The goal of Reach Out and Read (ROR) is to improve the preliteracy skills of Baltimore children so that they can enter kindergarten ready for success. Objective 1: Inspire and assist all pediatric clinicians serving low-income families to implement Reach Out and Read, an evidence-based early childhood literacy program that encourages parents to read to children. The program also provides free books to families at every well-child visit from six months to five years of age. In all other areas of the country, providers volunteer to participate in this program. In Baltimore, the health department applied a public health approach and challenged all clinicians serving low-income families to participate.
This practice addresses school readiness and its relationship to poverty as a public health issue. Poor children face many obstacles to healthy development, including one that is often overlooked--they grow up without books. Studies have found that there is limited reading aloud in low-income families, indicating multiple potential barriers to book use. These barriers may include the lack of discretionary income, low parental literacy, cultural beliefs, and family stresses that preclude setting aside time for reading aloud.
According to the National Center for Children in Poverty at Columbia University, in Maryland's urban areas-- including Baltimore City--60 percent of young children live in low-income families. Results of the Work Sampling System show that fewer than half of Baltimore City's kindergarteners entered school in 2006 with their language and literacy skills fully ready for the work that awaited them. This impact can be seen years later. According to Dr. Andres Alonso, the CEO of the Baltimore City Public School System, fewer than half of the city's middle school students are proficient in reading, and of the students who enter high school, only about half receive a diploma. The outlook for these students is dismal: without sufficient literacy skills, and without a diploma, jobs that pay a living wage are often out of reach, and the cycle of poverty repeats itself.
Reach Out and Read addresses two issues long known to have an impact on a child's health: parent/child bonding, which promotes healthy social/emotional development; and the promotion of early literacy skills, which has a significant impact on school readiness and subsequent success. Reach Out and Read makes literacy promotion a standard part of pediatric primary care, so that children grow up with books and a love of reading. The program trains physicians and nurses to advise parents about the importance of reading aloud and to give books to children at pediatric check-ups from six months to five years of age, with a special focus on children growing up in poverty--critical literacy skills acquisition years. By building on the unique relationship between parents and medical providers, ROR helps families and communities encourage early literacy skills so children enter school prepared for success in reading. Reach Out and Read enables medical providers to disseminate critical literacy information to parents, ensuring that parents of virtually every child have early and consistent access to the "hows" and "whys" of reading aloud. It also underscores the message that Reach Out and Read is promoting--books and reading together are essential aspects of a healthy childhood. The challenge to all pediatric medical providers to incorporate ROR into their practice is Baltimore's response to the issue discussed above. By expanding Reach Out and Read so that it is available to all children living in or near poverty, the program ensures that all families receive this vital message--each time they go to the doctor.
Agency Community RolesAs described in detail in step 2 above, the Baltimore City Health Department took the lead in planning and challenging pediatricians and family practitioners serving children to implement Reach Out and Read. In taking this role, the health department provided office space for additional staff, supervised the staff, and committed funding to support the cost of books associated with the expansion of Reach Out and Read in Baltimore City. In this lead role, the Baltimore City Health Department partnered with other agencies that also had a stake in seeing children do better--the Baltimore City Public School System (BCPSS), and the American Academy of Pediatrics, Maryland Chapter. The other partners were the physicians themselves--professionals who already had a commitment to childhood health and who were willing to expand their definition of what a healthy childhood means. Both the BCPSS and the AAP Maryland Chapter supported this initiative through two press events that underlined the message that books are part of a healthy childhood.
In addition, the AAP in Maryland committed to raising funds to support the ongoing administrative and book purchasing costs associated with expanding ROR. The AAP also took on the role of reaching out to its constituency for expansion and fundraising purposes. Prior to the challenge, Reach Out and Read in Baltimore worked with multiple partners to maximize program success. These partners include the city-wide library system, local cultural institutions, local social service agencies, schools, colleges and universities, community service groups, and local corporations. Each partner plays a different role in supporting Reach Out and Read in the community, and all were apprised of this expansion throughout the course of the Public Health Challenge.
