by immigrants from Myamar and Thailand. Natalie’s first story catalogued the devastation of COVID-19 on meatpackers — 59,000 workers infected in just the first year of the pandemic, with at least 269 deaths, more than from all meatpacking workplace accidents in the previous 15 years. While companies claim they took aggressive protective measures, Congressional investigators have found that companies pushed back against state and federal recommendations for coronavirus precautions early in the pandemic and “prioritized profits and production over worker safety, continuing to employ practices that led to crowded facilities in which the virus spread easily,” Krebs reported. Her second story described the demographics of the industry’s workers -- 38% foreign-born, more than twice the proportion of U.S. workers in general – and the disproportionate risks they faced from COVID-19 because of pre-existing conditions and barriers to health care. Her third story described the impact of the growth of the meatpacking industry in one Iowa town, Storm Lake, over two decades, when it went from being nearly all White to predominantly Hispanic and Asian, as well as the changes wrought by the pandemic. Krebs also produced a summary story for NPR’s Morning Edition, which ran on December 24, reaching a national audience of 14 million in more than 650 markets. In addition a colleague, Kassidy Arena, produced a companion piece in English and Spanish that profiled a Mexican American family in which every adult got COVID-19, most likely from exposure in a plant. (This unexpected extra story is an example of how our partnerships with media outlets can leverage additional investment by the outlet.) The family’s struggle to get public health information in Spanish and other community members’ inability to get vaccinated has prompted an adult son, Alejandro Murguia-Ortiz, a community organizer, to run for the state Senate. “I think people are seeing, you know, our structures or systems for what they truly are, and that they are oppressive and that they exist to be that way in many cases,” he said in the article.
Krebs teamed up with Tom Cullen, a reporter for Storm Lake Times, to hold a virtual forum on March 30, 2022 on "COVID and Worker Safety: How outbreaks at meatpacking plants have impacted their communities."
Sara Satullo, Lehigh Valley News
In an American narrative that could play out in virtually any city across the nation, Lehigh Valley News reporter Sara Satullo told the story of development, gentrification, rising rents and a community's struggle to save their neighborhood's rich character. That town of South Bethlehem, Pennsylvania, once a working class immigrant neighborhood supported by a local steel mill, has more recently captured the attention of high-end developers for its proximity to Lehigh University, a casino and a burgeoning arts district, Satullo writes in both English and Spanish the first part of her series, “Edged Out.” Since 2019, the median rent in South Bethlehem has spiked 34%, leaving legacy tenants grappling with how they will continue to afford their homes and small businesses. One community member decried the aggressive development in the largely Latino neighborhood as “white washing.” The series raises universal questions about how cities should handle development through an equity lens. In the second part of her series, Satullo explains how the changes to the real estate market have displaced lifelong residents. For example, Karen Saunders, a third-generation South Bethlehem resident whose grandfather first settled in the Slovakian enclave of town, said she felt forced to sell her home when Lehigh University — often cited as a top party school — erected a student housing unit on their street. Their neighborhood became overcrowded, raucous, and was incongruent with the environment where they wanted to raise their two children. They sold their home. “It broke my heart. It felt like I was taking a piece of her family tree away,” Saunders’ husband told Satullo. In the third installment, Satullo tells of the aggressive “block-busting” tactics developers deployed to buy up neighborhoods to convert to student housing, and offers a blueprint for coexistence among legacy residents and Lehigh University as more homes are sold off and used for student rentals. The fourth part of the series engaged with the community, sharing videos and stories from Southsiders talking about their experiences in South Bethlehem, what they love about their community and their concerns for the future. The final installment of Satullo’s series explores the real impacts of gentrification in communities: eviction. She highlights one example involving three school-aged children who were evicted from their home by the landlord while their mother was at work. For families like these, who make up one in four families in the Lehigh Valley, help is often out of reach. They are employed, and earning too much to qualify for government assistance, but too little to make ends meet. Her stories were picked up by local NPR affiliate WLVR. After the series ran, Satullo organized a community forum for Lehigh Valley residents to voice their concerns and hopes for South Bethlehem that was attended by community members and elected officials. The forum rose out of a desire among community members to talk with elected leaders in a format outside of formal town halls, where their voices carried an equal amount of weight.
Satullo's project led to an offer from Bethlehem Mayor J. William Reynolds to join his administration as deputy director of community and economic development. She starts May 4, 2022.
