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The journey toward literacy begins in infancy: the Reach Out and Read innovation.


Reach Out and Read is an evidence-based nonprofit organization that promotes early literacy and school readiness in pediatric exam rooms throughout the United States by giving new books to children and advice to parents about the importance of reading aloud. The program began in 1989 at what was then called Boston City Hospital, and is now known as Boston Medical Center.

Today, Reach Out and Read doctors and nurses at more than 4,900 health centers, hospitals, and pediatric clinics provide books and literacy advice to more than 4 million children and families annually. The program begins at the 6-month checkup and continues through age 5, with a special emphasis on serving children growing up in low-income communities.

In addition to the "traditional" program, Reach Out and Read also has Special Initiatives targeted at three communities (Spanish-speaking, American Indian/Alaska Native, and military families) for whom the Reach Out and Read intervention has been found to be especially beneficial.

The Need for Reach Out and Read

Studies show that the young brain is highly malleable and is shaped--either positively or negatively--by a baby's day-to-day interactions with the important people in his or her life. Given that 96% of all children under age 5 see a pediatrician or a family practitioner, the Reach Out and Read medical provider is in a strategic position to be the first to coach parents about the critical impact that reading aloud can have on the development of the reading brain. Reading aloud, even to the tiniest of babies, helps build crucial brain connections for language and literacy learning. Infants are soothed by the rhythm and tone of the spoken language around them and may even try to "mimic" the melodic contour of the mother's voice to attract more of her attention (Wermke, Mampe, Friederici, & Christophe, 2009).

At the same time, too many of our children continue to begin school ill-prepared to learn. Children raised in poor neighborhoods, children whose second language is English, children whose parents struggled with learning to read, and children who, as toddlers, experienced a late onset of talking, are highly represented in groups of children experiencing early difficulties in learning to read (Commission on Behavioral and Social Sciences and Education, 1998; Preston et al., 2010).

The learning gap begins to widen as early as infancy, especially for low-income children. A nationally representative sample of 1,100 infants born in 2001 was studied using data by the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), gathered by the National Center for Education Statistics with the U.S. Department of Education. Children from low-income families scored lower on cognitive assessments, were in poorer health, and had more behavior problems at 9 and 24 months than their counterparts in higher-income families (Halls et al., 2009). Mendelsohn and colleagues (2011) studied babies after coaching low-income parents--with video and modeling--to read to and otherwise stimulate their newborns once they brought them home. Disparities were already present at 6 months among babies whose parents were coached with the videos and those who were not.

Vocabulary development at age 3 has been found to predict reading achievement. By age 3, children from more educated families have typically heard 30 million more words than children from low-income and undereducated families (Hart & Risley, 1995). Furthermore, while a record number of young children are being cared for outside the home, studies also show that many children are enrolled in child care settings of poor quality (Bryant et al., 2003; Center for Research on Women, 2001). Half the kindergarten teachers across the United States report that at least half of their students experience difficulty following directions, working independently, and learning about books, letters, and numbers. And when children begin kindergarten with fewer language and cognitive skills, they often fall further behind, while the children with higher skills make increasing gains in reading and math (Rimm-Kaufman, Pianta, & Cox, 2000; West, Denton, & Reaney, 2001). By 1st grade, the consequences of reading failure are profound. Without intervention, these children are not on course to make the necessary transition from "learning-to-read" to "reading-to-learn." According to Double Jeopardy: How Third Grade Reading Skills and Poverty Influence High School Graduation (Hernandez, 2011), 83% of low-income 4th-graders score "Below Proficient" reading levels, vs. 55% of middle-income cohorts.

