Pediatricians in Colorado are prescribing over 200,000 books a year to children aged six months to five years old, three-quarters of whom are from low-income families. Nearly 90% of children visit a doctor at least once a year, which makes them perfectly placed to help with early literacy development. The intervention makes parents more likely to read to their children and boosts language development.
Results & Impact
The program, which operates in 62 out of Colorado's 64 counties, reaches approximately 125,000 children aged between six months and five years old, three quarters of whom are from low-income families. More than 200,000 books are prescribed each year in around 330 participating clinics by more than 1,700 health professionals. Studies from other states show participating parents in the US are two-and-a-half times more likely to read to their children, and children’s language development is improved by three to six months by the time they reach school. They aim to reach every at-risk child from six months to five years old in the state by 2020.
Reach Out and Read Colorado, Colorado Governor’s Office, Colorado Department of Public Health and Environment
The books come in more than 60 languages and are designed to be developmentally appropriate for all children, who are prescribed books based on their age and ability. They are also placed in waiting rooms for parents and children to peruse. Training for partner healthcare providers takes place online and lasts about an hour a half. The training includes video clips of providers in the exam room modelling the intervention, guidance on things like using the books to monitor child development, and information on how to communicate with parents who struggle with English. Reach Out and Read Colorado uses data to prioritise communities with the most at-risk families, defined as those who have little or no health insurance coverage. Military communities are also targeted.
Parents, infants and toddlers
Cost & Value
Running the program costs approximately $1 million each year, 10-15% of which comes from government grants.
The first Reach Out and Read book was prescribed in Colorado in 1997, and in 2004 Reach Out and Read Colorado was set up as a nonprofit to grow and organise the program in the state.
One of the biggest challenges is continuing to maintain funding for the program, as funders often look for new projects rather than simply backing what’s already working. Meanwhile, as the program reaches more and more families it makes it more difficult to maintain the original model. Also, every time there’s a change in practice or new successful pilot, it needs to be spread to the 330 clinics.
Reach Out and Read is practised in all 50 US states at varying degrees of progress.
Doctors in Colorado are boosting literacy by prescribing books to young children aged six months to five years old.
The evidence suggests that prescribing books makes parents in the US two-and-a-half times more likely to read to their children, improving language development by three to six months by the time they reach school.
The books, which come in more than 60 languages, are developmentally appropriate, and prescribed by pediatricians who are specially trained to gauge and help ameliorate children’s literacy. Around 330 clinics participate in 62 out of 64 counties, including more than 1,700 healthcare professionals.
“It just creates such a nice sense of community,” said Dr Larry Wolk, Executive Director and Chief Medical Officer of the Colorado Department of Public Health and Environment. “It’s not just targeted to the underserved or to the illiterate: it’s really a true population health approach that can involve everyone.”
“The path to improving literacy as a pediatrician is to start at the very young age of six months”
Now a senior civil servant, Wolk was one of the original pediatricians who partnered with the national organisation Reach Out and Read in 1997. Seven years later, Reach Out and Read Colorado was set up as a nonprofit to grow and organise the program in the state.
Wolk, who still practices as a pediatrician once a week, emphasises the need to think broadly about the social determinants of health, which includes making sure kids have access to better education and jobs. “The path to that is literacy,” he said. “And the path to improving literacy as a pediatrician is to start at that very young age of six months, getting kids to appreciate books and getting the child and their family to read.”
Reach Out and Read Colorado utilises health data on how many families in each county are uninsured or underinsured to decide where to prioritise their efforts to expand the program. They also target military communities.
“For the child, it’s an opportunity to read aloud and learn,” explained Maureen Maycheco, Communications Director at Reach Out and Read Colorado. “For the healthcare provider, it’s a tool to be able to assess the child.”
Participating pediatricians are trained online, which usually takes about an hour and a half. The training includes video clips of providers in the exam room modelling the intervention, guidance on things like using the books to monitor child development, and information on how to communicate with parents who struggle with English. In addition to the books that are prescribed, several more are placed in waiting rooms for parents and their children to peruse.
The scheme takes advantage of the fact that healthcare providers occupy a key role in the lives of young families. Nearly 90% of all young children see their provider at least annually, compared to the less than one-third who attend formal childcare. Meanwhile, according to Generation X parents (aged 35 to 50) in the US, medical professionals are the second most useful resource after their own parents for advice, information and guidance.
Building a rapport with parents is a key aspect of the program, which makes language-appropriate books especially important. “We’ve heard from our families that even when they’re illiterate in their native language, they recognise those letters and symbols,” said Meredith Hintze, Executive Director of Reach Out and Read Colorado. They appreciate that doctors “took the time to have a book that was unique for that family.”
“There was an opportunity even for some of the parents to learn along with their children,” said Wolk. “Moving up through the developmentally appropriate books could be very helpful for a parent who struggles with their own literacy.”
Overall, running the program costs approximately $1 million each year, which includes around 10-15% from government grants.
The state government also supports the program by looking out for more funding opportunities, and helping to promote it more generally. The latter has included initiatives such as One Book 4 Colorado – organised in partnership with Reach Out and Read Colorado – in which all four-year-olds in the state are given a free book each spring.
A number of government leaders such as Wolk have been involved with Reach Out and Read Colorado before taking their positions. “We don’t need to explain to them what the program is, how it looks, how it impacts families,” said Hintze. “Because they served families and saw the look on a child’s face at one point or another in their career.”
Moving forward, Wolk wants to work towards making it a required component of children’s healthcare visits. He sees this as part of a broader change in healthcare that he advocates for: “The evolution is how do we shift from this fee-for-service system to a value-based system.”
In 2018, Reach Out and Read Colorado are piloting two new programs to begin literacy development even earlier. Their New Parent Empowerment Initiative (NPEI) aims to engage with parents in the information-gathering stage before birth, and the “0-6 Month” program plans to scale early literacy interventions. The plan is to reach more than 2,500 expectant mothers and prescribe more than 15,000 books to families with infants in the Denver metro area.
“The pediatrician is in a good position to screen the mother during pregnancy or shortly afterwards for depression”
The reasoning behind the new schemes is that the literacy gap starts very early. One landmark study, for example, showed a word gap by the age of three to the tune of 30 million words.
Wolk also points out that these new projects could help in identifying potential risks earlier. “We have seen, from a public health standpoint, a rise in postpartum depression,” he said. “The pediatrician is in a good position to screen the mother during pregnancy or shortly afterwards for depression.”
These new projects are also important for maintaining the interest of funders, which can be difficult for a project which has been running for a number of years. “As we’ve expanded, fundraising and getting support for that work is a challenge,” said Hintze. “Also, as we’ve run these pilots, and we recognise: ‘Wow, it’s very impactful for families. Now we need to field that work to the 330 clinics because we know that it’s good work’.”
Reach Out and Read Colorado plan to continue growing and reach all at-risk kids between six months and five years old in the state by 2020. As the project continues to grow, it’s increasingly important to maintain fidelity to the model, so that the quality of the intervention isn’t sacrificed by its wide reach.
Pediatricians like Wolk believe the scheme, which now has practices in every state in the US, has huge potential to help close the achievement gap and remove children from cycles of poverty. It also makes life more enjoyable for the health providers themselves: being able to prescribe books to kids as a treat.
(Picture credits: One Thousand Design)