Letitia Stein, USA TODAY
National nursing home chain Trilogy Health Services was purchased by a California-based real estate venture promising a new business model for elder care. Instead, a first-of-its-kind USA TODAY analysis spearheaded by National Fellow Letitia Stein found it delivered some of the country's highest death rates during the COVID-19 pandemic. Residents at Trilogy’s 115 campuses died of COVID-19 at twice the national average for nursing homes in winter 2020, USA TODAY found. Trilogy officials challenge the analysis, saying they mistakenly overcounted and reported hundreds of deaths to the federal government. Even taking that into account, Trilogy would still be operating a nursing home chain with one of the worst death rates in the nation, Stein wrote. The USA TODAY analysis “revealed ownership webs invisible to consumers,” and problems across chains of nursing homes while federal investigators were focused on individual facilities. Stein and her colleagues deciphered quality, mortality, infection rate data and more to score the performance of every nursing home in the country “to probe questions of corporate responsibility left unanswered by dozens of research papers on COVID-19’s more than 140,000 nursing home deaths,” Stein wrote. This type of analysis isn’t available anywhere else, and reporters made the dataset interactive for the public to explore how nursing homes near them are scored. Through their analysis, they found that the high mortality rate at Trilogy nursing homes wasn’t driven by an older, more medically vulnerable residency. Instead, they found that Trilogy went further than any other major nursing home chain in the nation to cut staff hours, with staff hours spent with residents falling below federal recommendations. Paid hours per resident for nurses and aides fell by 13% over four years at facilities Trilogy operated. In contrast, nursing homes nationally cut 2% on average in that timeframe. Reducing labor is one of the few ways that nursing homes can increase their profits. Half of all Trilogy facilities were cited by health inspectors the first year of the pandemic, many for poor hand-washing practices among staff. “After learning of USA TODAY’s analysis, federal nursing home regulators said they need to collect better information about real estate ownership models like Trilogy’s,” Stein wrote, based on an interview she had in January with Centers for Medicare and Medicaid Services leaders. A week ahead of publication, President Joe Biden announced reforms to track problem owners across states and shed light on how Wall Street profits from nursing homes, Stein wrote.
In a separate piece, "Lives Lost to the Pandemic in Trilogy Nursing Homes," Gannett reporters in the four states in which Trilogy operates contributed profiles of 14 of the residents who died from COVID, and USA Today published a digital "memorial wall" on which loved ones could enter remembrances of loved ones who died of COVID while in a nursing home. USA Today's package also included an interactive feature through which readers could look up the records of nursing homes, and a piece explaining to readers how to go about choosing a safe nursing home.
American Healthcare REIT, which owns Trilogy, told USA Today that the numbers it gave the federal government were wrong and included deaths that shouldn't have been attributed to COVID, an explanation that USA Today couldn't substantiate. In an op ed published in USA Today, Dr. David Gifford, a geriatrician who is the chief medical officer at the American Health Care Association and the National Center for Assisted Living, criticized the USA Today project for blaming nursing homes for residents' deaths from COVID. "Together, let’s focus on meaningful solutions that can improve the care residents receive and encourage policymakers to prioritize long term care for the resources our nation’s seniors deserve," he wrote.
Early Impacts: After the project published, U.S. Rep. Bobby Rush, D-Ill, cited USA Today's reporting in a scathing letter in which he called for Congressional investigations and reforms of the nursing home industry— particularly “profiteering, cold-hearted” corporations that act as landlords in the industry, he wrote, USA TODAY reported. “It is up to Congress … to shine a bright light on the current practices, to reign them in, and to set and strictly enforce high standards for performance,” Rush wrote to the chair of the House Oversight Committee. “It is Congress’s job to stand in-between greedy corporations and those who are the most defenseless.” And the day after the project ran, senior health policy advisers to President Joe Biden cited it as evidence of a troubled industry urgently in need of reform to crack down on poor performers and profiteering. They told USA TODAY that they were discussing reforms with the Centers for Medicare and Medicaid Services at the Department of Health and Human Services that can be enacted through administrative action after a rulemaking process, as well as other reforms that would require Congressional approval.
In another development stemming from Stein’s project, federal regulators said they would review the number of COVID deaths at nursing homes operated by Trilogy Health Services, the subject of the USATODAY investigation after the company cut its reported death toll by 42 percent. “CMS takes reports of data inaccuracy very seriously and will hold any bad actors accountable,” Dr. Lee Fleisher, the agency’s director of clinical standards and quality, wrote in an emailed statement. Based on Trilogy’s report to the federal government of 772 deaths at 113 facilities from October 2020 through February 2021, USATODAY had calculated that it had the worst death rate of any nursing home. After USATODAY presented its findings to Trilogy officials, they countered that their initial numbers were wrong and that there were just 325 deaths, which give Trilogy the third-highest rate among the 10 largest nursing home chains.
