Agency-wide Achievements

NMPP is a community-based maternal and child health agency serving the various communities of Northern Manhattan for eighteen years. Our mission is to save babies and help women and men take charge of their reproductive, social and economic lives. We achieve this mission by offering over twenty-two programs that helps reduce the target area’s infant mortality rate and improve the community’s overall health. NMPP serves the needs of women of childbearing age (12-44) in Washington Heights, East, Central and West Harlem.

In East Harlem, we serve primarily Mexican, Puerto Rican and African-American women and their family members. In Central Harlem our target populations are African-American and Puerto Rican teens, pregnant and parenting women and men. In Washington Heights, NMPP has a large early childhood operation that delivers Head Start and Universal Pre-Kindergarten services to a West African and Dominican population of over 250 children and their family members. NMPP hires a diverse staff that is culturally competent in meeting the health and social service needs of various ethnicities and class formations.

NMPP is also a HRSA/MCHB grantee agency (for 16 years) for the Central Healthy Start Program in Harlem. The agency has case managed over 10,000 pregnant and parenting women since its inception. NMPP has managed to reduce Central Harlem’s infant mortality rate from a high of 27.7 deaths per one thousand live births in 1990 to 8.1 deaths by 2007.

Two years ago, HRSA/MCHB designated NMPP as a National Center of Excellence in delivering perinatal case management services and reducing racial disparities in birth outcomes among pregnant and parenting African American and Latina mothers. The agency has six perinatal case management programs, a fatherhood case management program and delivers center-based Head Start services to over 250 children in Northern Manhattan. The agency is known for its effective asthma/immunization, healthcare access, anti-smoking and obesity prevention programs.

NMPP has three income-producing businesses as part of its structure that helps the agency meet new MCH challenges. In 1997, NMPP started the Social Health Marketing Group (SHMG) which is a cutting edge marketing entity serving the business communications needs of hospitals, community based agencies and small businesses. Over the last ten years, the SHMG has launched many award winning campaigns for state governments, health departments and nonprofits that helped these entities position their public health messages to segmented client markets and moved them to change their consciousness as well as their health behaviors. Over the last three years, the SHMG produced a profit of $700,000 that was reinvested into NMPP’s general fund.
Recently, Mr. Drummonds and Dr. Michael Lu were asked to be consultants to the State of Wisconsin to help them market the concept of interconceptional care to women of childbearing age throughout the state.

Last year, NMPP started up Practice Matters, a full-service management consulting business after HRSA/MCHB asked NMPP/CHHS to consult with health departments and Healthy Start programs across the country to help them improve their direct practice and systems change infrastructures to reduce racial disparities in birth outcomes. There were so many consulting assignments that NMPP had to create a business structure to meet the demand for service.

On September 7, 1998, NMPP opened Harlem Works, a full service technology/job readiness-learning center that has trained over 1,300 pregnant and parenting women and placed them in full-time jobs throughout NYC. Finally, the New York Nonprofit Press Newspaper designated NMPP the Agency of the Month in February 2007 for our work reducing infant mortality and managing the health of women in Harlem from the womb to the tomb.

