REACH OUT AND READ MINNESOTA

Reach Out and Read Minnesota's vision is that every child will have the opportunity to participate in Reach Out and Read no matter where they live in the state; to essentially make Reach Out and Read a standard of care. Sites includes pediatric clinics, family medicine clinics, outpatient hospital clinics, federally qualified health centers, clinics on reservations, or in homeless shelters, private practices or public health clinics. No matter where they are located or what kind of clinic they are, sites that implement the Reach Out and Read model provide pediatric primary care, incorporate books into their well-child exams, and encourage families to read aloud together.

Many parents don't know that 90% of brain development happens before their child even enters kindergarten or that they have the power to affect the healthy development of their child's brain starting at birth. Studies have shown that when they do, they intentionally interact more with their babies and young children.

Reach Out and Read providers give families the tools and information they need to support their child's health. Nurturing from a loving parent or caregiver in the early years supports brain development that forms the foundation for success later at school and in life. One of the best ways of engaging with young children is through looking at books together. Babies and young children love to be held close and hear the voice of someone who cares for them read a book aloud.

Over the years, the Reach Out and Read model has been examined by academic investigators in a variety of settings, providing a substantial body of peer-reviewed research on the impact of the program. When our Minnesota clinics implement Reach Out and Read with fidelity to the model we expect our results to reflect these national research results.

This body of published research is more extensive than for any other psychosocial intervention in general pediatrics and shows that the program changes child outcomes (a reduction in language delays of at-risk children, higher expressive and receptive language scores), parental attitudes and practices (more likely to cite sharing books as a favorite activity, 2.5 times more likely ever to read to their children, twice as likely to read to their children more than three times a week), and reflects the quality of primary care (parents more likely to rate providers as helpful; providers more likely to rate parents as receptive, staff at successful sites worked as a team and expressed strong commitments to their communities.)

Compelling results place Reach Out and Read as a leader in early literacy and stimulate a more widespread adoption of our program. By operating through the primary medical care network, Reach Out and Read has the greatest reach of all early literacy programs to families with young children - and the capacity to scale up to reach many more.

The Reach Out and Read model is simple, inexpensive, scalable and highly effective.

(1) During regular well-child checkups, Reach Out and Read providers (pediatricians, family physicians, nurse practitioners, and physician assistants) give new, developmentally-appropriate books to children from infancy through five years of age. Children keep these books at no cost to their family.

(2) Providers advise parents about the importance of reading aloud and provide them with information and literacy strategies appropriate to their child at that age. For instance, babies explore the world, including their books, with their mouths, so chewing is perfectly normal and to be expected, not discouraged. Two-year-olds love rhymes and flaps – the sillier the better. Preschoolers can follow more complicated stories such as folktales, wildly imaginative stories, or tales of family life.

(3) Families make reading part of their daily routine. Research shows that in Reach Out and Read families parents are 2.5 times more likely to ever read to their children and twice as likely to read to their children more than three times a week.

Reach Out and Read Minnesota leverages the existing healthcare network of primary care clinics in our state and helps providers build on the unique relationship they have with the parents of their youngest patients to engage them in the vital work of early brain development.

We train and guide providers to support their implementation of the Reach Out and Read model. We encourage them to use books as developmental surveillance tools during well-child exams and help them identify books that are developmentally, culturally, and language appropriate for their young patients.

Reach Out and Read providers have the greatest access to families with children in the early years, when it counts - more than 91 percent of children under the age of six attend routine pediatric visits (i. e. well child checkups) at least once a year. Clinics don't have to convince parents to attend a class or find time in their already busy schedules to receive this crucial brain development information. They are walking through the door every day on their own.

This unparalleled access during a child's first five years offers a critical window for learning because the brain is developing at a rapid rate that does not occur at any other time. Many children, especially from low-income families, are not read to from birth. Children who hear fewer words during early childhood start school developmentally behind their peers and may never catch up.

In a nutshell, we help providers leverage the capture opportunity that a well-child exam provides to encourage parents to read aloud daily to their infants, toddlers and preschoolers, as a simple and effective way to foster nurturing, language-rich family interactions that support brain development and provide a foundation for success.

In order to reach our goal of every child in Minnesota having the opportunity to participate in Reach Out and Read no matter where they live in the state, we must (1) actively guide and support clinics currently using the program so that they implement the model with high fidelity and quality, and (2) identify and recruit sites not using the program.

