REACH OUT AND READ
Achieving Local Outcomes as a
Nationally Evidence-Based Program
Callee Boulware, Executive Director
Reach Out and Read Carolinas
What We Know
BOOKS BUILD BETTER BRAINS
Being read to, and growing up with
books, literacy, and language are major
components essential to eventual
academic success for children.
What?
What is Reach Out and Read?
What are we doing to help children
get to school ready for success?
Reach Out and Read
Our Mission
To prepare America’s youngest children to succeed
in school by partnering with doctors to prescribe books
and encourage families to read together
Our Vision
We are working toward the day when all children enter
kindergarten with highly-engaged parents, performing at
grade level, and prepared to excel
5
Three-Part Model
Pediatrician
Guidance
Prescribe a
Book
Parents Read
Aloud at Home
In the pediatric exam
room, pediatricians
speak to parents about
the importance of
reading aloud to their
children every day, and
offer age-appropriate
literacy tips and
encouragement.
At each regular checkup
from 6 months through
5 years of age, the child
receives a new,
culturally- and
developmentallyappropriate book to
take home and keep.
Parents incorporate
advice received through
pediatric visits and
make reading aloud
part of their daily
routine. Our families
read up to 350 hours
with their children prior
to kindergarten.
6
How We Reach Families
• Leverage pediatric care providers’ unique access
• 90% of children ages 6 months through 5 years
visit their healthcare provider regularly
• Influence parental behavior
• Parents view pediatrician as a trusted advisor
• Reach Out and Read engages children early, before
learning deficits are accrued
7
Prevention Works –
Immunizing Children Against
Illiteracy
“Furthermore, it has been shown that
interventions for at-risk children are
most effective when they begin during
infancy.”
Preschool foundations of early reading acquisition
Susan Rvachew, PhD S-LP(C)1 and Robert Savage, PhD2
Evidence-Based, Research-Tested
Fifteen published, peer-reviewed research
studies support the efficacy of our model, a
more extensive body of research than for
any other psychosocial intervention in
general pediatrics.
9
National Outcomes
• Parents served by Reach Out and Read are four times
more likely to read aloud with their children.
• Reach Out and Read reaches the child through effectively
teaching the parent to start lifelong learning in the home.
• During the preschool years, children served by Reach Out
and Read score three to six months ahead of their nonReach Out and Read peers on vocabulary tests. These
early foundational language skills help start children on a
path of success when they enter school.
American Academy of Pediatrics
Policy Statement- June, 2014
We needed AND wanted more…
Needed to balance the demand for local
outcomes with the responsible use of
resources.
How to achieve this?
Local Outcomes
• Short-term outcomes – how we are
“moving the needle”
• Model fidelity and quality
implementation
Assistance of Experts
• Nonprofit Finance Fund
– With the help of the i(c)s
1. What is our mission?
2. What data do we collect?
3. What results we actually commit to?
Review/update of Theory of Change
Theory of Change (ToC) is a specific type of methodology for
planning, participation, and evaluation that is used in the
philanthropy, not-for-profit and government sectors to promote
social change. Theory of Change defines long-term goals and then
maps backward to identify necessary preconditions.[1] Theory of
Change explains the process of change by outlining causal linkages
in an initiative, i.e., its shorter-term, intermediate, and longer-term
outcomes.
Reach Out and Read Southeast
Theory of Change
Mission
Inputs
Reach Out and Read
prepares our youngest
children living in lowincome communi es
to succeed in school
by partnering with
doctors to prescribe
books and encourage
families to read
together.
Reach Out and
Read providers are
trained and
supported as they
integrate the
Reach Out and
Read model into
the pediatric well
visit and provide
guidance and
books to families
at each well-visit
between 6 months
and 5 years old.
→
→
Activities
1. Providers are
trained in the
program model.
2. Providers reach
families with
guidance and books
at each check-up.
3. Reach Out and
Read supports
programs with
technical
assistance, training,
quality and support
to ensure model
fidelity.
→
→
Outputs
1. Reach Out and
Read reaches nearly
250,000 children
across the region in
their well-visit
through 276
program loca ons.
2. Children take
home new age,
language and
developmentally
appropriate books,
and build a literacyrich environment.
3. Parents are
advised and
supported as their
child's first and
most important
teacher.
4. Providers are
consistently sharing
literacy guidance
with families at
each well-visit.
→
→
Shorter Term
Outcomes
1. Parents have
increased
knowledge and
skills to support
literacy ac vi es at
home.
2. Parents read
aloud more o en
with their children.
3. Parents are more
likely to try
different literacy
ac vi es at home
with their children.
→
→
Longer Term
Outcomes
1. Children have
higher recep ve
and expressive
language skills.
2. Children have
higher vocabulary
scores.
3. Children are
more prepared for
kindergarten.
4. Increase in
Child’s 3rd Grade
Reading Skills
5.Increased
success in school
and life.
What data do we collect?
• Review of all evaluation tools
–
–
–
–
Semi-annual progress report
Site observation assessment
Parent Survey
Provider Survey
• Matrix of what data we collect
– Outputs
• Children
• Quality/model fidelity
– Short-term outcomes?
• Identify holes in our current evaluation
methods
Results…
1.
2.
3.
4.