NMPP Specific Achievements

* By early 2007, Harlem Hospital increased their market share of enrolled pregnant women by 25 percent at the Birthing Center.
* Harlem Hospital decreased patient wait times within the entire labor and delivery department by 20 percent from 2005 to 2007.
* By 2005, Harlem Hospital was designated a Level 3 hospital by the New York State Department of Health’s Regionalization of Perinatal Care Committee. A Level 3 designation is the second highest level a hospital could be designated before being a Regional Perinatal Center.
* As a result of the marketing and quality improvement work achieved above, NYC Mayor Michael Bloomberg allocated $250 million dollars in 2005 to Harlem Hospital to build a brand new hospital.
* As a result of implementing our women’s health strategy and programs outlined above, HRSA/MCHB designated the Central Harlem Healthy Start program as a Center of Excellence and NMPP senior managers have been asked to consult with other Healthy Start programs across the country to implement similar clinical and organizational change solutions in several cities.
* NMPP received an award in 2005 from the National Alliance for the Mentally Ill of New York City Metro, Inc., for Achievement in Family Services and Education. The award was given for our effective anti-stigma marketing campaign in Harlem to enroll more depressed women into care. The award stated that “NMPP provides crucial services to women and children in Harlem and Washington Heights and has been a pioneer in examining the root causes of stress and depression in pregnant and parenting African American women.”
* In February 2007, the New York Nonprofit Press Newspaper designated NMPP as the Agency of the Month for our effective financial and programmatic management of MCH programs that produces results for mothers and babies throughout the Harlem community.
* Finally, in July 2008, Harlem Hospital was the first hospital in NYC to receive the coveted “Baby Friendly” certification granted by Baby Friendly USA, part of a global initiative sponsored by the World Health Organization (WHO) and United Nation Children’s Fund (UNICEF).

As a result of the achievements outlined above, NMPP’s and Harlem Hospital’s management teams improved their marketing core competencies. In addition, Harlem Hospital developed a customer-focused and marketing mindset after two and half years of effective practice. The infant mortality and low birth weight rates declined in Harlem during this period thus improving the overall public’s health since infant mortality has historically been used as a measure of a locality’s overall well being. For NMPP’s leadership team, this consulting experience improved our skill sets working with large hospitals and prepared us to start-up in 2007 our own management consulting firm, Practice Matters to complete more assignments like this around the country.

Consumers at the hospital service satisfaction scores improved because the quality and timeliness of the services delivered to them increased five-fold and how they were engaged interpersonally also improved. Staff from both agencies finally understood their patients are their lifeline and that patients should be treated like human beings and valued.

CHHS Achievements

Central Harlem Healthy Start (CHHS) program is committed to reducing racial disparities in birth outcomes and improving family health status in Central Harlem. CHHS implements outreach, case management, perinatal depression screening, interconceptional and health education services. In addition, CHHS implements health systems change interventions to reduce excess infant mortality and low birth weight rates in Central Harlem.

The infant mortality rate (IMR) in Central Harlem from 2003 to 2007 significantly declined since the initiation of the Central Harlem Healthy Start program in 1990 when it was at 27.7 infant deaths per 1,000 live births.  The IMR was at a low of 5.2 in 2004, 7.8 in 2005 and in 2006 the rate increased to 11.0 infant deaths per 1,000 live births. By 2007, however, it dropped to 8.1 infant deaths per 1,000 live births. From 2000 to 2007, five out of the seven years where vital statistics data is known, Central Harlem’s infant mortality rate was below 10 deaths per one thousand deaths.

Our robust comprehensive case management services link high-risk women with access to both needed health services and social support services. These linkages are especially important for Central Harlem high-risk women. Linking high-risk pregnant and parenting families with services to meet their needs provides them with economic, social and mental health supports which serve to decrease their stress level and promote healthy birth outcomes.

In 1990 only 25 percent of Harlem-based pregnant women entered prenatal care in the first trimester. By 2005, 90.6 percent of mothers in Central Harlem received early prenatal care. As a result of this, CHHS has targeted the remaining 9.4 percent of the population that has proven to be of high-risk nature. In 2007, 72 percent of the high-risk mothers within the Central Harlem Healthy Start program received early prenatal care.

We recorded thirty-seven ( 37) deliveries among our clients in 2007 with zero (0) low birth weight singleton infants. One hundred-ninety two (192) children received comprehensive case management services. Seventy-nine percent of our infants and toddlers had up-to-date immunizations. Seventy-nine percent of our infants/toddlers enrolled with pediatricians and 84% of the moms were enrolled in primary care.

