Thousands of doctors and nurses across the country, in large urban hospitals and small rural clinics, tell us that Reach Out and Read has become an essential part of their pediatric practices. By introducing a beautiful new book at the beginning of a well-child visit, providers find they can better engage and calm the child, provide meaningful, positive messages to the parent, and build connections with the family. Using the book in the exam room opens up the opportunity to talk about other issues - healthy routines, sleep issues, and even school readiness, and also offers providers a new and valuable tool for assessing the child's development. Becoming an ROR Program will mean that your clinic offers new and valuable benefits to your patients and their families' important developmental guidance, beautiful, age-appropriate books, enrichment in the waiting room - and also gives your providers new ways to strengthen their relationships with the families of young children.

The ROR model for pediatric literacy intervention has three key elements:

• Primary care providers (doctors and nurses) are trained to deliver early literacy guidance to parents of children 6 months through 5 years of age during each well-child visit. This guidance centers on age-appropriate strategies, including: how to enjoy looking at board books and naming pictures with infants, the importance of rhyme and repetition to toddlers, and open-ended questions to use when reading with preschoolers.
• During the well-child visit, in the exam room, the provider gives the child a new, developmentally-appropriate children's book to take home, building a collection of 10 new books in the home before the child goes to kindergarten.
• Many ROR Programs also create literacy-rich waiting rooms, including gently-used books for waiting room use or for siblings to take home. In many of these waiting rooms, ROR volunteers model for parents the pleasures and techniques of reading aloud to very young children.

ROR is an evidence-based intervention. Peer-reviewed and published studies show that literacy promoting interventions by the pediatrician, using the Reach Out and Read model, have a significant effect on parental behavior, beliefs, and attitudes toward reading aloud. Studies also show that parents who get books and literacy counseling from their pediatricians are more likely to read to their young children and provide more books in the home. Several studies also show improvements in the expressive and receptive language scores of young children receiving this intervention. Check the Impact & Research section of the ROR website for additional information on ROR-related research.

The number of new books you need depends on your Annual Book Commitment (ABC), which is equivalent to the annual number of well-child visits for children ages 6 months through 5 years. On average, ROR Programs' books cost approximately $2.75. To determine your estimated Annual Book Budget, multiply your annual number of well-child visits for children aged 6 months through 5 years old (we used 620 in the below example) by $2.75. During your first year, some of the books for your Program may be provided by an ROR Coalition and/or other sources, thus lowering the number of books you will need to purchase each year. After a Program has completed two brief ROR biannual Progress Reports (see Question #12), it may be eligible for books from the ROR National Center.

There are lots of ways to raise money for your ROR Program. Many small Programs hold an annual fundraiser, such as a bake sale or a pancake breakfast. Still others seek funding from wealthy individuals in their communities or from small businesses, large corporations, or charitable foundations that support local causes. The kind of fundraising plan that you need will depend on the size of your population and your budget. www.myROR.org provides templates for fundraising letters and grant applications that you can personalize for your own Program. ROR Coalitions can also assist with your fundraising efforts. Click here to see if there is a Coalition in your area.

Local community groups can help your ROR Program with fundraising for books, volunteer recruitment, community visibility, and publicity. There are other people in your community working to promote literacy, and there are many service organizations that might want to link up with you locally. ROR Programs often work with the following groups:

• Libraries
• Faith-based organizations
• High school and college community service leaders
• Civic groups (e.g., Rotary Club, Kiwanis, Junior League)
• Municipal literacy initiatives

The ROR model is designed to be implemented by medical professionals who provide primary care to children, ages 6 months through 5 years, as part of the well-child checkup. We at the ROR National Center feel strongly that the message about the importance of reading aloud is important for every young child and every family - and, of course, that books are important for every child. We are eager to work with any clinic or practice which wants to implement the program. However, our funds are limited, and our federal funding in particular is designated for children at-risk.

Each ROR Program has an ROR Medical Director - a doctor or nurse who is responsible for the job of training medical colleagues, connecting with the executive leadership of the clinic, and generally serving as the medical "face" of the Program. The Medical Director is supported by a Program Coordinator who is responsible for the administrative aspects of running the ROR Program (i.e. ordering books, stocking exam rooms, coordinating volunteer readers). The ROR Coordinator can be any interested staff member familiar with the clinic, the staff, and the patient population. Both roles are most often voluntary in nature and take very little time each month.

• Review information about the ROR model at www.reachoutandread.org.
• Identify an on-site ROR Medical Director.
• Talk to your clinic's administration and pediatric staff to engage their support.
• Begin to gather demographic information on your clinic population - ages 6 months through 5 years. (You will also need to determine a rough approximation of the percent of families living at or near 200% of the poverty level, or give us other demographic information to indicate whether you serve a substantial number of children who should be considered at-risk.)
• Develop and implement a fundraising plan to generate support for your books. You will need to demonstrate in your ROR application that you have secured at least 75% of your Annual Book Commitment (ABC) for the first year.
• Find out if you are located within an ROR Coalition. Click here to see a list of ROR Coalitions.

Begin an online application.

ROR training for pediatric primary care providers offers practical, concrete, and effective strategies for talking to parents about books and for using books in the well-child visit. All participating ROR providers need to complete the ROR training before they begin implementing the program. For new Programs with more than eight providers, the ROR National Center can arrange an on-site training session shortly after the application is approved; alternatively, Programs in Coalitions may be eligible for on-site training arranged by the Coalition. Both a training video and a one-hour online CME course on pediatric literacy promotion are also available, for clinics with fewer providers or for individual providers interested in these training options.

The ROR model calls for the provider to give a new, age- and culturally-appropriate book in the exam room at each well-child visit. There are a number of ways that you can procure books for your Program.

ROR publishes a book catalog available exclusively to approved ROR Programs with books at substantially discounted prices. The catalog is organized by child's age to make the book selection process easy. ROR Programs may also choose to purchase high quality children's books from book specials offered by publishers and book distributors. These offers can be found at www.myROR.org/books. You can also solicit new book donations from individuals or businesses in your area.

The ROR Program Manual, has a chapter devoted to identifying good children's books for use in the program, as well as suggestions for ordering, tracking, and storing your book supply.

Many ROR Programs also like to have "gently-used" donated books available in the waiting areas for siblings, for sick visits, or for long waiting periods.

ROR recognizes that children and parents often spend a fair amount of time in the waiting room. To take advantage of this time, the ROR model recommends using the waiting room to promote the joy of reading aloud and to provide information for parents about how to read to their young children. In many ROR waiting rooms:

• Volunteers provide children with positive reading experiences and help parents understand that a picture or storybook is an easy, portable way to keep a young child engaged in almost any situation.
• Volunteers model read-aloud techniques that show parents by example that reading with children is a vigorous, enjoyable process.

Not all clinics have waiting rooms or wait times suitable for volunteer reader programs. However, all ROR Programs can develop a waiting room component of the Program. For example, ROR Programs can:

• Ask volunteers to collect gently-used books, sort them, and put them out on shelves in the waiting room so children of all ages can read them in the waiting room and take them home if they choose.
• Develop displays of short poems, stories, and laminated posters to display in the waiting area.
• Provide posters and pamphlets about health literacy and family literacy opportunities available in the community.

The staff at the ROR National Center are available to provide ongoing technical assistance to our Programs. We like to keep in touch, often through our regular e-newsletter. In addition, if your Program is in a region with an ROR Coalition, you will benefit from their assistance and support as well.

If you have further questions, see our Starting a Program brochure, email the ROR National Center, or call 617-455-0600.