1. Promoting Childhood Literacy in Family Medicine Residency Programs: Creating New Partnerships to Benefit the Community Jackie Weaver-Agostoni, DO Jonathan Han, MD University of Pittsburgh Dept. of Family Medicine UPMC St. Margaret Hospital

2. Goals and Objectives Review importance of early childhood literacy promotionReview importance of early childhood literacy promotion Familiarize participants with an effective, evidence based intervention – the Reach Out and Read modelFamiliarize participants with an effective, evidence based intervention – the Reach Out and Read model Discuss importance of community collaborations to strengthen and expand upon the ROR modelDiscuss importance of community collaborations to strengthen and expand upon the ROR model

3. The Problem Up to 25% of adults in US functionally illiterate (lacking 5 th grade language ability)Up to 25% of adults in US functionally illiterate (lacking 5 th grade language ability) Another 25% are marginal (8 th grade or below)Another 25% are marginal (8 th grade or below) These adults are at risk for:These adults are at risk for: –Poor economic potential –Poor health literacy and problems accessing care –Poor ability to help children advance in school

4. The Problem 35% of American children enter kindergarten unprepared to learn, most lacking the language skills that are the prerequisites of literacy acquisition (National Academy of Education, 1985)35% of American children enter kindergarten unprepared to learn, most lacking the language skills that are the prerequisites of literacy acquisition (National Academy of Education, 1985)

5. National Assessment of Educational Progress (2000) One third of First Graders placed in remedial reading programsOne third of First Graders placed in remedial reading programs 37% of 4 th graders perform below basic reading levels on national standardized tests for reading37% of 4 th graders perform below basic reading levels on national standardized tests for reading After 4 th grade, all school success contingent on reading successAfter 4 th grade, all school success contingent on reading success

6. The Problem Duquesne, PADuquesne, PA –73% of elementary school children are reading below the basic level (PA System of School Assessment) –Only 36% of high school students are reading at grade level

7. Consequences of School Failure Poor self esteem, boredom, frustrationPoor self esteem, boredom, frustration Increased risk of absenteeism, school avoidance, truancy, dropping outIncreased risk of absenteeism, school avoidance, truancy, dropping out Increased risk of early pregnancy, substance abuse, legal troubleIncreased risk of early pregnancy, substance abuse, legal trouble

8. Consequences of Poverty In general, children living in poverty:In general, children living in poverty: –Are 1.3 times more likely to exhibit developmental delays –Are 1.4 times more likely to be diagnosed with a learning disability –Are 2 times more likely to repeat a grade (Brookes-Gunn & Duncan, 1997)

9. The Solution Early Childhood Literacy PromotionEarly Childhood Literacy Promotion –Reading out loud to children “Single most“Single most important activity to promote success in reading.”

10. Children’s Literacy Development Literacy development begins prior to readingLiteracy development begins prior to reading Early language and literacy experiences form the foundation for later reading and language competenciesEarly language and literacy experiences form the foundation for later reading and language competencies

11. Reading Aloud and Children’s Literacy Development Brain architecture is shaped by early experiencesBrain architecture is shaped by early experiences –repetitive use of cognitive skills associated with reading aloud –language, memory, comprehension –ensure that associated brain connections persist

12. “Teach children to learn to read, so they can read to learn” (Mrs. Clements, 2 nd Grade Teacher, Ohara Elementary) “ Help our brains to grow.” (Gracie Han, age 4)

13. Motivation “Perhaps the best way of inspiring a young child with a desire of learning to read is to read to him.”“Perhaps the best way of inspiring a young child with a desire of learning to read is to read to him.” Horace Mann, 1898Horace Mann, 1898

14. Importance of Early Childhood Literacy Promotion 1.Public Health Impact Health of Children, Families, CommunitiesHealth of Children, Families, Communities 2.Increased national productivity and economic security 3.Promote adult literacy Link them to community resourcesLink them to community resources

15. Family Medicine Perspective Unique access to both children and their parentsUnique access to both children and their parents –excellent opportunity to intervene for entire family Teach residents importance of literacy promotionTeach residents importance of literacy promotion Enable future physician teachers and community leaders to start literacy promotion programsEnable future physician teachers and community leaders to start literacy promotion programs

16. Reach Out and Read National non-profit organizationNational non-profit organization Mission: To make literacy promotion a standard part of pediatric primary care, so that children grow up with books and a love of reading.Mission: To make literacy promotion a standard part of pediatric primary care, so that children grow up with books and a love of reading.