In response to the statewide survey on the extent of screening for depression by perinatal providers, during 2007 NMPP/CHHS, through its work on the Harlem Strategic Action Committee, offered grand rounds via web cast on perinatal depression in hospitals and health centers that serve Central Harlem. In addition, we mounted a social marketing campaign to reduce the stigma associated with mental illness in 2006 and continued to spread these efforts to address all of these issues in 2007. CHHS sponsored several perinatal depression grand round lectures and web casts. To date, over 600 providers have been trained to screen, diagnose and treat perinatal mood disorders.

Starting in 1999, CHHS began the work to plan, build and staff a birthing center with Harlem Hospital. Over two million dollars was raised and on September 7, 2003, the birthing center at Harlem Hospital opened. As a result of our quality work with the hospital, Mayor Bloomberg allocated 250 million dollars to build a new hospital and during the month of August 2008, Harlem Hospital was designated a “Baby Friendly” hospital.

Finally, starting in 2000, staff from the Central Harlem Healthy Start led a citywide public health movement that convinced two Republican Mayors to invest 70 million city tax-levy dollars in forty-five community based MCH organizations throughout NYC to reduce racial disparities in birth outcomes. This model of MCH systems change is being replicated in Illinois, Nebraska, Texas, Indiana and Tennessee. NMPP/CHHS started a management consulting firm called Practice Matters in 2007 to assist and guide other Healthy Start programs around the nation to achieve better birth outcomes through implementing a life course strategy.

Contextual Changes and Program Accomplishments

The population, community and national context or environment in which the program
operated underwent significant changes in the recent past. Demographics of the Harlem
area became more diversified while development and gentrification of the community
continued at an accelerated pace, further aggravating the availability of low-income housing
for our participants. The Healthy Start Initiative program, due to flat federal funding and
rising inflation costs, and many other community health and human services continued to be inadequately funded. Nevertheless, some of our partners achieved some increases in
community resources, for instance through the Harlem Strategic Action Committee.

Implementation of core services and system building interventions generally remained
faithful to the CHHS program model. The program experienced some anticipated barriers to program implementation. For example, staff turnover occurred particularly at the program evaluator, consortium manager, program assistant and case manager levels. Participant rate of response to the client feedback survey was lower than expected as well. Consumer involvement in consortium activities was sometimes low but sometimes gained momentum. Program implementation was nonetheless facilitated by increased oversight activity and expertise of the parent agency board of directors.

The program achieved most of its expected outcomes of the periods. It successfully met its target of recruiting and serving 200 participants annually. Monthly and quarterly monitoring of program statistical output facilitated in meeting service targets. On the system side, program leadership on the Manhattan Regional Perinatal Forum resulted in better-coordinated services in the target area. A challenge emerging from program organizing activities was the inadequate awareness on the part of the community of the urgency of its high infant mortality rate associated with unhealthy life choices.

Community birth outcome statistics showed wide fluctuation in rates from year to year but there were broad trends: the infant mortality rate, which dramatically declined in the early years of the program, saw marked rise later due to increased social and health challenges faced by area residents. Nevertheless, we believe that the health service system sector is becoming better coordinated, community residents are more aware of women’s health issues and maternal mental health problems are being addressed.

Changes in Target Area Birth Outcome

In Phase 3 (2001 to 2005) of the program, CHHS met its overall objective of helping to reduce the infant mortality rate in the target area by 50 percent by the end of the program period. The infant mortality rate in the target area at the start of the period in 1999 was 15.5 and by 2004 was 5.1, a reduction of 67.1 percent. By comparison, the city IMR decreased by 12 percent, from 6.9 to 6.1 for the same period. Similarly, neonatal (less than 28 days) mortality rate for the area declined by 66 percent from 12.4 in 1999 to 4.2 in 2003, compared to a 10 percent decline in the city rate from 6.9 to 6.1

In Phase 4 (2005 to 2009) of the program, CHHS established a goal of reducing the infant mortality rate in Central Harlem to less than 7 deaths per 1000 live births. It is unclear whether this goal will be met since the program period has not ended and data is available from the local department of health only up to 2006 at this time. So far, in spite of our best efforts and those of our partners, the infant mortality rate for Central Harlem increased by 120 percent from 5.1 in 2004 to 11.2 percent in 2006 and the neonatal mortality rate increased by 137 percent over the same period. By comparison, the city IMR decreased slightly from 6.1 to 5.9 over the same period.