The Evidence for Reach Out and Read

A number of studies have emerged from among the many thousands of Reach Out and Read programs across the United States. Appearing in peer-reviewed journals, they point to the effectiveness of the program. Reach Out and Read has proven it can make a difference in:

* Increasing the number of days per week parents read aloud to their children

* Enriching the home literacy environment by increasing the number of books in the home

* Improving the language skills of older toddlers at risk for reading difficulties. (Chrisler & * Thompson, 2011; High, LaGasse, Becker, Ahlgreen, & Gardner, 2000; Mendelsohn, Magiler et al., 2001; Needleman, Toker, Dreyer, Klass, & Mendelsohn, 2005; Sharif, Rieber, & Ozuah, 2002)

To stimulate ongoing research in the field of pediatric early literacy and encourage collaborative research efforts between pediatrics and early education, the American Pediatric Association (APA) instituted the Young Investigator Award in 2011. With generous support from Reach Out and Read, APA provides once-a-year financial support for intervention research in primary care. One $15,000 grant is dedicated to support the early stages of literacy development and school readiness among children at risk for reading and learning difficulties.

The first grant was awarded in 2011 to Meghan Treitz from Children's Hospital, Colorado. Dr. Treitz is promoting early literacy with low-income families using a video tutorial to teach dialogic reading. The 2012 awardee will be announced soon.

Human Interest Stories

What distinguishes Reach Out and Read from other interventions is that it is evidence-based. Since 1991, the Reach Out and Read model has been studied by academic investigators in a variety of settings, providing a growing body of peer-reviewed research on its effects. The body of published research supporting the efficacy of the model is more extensive than for any other psychosocial intervention in general pediatrics.

In addition to the vast base of evidence behind Reach Out and Read, we also have scores of anecdotal evidence of its success from pediatric medical providers nationwide, such as:

1. When Marshalltown, Iowa, was recognized as a Bookend City, health providers and community leaders invited families to join the celebration event. One family eloquently described how much they appreciate Reach Out and Read and love sharing books with their young children, and related one of their Reach Out and Read experiences with their pediatrician. The Marshalltown mother brought her young daughter and son to their well-child checkups. When the doctor entered the exam room, the boy asked, "She gets a book today, right?" When the doctor agreed, and held out the day's Reach Out and Read book, the boy said proudly, "I told her that! I told my sister and I told my mom ... she's going to get a book and then I'm going to read it to her!" He then proceeded to demonstrate how he shares books with his little sister. This is a proud moment in so many ways--a child who is proud of his family, proud of his reading skills, and proud to be proven right in his promise that a visit to the doctor means a beautiful new book. And it is a perfect illustration of what makes Reach Out and Read so successful in fulfilling its mission.

2. While we are still wrestling with getting the right age mix of Native American grant books to our kids, the books, referrals, and the parent education that go hand-in-hand with book distribution are already influencing our local reservations for the better! Home visitors are reporting that a higher percentage of families with young children on the Bishop and Lone Pine Paiute reservations have some children's books in their home; just a few years ago, it was rare to find any. In addition, grandparents and aunts and uncles have embraced reading to young children as an important family pastime. Our largely native-servicing Toiyabe clinics have been our most diligent participants and trainees; they have increased parent participation from 13% of families reading daily with their child in 2007 to more than 35% reading daily in December 2010.

3. We found that one of our patients had no books at home and the parents did not read to their children. We were able to provide the child's first book and encouraged the parents to read to that child and to the other children in the home. At the next visit, the parent proudly reported that she and the grandparents had started to read aloud daily and were making reading part of their daily routine at home. The family purchased books and asked for books as gifts instead of toys.

How To Become Involved

Reach Out and Read works because of two important buy-ins--that of the pediatrician and that of the parents. It is made possible, however, through the support of a wide network of donors, foundations, legislators, volunteers, and corporations.

The general public is also encouraged to get involved in Reach Out and Read via the "Supporters" section of our website at www. To keep up with the latest early literacy news and information, supporters are also encouraged to become a fan on Facebook at and follow us on Twitter at reachoutandread.

Global Connections

While Reach Out and Read is primarily an American initiative, several programs worldwide mirror this format of early literacy intervention via the pediatric clinician. Such programs can be found in Israel, England, Canada, Bangladesh, the Philippines, and Italy (Born to Read).