17. ROR Historical Information Started in 1989 by pediatricians Dr. Barry Zuckerman and Dr. Robert Needlman, and Kathleen Fitzgerald Rice, MS Ed, at Boston City HospitalStarted in 1989 by pediatricians Dr. Barry Zuckerman and Dr. Robert Needlman, and Kathleen Fitzgerald Rice, MS Ed, at Boston City Hospital 3083 participating programs in all 50 states, the District of Columbia, Puerto Rico, Guam, US Virgin Islands, and military bases worldwide3083 participating programs in all 50 states, the District of Columbia, Puerto Rico, Guam, US Virgin Islands, and military bases worldwide In 2006, over 4.1 million books distributed to 2.5 million children in mostly low income familiesIn 2006, over 4.1 million books distributed to 2.5 million children in mostly low income families Funded through US Dept of EducationFunded through US Dept of Education

18. ROR Historical Information 45,000 healthcare workers trained in the ROR model of early-literacy promotion45,000 healthcare workers trained in the ROR model of early-literacy promotion Endorsed by the American Academy of Pediatrics (AAP)Endorsed by the American Academy of Pediatrics (AAP) In PittsburghIn Pennsylvania  7 ROR healthcare sites  76 ROR healthcare sites  1,750 children served annually  58,500 children served annually  2,300 books given to children annually  101,000 books given to children annually

19. ROR Project 3 Elements: 1.Trained doctors and nurses talk to parents about the importance of reading out loud 2.At each well child visit, from ages 6 months to 5 years, children receive a new, developmentally appropriate book 3.Volunteer in waiting room to read aloud and role-model

20. The Cost of Success The cost: $27.50 per Child for a Lifetime of Learning!The cost: $27.50 per Child for a Lifetime of Learning! Why is Reach Out and Read so effective and inexpensive?Why is Reach Out and Read so effective and inexpensive? –Parent involvement –A trusted messenger – the child’s physician –Broad Scope and Reach –Guidance Parents can Follow –Hope for Educational Success –Positive Reinforcement

21. The Evidence Supports ROR ROR has a direct effect on Literacy Development:ROR has a direct effect on Literacy Development: –Improves child’s ability to express herself verbally –Increases child’s listening vocabulary –Reduces the number of children with language delays

22. “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.”“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 Founder, Reach Out and ReadFounder, Reach Out and Read

23. 6 month Well Child visit Developmental Milestones identified by the American Academy of Pediatrics: Cognitive:Cognitive: –Explores with hands and mouth –Reaches for objects out of reach –Looks at book upside-down MovementMovement –Reaches with one hand –Can turn pages

24. One year Well Child visit CognitiveCognitive –Explores objects in various ways –Looks at named image –Imitates gestures –Can point with one finger LanguageLanguage –Responds to simple verbal requests –Points when asked “where”

25. Eighteen month Well Child visit CognitiveCognitive –Listens to a story –Can turn board book pages –Will turn book right side up –Can hand book back to adult LanguageLanguage –Points and asks “what’s that?” –Vocabulary spurt

26. Two year old Well Child visit LanguageLanguage –Points to pictures when names –Follows simple instructions –Begins “No” MovementMovement –Carries toys while walking

27. Three year Well Child visit CognitiveCognitive –Matches object in the room with picture in a book LanguageLanguage –Identifies almost all common pictures –Follows a two- or three-part command –Uses 4- to 5-word sentences

28. Four year Well Child visit CognitiveCognitive –Correctly names some colors –Recalls parts of a story LanguagesLanguages –5- to 6-word sentences –Dialogic reading – child becomes “teller of the story”

