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News, Events, and Updates from Reach Out and Read

Reach Out and Read Improves Family and Child Health Outcomes through Primary Care

New article "The Elephant in the Clinic" examines the multifaceted role of Reach Out and Read in the promotion of early literacy and family well-being through primary healthcare.
Written by Nikki Shearman at 12:05

Closing the Achievement Gap Requires Interventions that Target Children from the Earliest Years

With the author's permission, this article is an adaptation of a letter to the editor of Pediatrics by Reach Out and Read Co-Founder Dr. Robert Needlman M.D., F.A.A.P. following the publication of the report Positive Parenting Practices, Health Disparities, and Developmental Progress

Reading aloud statistics

A new study published inPediatrics last month provides further evidence that economic disadvantage is associated with fewer stimulating early childhood experiences and increased risk of developmental delays. Working with data from 12,642 children 4 to 36 months of age, Shah and colleagues analyzed interactive parent practices, such as reading aloud, talking and playing, and showed that "less participation in interactive activities is associated with increased risk of development delay among those experiencing significant adversity."

This report confirms and builds on the message of the landmark Hart & Risley study, published 20 years ago that studied a total of 42 children intensely over 30 months, recording at intervals every word that was said to them, and every word they said in turn. These scientists found that by the age of four, children from lower-income families hear 30 million fewer words than their more affluent peers.

That these two disparate approaches reached the same conclusion is reassuring. That the underlying reality has remained unchanged for 20 years, that is, the propagation of social and developmental disadvantage, is not.

What has changed is the response to the problem. Both studies conclude that the achievement gap starts in infancy, and is already established by the age of four. Closing the achievement gap, therefore, depends on interventions that target children from the earliest days. Shah and colleagues go further to suggest that pediatricians have a vital role to play in delivering programs that strengthen parenting practices for the very young. "The advantages are that the primary care setting is established, non-stigmatizing, accessible locally, and has the potential to disseminate parenting interventions."

Reading aloud 2There are now many programs, both local and national, that seek to influence early childhood development, and several that operate through the primary care setting. Of the latter, Reach Out and Read is a well-established and successful non-profit organization - implemented in every state, in more than 5,500 clinics, and in virtually every pediatric training program. In fact, the American Academy of Pediatrics, that recommends "pediatric providers promote early literacy development" references Reach Out and Read as an effective intervention to engage parents and prepare children to achieve their potential.

Reach Out and Read was developed some 26 years ago and uses a simple time-honored model in which medical providers give books to children at each of their well-child checkups and encourage their parents to read aloud to them. It is supported by a large body of published research showing that the children we serve are read to more often by their parents, have improved language skills and a greater love of reading. Reach Out and Read now serves over 4.5 million children annually, including one in five disadvantaged children. We still have a long way to go, and we plan to continue to grow and reach more families and children across the nation, but as we contemplate how far we have yet to go in our efforts to combat social disadvantage, it's important to keep in mind how far we have come.

Bedtime Stories for Young Brains

NY Times article

Ed. Note: This guest article, written by Perri Klass, M.D., was originally posted in the New York Times on August 17, 2015. The original article can be viewed here.

A little more than a year ago, the American Academy of Pediatrics issued a policy statement saying that all pediatric primary care should include literacy promotion, starting at birth.

That means pediatricians taking care of infants and toddlers should routinely be advising parents about how important it is to read to even very young children. The policy statement, which I wrote with Dr. Pamela C. High, included a review of the extensive research on the links between growing up with books and reading aloud, and later language development and school success.

But while we know that reading to a young child is associated with good outcomes, there is only limited understanding of what the mechanism might be. Two new studies examine the unexpectedly complex interactions that happen when you put a small child on your lap and open a picture book.

This month, the journal Pediatrics published a study that used functional magnetic resonance imaging to study brain activity in 3-to 5-year-old children as they listened to age-appropriate stories. The researchers found differences in brain activation according to how much the children had been read to at home.