Changes in Central Harlem Birth Outcome, 2002-2006

2002 2006 Change (N) Change
(%)
Live births 1934 1965 31 1.6
Infant deaths 12 22 10 83.3
Infant mortality rate 6.2 11.2 5 80.6
Neonatal mortality rate 3.1 7.1 4 129.0
Low birth weight rate (%) 10.8 12.4 2 14.8
Late or no prenatal care (%) 10.4 9.9 (1) (4.8)

Program Hypothesis Findings

CHHS tested two hypotheses. The first hypothesis was that high-risk women who participate in our case management and other core services will have lower infant mortality rates, fewer low birth weight births, and fewer pre-term deliveries than Central Harlem resident women will as a whole.

In 2003, the finding was that CHHS had no infant deaths among participants live births compared to an infant mortality rate of 4.2 per 1,000 live births for Central Harlem residents. Our participant infant low birth rate was 3.1 percent of live births compared to 11.1 percent in 2003 for area residents. Our participant infant pre-term rate was 9.9 percent compared to 12.0 percent in 2003 for area residents.

In 2006, the second of five program years, the finding was that CHHS had no infant deaths compared to an infant mortality rate of 11.2 per 1,000 live births in 2006 for Central Harlem residents. Our participant infant low birth rate was 5.4 percent of live births compared to 12.4 percent in 2003 for area residents.

Target Area and Program Participant Birth Outcome, 2002-2006

CHHS Pre-natal Participants Central Harlem Residents
2002 2006 2002 2006
Live Births 42 37 1,934 1,965
Infant Mortality Rate 0.0 0.0 6.2 11.2
Low Birth Weight (%) 3.0 5.4 10.8 12.4

The second program hypothesis was that to reduce infant mortality our local perinatal health care system must be substantially transformed. During each program period, CHHS consistently demonstrated, through qualitative data, clear evidence that the perinatal health care system in Central Harlem is undergoing substantial transformation.

Each year CHHS conducts a massive public relations and social marketing campaign that make infant mortality reduction in Harlem and throughout NYC the number one public health and political issue. CHHS conducts annual citywide infant mortality conferences that mobilized MCH activists from across NYC to address the problem. The advocacy team meets with decision makers from the Mayor’s office and City Council leadership to inform them about their budget and policy development role in reducing infant mortality in Central Harlem.

CHHS plays an instrumental role in creating the Citywide Coalition to End Infant Mortality organization that leads an advocacy campaign to secured since 2001over seventy million dollars from the Mayor’s office and New York City Council. The CHHS program collaborates with its elected officials and senior staff from Harlem Hospital in opening a birthing center in the target area. CHHS provides health education messages to community residents, consortium members, health care providers and the general population using a variety of strategies, each tailored to the educational level and interests of participants.

Performance Measures, 2006

PM# Performance Measure Objective Indicator
7 Family Participation 15 16
10 Cultural Competence 58 64
17 Children Medical Home 95 56
20 Women Medical Home 95 52
21 Completed Referral 56.2 61.3
22 Risk Factor Screening 57 43
35 Comprehensive Systems 26 26
36 Prenatal Care Visit 80 75
50 Very Low Birth Weight 4 5.4
51 Low Birth Weight 7 5.4
52 Infant Mortality 7 0
53 Neonatal Mortality 4 0
54 Post-Neonatal Mortality 3 0
55 Perinatal Mortality 28 0

Progress in Core Service Activities

As testament to its high level of quality program services, CHHS was selected by HRSA as a best practices model for replication by other Healthy Start Initiative programs across the country. The Chicago Regional Office of Performance Review is developing the replication document.