29. Five year Well Child visit Cognitive:Cognitive: –Correctly names at least 4 colors –Can count 10 or more objects LanguageLanguage –Recalls part of a story –Speaks sentences of more than 5 words

30. How to Start a ROR Site Request an application: Request an application: –by mail: Reach Out and Read National Center 29 Mystic Avenue Somerville, MA 02145 –by phone: 617-629-8042 x236 –by email: startup@reachoutandread.org –from website: www.reachoutandread.org

31. How to Start a ROR Site Application Components:Application Components: –Letter of Support: Medical Director and/or Executive Director –Identify a Site Contact/Coordinator, and Medical Consultant/Director –Satellite Sites –Demographics –Annual Book Budget –Fundraising –Volunteers/Literacy Rich Waiting Area

32. How to Start a ROR Site 1.Submit Application (Including Letter of Support) 2.Panel Review 3.Decision Letter Sent- 4-6 days after review 4.Award Agreement Returned- within 10 days 5.Training

33. Creating the Literacy Rich Physician’s Office Books available in the waiting area and exam roomsBooks available in the waiting area and exam rooms ROR and Reading Is Fundamental (RIF) educational materials displayed prominently in officeROR and Reading Is Fundamental (RIF) educational materials displayed prominently in office Literacy promotion literature and bookmarks availableLiteracy promotion literature and bookmarks available Volunteer reader in the waiting roomVolunteer reader in the waiting room DVD modeling reading activities by staffDVD modeling reading activities by staff

34. Implementation of ROR at University of Pittsburgh Dept of Family Medicine Initial ROR program at UPMC New Kensington FHC 2002Initial ROR program at UPMC New Kensington FHC 2002 Expansion to UPMC St. Margaret Family Practice Residency Program FHC’s in Lawrenceville and Bloomfield-Garfield, 2004Expansion to UPMC St. Margaret Family Practice Residency Program FHC’s in Lawrenceville and Bloomfield-Garfield, 2004

35. Implementation of ROR at University of Pitt Dept of Family Medicine Grable Grant 2004 (Julie Yeh MD/Don Middleton MD)Grable Grant 2004 (Julie Yeh MD/Don Middleton MD) Expansion to University of Pittsburgh Dept of Family Medicine Residency Program Health Centers (Shadyside FHC, McKeesport/Latterman FHC) 2004Expansion to University of Pittsburgh Dept of Family Medicine Residency Program Health Centers (Shadyside FHC, McKeesport/Latterman FHC) 2004

36. Expanding upon the ROR model Collaboration with RIF Pittsburgh in 2005Collaboration with RIF Pittsburgh in 2005 National RIF (founded 1966) RIF Pittsburgh (founded 1981)

37. Reading Is Fundamental Allows us to reach children age 6-12 with ongoing physician emphasis to encourage literacyAllows us to reach children age 6-12 with ongoing physician emphasis to encourage literacy Provides:Provides: –Linkages to after school tutoring programs –Grant funded Book Distributions for Health Center “Literacy Fairs”

39. Raising Awareness in the Community Physician education –Physician education – –Lectures, seminars within Residency Program –Grand Rounds with Perri Klass, MD –Attendance at National ROR meeting Community education –Community education – –Newspaper publicity –Public television piece –Health/Literacy Fairs

40. Doctors write prescription to help children enjoy reading Wednesday, July 12, 2006By David Templeton, Pittsburgh Post-Gazette “Based on a successful national program, local doctors are discovering the power of books in improving childhood development and health, and in bonding with parents. Books even make children look forward to going to the doctor's office. Key to the Pittsburgh program, Dr. Klass said, is the fact UPMC medical centers are teaching programs where medical residents learn pediatric skills. At that stage of medical education, she said, it's important they recognize the importance of books and literacy in childhood development. Key to the Pittsburgh program, Dr. Klass said, is the fact UPMC medical centers are teaching programs where medical residents learn pediatric skills. At that stage of medical education, she said, it's important they recognize the importance of books and literacy in childhood development. The program is successful and will remain a crucible in UPMC family health centers because it builds healthy minds and imaginations to match healthy bodies.” The program is successful and will remain a crucible in UPMC family health centers because it builds healthy minds and imaginations to match healthy bodies.”