Children whose parents reported more reading at home and more books in the home showed significantly greater activation of brain areas in a region of the left hemisphere called the parietal-temporal-occipital association cortex. This brain area is "a watershed region, all about multisensory integration, integrating sound and then visual stimulation," said the lead author, Dr. John S. Hutton, a clinical research fellow at Cincinnati Children's Hospital Medical Center.

This region of the brain is known to be very active when older children read to themselves, but Dr. Hutton notes that it also lights up when younger children are hearing stories. What was especially novel was that children who were exposed to more books and home reading showed significantly more activity in the areas of the brain that process visual association, even though the child was in the scanner just listening to a story and could not see any pictures.

"When kids are hearing stories, they're imagining in their mind's eye when they hear the story," said Dr. Hutton. "For example, 'The frog jumped over the log.' I've seen a frog before, I've seen a log before, what does that look like?"

The different levels of brain activation, he said, suggest that children who have more practice in developing those visual images, as they look at picture books and listen to stories, may develop skills that will help them make images and stories out of words later on.

"It helps them understand what things look like, and may help them transition to books without pictures," he said. "It will help them later be better readers because they've developed that part of the brain that helps them see what is going on in the story."

Dr. Hutton speculated that the book may also be stimulating creativity in a way that cartoons and other screen-related entertainments may not.

"When we show them a video of a story, do we short circuit that process a little?" he asked. "Are we taking that job away from them? They're not having to imagine the story; it's just being fed to them."

We know that it is important that young children hear language, and that they need to hear it from people, not from screens. Unfortunately, there are serious disparities in how much language children hear - most famously demonstrated in a Kansas study that found poor children heard millions fewer words by age 3.

But it turns out that reading to - and with - young children may amplify the language they hear more than just talking. In August,Psychological Science reported on researchers who studied the language content of picture books. They put together a selection from teacher recommendations, Amazon best sellers, and other books that parents are likely to be reading at bedtime.

In comparing the language in books to the language used by parents talking to their children, the researchers found that the picture books contained more "unique word types."

"Books contain a more diverse set of words than child-directed speech," said the lead author, Jessica Montag, an assistant research psychologist at the University of California, Riverside. "This would suggest that children who are being read to by caregivers are hearing vocabulary words that kids who are not being read to are probably not hearing."

So reading picture books with young children may mean that they hear more words, while at the same time, their brains practice creating the images associated with those words - and with the more complex sentences and rhymes that make up even simple stories.

I have spent a great deal of my career working with Reach Out and Read, which works through medical providers to encourage parents to enjoy books with their infants, toddlers and preschoolers. This year, our 5,600 program sites will give away 6.8 million books (including many to children in poverty), along with guidance to more than 4.5 million children and their parents. (The group also provided some support to Dr. Hutton's research.)

Studies of Reach Out and Read show that participating parents read more and children's preschool vocabularies improve when parents read more. But even as someone who is already one of the choir, I am fascinated by the ways that new research is teasing out the complexity and the underlying mechanisms of something which can seem easy, natural and, well, simple. When we bring books and reading into checkups, we help parents interact with their children and help children learn.

"I think that we've learned that early reading is more than just a nice thing to do with kids," Dr. Hutton said. "It really does have a very important role to play in building brain networks that will serve children long-term as they transition from verbal to reading."

And as every parent who has read a bedtime story knows, this is all happening in the context of face-time, of skin-to-skin contact, of the hard-to-quantify but essential mix of security and comfort and ritual. It's what makes toddlers demand the same story over and over again, and it's the reason parents tear up (especially those of us with adult children) when we occasionally happen across a long-ago bedtime book.

 

Written by Perri Klass at 10:35

Reach Out and Read has a Prescription for Success

IMLS marquee

Ed. Note: This blog was originally posted by UpNext, the Official Blog of the Institute of Museum and Library Services. The original post can be viewed here.

Reach Out and Read is pleased to announce the launch of our Prescription for Success Toolkit, designed to support collaborations between libraries, museums, and Reach Out and Read program sites, natural partners that have a collective impact on the lives of young children. 