The strategic outreach activities of our CHHS team have been successful in recruiting pregnant and parenting women at high risk for poor birth outcome. Recruitment was targeted at area residents who were living in homeless shelters, experiencing domestic violence, using illicit substances and were once formerly incarcerated. Most were African Americans consistent with the area’s racial composition but we also reached out to West Africans, Latinos and Asians.

Our robust comprehensive case management services linked high-risk women with access to both needed health services and social support services. These linkages were especially important for teenagers, recent immigrants, victims of domestic violence and women recently released from incarceration. Linking high risk pregnant and parenting families with services to meet their needs provided them with economic, social and mental health supports which serve to decrease their maternal risk level and promote healthy birth outcomes.

Participants Served, 2002-2006

Participant Type
Number Served
Families served
975
Pregnant participants served
419
Interconceptional women served
589
Children served
550
Male served
83

Having a multilayered health education program provided us the opportunity to educate our clients either in their homes, while being escorted to services, awaiting services, as well as one-on-one or in groups in our office. In addition, our trips to the grocery store, participation in the annual Breast Feeding Awareness Day and other special events and conferences sponsored by CHHS and NMPP reinforced our health promotion messages within the community.

Our public education and social marketing campaigns have been particularly useful in educating community residents in the ways they can assist pregnant and parenting families in being healthy, safe and feeling protected. This is accomplished through presentations before community groups and at community health fairs.

We responded to the statewide survey on the extent of screening for depression by perinatal providers, through collaboration with the Harlem Strategic Action Committee, by offering grand rounds to service providers on detection and treatment of perinatal depression in local hospitals and health centers that serve Central Harlem. We also mounted a large social marketing campaign to reduce the stigma associated with mental illness. Our case managers continued to screen incoming participants for depression and refer those testing positive to mental health specialists for further intervention.

Services Utilized, 2002-2006

Core Service Number Served
Outreach 968
Case Management 924
Health Education 750
Depression Screening 790
Male Services 138
Harlem Works (Skills Training) 82

The consortium manager initiated a fatherhood program called the Mankind Program funded by the Department of Youth and Community Development. The program sought to promote positive involvement of low income, non-custodial fathers in the lives of their children and help facilitate their economic support of their children. Two social work interns from the Children of the World Community Program conducted street outreach, did tabling, distributed fliers and developed a questionnaire to survey the special needs of men.

Two case managers were later hired to provide social services to program participants and initially they conducted recruitment and developed a community resource guide. They established working relationship with other community providers such as Strive, Exodus, Global Business Institute and Bethel Gospel Assemble Church, Family Court, and barbershops. Thirteen fathers have been enrolled in the program that followed a case management approach. Two workshops were conducted: the first workshop, “Reversing the Hustle”, addressed how to positively utilize street skills to gain employment. The second workshop, “The Big Payback: The Other Side of Child Support” addressed legal aspects of child support.

Progress on System of Care

* Collaboration between target area institutional and community-based perinatal providers increased steadily over the periods through developing memorandum of agreements between entities and providing leadership in coalitions such as the Manhattan Regional Perinatal Forum.

* Local MCH providers became more aware of perinatal depression through professional training and media information campaign conducted by the CHHS Consortium.

* CHHS organized a male involvement consortium through collaboration with other providers of male services resulting in increased job opportunities and career workshops to area residents.

* CHHS increased involvement by local community residents/leaders in addressing perinatal issues through the establishment of a consumer involvement organization, outreach to local churches and a beautician initiative.
* CHHS increased the cultural competence of local MCH providers by raising their awareness of cultural issues of subpopulations and assisting them in meeting the health care needs of West African immigrants.

