The Rangel Community Health Center is located at 534 West 135th Street in Manhattan. It offers pediatrics, obstetrics and gynecology, and internal medicine care. Mental health, social work, care coordination, and nutrition staff are also available in the same building. It is part of the NewYork-Presbyterian(NYP)/Columbia ambulatory care network and is a training site for four Columbia Medical School pediatric residents.

The Center sees about 1,500 children under age 5 annually. Its patients come primarily from five Harlem neighborhoods that are approximately 50% Black families and 35% Latino families. Ninety percent of the children are insured by Medicaid.

Rangel Community Health Center: Key Elements

The Rangel Center has been conducting social determinants of health screening since 2015 and has an established a working partnership with the Northern Manhattan Perinatal Partnership (NMPP), including its Great Harlem Healthy Start program. The Great Harlem Healthy Start staff provides comprehensive case management and health education for pregnant women, home visiting, and parenting support until the child is two years old. NMPP also offers maternal depression assistance.  

Families are asked about socioeconomic needs, maternal depression, and child behavior issues and then, depending upon their answers, are sorted into three risk categories. Parents who report some concerns about their child’s development or at least one non-acute social stressor receive advice and coaching from the clinic staff, with follow-up by phone. Families who have concerns and stressors that require more assistance are referred either to NYP social work or psychiatric staff or to NMPP.  

In 2017, the Rangel Center leadership enhanced its screening program by adding an early childhood community health worker (CHW) position to the NMPP partnership arrangement.  After training in child development, motivational interviewing, and care coordination, this CHW divides her time between NMPP and the center. Parents scoring as medium- or high-risk are sent to her for intake, which might include paying a home visit, and referral to NMPP or other community organizations as appropriate. She also participates in regular case discussions with the NMPP staff about families she refers to them. In 2018 she engaged with and followed almost 50 families.

In 2018 the Rangel Center transitioned all its screening from paper to tablet and began using NowPow to assist in referrals to organizations other than NMPP. The automated system makes recommendations based on the family’s risk level, zip code, and preference. While certainly reducing the time and effort required to identify an appropriate referral, center staff has learned that the automated system sometimes does not capture the full scope of services a community organization offers. In addition, in conversation with waiting room volunteers, clinic staff or the CHW families often volunteer information about other problems not identified by the screens. Relying on the automated referral system can result in missed opportunities to help that family. 

As Dr. Renee Jenkins, director of the NYP/Columbia program notes, “The more we ‘automate’ our processes, the less we engage with each other on a personal level. We are very interested in finding the right balance of these two necessary strategies (technology and personal co-management) to provide the best we can for our families.”