Reach Out and Read (ROR) is a national nonprofit organization that trains clinicians in supporting, coaching, and modeling for parents shared reading with their children, and provides books to families at pediatric well-child visits. Pathways to Resilience Expert Advisory Committee member Dr. Dipesh Navsaria has been engaged with ROR for over 25 years and has worked to expand the program in Wisconsin, where he lives and works. In the last few years, he was named to the national ROR Board of Directors, and is currently the Board Chair. Dr. Navsaria describes ROR as “a scalable, evidence-based, feasible way to help parents connect with their children through shared reading.” He considers ROR an essential part of primary care pediatric practice.

Reach Out and Read was established in 1989 to help families make reading a regular part of their children’s lives. There are now roughly 6,000 ROR sites across all 50 states that reach 4.2 million children per year, a quarter of whom are from low-income families. Every year, the program provides 6.6 million books during pediatric visits, where trained clinicians help families use developmentally appropriate techniques to ensure they have the skills and confidence to read well with their children. ROR has a strong evidence base, with peer-reviewed studies showing that parents involved in the program are more likely to read with their children and that children in the program demonstrate higher language scores.

ROR promotes early relational health, which is a framework that emphasizes the role of safe and nurturing relationships between children and caregivers in healthy childhood development. As Dr. Navsaria puts it, ROR is “not just a book giveaway program, it’s a parenting program that allows clinicians to assess, reinforce, and repair the connections that kids have with their families through shared reading.” By training clinicians to give the book directly to the child at the outset of the visit, they are able to observe what happens immediately after; skillful, intentional observation can provide a clinician with valuable information in a short amount of time, ranging from how developed a child’s motor skills are to how they interact with their parents. These insights may be more difficult to gather with the standard questions and practices clinicians use during pediatric visits, which is why Dr. Navsaria says “where there are no other pre-identified concerns, I would rather walk into a well child visit without a stethoscope than without a book.”

A strong proponent of the evidence model for ROR as a standard of good practice in pediatrics, he emphasizes that it’s important to follow implementation guidance. For example, clinicians should walk into visits with a book in hand to give to a family, rather than them getting the book at the front desk, or at the end of the visit: “The book shouldn’t be treated like a sticker — it’s an important tool for accomplishing many of the well-child visit goals.” The clinician can then ask open-ended questions about how often families get the chance to share books together and observe how the parents and children interact with the book. Clinicians should also take an intentional two-generation approach when implementing ROR, since it can be daunting for parents to read to their children if they did not grow up being read to or around adults who read with young children regularly. Dr. Navsaria notes that there may be both a skills and confidence gap for parents, which clinicians can help address by offering advice for reading with children at different ages, modeling ways to keep children interested in the book, and providing referrals to adult literacy clinics for parents who may have difficulty reading themselves.

Implementing ROR is not time consuming or costly, but it does require intentional effort from clinics. Some clinics fundraise to buy their own books, which need to be new and meet ROR guidelines, while others write ROR into their budgets or seek financial support from foundations or other sources. In Wisconsin, Dr. Navsaria first established a ROR program within UW Health in Madison and over 12 years ago established a statewide affiliate, which has thrived. There are now 260 clinics implementing ROR in Wisconsin, and while funding limitations kept limits on new clinics joining, new successes mean they are once again taking new clinic applications. Though many programs exist that support healthy childhood development, ROR is meant to be a scalable, lighter-touch program that has a broad reach and can complement more intensive programs like home visiting. As ROR continues to grow, the organization is focused on further supporting early relational health and maintaining consistency and quality through fidelity to the ROR evidence model and coordination via local and regional affiliates.

Pathways to Resilience is proud to highlight ROR’s efforts to promote healthy child development and Dr. Navsaria’s work with the organization. To learn more about ROR, visit their website or check out the Reach Out and Read podcast hosted by Dr. Navsaria, which was recently honored with a Silver award in the health category in the second annual Anthem Awards.

Pathways to Resilience will continue to amplify strategies for promoting healing and resilience in the health sector and share resources to provide guidance to states seeking to implement similar approaches.