Early Literacy Promotion in Pediatric Primary Care: Advocating for Policies to Support Reach Out and Read Across PA

Statement of Problem

Reading aloud together during the earliest years is a daily experience with lifelong benefits. Birth to age five is a critical window when our brains grow more than at any other time. By establishing routines that include nurturing, language-rich interactions, we can further a child’s language acquisition, promote healthy brain development, and provide opportunities for families to build powerful, lasting bonds.

Despite these benefits, an annual national survey found that less than 46% of Pennsylvania parents report reading aloud with their young children each day. Projecting forward, 38% of Pennsylvania students tested below proficient in English and Language Arts in third grade in 2019. Once students begin fourth grade, they transition from learning to read to reading to learn, which can cause students who are struggling to fall behind in other subjects. Finally, if we look at the broader context, approximately 21% of U.S. adults have low literacy skills, which impacts daily life. While there are programs that exist to support early literacy, more funding is needed to advance evidence-based models that support caregivers and children reading together.


Early Literacy Promotion in Pediatric Primary Care: Advocating for Policies to Support Reach Out and Read Across PA

Our team aims to strengthen the Reach Out and Read (ROR) network across the state by collaborating with ROR clinic-champions, identifying policy mechanisms to link early learning and pediatric care, and developing materials to present the evidence base for early literacy promotion.


One critical venue for encouraging shared reading is in routine pediatric check-ups (or well-child visits). Pediatric medical providers are a trusted source of information and most children attend these medical check-ups before entering child care, Head Start or preschool. A 2014 American Academy of Pediatrics (AAP) policy statement, titled “Literacy Promotion: An Essential Component of Primary Care Pediatric Practice,” elevated Reach Out and Read (ROR) as “…the most widely studied and disseminated model of literacy promotion in the child’s medical home.” Furthermore, an AAP Policy Statement on Poverty and Child Health in the U.S. included ROR as one of a series of programs recommended to improve the quality of life and health outcomes for children and families living in poverty.

ROR is a nonprofit that supports a national network of 33,000 pediatric clinicians trained in the evidence-based model now delivering high-quality care to 4.5 million children.

ROR’s three-part model includes:

  • Books Incorporated into Routine Well-Child Visits as a Tool for Offering Anticipatory Guidance and Evaluating Child Development: Participating medical providers are trained to utilize a new, culturally and developmentally appropriate book in well-child visits. The book helps survey the child’s gross and fine motor skills, cognitive and speech milestones and to observe parent/child interactions. Clinicians also offer reassurance and guidance to caregivers on shared reading behaviors that help foster strong relationships and optimize everyday brain-building activities with the child. Watch an example of a ROR 12-month well-child visit here.
  • A Prescription to Read: Each child is given the new book used during the visit to take home supporting the prescription for reading, building a collection of 10-15 books in the home before kindergarten.
  • Literacy-rich Clinic Environments: Throughout the clinic, displays of information, gently used books, artwork and community resources all help promote a literacy-rich environment that reinforces the messages given to families in the exam room.

In Pennsylvania, the ROR program is primarily donor-driven, requiring the 200+ participating clinics that serve over 150,000 children to fundraise in order to support implementation. The lack of access to sustainable funding is often the reason clinics opt to discontinue or not participate in ROR.    

This three-year policy-focused project aims to secure sustainable public funding to support and expand ROR in Pennsylvania. The project will build on the successes of ROR regional affiliates in 15 other states who have received public investment from federal, state, county, and municipal sources linking pediatric care and early learning. More broadly, by focusing on incremental policy and systematic change, we can move towards a future where literacy promotion is a standard component of pediatric primary care. This is one piece to the puzzle when considering transforming the pediatric medical home to better address social drivers of health, promote early learning and nurture the foundational relationships that are critical to child development.

Currently, our team is working to build relationships and align with like-minded partners. One specific way we will do this is by strengthening the ROR network across Pennsylvania. The ROR team based at Children’s Hospital of Philadelphia (CHOP) works closely with over 80 participating clinics in the Greater Philadelphia region providing program support and technical assistance. An integral component of this project includes both meeting and collaborating with the other ROR clinic-champions that currently span 34 counties in Pennsylvania—bolstering ROR connections across the state and activating potential early literacy advocates. 

Next Steps

As part of this exciting project, the team will undertake:

  • Identifying possible policy mechanisms to link early learning and pediatric care through public investment in ROR by evaluating the existing policy landscape in Pennsylvania and learning from others in the ROR nationwide network about policy and advocacy best practices.
  • Developing materials that frame the evidence base for early literacy promotion paired with the identified possible policy approaches to disseminate and discuss viability with stakeholders.
  • Executing the ROR Pennsylvania policy strategy and associated advocacy campaign.
    • If public funding becomes available, this will be followed by program support and technical assistance for successful implementation and expansion with fidelity to the ROR model across Pennsylvania.

It is hard to understate the value of literacy—or the ability to read, write, speak, think and respond critically. These skills can open the door to many possibilities across the lifespan both in school and beyond, affecting how we interact with our communities, engage as citizens, consume health care, express ourselves and more. If we help give every young child a foundation for success through the power of reading regardless of background or economic means, we can contribute to brighter futures.

This project page was last updated February 2021. 

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Early Literacy Promotion in Pediatric Primary Care: Advocating for Policies to Support Reach Out and Read Across PA [online]. Available at: http://www.policylab.chop.edu. [Accessed: plug in date accessed here].