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Aligning Reach Out and Read with Research

Extending our program to the first few months in accordance with research demonstrating the importance of the first few months to a child's foundation for success.

A guest blog from Teandra Ramos-Hardy, MSW, Director of Medical Engagement for Reach Out and Read Carolinas

Reach Out and Read in InfancyWe know from research that brains are built over time through a process that begins prenatally. The Center on the Developing Child at Harvard University has an abundance of research confirming that the foundation for all future learning is shaped by early experiences, beginning at birth.  A brain's architecture does not grow in isolation; it is developed by interactions with both genes and experiences.  The early years are the most active period for establishing neural connections in the brain.  The environment where one lives and grows, and the exchanges that take place with people in the environment shape the capacities that emerge in the early years.    

In the very first few weeks and months of life, milestones can be seen that reinforce the construct of brain architecture.  A newborn does not immediately have neck control, but a newborn's head gradually wobbles less in the weeks after birth.  One of the best times to observe this is during tummy time.  A newborn will also become responsive to sounds, especially their mother's or caregiver's voice.  They will become drawn to the voice and respond by focusing in the direction of the sound.  A newborn can also communicate by being quiet, cooing or babbling, and reaching.

The postnatal period is a critical time for newborn babies and mothers and many changes occur during this period. Although manuals are helpful, they are not provided at discharge from the hospital, and the web is overloaded with information that can easily overwhelm new parents.  The pediatric provider is the filter and support system a family needs to navigate through information they'll receive to care for their newborn.  Lack of appropriate care during this time can result in significant issues lasting into adulthood.  Newborns and mothers should be assessed at regular intervals following delivery. Further evaluation can be achieved through referrals from the healthcare provider as needed.  The American Academy of Pediatrics has developed a periodicity schedule that providers can follow to assess the health of the newborn, and the health and emotional well-being of the mother. 

The newborn checkup is an important medical visit for the provider to assess the health and development of the newborn following discharge from the hospital.  This initial visit with the healthcare provider allows the family to begin building a relationship with the provider and the medical home as important resources for them and their child - a partnership that lasts throughout the life of the child.  Although the newborn checkup is for the new patient, it is equally important to focus on how the entire family is adjusting to the new addition to the family.  This visit sets the expectation for the two-generational relationship that is created, and includes asking questions, addressing concerns, and providing parent education and anticipatory guidance.

Reach Out and Read Early YearsProviders spend time educating and giving anticipatory guidance to parents.  It has been found that books effectively increase maternal knowledge of anticipatory guidance material and encourage social and emotional bonding between parents and babies.  During well-child visits, parents are educated on many topics, and are likely to recall less of the information as more topics are covered.  Given the brevity of pediatric visits, providers can target behaviors like reading, talking, singing, cuddling, and bonding that are important. Embedding Reach Out and Read in the standard of medical care offers additional opportunities to encourage parent-infant reading, which influences parent-child interactions, children's language development, and future reading ability. The value of the intervention has been shown in lower maternal depression scores, and reports of maternal enjoyment of reading, and time spent reading with their children.  This is significant because the AAP supports maternal depression screenings per "Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice," beginning at the one-month well-child visit.

The research supports the value of starting Reach Out and Read in infancy.  Through this early literacy intervention, providers can support parents and impact children's lives from the beginning.  Here in Reach Out and Read Carolinas, we are joining with a National Reach Out and Read initiative to align with science and incorporate a zero to 6-month component of the Reach Out and Read program, encouraging our providers to talk with the pediatric patient and family about the importance of engaging with infants and sharing books in the first few months.  Research on the impact of this early intervention will continue to inform and guide our rollout across the country.

Written by Teandra Ramos-Hardy at 17:07

Screen Free Week is May 1-7

Screen Free Week is May 1 – 7, a great time to promote family reading!
Written by Kathy Ingram, Laura Bailet at 14:30

Empowering Parents of Preschoolers with the Nemours Preschool Reading Screener

Reach Out and Read partners, Nemours BrightStart! have released the 2nd Annual Reading Readiness Snapshot for America's Preschoolers - a guest blog post from Laura Bailet and Kathy Ingram at Nemours BrightStart! 

