In medicine, it’s often called doorknob syndrome—a family’s deepest questions come out as the visit wraps, the doctor’s hand already on the doorknob. In a recent visit, we reviewed Ava’s* growth and development, touched on all relevant age-appropriate guidance, and on all accounts discussed, she was thriving.
Then, as my hand reached toward the doorknob, I (Danielle) reminded mom of the book we used to start the visit, provided through our Reach Out and Read (ROR) program. In that moment, mom looked up at me and I noticed grief cross her face. She shook her head with a manufactured smile. In the moments that followed, I learned how she had lost four family members in the pandemic including, most recently, her father. Mom explained how her dad was a wonderful storyteller, and would read to Ava before bed most nights. The book we used in that day’s visit reminded her of the void she and Ava were facing each night.
Like in this visit, it’s almost impossible to fully unveil and quantify the impact COVID-19 has had on families. Although children have largely been spared the harshest medical effects of the disease, there’s no denying they have been deeply impacted. It’s commonly said that “it takes a village to raise a child”; this year, those villages have been socially distanced and placed under immense stress from heightened physical or mental illness, underemployment, food insecurity, housing instability, loss of family, friends and more—each of which affects a child’s ability to thrive. Under this stress, the routines and rituals created within families, like when adults and their children read aloud together, are essential protective factors amidst the storm.
Storytelling promotes bonding, creating strong foundations, easing feelings of stress—for both adult and child—and fostering feelings of safety and security that can help families cope with adversity.
Promoting Early Literacy Through Evidence-based Programs
While the power of storytelling and shared reading may seem like a small intervention amidst the turmoil of the pandemic, pediatricians have long seen the power of these routines in families. Through the ROR program, during regular check-ups from infancy to kindergarten, pediatricians walk into the exam room with a new, age-appropriate children’s book. The book, a gift to the family at each visit, focuses and calms the child, easily guiding the evaluation of developmental milestones, and allowing the pediatrician to demonstrate the power of a story in each visit.
During this time, pediatricians encourage reading aloud, storytelling, lap time, singing and other language-rich interactions. When books come out, a change is noticeable—children and caregivers come together, sit closer and smile more. For a moment, the stress of the visit and the stress of the day lightens; it becomes about the story—empowering their child through the power of their words.
It is on this foundation that ROR, an evidence-based program endorsed by the American Academy of Pediatrics (AAP), was born. Since 1989, ROR has trained more than 30,000 pediatric clinicians to integrate books into primary care clinics nationwide. The AAP describes ROR as the most widely studied and disseminated model of literacy promotion in the child’s medical home. ROR is associated with more books in the home, more frequent reading aloud by parents, strengthened parent-child interactions, and significant increases in expressive and receptive language in early childhood.
Research and Policy Efforts to Expand the Benefits of Reading Beyond the Pandemic
Currently, the ROR program in Pennsylvania includes 200+ clinics, which implement the model primarily through philanthropic support. Here at PolicyLab, we continue to research early literacy to add to the growing evidence base and are developing and implementing a policy strategy analyzing lessons learned from the 15 states that have obtained public investment in ROR, to better advocate for early literacy policies that would help sustain the program in Pennsylvania.
Most recently in North Carolina, public funding is helping to expand ROR to all 100 counties. PolicyLab’s evidence-to-action approach is poised to help us launch similar policy efforts to support bringing this powerful program to more children across the Commonwealth.
In addition, a collaboration between LiteracyLab @CHOP and ROR Greater Philadelphia has brought mural-sized storybook pages onto Children’s Hospital of Philadelphia exam room walls through a pilot program called Picture This! These murals are linked to digital storytelling prompts that spark parent-child interactions and kick start imaginations while families wait for the pediatrician. This environment, rich in messaging around storytelling, goes beyond the potential of the story in the moment, encouraging families to continue these language-rich routines when they venture beyond the clinic walls. As primary care clinics remained safely open through the closures of the pandemic, we feel there couldn’t be a better place to provide this powerful message.
Stories Offering Windows to Brighter Futures
Particularly now, when patients like Ava and her mom leave our primary care clinic, it’s a small relief to know they are taking a book home to add to their growing library—serving as windows into new times and mirrors to help explain, reflect on and grow from the traumas they’ve faced this year. While the stories that remain untold due to the pandemic cannot be remade, we know that the routines we can promote can serve to write new stories, ones that will empower our patients and their families through the pandemic and beyond.
In honor of Read Across America Day, we conclude by encouraging you to check out Ruby Finds a Worry by Tom Percival. This book was Reach Out and Read’s 2020 Judy Newman Book Award winner, a book selected annually to highlight a story that resonates with families and encourages reading aloud. The reassuring story is about what to do when a worry just won’t leave you alone and has a strong message to empower families now more than ever.
* Name changed to protect patient privacy
Katie Lane, MPH, is the former policy manager for Reach Out and Read based at PolicyLab at Children's Hospital of Philadelphia.