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Laura L. Brown Advocacy Morning Report January 4th, 2012

From Clinic to WBN

2 yo female Kiara (new

patient) WCC no concerns except constipation prescribed miralax Given Goodnight Moon her first book 6 months later, I crosscovered in the WBN and met her newborn sister Mom proudly told me that Kiara had already read Goodnight Moon to her new sister, and was asking for more books

The Problem of

Illiteracy The Importance of Early Exposure to Language/Reading A Solution: Reach Out and Read Strategies for Literacy Guidance as Pediatricians

The Problem of Illiteracy

34% of U.S. children enter school lacking the basic

language skills they need to learn to read 68% of students who cannot read proficiently by the end of 4th grade will end up in jail or on welfare Over 70% of inmates cannot read above a fourth grade level, and 85% of all juveniles within the court system are functionally illiterate Of 16-19 year old girls at the poverty level and below, those with reading skills below average are 6 times more likely to have out of wedlock children than their reading counterparts, and 10 times more likely to end up on welfare

Significant Variability

Early Exposure to Language is Critical

The more words parents

use when speaking to their 8 month old infant, the greater the childs vocabulary at age 3 years Children from low-income families hear as many as 30 million fewer words than their affluent peers before the age of 3 years 61% of low-income children have ZERO 0 childrens books

The Solution:

Reach Out and Read

1) Anticipatory guidance about reading aloud and

modeling and observation of parent-child book use. 2) Developmentally and culturally appropriate picture books given by the doctor at each health supervision visit. 3) Community volunteers who read to the children in the waiting room.

ROR Works!
Statistically and clinically significant increase in the

following: 1. Child-centered literacy orientation (parent reading aloud among parents or childs favorite activities, or reading aloud at bedtime at least 6 nights/week) 2. Receptive and expressive language scores (up to a 6 month developmental difference in the preschool years alone), with a dose-dependent effect.

ROR is Effective and Inexpensive!

Total cost of $50/child (deep discounts from publishers):

every child enters kindergarten with at least 10 books, and parents who understand the importance of reading! Trusted messenger YOU! Broad scope and reach 96% of kids under age 6 yrs are seen at least once/year by their pediatrician! Positive reinforcement! Hope for educational success!

Strategies for Literacy Guidance: SAFER Model

Show the child the book early in the visit; share (look at

or read) the book with the child yourself, modeling for the parent) Ask the parent about reading aloud; assess the childs development and child-parent relationship Feedback about what youve observed the child do; give feedback about parents attitudes and interaction with the child Encourage the parent to read aloud daily to the child; explain about literacy development Refer (to the library or family and adult literacy programs); record in the chart your actions

Dialogic Reading: Keeping Children Involved

6-12 mo: Parents can point to and name pictures.

12-18 mo: Let child control the book, ask wheres the?

and let child point. 18-24 mo: Relate books to childs experiences, ask whats that? and give child time to answer, pause and let child complete the sentence. 24-36 mo: Be willing to read the story over and over. 3 yrs and older: Ask whats going to happen?; let child tell story

Kids Count Data Book (Produced by Utah Voices for Children) Hart, B. Risley, T. Meaningful Differences in the Everyday

Experiences of Young American Children (1995), Paul H. Brookes Publishing Co. National Education Association: Needlman, R., et al., Clinic-based intervention to promote literacy. American Journal of Diseases of Children, 1991. 145: p. 881-884 Needlman, R., et al., Effectiveness of a Primary Care Intervention to Support Reading Aloud: A Multicenter Evaluation. Ambulatory Pediatrics, 2005. 5:209-215. ROR web-based training for providers: Sharif et al 2002. Exposure to Reach Out and Read and vocabulary outcomes in inner city preschoolers. J Natl Med Assoc 94(3): 171177. The Annie E. Casey Foundation, 2012 Kids Count Data Book, State Trends in Child Well-Being.