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Before Dr. Anna Miller-Fitzwater greets a patient in her clinic, she opens a cupboard door and reveals books of all sorts. There are books in Spanish, books that have patches of fur on thick cardboard pages, and even a book with a high-contrast barnyard story illustrated with newborns in mind.

Reach-Out-and-Read

As a pediatrician at Wake Forest Baptist Health–Downtown Health Plaza, an outpatient clinic of Wake Forest Baptist Medical Center, Dr. Miller-Fitzwater begins each patient visit by offering a gift: an age-appropriate book followed by tips for families to read together. “No amount of TV watching – even educational programs – is going to replace interacting with your baby and having them hear your voice and feel that loving relationship,” she explains.

The clinic is a Reach Out and Read partner site. Reach Out and Read is a highly effective early literacy intervention program with benefits for children, parents, and healthcare providers. Dr. Miller-Fitzwater and Reach Out and Read Carolinas are working to make the program even better in North Carolina, starting with Forsyth County. 

Dr. Anna Miller-Fitzwater in a patient room at Downtown Health Plaza, and a peek inside the book cupboard.
Dr. Anna Miller-Fitzwater in a patient room at Downtown Health Plaza, and a peek inside the book cupboard.

As Callee Boulware, executive director of Reach Out and Read Carolinas, explained in her February 2, 2017, perspective piece, “There is extremely strong evidence that a child’s first years establish the foundation of lifelong experiences.”

Before children enter kindergarten at age 5, there are few opportunities to reach young families to offer support in developing healthy learning habits. The Reach Out and Read model solves this challenge by partnering with medical facilities to make books a fundamental part of every child’s periodic well visits between six-months and five-years old.

Courtesy Reach Out and Read Carollinas.
Courtesy Reach Out and Read Carolinas.

The national program serves an estimated four million children each year. Reach Out and Read Carolinas manages a two-state region, with 239 partner sites serving roughly 210,000 kids a year in North Carolina.  In Forsyth County, Reach Out and Read partners with Smart Start of Forsyth County to serve nine sites.

“We touched 35,000 books [in 2016]. Every one of those books went back out into the community via medical providers,” says Jackie Lofton, director, advancement and professional outreach for this Smart Start. At the Winston-Salem Downtown Health Plaza, roughly 3,400 new books are given out each year, in addition to the donated used books families can take home from clinic waiting rooms.

A book can change the tone of a check-up. “The child almost always takes the book immediately and smiles,” says Dr. Miller-Fitzwater. Reach Out and Read prioritizes partnering with clinics that serve children at or below the poverty line which means a family’s first books may come from their doctor.

As Boulware stresses, however, the program is about more than building home libraries.  A book is also a helpful diagnostic tool for doctors, and reading together powerfully impacts how parents and children interact.

The pediatrics clinic waiting room at the Downtown Health Plaza has books families are welcome to take home.
The pediatrics clinic waiting room at the Downtown Health Plaza has books families are welcome to take home.

For parents and caregivers, learning to be their child’s first teacher is empowering. “Being a parent is hard,” says Boulware. “Being a single parent in poverty is really hard.” Reach Out and Read provides the tools and guidance needed to make a powerful impact on the rest of a child’s life. Knowing they are doing something so important also benefits parents. For example, a pilot study found that Reach Out and Read can alleviate maternal depression. This early research is one of several new areas of exploration on changes in parental attitudes and practices.

Now, Reach Out and Read wants to do even more. With funding from private donors and a Young Investigator Award from the Academic Pediatric Association, Dr. Miller-Fitzwater and her colleagues tested starting Reach Out and Read at children’s very first well visit, rather than the established start at six months. The program was developed, implemented, and reported on at the Downtown Health Plaza.

“Everybody has responded favorably and [the providers] have universally liked doing it,” says Dr. Miller-Fitzwater. At least four well visits are recommended for children before they reach six months, each representing another “golden opportunity” to instill beneficial literacy habits in North Carolina’s youngest. Reach Out and Read Carolinas plans training to start the program at the first visit on July 1, 2017.

New training and more books will require more funding. As the organization seeks to continue to grow in the state, Boulware knows one of the next steps is to advocate for better legislation that supports early literacy intervention. 

Reach Out and Read has transformed the Downtown Health Plaza from a clinic into a learning space.
Reach Out and Read has transformed the Downtown Health Plaza from a clinic into a learning space.

The case for supporting Reach Out and Read is strong. As Boulware says, the proven benefits of Reach Out and Read “can break the cycle of poverty in one generation.” Language development in children served by the program improves by three to six months, making them more prepared to enter kindergarten, which in turn sets them up for success throughout K-12.

Dr. Miller-Fitzwater is reminded with every patient visit why Reach Out and Read works so well. “I’m coming in with a gift, this is a time for the family and me to get to know each other,” she reflects. “And the children’s smiles are great.” Through books and reading tips, her well visits provide families with so much more than a check-up or immunization. 

Katy Clune

Katy Clune is engaged in cultural communications — writing, design, and multimedia storytelling — for a variety of freelance clients. She has interviewed people from Boone to Ocean Isle and assisted with curating the Carolina Food Summit (2016) and “North Carolina: The New North American Heartland” (2017) for EducationNC.