An Introduction to Reach Out and Read

1
An Introduction to Reach Out and Read

• Provider Training Workshop
• Reach Out and Read National Center
• 56 Roland Street
• Suite 100D
• Boston, MA 02129
• 617-455-0600

2
Training Objectives

• Describe the ROR model of pediatric literacy
  promotion
• Discuss importance of reading aloud
• Explain anticipatory guidance for parents about
  books and reading
• Review milestones of childrens early literacy
  development
• Present some relevant research

3
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.
4
Three Components of Reach Out and Read

• Medical providers encourage parents to read aloud
  and offer anticipatory guidance
• At every health supervision visit, children aged
  6 mos.- 5 years receive a new developmentally-appr
  opriate book
• The waiting room is made into a literacy-rich
  environment with displays, gently used books, and
  volunteer readers.

5
Reach Out and Read June 2007

• Founded in 1989 at Boston City Hospital by
• Barry Zuckerman, MD
• Robert Needlman, MD
• Kathleen Fitzgerald Rice, MS Ed
• Over 3,500 locations
• Over 47,000 providers trained
• Over 3 million children reached annually
• Over 4.9 million books distributed per year

6
Reading, Language, and Brain Development

• Childrens language evolves primarily through
  parent-child interactions by two years of age,
  childrens language correlates with later
  cognitive performance
• The architecture of the brain is shaped by early
  experiences cognitive skills associated with
  books--memory, creativity, comprehension,
  language--stimulate brain development

7
Benefits of Reading Aloud

• Reading aloud to children
• Fosters language development
• Promotes reading skills
• Prepares children for school success
• Motivates children to love books

8
Verbal Responsiveness Why its Important

• Repeating and expanding reinforces a childs
  communicative attempts and offers advanced
  language
• Labeling and describing emphasizes that objects
  have names (symbolic representations)
• Questioning promotes verbal exchanges between
  parent and child
• Emphasizing sounds and letters increases a
  childs phonological awareness

9
Reading Aloud and School Readiness(National
Center for Educational Statistics, 1999)
10
The Importance of Emerging Literacy (National
Research Center, 1999)

• Children at risk for reading difficulties are
  those who start school with
• lower verbal skills
• less phonological awareness
• less letter knowledge
• less familiarity with the processes
• of reading

11
Children from Low-Income Families

• Low-income status significantly predicts
  childrens exposure to language (Bloom, 1998)
• Children from low-income families are far less
  likely to be read to on a daily basis (National
  Research Council, 1999)

12
Literacy-Rich Waiting Rooms

• Displays and information about libraries, reading
  aloud, and adult and family literacy
  organizations
• Gently used books should be available
• Volunteer readers (where appropriate)
• Model reading aloud techniques, varying voices
• Show parents how books can entertain and create a
  bond between child and parent

13
ROR in the Exam Room

• The provider gives the child a developmentally
  appropriate book at each well-child visitthats
  10 books by kindergarten!
• The book is introduced EARLY in the visit
• The book is accompanied by anticipatory guidance
  for the parent, and by modeling
• The provider uses the book to assess the childs
  developmentmotor, cognitive, social, language

14
Anticipatory Guidance

• Underscore reading aloud is important even before
  a child can talk, and it promotes the childs
  love of books
• Trigger questions
• Have you and (childs name) begun to look at
  books yet?
• What are some things that you and (childs name)
  do at bedtime?

15
More anticipatory guidance

• Introduce the book early in the visit
• Mary is chewing on the book. Babies like to do
  that.
• Babies like pictures of babies.
• Encourage parent to talk about the book
• Wheres the baby? Wheres the babys nose?
• Point and name or describe objects
• Relate the book to childs experiences (He has a
  sister, just like you.)

