Injury is the leading cause of childhood morbidity, hospital admissions and mortality in the United States. Even so, few communities and fewer trauma centers have mounted efforts to prevent this significant health problem. Moreover, hospital administrators rarely accept responsibility for either improving community health or preventing injuries.

A decade ago, it was established that childhood injury rates in Harlem were substantially higher than national rates, as well as rates in most other New York City communities. Barbara Barlow, M.D., Director of Pediatric Surgical Services at Harlem Hospital since 1975 and Professor of Clinical Surgery at the College of Physicians and Surgeons of Columbia University, had a vision to change this.

The Robert Wood Johnson Foundation (RWJF) (ID#s 013396 and 014056) funded a four-year trial program, the Harlem Hospital Injury Prevention Program (HHIPP).

Key Results of the Trial Program
HHIPP demonstrated that:

• A hospital-based program designed to provide safety education, safe play areas, and extracurricular activities could markedly reduce childhood injuries and hospital visits.
• Through ongoing injury surveillance data there is evidence that HHIPP activities produced a 41 percent decrease in child injury admissions to Harlem Hospital for the five-year period 1988–1992, compared to 1983–1988 baseline data.

HHIPP also showed that such a program could produce savings in health care dollars, contribute to development of young people's skills and self-esteem and enhance a community's overall feeling of well-being.

The Expanded Program
The 1994 to 1998 national initiative, Dissemination of a Model Injury Prevention Program — recently renamed Injury Free Coalition for Kids — grew out of HHIPP's experience from 1988 to 1992. HHIPP was seen as a model hospital-based, community program that could be replicated at other inner-city sites nationwide.

Core activities of HHIPP included building community coalitions to reconstruct numerous park and school playgrounds in Harlem; initiating and supporting supervised activities in art, dance, cycling, Little League baseball and soccer; and providing educational programs in bike and street safety, firearm dangers, violence prevention, and motor vehicle safety.

On April 7, 1994, a presentation to RWJF's Board of Trustees cited HHIPP's success and proposed a grant to replicate the HHIPP model in five cities nationally that have high child injury rates. The three-year $1,143,657 grant (ID# 023514) was extended for a fourth year, through June 1998.

In supporting the initiative, the Foundation Board presentation observed that HHIPP addressed "one of the most serious, persistent, and under-recognized child health problems in the country." When RWJF Program Officer Michael Beachler approached Barlow in 1994 about expanding the program with hospital-based sites in other U.S. cities, they worked together to develop the proposal to the Foundation.

Upon receiving funding, selected sites at pediatric trauma centers in five cities: Pittsburgh, Chicago, Kansas City, Atlanta, and Torrance, Calif. Most sites were provided with $120,000 in funding over three years. Torrance received $80,000 for two years.

Interest earned on the $1.1 million grant was used to provide half-funding for a sixth site in St. Louis, and to extend the lives of the sites in Pittsburgh, Chicago, and Kansas City with $10,000 each for an additional six months.

A seventh site, in Philadelphia, began in 1998 with technical assistance only and in 1999 received funding; eighth site was started in Dallas in 1999 by the director of Torrance, Calif., site, and receives technical assistance only. Five of the sites are in children's hospitals and three in general hospitals.

Key Results of the Expansion Sites
While using the Harlem program's blueprint as a basis for their activities, each expansion site developed its own response to childhood injury after identifying community needs based on childhood injury data for the local region.

During the grant period, injury control centers were established in the hospital pediatric trauma centers in all seven cities. Each received institutional support from the hospital.

Other accomplishments included:

• Development of injury surveillance systems which did not previously exist at any expansion site.
• Formation of community-oriented injury prevention coalitions. Five of six sites had never worked outside the hospital on injury control.
• Creation of educational injury control activities based on local injury data.
• Initiation of programs to physically and socially improve the community to make it safer for children.
• Evaluation of the new interventions to assess their effectiveness in injury reduction.
• Reduction in injury.
• Leveraging other funding sources.
• National attention through press coverage, awards and recognition from national medical organizations, medical journals, and national and local newspapers.

National Network: Injury Free Coalitions for Kids
In July 1998, the Foundation's Board approved a new $3 million grant (ID# 032588) for development of a national network and technical assistance center on pediatric injury prevention. The network and center are working with the expansion sites to help them become institutionalized in their hospitals and allow for them to further develop their programs.

Under this grant, a trademarked network, Injury Free Coalitions for Kids, has been developed. Each site is developing letterhead based on the trademark. The Coalition is planning five minute promotional videos and has established a Web site.

Technical Assistance is being provided to four new sites: Johns Hopkins Medical Center, Akron Children's Hospital, University of Miami, and Babies Hospital at Columbia Presbyterian Medical Center.