In January 2015, we embarked on a yearlong project, Prescription for Success, funded by the Institute of Museum and Library Services. The project is aimed at helping more families benefit from museum and library services that foster literacy development in young children. As a national nonprofit organization comprised of doctors, who promote early childhood literacy, Reach Out and Read has deep and broad relationships within the medical community. Prescription for Success has leveraged these connections to explore new ways doctors and their staffs can collaborate with museums and libraries.

Waiting_roomReach Out and Read is a nonprofit organization that gives books to children at pediatric checkups, and encourages families to read aloud to their infants and toddlers. For many of the low-income families that we serve, this is the first book in the home. Encouraging families to make use of local libraries and museums extends the impact of our program, giving them opportunities to read more books together, and to spend time enjoying library and museum activities. And library and museum staff can reinforce our message that engaging with young children through reading and playing together helps foster healthy brain development that gives them the best start in life.

Conversely, Reach Out and Read can further the special role that museums and libraries have in meeting the needs of America's youngest learners and their caregivers. With unparalleled access to young children through pediatric checkups, we are able to open the door to libraries and museums for many families, especially those struggling on a low-income, who might otherwise not know the value of these institutions.

IMLS_Rx_Pad The Prescription for Success Toolkit is a compilation of best practices learned from a survey of current state and local partnerships between Reach Out and Read, libraries, and museums. It provides ideas and resources for those who currently, or would like to, work together.

The toolkit encourages local libraries, museums, and Reach Out and Read program sites to open conversations with one another to explore common interests and learn about one another to build trust and community. It suggests ways they can support one another, such as clinics prescribing visits to the library using a prescription pad, libraries distributing Reach Out and Read materials or helping to create literacy-rich waiting rooms at Reach Out and Read clinics. Links to materials and resources and examples of successful established partnerships help with collaborations.

Written by Nikki Shearman at 12:00

Reach Out and Read Expands to Serve Infants from Birth to Six Months

Reach Out and Read doctors are starting to guide parents about the importance of talking, singing, reading and playing with their babies as early as the newborn checkup.

0-6 month 1Our organization has traditionally promoted the importance of reading aloud to children aged 6 months through 5 years. Reach Out and Read was founded in 1989 to take advantage of the unique opportunity that pediatricians have to affect the development, as well as the health, of the children they serve, especially those from low-income communities. A simple model was established of giving books to children and advice to families about the benefits of reading aloud together starting at the 6-month pediatric checkup. This reflected a tactical awareness that a 6-month old child can sit up on a parent's lap, and begin to grab and move the pages of a board book.

 However, advances in our understanding of early childhood development over the last 25 years have shown us that it is essential to encourage parents to engage with their infants right from birth. The first six months of life is a period of rapid brain development that does not occur at any other time, and is a critical window when parental responsiveness can shape a child's development (for more details, please read our previous blog post).  Accordingly, in 2014, the American Academy of Pediatrics released a policy statement recommending literacy promotion in primary care starting at birth.

In recognition of this, the Reach Out and Read leadership has announced a move to start the program earlier, such that it will now officially serve children from birth through 5 years.

"We believe that this will help us to do our job more effectively with families, bring us clearly into alignment with current scientific thought and best practices, and help us partner more effectively with other organizations in the field" explained Brian Gallagher, Executive Director of Reach Out and Read.

0-6 month 2

Reach Out and Read Medical Advisors have urged the 21,000 healthcare providers practicing the program to start recommending to parents the importance of talking, singing, reading and playing with their babies as early as the newborn visit. Materials, such as our popular Developmental Milestones chart, have been revised to reflect the change, and training will support the program expansion. 

"We are considering carefully and seriously how best to get guidance to parents during those complicated, joyous, and sometimes overwhelming months when they are learning to care for their new babies." said Perri Klass, Reach Out and Read National Medical Director. "We want Reach Out and Read providers to use those formative early visits in the most helpful, practical, developmentally appropriate, supportive ways, helping parents develop the responsive, positive, language-rich interactions, which should surround babies from the very beginning."

Written by Nikki Shearman at 09:00

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Reach Out and Read National Center
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