Nemours logoLearning to read is a challenging task for the brain, and one of the most important developmental tasks facing young children.  Only about a third of U. S. students score as 'proficient' readers (Nation's Report Card, 2016). In response to overwhelming evidence that the foundation for successful reading is built in the early years, when a young child's brain is highly responsive, adaptable and attuned to learning language, the Nemours Children's Health System has created Nemours BrightStart to research, develop and offer evidence-based tools targeting young children at risk for reading failure. One of our tools, the Nemours online Preschool Reading Screener, is an effective, free screener that is widely available and easy to complete, to identify children in need of assistance early.

For children between birth and five years, developmental screening is often the domain of pediatricians, as part of routine developmental surveillance (Halfon et al., 2004).  However, even with well-established guidelines and reliable tools, nearly half of all children fail to receive recommended screening (Halfon et al., 2004; Sand et al., 2005). For children with subtle developmental problems, such as reading readiness delays, 70 percent or more may go undetected (Glascoe, 2000) with the current system.  Part of the challenge is time constraints for the pediatrician, and lack of an easy and effective screening tool.

Parents often play a central role in developmental screenings of their children.  Research shows that, if questions are clearly stated, they are able to respond accurately (Dewey, Crawford, & Kaplan, 2003; Fenson et al., 1994; Glascoe, 2000).  Studies also show that parental self-efficacy and parenting competence are positively correlated when parenting knowledge is high (Bornstein et al., 2010).  Yet parents' specific knowledge of key normal developmental indicators and milestones in the preschool years is low (Bornstein et al., 2010).

Nemours BrightStart!Completion of a straightforward screener thus may serve simultaneously to increase parents' knowledge, promote greater intentionality with early literacy activities at home, and improve future reading outcomes.  The Nemours' Preschool Reading Screener  is designed for this purpose.  It contains 31 questions organized into key reading readiness skills including oral language, letter knowledge, phonological awareness, and beginning writing.  Parents receive a rating of their child's skill levels and an action plan. Thousands of parents of 3-, 4- and 5-year old children have completed the screener and a summary of their results can be found in the 2nd Annual Reading Readiness Snapshot for America's Preschoolers released this week. The Snapshot reports:

Snapshot image

Out of a maximum possible 31 points, the average score for 3-year olds is 18; for 4-year olds, 23; and for 5-year olds, 26.  Not surprising, 3-year olds earn most of their points on oral language items and also have some beginning knowledge of rhyming and beginning sounds.  For 4-year olds, the emergence of letter knowledge is especially striking; nearly 68% of them are able to identify at least 18 upper case letters, a skill that is vital for being on track for reading success as they move into kindergarten.  More than 90% of 5-year olds demonstrate strong letter naming skills, and skill with letter sounds and with rhyming are also strong.  Blending words is easier for 5-year olds than breaking them apart.

The Snapshot shows how preschoolers are actually doing in reading readiness, according to the people who know them best: their parents.  With reasonable efforts to expose young children to books, language, drawing and writing, they will develop a solid foundation for future reading success.  Screening for early literacy skills can be empowering and motivating for parents; they want to know early if their child is on track with reading readiness skills, or may need increased home literacy activities and book reading opportunities.  It also helps parents understand connections between oral language, reading and writing, which in turn helps them offer a broader array of experiences, woven into their daily routines, that ultimately support reading development.

References

Bornstein, M. H., Cote, L. R., Haynes, O. M., Hahn, C., & Park, Y. (2010). Parenting knowledge: Experiential and sociodemographic factors in European American mothers of young children.Developmental Psychology, 46(6), 1677-1693.