* CHHS improved the quality of the birthing experience for mothers who deliver at the local public hospital by assisting in the establishment of a birthing center at the hospital with enhanced services including mid-wife services.

* Community residents became more knowledgeable about available community resources and were able to better access resources because of CHHS case management, and health education and outreach services.

* Key CHHS consumers took an active role in advocating for funding of MCH services and policy changes at local public conferences, the local city council and the U.S. Congress.

* Job readiness and opportunities were created in the community through annual job fairs, a computer-training program and the hiring of residents by this agency.

* The state and the program collaborated in creating and implementing a strategic action plan to improve maternal and child health in northern Manhattan through the work of the Manhattan Regional Perinatal Forum and other initiatives.

* The city and the program collaborated in reducing the high rate of infant mortality in the target area through the work of the Harlem Strategic Action Committee on Infant and Maternal Mortality and other initiatives.

Human Resources

The most significant challenge in the management and governance of the program related to ensuring adequate and appropriate staffing of the program. The Healthy Start Initiative application submitted to HRSA for continuation of CHHS requested a budget of 1 million dollars; however, $875,000 was received. No adjustment was made in staffing or deliverables for this 12.5 percent reduction in funding. In order to retain the initial staffing proposal, other budget lines were reduced. When the Health Education and Outreach Supervisor resigned, this position was abolished. The Outreach Worker was first placed under the supervision of the Case Management Supervisor, which led to better coordination of outreach activities with case management capacity.

The position was vacated at a time when referrals from providers and self-referrals were effectively filling case management capacity. The next Outreach Worker was placed under the supervision of the Program Director to conduct more community based health education activities. The Health Educator was also placed under the supervision of the Program Director who had a history of providing education services tailored to client needs through her four years of volunteer activities as a tutor for high school students.

The Program Director developed the contracts per agency guidelines that were reviewed and signed by the NMPP CEO. Implementation of the contracts was monitored by the Program Director. When milestones in the contract work were reached, memoranda to the Fiscal Officer were developed for payment, which delineated the work accomplished, and the payment for it.

The memoranda were reviewed by the CEO prior to signing vouchers for payment. The Fiscal Officer prepared checks for payment after receiving the deliverables/payment memoranda and the payment voucher signed by the CEO. The checks were signed by the CEO and the Treasurer of NMPP’s Board.

Cultural competency of direct service staff was ensured by hiring bilingual English/Spanish staff. We hired a male case manager from Cameroon who effectively attracted and retained West African French speaking clients. It was especially helpful having a male case manager who could persuade the African heads of households to permit companions to participate in the CHHS program since West African households are usually male dominated.
CHHS staff participated in workshops on Latino and West African health seeking behaviors and cultural mores to enhance our outreach efforts and to assure appropriate respect for client behaviors. English as a Second Language (ESL) was offered to French speaking West African clients and community residents to enhance referrals; however, we attracted no more than five or six West African clients each year for a total of 25 for the program period.
The program employed one full time Outreach Worker/Case Manager, who carried a caseload of 10 participants, to meet the demands of a growing West African, French speaking population. The Outreach Worker/Case Manager is fluent in French, is from Cameroon, and has a Bachelor of Arts in Health Education.

In addition to referrals, this allows her to provide intensive health education with her caseload, since our health education workshops are rarely conducted in French. Our outreach worker/case manager is assisted in outreach efforts by the CHHS case management team and by our linkage with the Sisterlink program.

CHHS full-time Health Educator delivered health education interventions to program participants. She has a Bachelor’s degree, is working towards a nursing degree and came to us through the New York City Department of Health and Mental Hygiene, Bureau of Maternal, Infant and Reproductive Health (NYC DOHMH) where she worked for over 13 years and received considerable training in perinatal health education topics. She is able to present bilingual, culturally competent workshops to community groups on a variety of subjects and is dedicated, knowledgeable, as well as sensitive to the health care needs of the community we serve.

