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hen Harlem Hospital Center's Dr. Barbara Barlow started a program in the mid-1970s to reduce injuries among Harlem children, it was unclear whether she would succeed. She asked foundations and other charitable institutions at the time to help fund the initiative but initially got nowhere.

"I wrote grant proposals for seven years," recalls Dr. Barlow, director of surgery at Harlem Hospital Center and professor of clinical surgery at P&S. "Some grantors turned me down because I didn't live in the community. Others said the problem was much too big for us to make any difference."

Now, when asked what those same people say today, Dr. Barlow smiles. "As you can see, I've won a lot of awards," she says, glancing at an array of recognition dotting her Harlem office. From there, Dr. Barlow oversees what is now a national program she founded in 1988, the Injury Free Coalition for Kids (www.injuryfree.org). The organization is built upon a pilot program she started in Harlem Hospital in 1981, which focused on promoting window guard use to prevent falls.

Dr. Barlow prefers to measure success not by awards, but by a reduced number of accidents among children. There has been a staggering decrease in injuries to children living in central Harlem since 1988, when Dr. Barlow also created the Harlem Hospital Injury Prevention Program. And Dr. Barlow has made such a convincing case that the project is indeed responsible for reducing injuries that children's hospitals in eight sites throughout the country are setting up similar programs.

In August, the coalition received a $15 million grant to expand to 40 cities nationwide. The first grant in 1988 was for only $125,000.

The methodology is simple: Spread safety advice to parents and children and channel children away from the streets into safe, healthy environments. To support these goals, the program contains a number of smaller initiatives, such as building new playgrounds and creating art and sports programs for children.

Since the local chapter's founding in 1988, Harlem has seen a 55 percent reduction in injuries requiring hospitalization, a 95 percent decrease in window falls, 61 percent fewer suicide attempts, a 46 percent drop in violent injuries, and a 50 percent reduction in motor vehicle and bicycle injuries, Dr. Barlow says.

To verify that the prevention program, and not other factors, is responsible for injury reductions, Dr. Barlow's team has shown the declines have been strongest in specific geographic areas and in types of problems on which the effort focused.

The program's success is such that "people can hardly believe it," says Dr. Arthur Cooper, director of pediatric surgical services at Harlem Hospital and a close friend and colleague of Dr. Barlow's for 18 years. "They're awestruck," he says. "They look at what she's been able to accomplish, then they just sit back and say 'wow.'"

Her success explains why last year Dr. Barlow won the sixth annual David E. Rogers Award given by the Association of American Medical Colleges and the Robert Wood Johnson Foundation. The award is given to a medical school faculty member who strongly contributes to the health and healthcare of Americans.

"One of the things that really struck us," said the award committee's chairman, Dr. Robert M. D'Alessandri, "was the recommendation from the leadership and staff of Harlem Hospital. They talked about her work there, her commitment and compassion." Dr. D'Alessandri is vice president for health sciences and dean of the medical school at West Virginia University, in Morgantown.

Dr. Barlow and colleagues began the pilot program in Harlem after noticing an appalling increase in injuries among local children, including stab wounds, window falls, and gunshot wounds. "When I saw what was happening to the children, I felt we had to do something," she recalls.

Dr. Barlow and a handful of colleagues spent five years in the 1980s developing a child injury database, the Northern Manhattan Injury Surveillance System, which provides information about when and how injury occurs. The information is gleaned from a state health department database.

Dr. Barlow's team used this work as a basis to obtain a first grant in 1988 from the Johnson foundation, which has since been the project's main financial backer. Next they worked with community groups to build or rebuild playgrounds in Harlem.

"There was skepticism," Dr. Barlow says. "People thought the new playgrounds would be vandalized and destroyed. But we worked with Manhattan District Attorney [Robert] Morgenthau to keep the drug dealers away from the playgrounds." The coalition built or renovated 45 playgrounds in Harlem, replacing dangerous or drug-infested lots with safe, bright play places with murals painted by community children.

The coalition has spread its model to eight other cities—Chicago, Kansas City, Pittsburgh, Los Angeles, St. Louis, Atlanta, Philadelphia, and Dallas. With the new grant, the model will be spread to 40 children's hospitals.

While the methodology differs at each site, each site collects statistics on local children's injury rates, measuring how the rates change after prevention projects are put in place. Injury patterns identified this way guide future prevention efforts.

Pittsburgh's Allegheny General Hospital, which became the first replication site in 1994, documented widespread drops in injuries locally three years later, including a 50 percent decrease in gunshot wounds and a 30 percent drop in car accidents.

Dr. Barlow, 63, has no plans to slow down. She intends to launch a new effort to promote the use of window guards nationally. "Children fall out of the windows all the time," Dr. Barlow says. "There is still so much more work to do to protect kids—we really are just getting started."

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