Dewey, D., Crawford, S. G., & Kaplan, B. J. (2003). Clinical importance of parent ratings of everyday cognitive abilities in children with learning and attention problems.Journal of Learning Disabilities, 36(1), 87-95.

Fenson, L., Dale, P. S., Reznick, S., Bates, E., Thal, D. J., Pethick, S. J., . . . Stiles, J. (1994). Variability in communicative development.Monographs of the Society for Research in Child Development, 59(5), 1-185.

Glascoe, F. P. (2000).  Early detection of developmental and behavioral problems. Pediatrics in Review, 21(8), 272-280.

Halfon, N., Regalado, H. S., Inkelas, M., Peck Reuland, C. H.,Glascoe, F. P., & Olson, L. M. (2004). Assessing development in the pediatric office.Pediatrics, 113(6), 1926-1933.

Nation's Report Card. (n.d.).2015 mathematics and reading assessments. Retrieved July 21, 2016, from http://www.nationsreportcard.gov/reading_math_2015/#reading?grade=4

Sand, N., Silverstein, M., Glascoe, F. P., Gupta, V. B., Tonniges, T. P., & O'Connor, K. G. (2005). Pediatricians' reported practices regarding developmental screening: Do guidelines work? Do they help?Pediatrics, 116(1), 174-179.

 

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Written by Kathy Ingram, Laura Bailet at 14:30

Brush, Book, Bed - The Best Bedtime Routine

Reach Out and Read is partnering with the American Academy of Pediatrics to introduce the Brush, Book, Bed program
Written by Michelle Steffen, MD, FAAP; Lauren Barone, MPH at 14:30

Positive Parenting Overcomes the Effects of Poverty on Brain Development

New research shows that positive parenting can overcome the effects of poverty on healthy brain development in adolescents.  In a report published in the Journal of the American Medical Association, Brody and colleagues described a neuroimaging study demonstrating that supportive parenting prevented the reduced growth of certain areas of the brain that occurred as a response to living in poverty.

Positive parenting and brain development

Numerous studies on the association of poverty with poor academic and psychosocial outcomes in childhood have pointed to the critical role of stress on brain development. Physical and social stress that often occurs during childhood in lower socioeconomic environments can influence the growth of the brain. In particular, there is evidence that development of the amygdala and hippocampus, brain regions that support learning, memory, mood and stress reactivity, is suppressed in disadvantaged children.

Brody et al conducted a neuroimaging study on 119 25-year-olds who had participated as adolescents in the Strong African American Families randomized trial (SAAF), a program designed to mitigate the negative effect of life stress on rural African American youths by encouraging positive parenting.  The intention of the study was to correlate the size of specific areas of the hippocampus and amygdala in these individuals, as determined by magnetic resonance imaging, with the number of years between the ages of 11 and 18 that they had lived under the federal poverty line. 

The results showed that, in the control population that had not been enrolled into the SAAF program, more time spent living in poverty was associated with smaller than average volume in areas of the amygdala and hippocampus. The good news was that this suppressive effect of poverty on brain maturation was prevented in those youths whose families had the benefit of the SAAF intervention. The promotion of positive parenting had conferred resilience to the stress of poverty. Importantly, this protective effect was detected at age 25 - it had lasted into adulthood. 

Interestingly, these positive results were achieved in a program serving the families of adolescent children. More than 95% of brain development occurs during the first six years of life, and the brain is particularly susceptible to the stress associated with poverty during this timeframe

Through the Reach Out and Read program, pediatric care providers are able to take advantage of their access to children during these early years. They encourage parents to spend time engaging with their young children through looking at books together starting in infancy,building the parent-child bonds that will alleviate the effects of adverse circumstances in the early years. 

This study encourages us that, through interventions that help parents to bring up their children in a positive, responsive way, it is possible to buffer against the consequences of poverty and low socioeconomic environments.  Leveling the playing field for disadvantaged children in this way can contribute to closing the achievement gap.

Written by Nikki Shearman at 08:32

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