Casey Toner, Jared Rutecki and Frank Main, Better Government Association and Chicago Sun-Times
In Chicago, thousands of people are arrested every year for low-level drug possession, but because of an unwritten rule in the courts, most of their cases are dismissed. That doesn’t mean, however, that they don’t see jail time or that their lives aren’t upheaved because of it. Thanks to the support of the 2021 Center for Health Journalism National Fellowship, the Chicago Sun-Times and the Better Government Association joined together in a collaborative reporting effort. In "Dead-End Drug Arrests," reporters Frank Main, Casey Toner and Jared Rutecki delved into the seemingly unending churn of low-level drug possession arrests that clog courts, cost taxpayers tens of millions of dollars and leave those arrested often jailed, jobless and sometimes homeless. The arrests disproportionately impact communities of color. Oftentimes, those arrested are carrying less than a gram of heroin or cocaine, an amount weighing less than a paperclip. Judges and prosecutors say they’re reluctant to clog courtrooms and jails with people caught carrying a thimble-full of heroin or cocaine. Despite that, police officers say they are obligated to arrest them for felony possession. Compounding the problem in Illinois, it’s police officers — and not prosecutors —who decide whether to pursue criminal charges, a provision of the felony review process created to ease the burden on state’s attorneys. In a single five-year period between 2013 and 2018, reporters found these types of arrests cost Cook County taxpayers $100M to jail low-level drug offenders, not including medical care. It cost those arrested even more. Dan Galloway, for example, was arrested for possession of 0.2 grams of heroin, which he described as “dust.” “I was, like, ‘Y’all taking me to jail for this?’” Galloway said. The result of his arrest? A stay in a halfway house, jail time, the loss of his job and six months income and a felony on his record. If Galloway were stopped in Oregon, it would have been a different outcome, Main, Toner and Rutecki show in the second part of their series. That’s because of a new Oregon law — the first in the nation — making possession of small amounts of drugs, such as heroin, cocaine and methamphetamine, into the equivalent of a minor traffic infraction. Additionally, it steers millions of dollars toward expanding substance use treatment. Since the law went into effect in February, officers have written 1,300 tickets for possession, steering them away from courts and jails. A review of the program, however, shows just seven of those 1,300 ticketed have followed-up for treatment. In a sidebar to their series, they told the heartbreaking story of Juan Johnson, States’ Attorney Kim Foxx’s ex-trainer who fell into a life of heroin addiction, illustrating the pervasive reach of substance-use disorder in Chicago’s westside.
The reporters discussed their findings on several Chicago radio and TV shows. On December 8, 2021, they held a virtual forum on Youtube and Facebook featuring drug and criminal justice experts discussing their findings and the history of the nation's drug laws. Based on the trio's reporting, the editorial board of the Chicago Sun-Times called for an end to arrests for people possessing small amounts of drugs. "Year after year, the Illinois system has marched along, throwing people into jail without providing a solution to the scourge of drugs and drug crime," the editorial stated. "More of the same is not an answer." In an op ed published in the Sun-Times, Joel K. Johnson, president and CEO of TASC, which provides substance use and mental health assessment, and Jac A. Charlier, executive director of the Police, Treatment, and Community Collaborative, cited the project in calling for replacing the current system with a reform called "deflection" in which people with substance use and mental health disorders are deflected away from the criminal justice system and connected to evidence-based treatment, harm reduction, recovery and prevention services.
Early Impacts and Recognition:
2021 National Fellows Frank Main, Casey Toner and Jared Rutecki reported a story for the Chicago Sun-Times and the Better Government Association about a new law that addresses the central issue they explored in their Fellowship project: the jailing of thousands of Chicagoans, mostly people of color, because of arrests for minor drug charges that were rarely prosecuted. The jailings disrupted people’s lives and often cost them their jobs, child custody and sometimes their homes, even though most charges were ultimately dismissed. Under the new law, a police officer who catches people with small amounts of drugs will have discretion to release them with a citation that orders them to show up in court on a specific date within 21 days. Cook County Public Defender Sharone Mitchell Jr. told the reporters that the Pretrial Fairness Act “takes an important step to remedy the harms of the short jail stays documented in your article by allowing police to release people accused of simple drug possession from their custody without detaining them for up to two days in order to send them to court.” Other impacts from the project: Following its publication, Chicago Police doubled the quantity of drugs that a person could be in possession of to qualify for the drug diversion program that keeps people out of the criminal justice system - from one gram to two. That represents the vast majority of possession charges in Illinois, and it means that many, many more people will avoid jail stays that could have cost them their jobs or homes. The reporters hosted three separate educational events with community members, politicians and experts to spread the message. One event was at a harm reduction open house in one of the neighborhoods highlighted in their stories. Their project won two National Awards – a National Association for Black Journalists “Salute to Excellence” Award for series reporting and a SPJ Sigma Delta Chi Award for non-deadline reporting.HB 3447, a bill introduced in the Illinois Legislature in 2022 would defelonize possession of small amounts of illegal drugs. It would reclassify small amounts of drug possession, including heroin and cocaine, from low- level felonies to a misdemeanor. The Illinois House passed a similar bill in 2021, but the Senate did not vote on it. Legislators have told the reporters that their project will help build legislative support for the measure and that a vote is expected after the November 2022 general election. The reporting has been recognized with the SPJ Sigma Delta Chi Award for Non-Deadline Reporting and the NABJ Award for a series from a newsroom of 51-100.