New Theory of Change
New Logic Model
New Parent Survey tool
New Quality Matrix/Evaluation
methodology
Program: Reach Out and Read South Carolina Logic Model
Inputs
Staff
· Exc Dir 1 FTE
· Program staff 3 FTE
· Admin Support .5 FTE
· 1 Medical Director
Volunteers
· Doctors, nurses, and other
clinic staff
· Waiting room readers
Money
· 50% min. book funding
· Funds for extra books,
literacy rich waiting rooms
and other program materials
Research
· Parent centered evaluation
· 15 peer reviewed, national
studies
Partners
· Libraries
· First Steps
· SC-AAP
· Hospitals and health systems
Training
· Train doctors and nurses in
how to offer anticipatory
guidance
· Age-/Culture-/Languageappropriate books
Outputs
Activities
Participation
ROR model
·
•Doctors and nurses
give parents
guidance on the
importance of
reading aloud daily
•Providers give ageappropriate book at
each well child
check-up, 6 months
to 5 years
•Each Program
creates a “literacy
rich” clinic
environment and
parents take advice
home and integrate
daily reading into
their family routine.
·
·
Short
120,000 children
and families
120 clinics
700+ primary care
providers
Assumptions
· That every clinic/provider faithfully implements the program
model with fidelity.
·
·
·
Outcomes -- Impact
Medium
240,000 new books
and parent
education messages
sent home annually
Parents 4 x more
likely to report
reading with their
children, or that
reading is a favorite
activity
Parents are more
likely to rate
pediatrician as
helpful
·
·
·
·
Increased weekly
bedtime reading
Reading
incorporated into
daily routines
More books in the
homes and hands
of children
Children enter
school with
language and
book-handling
skills that prepare
them to learn to
read
Long
·
·
·
·
Long term
exposure to
ROR results in
larger
increases in
language
scores
Children
participating
in ROR have
higher
receptive
vocabulary
scores
Children in
3rd grade and
beyond more
likely to read
at grade level
Children in
3rd grade and
beyond are
now more
likely to be
able to read
to learn
External Factors
· Children/family involvement in other early literacy programs
· Parent/Adult literacy level;
· Adult caregivers are motivated to heed provider’s advice
Parent Survey
• Did not find old survey useful
(Nationally designed)
• Reviewed NCPC survey tool
• Goal: design a tool that will fulfill the
needs of our partners (NCPC) and ROR
Carolinas AND answer the questions
that we wanted to ask
Parent Survey
1. Ease of implementation
• Parents
• ROR Clinical Locations
2. Meaningful Data
3. Historical Knowledge of program
For office use only
Medical Practice ID:
Reach Out and Read Parent Feedback Survey
1) How old is the child who had a check-up today? Check one answer.
O 6-12 months O 1-2 years
O 3-5 years
2) Did the child receive a book during today’s visit? Check one answer.
O Yes
O No
3) Is this the first time this child has received a book at the doctor’s office? Check one answer.
O Yes
O No
O I don’t know
4) Did the medical provider talk to you about reading or looking at books with the child?
O Yes
O No
5) About how often do you read or look at books with this child? Check one answer.
O
O
O
O
O
Never
Several times
Several times
Once a week
Several times
a year
a month
a week
6) Do you think you will try any of these reading activities with this child?
O
Every day
Yes, I will
try this.
Maybe,
I might
try this.
No, I
don’t
think so.
I already
do this.
a. Let the child turn the pages.
O
O
O
O
b. Make up stories about what is happening in the pictures.
O
O
O
O
c. Ask the child to tell you what is happening in the pictures.
O
O
O
O
d. Help the child to identify shapes, colors, numbers, letters,
or things in the pictures.
O
O
O
O
e. Read to the child at least 30 minutes every day – for
example: during meals or baths, before naps or bedtime
O
O
O
O
f.
O
O
O
O
Check one answer for each activity.
Take the child to the library.
7) What type of health insurance does this child have? Check one answer.
O
O
O
O
O
None
Medicaid
TRICARE/
Military
Private
Insurance
I don’t
know
8) What is the highest level of education or schooling you have completed? Check one answer.
O
O
O
O
Less than
high school
High
school/
GED
Some college/
vocational
training
4-year
college degree
or higher
Thank you! We appreciate your input!
Methodology
•
•
•
•
•
•
How often to administer?
In-clinic administration/instructions?
How many surveys to collect?
How to tally data?
How to interpret data?
How to house data for institutional
memory and future evaluation?
What is the data showing us?
Quality/Model Fidelity
•
•
•
•
How do we consistently quantify?
Quantitative Data?
Qualitative Data?
Correlate with short-term outcomes?
…needed a new software to manage -
How to implement in our day-today operations?
1. Adoption of and training in new
evaluation matrix/methodology
2. Education to our programs and
providers
3. Shift in organizational culture = Data
Driven Decisions
What we can now do…
1. Provide quantitative measures of
program quality and model fidelity
2. Relate this data to short-term
outcomes with parents and families
3. Establish individualized action plans
for each program
4. More successfully allocate resources
across program needs
Benefits of new software system
1. Track all quality and evaluation data
in one place
2. Trending in program quality
3. Relate this trending to parent survey
data and interventions by program
specialists
…and ultimately…
• With confidence, provide data around
local short-term outcomes and model
fidelity.
• Understand the data sets that we CAN
provide, and make more appropriate
commitments to our investors around
accountability for these pieces of data.
Do we need long-term outcomes
data locally?
• Significantly more resources?
• Additional staffing?
• To what goal?
• Evaluation goals moving forward
Questions?