The Baltimore City Health Department has strong connections to partners throughout the city, due to the need to collaborate on multiple projects to maximize effectiveness. The very fact that the health department is looking at literacy as a public health issue puts a unique spin on the issue, and brings a different level of public focus. By connecting the school system and the health systems in the city, the health department sets up a collaborative relationship that acknowledges the impact and importance of each.
Costs and Expenditures
Staff: Contractual for one part-time worker: $18,800/year; health department staff salary at .4 FTE: $19,200/year.
Printing/copying, postage, phone: $2,000.
ImplementationReach Out and Read has been the subject of multiple studies reported in peer-reviewed journals since 1991. Research has shown that this intervention has had a positive effect on parent/child reading-aloud frequency, reading as a favorite activity, and on the receptive and expressive language ability of the children participating in this program (with improvements of three to six months on average). It follows that implementation of Reach Out and Read according to the model will improve the preliteracy skills of Baltimore children, improving their school readiness.
Detailed below are the tasks accomplished prior to and during the actual challenge period, which extended from June 2006-July 2007.
March 2006-April 2006: Outreach to Reach Out and Read National Center for financial and programmatic support. Outreach to the Maryland Chapter of the American Academy of Pediatrics (MDAAP) to partner with BCHD in support of this Reach Out and Read expansion. The MDAAP provided outreach to its membership and assisted with fundraising to support book purchases for the new practices that were brought on board through the challenge. Obtained and analyzed the Vaccines for Children (VFC) list of providers in Baltimore City. The VFC program is a federally funded program that provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay--children who are uninsured, underinsured, or Medicaid eligible. Of the 92 providers on the VFC list, 72 were eligible ROR sites. Of those 72 sites, 26 were sites with existing ROR programs, leaving 46 practices targeted for ROR expansion. Planning for press conference to announce the Health Commissioner's Public Health Challenge, including partnering with the CEO of Baltimore City Public School System.
May 2006: Outreach letters from the Health Commissioner and the MDAAP were sent to each identified practice, along with ROR information packets. Each practice was invited to the press conference. Follow-up phone calls were made to each practice.
June 2006: Press conference held at local hospital to announce kick-off of the Reach Out and Read Public Health Challenge. September 2006: Additional staff hired (.8 FTE) for challenge-specific tasks.
June 2006 - June 2007: Intensive outreach to each identified practice including phone calls, letters, and on-site visits with key staff at each practice. Weekly updates provided to stakeholders regarding successes and challenges of expansion efforts. Partnered with MDAAP to complete grant applications in support of expansion efforts. Extensive technical assistance provided to practices in order to facilitate ROR applications and establish tracking and distribution systems within new practices. Books ordered and delivered to new ROR sites as needed. Hands-on assistance provided to new ROR sites including training to ensure program fidelity to model.
July 2007: Press conference planned and held to announce success of Reach Out and Read Public Health Challenge. Ongoing: Intensive administrative and book purchasing support to maintain integrity of ROR programs
At the end of the one year public health challenge, the following outcomes were noted: 24 new medical practices in Baltimore City had implemented Reach Out and Read or had committed to doing so; and approximately 13,900 additional children who get their medical care through these new medical practices will receive books and anticipatory guidance about literacy.
The Public Health Challenge was a time-limited event, aimed at encouraging pediatric medical practices to implement Reach Out and Read. Led by Baltimore's Health Commissioner, those pediatric practices who met the challenge were able to take advantage of intensive administrative support, and guaranteed book funding for the first year.
The Maryland Chapter of the AAP committed to raising funds to support this expansion and has raised over $13,000 to date. It has committed to continuing to secure funding through grant writing and member outreach campaigns. AAP is also working with Reach Out and Read to plan for a fundraising event. Reach Out and Read in Baltimore has a strong support base. The health department anticipates that the stakeholders who have supported the program to date will continue to support the costs brought about by the expansion. For the past 10 years, funding and in-kind support has been obtained from family foundations, local community foundations, national foundations, large corporations, individuals, and other literacy organizations. The Baltimore City Health Department will also continue to provide support for Reach Out and Read in Baltimore City, as it has for the past two years.