Early Literacy in the Office: Reach Out and Read Wendy L. Hobson-Rohrer, MD, MSPH Associate Professor of Pediatrics Medical Director, ROR Utah

n “Anticipatory guidance for parents about sharing books with young children may be the only concrete activity of a pediatric provider that has been proven to promote child development.” Barry Zuckerman, MD Founding Director, ROR

Objectives n Describe the Reach Out and Read model of pediatric literacy promotion n Discuss importance of reading aloud n Discuss some research supporting Reach Out and Read n Explain how to become a Reach Out and Read site

The Mission of Reach Out and Read To make literacy promotion a standard part of pediatric primary care, so that children grow up with books and a love of reading.

Reach Out and Read Statistics n Founded in 1989 at Boston City Hospital by – Barry Zuckerman, MD, Robert Needlman, MD and Kathleen Fitzgerald Rice, MS Ed n Over 4100 sites n Over 50,000 providers trained n Over 3.5 million children reached annually n Over 5.4 million books distributed per year n Over 20 million books distributed overall

Endorsements American Academy of Pediatrics Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents White House Conference on Global Literacy 2007 UNESCO’s Confucius Prize for Literacy

Utah Navajo Health System: Montezuma Creek Clinic Montezuma Valley Clinic Blanding Family Practice Monument Valley Clinic Community Health Center of St George Enterprise Valley Medical Clinic Hill Air Force Base  Central City CHCCopperview CHC  OquirrhView CHC Steven D. Ratcliffe CHC  Granger Medical Clinic South Main Clinic  U of U Pediatric Clinic 6Cottonwood Pediatrics  Willowcreek PediatricsDr. Bob Terashima  St Mark’s Family Medicine Residency Program  Wasatch Homeless HealthCare - 4 th St. Clinic  U of U RedwoodU of U Westridge  Madsen Family Health Center Dinosaur Land Pediatrics Uintah Basin Medical Center Color Country Pediatrics U of U Stansbury Health Center 34 ROR clinical locations 41,026 children participate annually 66,946 new books distributed annually Bear Lake CHCCache Valley CHC Intermountain Budge Clinic McKay DeeMidtown CHC Pediatric Care of Ogden

Three Components of Reach Out and Read n Medical providers encourage parents to read aloud and offer anticipatory guidance n At every health supervision visit, children aged 6 mos.- 5 years receive a new developmentally-appropriate book n Volunteers in waiting rooms read aloud to children

Reading Aloud and Children’s Literacy Development (National Research Council, 1999) n Literacy development begins prior to reading n Early language and literacy experiences form the foundation for later reading and language competencies

Parental Language and Children’s Language n Children’s language evolves primarily through parent-child interactions n By two years of age, children’s language correlates with later cognitive performance

Reading Aloud and School Readiness (National Center for Educational Statistics, 1999)

Summary of ROR Research n ROR significantly and positively influences the literacy environment of children –Parents read more to their children –Parents and children have more positive attitudes toward reading aloud

Frequency of Reading Aloud (High et. al., 2000)

Attitudes Toward Reading (High et. al., 2000)

Summary of ROR Research Shows that ROR is having direct effects on literacy development –Improving children's ability to express themselves verbally. –Increasing children's listening vocabularies. –Reducing the number of children with language delays that can prevent them from succeeding in school.

Children’s Expressive and Receptive Language Competencies (Mendelsohn et. al., 2001)

Why me? I already have enough to do. Medical Providers: –Have repeated one-on-one contact with families –Provide trusted guidance about children’s development –May serve as the only source of formalized support for poor families

The ROR Model 1) Books Given in Exam Room –At each health supervision visit, a child age 6 mos. - 5 years receives a new developmentally-appropriate book –Before kindergarten, a child receives 10 books –Books are introduced early in the visit and integrated into the examination within the context of other anticipatory guidance

The Book as Assessment Tool n Using the book to assess child development: – Fine motor development (maturity of grasp, hand skills) – Social/emotional interaction with others (shared attention, affect) – Cognitive skills (attention, memory) – Expressive and receptive language (vocabulary, comprehension of words) – Vehicle to offer parents concrete advice about child development

The ROR Model: Volunteers n Demonstrate reading aloud techniques n Show that reading is entertaining for children n Make waiting room experience more fun

The ROR Model 3) Anticipatory Guidance - Underscore reading aloud is important even before a child can talk - Stress that reading aloud is to promote the child’s love of books, not early reading - Emphasize reading is meant to be fun!

Who Benefits from ROR ? n Medical providers use books as valuable assessment tools and build bonds with families n Parents are given essential information about reading aloud and suggestions for parent-child interactions n Children get all the early literacy benefits of reading aloud and have 10 books of their own by age 5

How does my clinic become a ROR site? Apply through Budget calculation: –$2.75 per book x Number of WCC 6 mo - 5 yrs –Average peds practice: $7000 –Average family medicine practice: $2000 Funding from Utah Coalition

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