16
More Anticipatory Guidance

• Give parents age-appropriate expectations
• 6-month-old babies put books in their mouth
• 12-month-olds can point with one finger
• 18-month-olds can turn board book pages
• 2-year-olds may not sit still to listen to a book
• 3-year-olds can retell familiar stories

17
The Book as Assessment Tool

• Use the book to assess childs development
• Fine motor development
• (maturity of grasp, hand skills)
• Social/emotional interaction
• Cognitive skills
• (attention, memory)
• Expressive and receptive language
• (vocabulary and comprehension)

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Which Books to Choose

• For 6-12-month-olds
• Board pages
• Pictures and faces
• Bright colors
• Familiar objects
• Limited text / small size

19
6-12 Months

• Parent
• Lets child explore book
• Holds child in lap
• Responds verbally
• Labels
• Talks during routines

• Child
• Reaches for book
• Puts book in mouth
• Sits in lap
• Communicates through gestures and early
  utterances
• Begins to understand a few words

20
Which Books to Choose

• For 12-24-month-olds
• Board pages
• Familiar objects
• Relevant to childs life
• Rhyming words
• Animal or shape-focused

21
12-18 Months

• Child
• Holds book
• Turns board pages
• Turns book right side up
• Points when asked where is--?
• Points to pictures
• Imitates parents vocals

• Parent
• Lets child control book
• Asks where is---?
• Labels/describes
• Sings songs/rhymes
• Reads as part of routine

22
18- 24 Months

• Parent
• Lets child control book
• Re-reads stories!!
• Engages in verbal turn-taking
• Labels /describes
• Points and asks Whats that?
• Relates books to childs own experiences

• Child
• Turns pages
• Carries book around
• Fills in words of stories
• Recites parts of stories
• Reads to dolls
• Begins to combine words

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Which Books to Choose

• For 24-36-month-olds
• Paper pages
• Routine focused
• (naptime, bedtime)
• Rhyming words
• Relevant to childs life
• More advanced themes (big/small, on/under)

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24-36 Months

• Child
• Turns paper pages
• Protests when pages are skipped
• Recites familiar parts of stories
• May know 320 words
• Requests same book repeatedly

• Parent
• Lets child control book
• Points out letters and reads as part of routine
  (e.g., street signs)
• Reads to assist with daily routines
• Asks child to name objects
• Relates books to childs experiences

25
Which Books to Choose

• For 3-year-olds and above
• Folk tales and legends
• Alphabet and counting books
• Exercise the childs imagination
• Books can be chosen by child

26
3 Years and Older

• Parent
• Asks What happened?
• Lets child tell story
• Encourages writing
• Points out letters and sounds
• Responds/expands on childs questions

• Child
• Understands more complex stories
• Anticipates outcomes
• Attempts writing
• Begins recognizing letters
• Asks why questions
• Attempts to use sentences and grammar

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Summary of research on ROR

• 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
• Children participating in ROR tend to have
  increased language development in comparison to
  non-participating children

28
Clinic-based Intervention to Promote Literacy
(Needlman et. al., 1991)

• A pilot study designed to determine if exposure
  to a clinic-based literacy intervention promotes
  parents reading aloud to children
• Conducted waiting room interviews with 79 parents
  regarding childrens literacy orientation
• Results indicated that parents who received a
  book through ROR were 4 times more likely to
  report reading to children

29
Literacy Promotion in Primary Care
Pediatrics Can We Make a Difference? (High, 2000)

• Evaluated the impact of a clinic-based literacy
  program, based on the ROR model, on parent-child
  book sharing
• 205 low-income families
• - 106 Intervention - 99 Control
• Results indicated that intervention families read
  aloud more frequently to their children and had
  more positive attitudes toward reading

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Frequency of Reading Aloud (High et. al., 2000)
31
Change in Parent-Child Book Sharing (High et.
al., 2000)
32
Attitudes Toward Reading (High et. al., 2000)
33
The Impact of a Clinic-Based Literacy
Intervention on Language Development in
Inner-City Preschool Children (Mendelsohn et.
al., 2001)

• Examined the impact of an ROR program on
  childrens language development
• 122 participants
• - 49 Intervention - 73 Comparison
• Parents receiving the intervention read to their
  children approximately one more day/week than
  those in the control group
• Children participating in the intervention had
  higher receptive and expressive language scores

34
Childrens Expressive and Receptive Language
Competencies (Mendelsohn et. al., 2001)
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Who Benefits from ROR

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