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Doctors can now ‘prescribe’ books for families with young children

By Jeanna Baxter White

Word Master Media Group for

The Mebane Foundation

Anyone who has ever looked into the eyes of a child entranced by the soothing cadence of Goodnight Moon knows that shared reading is magical.

“One of the best ways to engage with young children is through looking at books together. Every time a parent or caregiver snuggles with a child on their lap to read a book, a message is sent to the child that they are loved and will be okay,” said Callee Boulware, regional director for Reach Out and Read Carolinas (RORC).

“Shared reading helps to develop not only strong parent-child bonds, but also promotes healthy brain development, improves language and listening skills, builds resilience, and buffers toxic stress in children and families.”

Primary care providers have a unique opportunity to educate and encourage parents to read with their children beginning in infancy. By targeting children and families through their medical provider, Reach Out and Read (ROR) provides a two-generation strategy focused on improved literacy and language skills, increased reading frequency, increased book ownership, and improved home literacy environments.

Recognizing the value of this approach, the Mebane Charitable Foundation in Mocksville has given Reach Out and Read Carolinas, in partnership with Smart Start of Davie County, a $32,000 grant to support the deepening and expansion of the program in Davie County.

“The foundation has been familiar with the great work and partnership of Reach Out and Read of the Carolinas and Smart Start of Davie County, so when we were approached to fund an even larger collaboration that would include our Davie County Health Department our support was a no-brainer,” said Larry Colbourne, foundation president. “The program already reached more than 1,000 children before the health department partnership was added; now it will reach even more young families and children that need the support. Considering that more than 43 percent of children in Davie County are not proficient in reading by the end of third grade, the need for this robust support for all families is evident.”

The partnership between RORC and Smart Start of Davie started in 2012, and the two organizations began working with Wake Forest Health Network Pediatrics – Advance and Mocksville in 2014 through a three-year grant from the N.C. Partnership for Children. In 2017, the program was expanded to include Novant Health Davie Medical Associates and Novant Health Hillsdale Medical Associates through a second three-year grant.

Together these four ROR programs are reaching 925 children between 6 months and 5 years of age. An additional 100-plus Davie children are benefiting from ROR programs in Forsyth County.

The grant will help ensure the high-fidelity implementation of ROR at each of these locations, fund the expansion of the program to the Davie County Health Department in Mocksville, and implement the intervention “back to birth” in all active Davie ROR programs.

“Grants have been instrumental in sustaining this program and we are thankful to the Mebane Foundation for its continued support of literacy in our community, especially in the area of birth to 5,” said Gena Taylor, executive director of Smart Start of Davie. “Vocabulary building, brain development, and family bonding are at the core of all of our programs and Reach Out and Read promotes all three.”

“Reach Out and Read is a wonderful model that can be blueprinted into any clinical practice,” said Boulware. “But our partnership with Smart Start is so valuable because my staff can’t intimately know 100 counties in the way an organization in that county can know that county.

“Together we marry our evidence-based intervention with their local expertise. We also have families with additional challenges like housing, food, and adult literacy. Smart Start can bring the appropriate community resources into the waiting rooms and clinics as well as provide information to the doctors and staff so that we can connect all of the dots.”

Smart Start also delivers the books pre-sorted by age so that it is easy for the medical provider to quickly grab an age-appropriate book. More than 1,800 books have been distributed this year despite the significant number of well-child visits postponed because of COVID-19.

The Davie Health Department now has the opportunity to offer ROR to the 700 birth-to-5-aged children that they serve.

“Studies have shown that the number of words heard by young children as they grow up varies dramatically with socioeconomic status; children from low-income families hear significantly fewer words than their more affluent peers.

“The hope of the Reach Out and Read program is that by putting books into our patients’ lives and homes, we will be giving parents the tools and knowledge that will help their children grow up with increased language, increased stimulation, an enhanced home environment, and a better chance for success in school,” Davie County Health Department Pediatrician Dr. Stephanie Pirkle said.

