Education Columns

Gayle Thomas, MD, Keyona Oni, MD, University of North Carolina at Chapel Hill; Cheryl Holder, MD, and Suzanne Minor, MD, Florida International University, Herbert Wertheim College of Medicine

The Reach Out and Read (ROR) model of early literacy promotion is an evidence-based intervention that allows providers who care for children to intervene in the exam room and positively impact some effects of social determinants.¹ ROR pairs the gift of a new, developmentally and linguistically appropriate book to take home and use, with the opportunity to observe developmental milestones and child parent interactions. By using a 2- to 3-minute conversation at the beginning of a well-child visit to empower and encourage parents to share books with their children, the provider can partner with the parent to change small aspects of the home environment and protect their child’s developing brain.

ROR provides family medicine residents with the evidenced-based training to appropriately assess, accurately identify, and provide early intervention for those children at greatest need of support in developing a needed lifelong skill: literacy. Many family medicine residency programs provide care for underserved populations across the United States. Poor literacy, high environmental/home stress, and adverse childhood experiences (poverty, exposure to physical, verbal, and emotional violence, etc) are common ailments that plague our underserved communities. Without intervention, children are at risk for emotional and cognitive impairments, which may lead to the adoption of unhealthy behaviors (unhealthy relationships, intake of drugs and alcohol, violence, etc) that subsequently increase the risk for development of early disease and mortality.

In addition to serving patients by using ROR, family medicine residents can also achieve milestones in residency. This program specifically addresses the “Professionalism 3” milestone: Residents demonstrate the ability to determine social determinants of health, as well as “Patient Care 3”: Residents demonstrate that they can partner with families to improve health through disease prevention and health promotion. Furthermore, utilizing ROR during routine well-child care assessments also assists in achieving the Quadruple Aim of providing an intervention that (1) improves the patient experience, (2) is cost effective, (3) improves population health (through improvements in individual literacy), and (4) improves provider experience. Through gained experience and confidence in conducting well-child visits with the addition of ROR principles, residents become skilled in interacting with children and their families, which in turn improves the overall experience and assists in retention of pediatric continuity patients in resident practices.

ROR can also be used in the medical school setting. An example of this is NeighborhoodHELP™ (Health Education Learning Program). Medicine, nursing, social work, and other discipline students visit patients four times per year in their homes in underserved communities of Miami-Dade County, to learn how to address the social determinants affecting health access and outcomes. ROR is a vital aspect of the Education and Pipeline Program of NeighborhoodHELP™, which provides a myriad of services: assessment of reading and math skills; tutoring; referrals to community resources (GED, English classes etc); monthly neighborhood Science, Technology, Engineering and Math (STEM) activities, and book gifting for all adults and children. Prior to household visits, students prepare with didactic, online modules and readings covering ROR research and program processes. In the home, students actively participate in modeling dialogic reading and using book sharing to assess developmental stages. The medical student gives the book to the child, while inquiring about book sharing and reading aloud by parent to child. Parents receive appropriate feedback from the faculty of the medical student.

The National Center for ROR estimates that only 50% of family medicine residencies have registered ROR programs. Both the American Academy of Pediatrics and American Academy of Family Physicians have issued policy statements expressing the important impact of ROR on pediatric care. ROR meets the needs for undergraduate and graduate medical education programs to simultaneously teach social determinants of health while achieving the quadruple aim. ROR is an evidence-based opportunity to impact the lives of our most vulnerable pediatric population and support the training of our future family physicians in the care of children.

Reference
1. Zuckerman B, Augustyn M. Books and reading: evidence-based standard of care whose time has come. Acad Pediatr 2011;11(1):11-7.