Because we are a part of the Reach Out and Read national network, which includes 28 regional affiliates and clinics in all 50 states, we have access to an online platform that tracks detailed Minnesota data such as the training status and progress of every provider at participating clinics, the results of annual site visits, site quality ratings, and data from semi-annual progress reports (demographic information (ethnic, language, and insurance data), the number of children served, and the number of books distributed). By downloading customizable reports we can slice and dice our data based on a variety of criteria – region, zip code, number of patients, number of providers, patient language and/or ethnicity, percentage of Medicaid patients, health system affiliation, etc.

Reach Out and Read Minnesota staff members visit clinics in person (or virtually if the site is more than 3-4 hours away) to assess performance, and create an improvement plan, if necessary. We use a standardized quality assessment form to rate 14 metrics in the areas of program management, provider performance, books, and literacy-rich environment. We share best practices, learn about clinic innovations, and if technical assistance is needed use a standard form to identify deficits, goals, action plans, and eventual outcomes.

Our robust, high-touch customer service model encourages clinics to contact us as soon as they run into trouble – personnel changes, a funding shortfall, a clinic logistics problem (we've dealt with floods, remodeling, moving, and a devastating fire at one clinic) – whatever the problem is, the sooner we can brainstorm, the better support we can offer. Our staff are responsive, tenacious, and willing to think outside the box to find solutions.

One of our volunteers is a retired IT professional who focuses on data analysis, spotting trends and identifying clinics whose performance may have slipped from one reporting period to the next. Personnel changes are often the reason that performance falters so we contact the clinic immediately to help them get back on track, sometimes before they even know they have a problem.

When funding is available we identify new clinics to recruit, focusing on those serving low-income populations. Sometimes clinics contact us. In either case, when an application form is opened online we receive an email alert, which allows us to offer support from the very beginning. We nurture the relationship, providing planning and technical assistance through the application and training phases until the site is ready to implement the program as an active site.

GROWTH: All the big state health systems participate in Reach Out and Read but only HealthPartners and Fairview can claim enterprise-wide implementation. 63% of the state's counties (55/87) have at least one active site. All of the clinics in three cities, Fairmont, Northfield, and Minneapolis are active Reach Out and Read sites.

Our 266 active sites distribute more than a quarter of a million books to their 167,000 Reach Out and Read patients on an annual basis, which represent 43% of all the young children (6 months through 5 years) in the state.

ENGAGEMENT: A year ago we embarked on an experimental pilot project in the city of Minneapolis to see if more frequent clinic and provider interactions would improve the quality of program implementation. We doubled our interactions with them and tracked the results – which were for the most part, stellar.

SUSTAINABILITY: We have only been a stand-alone nonprofit for one year; previously we were a fiscally sponsored chapter of our parent organization. We've worked hard to create standard work documents so that we can be more efficient. We redesigned our website for mobile optimization, increased our social media exposure, and continue to explore new sources of support for our work.

INNOVATION: Coloring outside the lines allows us to develop tools to improve both site performance and organization operations. Our metrics dashboard transformed quality improvement and our quick-pick book order form made a tiresome task easy and fool proof. We assign staff to specific health systems instead of geographic regions. This allows them to develop a deeper rapport with health system administrators and decision-makers. When strategic diplomacy and historic context are needed, geography is often irrelevant.

PARTNERSHIPS: Though Reach Out and Read is a private intervention, its impact is both personal and public. It's essential that members of the community know what our program is, how it works, and why it's important. We work with librarians, bankers, educators, police chiefs, and mayors who all want the same thing for the young children in their communities: the best. Community partners provide that essential local perspective that explains what you could never figure out on your own because you aren't there, and they are.

CULTURAL COLLABORATION: Ethnicity, heritage, language, and experience are part of our cultural DNA. We make a limited number of bespoke bilingual editions from English-only books by inserting translated text onto every page so that our families that speak uncommon languages can see and read their own words. And we've learned that a young child who has witnessed the deportation of a parent does not view the scene of a policeman hauling away a mischievous monkey named Curious George as funny.

NEXT: Our brass ring hasn't changed. Going to scale requires us to continue to cultivate support and think outside the box while keeping our progress indicators