Specifically, ROR offers a three-pronged research-based model to promote healthy brain development in children:

1. The Primary Care Provider Coaching and Building Skills in Parents, Modeling and Supporting Early Brain Development and Relationships: During well-child visits, the doctor prescribes reading by modeling read-aloud strategies while teaching and training the parent about how to share books and why it is important, emphasizeing how reading brings families together.

2. The Book: Each child is given a new, culturally and developmentally appropriate book to take home, building a collection of 10-15 new books in the home before the child goes to kindergarten. According to recent reports, 41 percent of children are growing up in low-income households and almost  one-quarter of those children have fewer than 10 books of any kind in their household.

3. Literacy-Rich Environment and Resources: Clinic environments support literacy-rich messaging and resources to families, supporting providers in community-health resources, and supporting parents in daily literacy activities with their children.

Backing up to birth is a critical component of the project, built on the depth of research and guidance available about the developing brain and the critical nature of the first 1,000 days.

“For the first 20 years of the intervention, ROR started with the 6-month-old visit because the earlier visits were filled with immunizations and other concerns. We’ve since learned that 80 percent of the brain is developed by 3 years old, so we simply can’t afford to waste a single day,” Boulware said.

“By backing up all of our programs to begin with the first visit after birth, we capture six more months of brain development through four additional in-person visits, and we have the opportunity to help families develop a routine of reading together from the beginning, which is far easier than trying to implement one further down the line.”   

“Parents are a child’s first teacher, so it is critical that they understand the importance of reading from the beginning,” said Taylor. “Having someone influential in a child’s life, like the pediatrician, provide a book and prescribe reading together as a family really enhances a parent’s awareness of the importance of reading.”

Medical providers are required to participate in continuing certified medical education training.

“ROR is not going to cajole anyone into doing this,” Boulware said. “The primary care providers are the ones in the room with the patients, and if they don’t feel excited about the program it’s not going to be done well. Reach Out and Read is not just a book giveaway, it becomes an integral part of the visit, and a valuable tool in the provider’s toolkit.”

So far, 24 Davie medical providers have completed the training.

“It brings me so much joy to watch children progress from babbling to proudly saying their first words and later speaking in full sentences and sharing what is on their mind,” said Dr. Kelly Duffy, Wake Forest Health Network Pediatrics – Advance. “Children’s brains are developing rapidly in the first three years of life. Children that are read to more often in these early years go on to develop better language and literacy skills that are critical for the rest of their lives.

“Reach Out and Read makes it possible for every child in our practice to receive a book at each well visit from birth to age 5. The books help me reinforce the importance of reading with families. They also help me teach developmentally appropriate ways for families to share books and language in the natural rhythms of their daily lives.”

To emphasize the value of the program, Boulware detailed some of the information a medical provider can glean through presenting a book.

By observing the child’s interaction with the book, the provider can evaluate motor skills, cognitive skills, social-emotional skills, and get a sense of where the child is developmentally, such as:

• Does the child handle the book in an age-appropriate manner? For instance, does a  6-month-old immediately put it in their mouth?

• If the book is handed to a child upside down, can they re-orient it correctly at the appropriate age?

• Can they manipulate the pages?

• Can they identify colors, letters, and point to pictures at the appropriate age?

Assessing family dynamics and relationships in the sterile environment of a clinic can be hard. The book gives the provider a way to see how the family interacts together, providing insight into the strengths of the family and the opportunity to skill-build from there. For example:

• Does the child immediately hand the book to a family member to have it read to them?

• Does he get scolded for chewing on the book?

• Is there a teachable moment?

“Doctors have told us over and over, especially through COVID, that these visits are the best part of their day,” said Boulware. “I’ve heard comments like ‘The children love it,’ ‘the families love it,’ and ‘I can use Reach Out and Read to encourage families and to reinforce the message that whatever your challenges, you are still the most important thing in your child’s life and it is my job as your doctor to partner with you and to help you make all of your dreams for your baby come true’.”