What CHHS Has Learned About How to Reduce Infant Mortality in Central Harlem

* Take a women’s health approach to perinatal health practice by focusing on women’s health over the life course and on social condition affecting the life course of racially disadvantaged groups.

* Provide guidance and motivation for women with chronic diseases or other risk factors for pregnancy such as diabetes, hypertension and obesity as a strategy for decreasing racial disparities in improving birth outcome.

* Promote the benefits of routine depression screening of pregnant and post-partum women and the appropriate treatment of those in need of such services.

* Increase public awareness of perinatal mood disorder aimed at reducing stigma and remove barriers to mental health services.

* Promote local government policy reforms of children, housing, public assistance and other municipal services that respond to the needs of pregnant and parenting women living in impoverished areas.

* Collaborate closely with the local Title V agency to implement a movement for women’s health and address slot capacity problems and difficulties in screening and treating women for various perinatal mood disorders.

* Develop a local system action plan that builds upon the successes of the Healthy Start model of effective collaboration among local perinatal service providers and encouraging citizen participation in promoting healthy births in the community.

* Sustain and augment the Healthy Start program by initiating a citywide advocacy campaign for city council appropriations to address racial disparities in infant mortality rates where they exist across the city.

* Train and deploy case managers to do more individual health education intervention focusing on disease prevention and assign the health education worker to do more of the community health education.

* Strengthen collaboration with local service providers, particularly women’s health services providers, by enacting formal memorandum of agreements with them.

Materials Published

a) Newspaper and Newsletter Articles:

Child Got a Healthy Start. New York Daily News. January 21, 2001.

Program for Babies Imperiled. New York Daily News. January 21, 2001.

More Money Sought to Fight Jumps in Infant Death Rates. New York Times. February 5, 2001.

Baby Death Rate Soars in Harlem. New York Post. March 18, 2001.

Central Harlem Healthy Start Program Explains Decline in Infant Mortality Rate. Caribbean Life. April 30, 2002.

Harlem Baby Deaths Up. New York Post. December 30, 2002.

Battling Infant Mortality on Two Fronts in Harlem. Crain’s New York Business. January 26, 2003.

Reaching Out: Central Harlem Healthy Start Newsletter. Northern Manhattan Perinatal Partnership, Inc. Newsletter published quarterly in 2003 and 2004

While New York City Is Getting Healthier, Disparities Persist Across Neighborhoods. Medical News Today. October 28, 2006

Harlem Moms Hail Care Despite Infant Death Rate. New York Post. October 5, 2007.

Programs Fight to Cut Infant Death Rate. New York Daily News. January 8, 2008.

Even First Birthday Can Be At Risk. The Tennessean. November 23, 2008.

Spaces of Hope in Harlem. PULSE: A Monthly Newsletter from the Association of Maternal and Child Health Programs. November 2008.

A Wonderful Mystery. Newsweek. October 22, 2009

b) Conference Presentations:

Healthy Families…Healthy Babies: Five-Point Program to End Infant Mortality.
Citywide Coalition to End Infant Mortality. April 6, 2001.

Sustaining Healthy Start Programs through Local Media and Legislative Efforts. Missouri Bootheel Healthy Start Regional Consortium: Business and Not-For-Profit Forum. Cape Girardeau, Missouri. March 21, 2003.

Using CHART Forms and MIS to Capture HRSA and Local Performance Measures. The 2003 Healthy Start Grantee Meeting, Washington D.C., September 23, 2003.

Sustainability as Organizational Strategic Intent. The 2003 Healthy Start Grantee Meeting, Washington D.C., September 24, 2003.

Building the MCH Lifespan Organization & Movement by Linking Women to Health Power & Love Across Their Lifespan from Harlem to Illinois. October 24, 2007.

c) Journal Article:

Central Harlem Health Travails Continue. Dawson, G.A. Journal of the National Medical Association. June 1, 2003.