In addition, Yokota Air Base in Japan began a Reach Out and Read program in the spring of 2011. Yokota is the first military base in Japan where pediatricians incorporate the program into their pediatric wellness plan.

Reach Out and Read garnered international recognition in 2007 when UNESCO (United Nations Educational, Scientific, and Cultural Organization) awarded our organization an international Confucius Prize for Literacy in recognition of our particularly effective contribution in the fight against illiteracy.


Bryant, D., Maxwell, K., Taylor, K., Poe, M., Peisner-Feinberg, E., & Bernier, K. (2003). SMARTSTART and preschool child care quality in North Carolina: Change over time and relations to children's readiness. Chapel Hill, NC: Frank Porter Graham Child Development Institute.

Chrisler, A., & Thompson, L. (2011). What works for early language and literacy development: Lessons from experimental evaluations of programs and intervention strategies. Washington, DC: Child Trends.

Commission on Behavioral and Social Sciences and Education. (1998). Preventing reading difficulties in young children. Washington, DC: National Academy Press.

Halle, T., Forty, N., Hair, E., Perper, K., Wandner, L., Wessel, J., & Vick, J. (2009). Disparities in early learning and development: Lessons from the early childhood longitudinal study-birth cohort (ECLS-B). Washington, DC: Child Trends.

Hart, B., & Risley, T. R. (1995). Meaningful differences in the everyday experiences of young American children. Baltimore, MD: Paul Brookes.

Hernandez, D.J. (2011). Double jeopardy: How third grade reading skills and poverty influence high school graduation. Baltimore, MD: The Annie E. Casey Foundation.

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Mendelsohn, A. L., Huberman, H. S., Berkule, S. B., Brockmeyer, C. A., Morrow, L. M., & Dreyer, B. P. (2011). Primary care strategies for promoting parent-child interactions and school readiness in at-risk families. Archives of Pediatrics & Adolescent Medicine, 165(1), 33-41.

Mendelsohn, A. L., Mogiler, L. N., Dreyer, B. P., Forman, J. A., Weinstein, S. C., Broderick, M., ... & Napier, C. (2001). The impact of a clinic-based literacy intervention on language development in inner city preschool children. Pediatrics, 107(1), 130-134.

Needleman, R., Toker, K. H., Dreyer, B. P., Klass, P., & Mendelsohn, A. L. (2005). Effectiveness of a primary care intervention to support reading aloud: a multicenter evaluation. Ambulatory Pediatrics, 5, 209-215.

Preston, J. L., Frost, S. J., Mencle, W. E., Fulbright, R. K., Landi, N., Grigorenko, E., ... & Pugh, K. R. (2010). Early and late talkers: School age language, literacy and neuro-linguistic differences. Brain, 133(8), 2185-2195.

Rimm-Kaufman, S. E., Pianta, R. C., & Cox, M. J. (2000). Teachers' judgments of problems in transition to kindergarten. Early Childhood Research Quarterly, 15(2), 147-166.

Sharif, I., Rieber, S., & Ozuah, P. O. (2002). Exposure to Reach Out and Read and vocabulary outcomes in inner city preschoolers. Journal of the National Medical Association, 94, 171-177.

Wermke, K., Mampe, B., Friederici, A. D., & Christophe, A. (2009). Newborns' cry melody is shaped by their native language. Current Biology, 19(23), 1994-1997. doi: 10.1016/j.cub.2009.09.064.

West, J., Denton, K., & Reaney, L. (2001). The kindergarten year. NCES 2001-023. Washington, DC: National Center for Education Statistics.

Jean Ciborowski Fahey is Early Literacy Research Specialist and Judith Forman is Public Awareness Manager, Reach Out and Read National Center, Boston, Massachusetts.
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Author:Fahey, Jean Ciborowski; Forman, Judith
Publication:Childhood Education
Geographic Code:1USA
Date:Jul 1, 2012
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