41. Other Community Collaborations Mon Valley Educational Consortium via UPMC McKeesport Family Medicine Residency ProgramMon Valley Educational Consortium via UPMC McKeesport Family Medicine Residency Program –provided us with access to over 80,000 books for distribution to children Guardian Storage – donated storage space for our ROR/RIF booksGuardian Storage – donated storage space for our ROR/RIF books

42. Site visit by Margaret Spellings By Craig Smith TRIBUNE-REVIEW Friday, September 15, 2006Craig Smith Spellings also visited UPMC St. Margaret Lawrenceville Family Health Center, where she read to young patients. The center is one of five UPMC Family Health Center Reach Out and Read sites, where doctors and nurses give books to children at health checkups and advise parents about the importance of reading aloud to their children.

43. "I've been a big fan of this program for a long time," Spellings said about Reach Out and Read. Over the past four years, UPMC doctors have distributed more than 2,500 books to their patients each year. Visit by Spellings

44. Financial Support –Hospital Foundations –RIF Pittsburgh –ROR –Local Philanthropic organizations (Grable) –Donations from community organizations

45. Future directions Improving early childhood literacy as a Global initiativeImproving early childhood literacy as a Global initiative Expand ROR model among Family Practice residency programs, and family medicine practices in the communityExpand ROR model among Family Practice residency programs, and family medicine practices in the community Advocate for increased Family Medicine presence within RORAdvocate for increased Family Medicine presence within ROR

46. Future Collaborations National ROR Annual Conference, Toronto, May 3-5, 2007National ROR Annual Conference, Toronto, May 3-5, 2007 –Family Physicians will be meeting to discuss new ways to collaborate across Family Medicine Residency Programs to encourage implementation of ROR/Early Childhood Literacy Promotion programs, and to advocate for increased Family Medicine profile within National ROR

47. Resources 1.ROR Website: www.reachoutandread.org www.reachoutandread.org 2.RIF Website: www.rif.org Content used with permission from National Reach Out and Read

48. Resources High P, et al. Evaluation of a clinic-based program to promote book sharing and bedtime routines among low-income urban families with young children. Archives of Pediatrics and Adolescent Medicine. 1998;152:459-465.High P, et al. Evaluation of a clinic-based program to promote book sharing and bedtime routines among low-income urban families with young children. Archives of Pediatrics and Adolescent Medicine. 1998;152:459-465. Jones VF, et al. The value of book distribution in a clinic-based literacy intervention program. Clinical Pediatrics (Phila). 2000;39:535-541.Jones VF, et al. The value of book distribution in a clinic-based literacy intervention program. Clinical Pediatrics (Phila). 2000;39:535-541. Mendelsohn A, et al. The impact of a clinic-based literacy intervention on language development in inner- city preschool children. Pediatrics. 2001;107:130-134.Mendelsohn A, et al. The impact of a clinic-based literacy intervention on language development in inner- city preschool children. Pediatrics. 2001;107:130-134. Sharif I, Reiber S, and Ozuah PO. Exposure to Reach Out and Read and vocabulary outcomes in inner city preschoolers. JAMA. 2002;94:171-177.Sharif I, Reiber S, and Ozuah PO. Exposure to Reach Out and Read and vocabulary outcomes in inner city preschoolers. JAMA. 2002;94:171-177.

49. Resources Mikovitz C, Hughart N, Strobino D, et al. “A Practice Based intervention to enhance quality of care in the first 3 years of life.” JAMA 2003: vol 290, 3081-3091.Mikovitz C, Hughart N, Strobino D, et al. “A Practice Based intervention to enhance quality of care in the first 3 years of life.” JAMA 2003: vol 290, 3081-3091. Frede, E and Burnette, W.S. “Preschool Policy Brief, National Institute for Early Education Research.” April 2006, Issue 10. www.nieer.orgFrede, E and Burnette, W.S. “Preschool Policy Brief, National Institute for Early Education Research.” April 2006, Issue 10. www.nieer.orgwww.nieer.org